European Expert Consensus Statement on the Systemic Treatment of Alopecia Areata

January 2024 in “ JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology ”

Lidia Rudnicka, Monika Arenbergerová, Ramón Grimalt, Dimitrios Ioannidis, Alexander Katoulis, E. Lazaridou, Małgorzata Olszewska, Yuliya Ovcharenko, Bianca Maria Piraccini, Asja Prohić, Adriana Rakowska, P. Reygagne, M.‐A. Richard, Rui Oliveira Soares, Michela Starace, Sergio Vañó‐Galván, Anna Waśkiel‐Burnat

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Baricitinib →

JAK inhibitor that reduces inflammation and immune attacks on hair follicles, leading to potential hair regrowth, especially in alopecia areata cases

Minoxidil →

An essential vasodilator with some anti-androgenic effects

Studysummary This consensus statement outlines a treatment algorithm for alopecia areata, detailing systemic treatment indications and options, including EMA-approved medications baricitinib and ritlecitinib for severe cases, as well as other off-label treatments and adjuvant therapies like oral minoxidil.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The European expert consensus statement on the systemic treatment of alopecia areata provides a comprehensive treatment algorithm for this autoimmune condition, which can range from limited hair loss to complete scalp and body hair loss. The consensus highlights the use of the Severity of Alopecia Tool (SALT) and the Alopecia Areata Scale (AAS) to evaluate disease severity, with a SALT score of 20 or higher indicating the need for systemic therapy. Currently, the only EMA-approved medications for severe alopecia areata are baricitinib for adults and ritlecitinib for individuals aged 12 and older. Other off-label systemic treatments include glucocorticosteroids, cyclosporine, methotrexate, and azathioprine, with oral minoxidil considered as an adjuvant therapy. The statement aims to guide the indications, efficacy, safety, and duration of systemic treatments for alopecia areata.

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Research cited in this study

33 / 33 results

research Diagnosis And Management Of Alopecia Areata: A Saudi Expert Consensus Statement (2023)

August 2023 in “Dermatology and Therapy”

This consensus statement from Saudi Arabia outlines evidence- and experience-based recommendations for diagnosing and managing alopecia areata, focusing on severity assessment, prognostic indicators, and therapeutic options, with special attention to pediatric patients and uncommon cases.

Major Improvement of Very Severe Alopecia Areata in Patients Treated With the Combination of Baricitinib and Low Doses of Corticosteroids: An Eight-Case Series

research Major Improvement of Very Severe Alopecia Areata in Patients Treated With the Combination of Baricitinib and Low Doses of Corticosteroids: An Eight-Case Series

July 2023 in “Clinical and Experimental Dermatology”

In this study, combining baricitinib and prednisone effectively achieved complete hair regrowth in seven out of eight women with very severe alopecia areata, contrasting with less effective results from each drug used alone.

research Efficacy and Safety of Ritlecitinib in Adolescents with Alopecia Areata: Results from the ALLEGRO Phase 2b/3 Randomized, Double-Blind, Placebo-Controlled Trial

48 citations , July 2023 in “Pediatric Dermatology”

This study found that among adolescents with alopecia areata and significant hair loss, treatment with ritlecitinib resulted in greater hair regrowth and self-reported improvement compared to placebo over 48 weeks, with common side effects including headache, acne, and nasopharyngitis.

research Janus Kinase Inhibitors For Alopecia Areata

12 citations , June 2023 in “JAMA network open”

In this study of seven randomized clinical trials, JAK inhibitors were associated with improved hair regrowth outcomes in alopecia areata patients compared to placebo, with oral administration being more effective than external application, though longer trials are needed to confirm safety and effectiveness.

research The Evaluation of JAK Inhibitors on Effect and Safety in Alopecia Areata: A Systematic Review and Meta-Analysis of 2018 Patients

4 citations , June 2023 in “Frontiers in immunology”

This study found that JAK inhibitors effectively improve alopecia areata outcomes, as indicated by SALT scores, but they were associated with an increased risk of adverse effects, with 921 out of 1508 patients experiencing adverse reactions.

research Trichoscopy Patterns in Alopecia Areata: A Systematic Review and Meta-Analysis

2 citations , June 2023 in “Skin Research and Technology”

This study reviewed 39 studies with 3204 patients to identify characteristic trichoscopic findings in alopecia areata, highlighting yellow and black dots, broken, short vellus, and tapering hairs as key indicators. It found no single diagnostic trichoscopic finding but observed trichoscopy's utility in monitoring treatment response.

research Safety of Janus Kinase Inhibitors in Patients with Alopecia Areata: A Systematic Review

3 citations , May 2023 in “Clinical drug investigation”

This study reviewed the safety of JAK inhibitors for alopecia areata, finding that common side effects included headache and acne, with varying risks for respiratory infections and no increased risk of serious adverse events.

research Efficacy and Safety of Different JAK Inhibitors in the Treatment of Alopecia Areata: A Network Meta-Analysis

7 citations , April 2023 in “Frontiers in immunology”

This source reports that a network meta-analysis found oral baricitinib and ruxolitinib to be effective and safe for treating alopecia areata, significantly improving response rates over placebos and showing fewer adverse effects than steroid treatments, though precise dosing needs further study.

