What criteria should I use to decide when to refer a patient with alopecia areata to a dermatologist?

You should consider referring a patient with alopecia areata to a dermatologist based on several key criteria:

• When intralesional steroid injections are considered for limited hair loss in adults, as this treatment typically requires a dermatology referral ².
• If the disease is not responding to treatments available in primary care ².
• If there is diagnostic uncertainty, as a specialist may need to perform a scalp biopsy to clarify the diagnosis ².
• For extensive, long-term, or refractory disease, to allow for consideration of specialist treatments ².
• Before starting treatment for children, due to the potential for adverse effects from potent corticosteroids and the recommendation for specialist supervision in this age group ².
• Before starting treatment for women who are pregnant or breastfeeding, as the limited benefit of topical corticosteroid use may not outweigh potential risks ².