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BackgroundAlopecia areata (AA), an autoimmune disease ­affecting the hair of the scalp, face, and/or body, can entail substantial psychological and physical burden for patients. There is currently no international agreement on how to treat AA and the approach may vary across countries.ObjectivesThis study investigated the management of AA in clinical practice.Materials & MethodsData from a point-in-time survey conducted in France, Germany, Italy, Spain, and the United Kingdom, between October 2021-June 2022, were analysed for adults with mild, moderate, and severe AA, based on physician assessment. Dermatologists were surveyed about factors used to assess disease severity, physician-reported treatment goals, and treatment patterns for AA, including the use of wigs.ResultsIn total, 239 dermatologists reported on 2,083 patients. Physicians’ severity assessment and treatment goals were predominantly driven by scalp hair loss. Topical and intralesional corticosteroids were the most prescribed treatments for mild and moderate AA. Conventional immunosuppressants, oral Janus kinase inhibitors, and topical immunotherapy use generally increased with AA severity and therapy line. Wig use was greatest for severe AA. The primary reasons for the last treatment change in the moderate and severe groups were worsening of condition, lack of initial efficacy, and loss of response, and for mild group were improvement in condition, lack of initial efficacy, and worsening of condition. Findings were generally similar across countries.ConclusionsThis analysis provides insights into the management of AA in five European countries and confirms the need for more effective therapies, especially for patients with severe AA.