Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what guidance his Department has issued to health boards on the factors that should be used to determine the severity of alopecia prior to a decision on treatment.

Healthcare is a devolved matter, and our response outlines information for England only. The Scottish Government is responsible for the activities and decisions of health boards in Scotland.

We have made no assessment of the effectiveness of the Severity of Alopecia Tool’s (SALT) scores in determining the correct treatment of alopecia areata. The National Institute for Health and Care Excellence (NICE) is responsible for issuing clinical guidance in England, including clinical guidelines on the treatment and care for specific conditions, as well as health technology assessments on new and existing medicines and technologies. It develops its guidance and recommendations independently from the Government, informed by scientific evidence, clinical expertise, and stakeholder input.

Technology appraisal guidance published by the NICE in March 2024, code TA958, recommends ritlecitinib for treating severe alopecia areata in people aged 12 years old and over.

Whilst severity is not specifically defined in the guidance, the evidence submission by the medicine’s manufacturer defined ‘severe’ as a SALT score of more than 50 out of 100. The guidance also acknowledges that living with severe alopecia areata can have a profound impact on psychosocial health.

It is the responsibility of a clinician to make decisions appropriate to the circumstances of their patient, while also ensuring they are taking account of appropriate national guidance on clinical effectiveness, as well as the local commissioning decisions of their respective integrated care boards in England.

Responsible clinicians should work with their patients and decide on the course of treatment, with the provision of the most clinically appropriate care for the individual always being the primary consideration.