research Efficacy and Safety of Ritlecitinib in Adults and Adolescents With Alopecia Areata: A Randomised, Double-Blind, Multicentre, Phase 2b–3 Trial

227 citations , April 2023 in “The Lancet”

Ritlecitinib effectively treats alopecia areata and is well-tolerated.

research The Burden of Alopecia Areata: A Scoping Review Focusing on Quality of Life, Mental Health, and Work Productivity

10 citations , January 2023 in “Journal of the European Academy of Dermatology and Venereology”

This review highlights the significant negative impact of alopecia areata on quality of life, mental health, and work, calling for individualized approaches and effective treatments to mitigate these effects.

research Alopecia Areata: Diagnostic and Therapeutic Recommendations of the Polish Society of Dermatology. Part 2: Treatment

1 citations , January 2023 in “Przegląd Dermatologiczny”

This review discusses current and emerging treatments for alopecia areata, emphasizing systemic treatments for moderate to severe cases, and reports no new clinical results.

Alopecia Areata: Diagnostic and Therapeutic Recommendations of the Polish Dermatological Society, Part 1: Diagnosis and Severity Assessment

research Alopecia Areata: Diagnostic and Therapeutic Recommendations of the Polish Dermatological Society, Part 1: Diagnosis and Severity Assessment

January 2023 in “Przegla̧d dermatologiczny”

There are two main types of alopecia areata with different severity, and diagnosis is made through clinical examination and trichoscopy, influencing treatment choices.

research Alopecia Areata and Risk of Atopic and Autoimmune Conditions: Population-Based Cohort Study

34 citations , November 2022 in “Clinical and Experimental Dermatology”

This study found that individuals with AA have a higher incidence of atopic and autoimmune conditions, suggesting both Th1 and Th2 immune responses may play a role in its development.

research Sisaipho Alopecia Areata Treated With Tofacitinib and Oral Minoxidil

1 citations , August 2022 in “JAAD case reports”

This article discusses the patterns and variants of alopecia areata, including the rare sisaipho, but reports no new research findings.

Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

research Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

8 citations , June 2022 in “Frontiers in Medicine”

This study found that tofacitinib is an effective and more tolerable treatment than systemic corticosteroids for moderate-to-severe alopecia areata, and its combination with corticosteroids may offer improved efficacy.

research Two Phase 3 Trials of Baricitinib for Alopecia Areata

148 citations , March 2022 in “The New England Journal of Medicine”

In two phase 3 trials, this study found that oral baricitinib significantly improved hair regrowth compared to placebo in adults with severe alopecia areata after 36 weeks, though longer trials are needed to ascertain its long-term efficacy and safety.

research Alopecia Areata: Current Understanding and Management

11 citations , January 2022 in “Journal der Deutschen Dermatologischen Gesellschaft”

This review discusses current and emerging therapies for alopecia areata, highlights the challenges in managing this chronic disease, and emphasizes the importance of addressing its psychosocial impacts; it reports no new clinical results.

research Maintenance, Withdrawal, and Re-Treatment with Ritlecitinib and Brepocitinib in Patients with Alopecia Areata in a Single-Blind Extension of a Phase 2a Randomized Clinical Trial

20 citations , December 2021 in “Journal of the American Academy of Dermatology”

This study found that the oral JAK inhibitors ritlecitinib and brepocitinib were effective in maintaining hair regrowth in alopecia areata with continuous use, though efficacy decreased after withdrawal.

research A Phase 2a Randomized, Placebo-Controlled Study to Evaluate the Efficacy and Safety of the Oral Janus Kinase Inhibitors Ritlecitinib and Brepocitinib in Alopecia Areata: 24-Week Results

138 citations , March 2021 in “Journal of the American Academy of Dermatology”

This study found that treatment with ritlecitinib or brepocitinib was effective in improving scalp hair loss for patients with alopecia areata over 24 weeks compared to placebo.

Utility of Azathioprine, Methotrexate, and Cyclosporine as Steroid-Sparing Agents in Chronic Alopecia Areata: A Retrospective Study of Continuation Rates in 138 Patients

research Utility of Azathioprine, Methotrexate, and Cyclosporine as Steroid-Sparing Agents in Chronic Alopecia Areata: A Retrospective Study of Continuation Rates in 138 Patients

12 citations , August 2020 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This study found that most chronic alopecia areata patients treated with azathioprine, methotrexate, or cyclosporine continued treatment for at least 12 months, often requiring concurrent low-dose prednisolone.

research Cyclosporine With and Without Systemic Corticosteroids in Treatment of Alopecia Areata: A Systematic Review

13 citations , April 2020 in “Dermatology and therapy”

This systematic review assessed cyclosporine's effectiveness with or without corticosteroids for treating alopecia areata, finding combined therapy more effective and with a lower recurrence rate than monotherapy, especially for severe cases, though results varied by alopecia type.

research Alopecia Areata Predictive Score: A New Trichoscopy-Based Tool to Predict Treatment Outcome in Patients with Patchy Alopecia Areata

19 citations , July 2019 in “Journal of Cosmetic Dermatology”

This study found that in patients with patchy alopecia areata, certain trichoscopic features like upright regrowing hairs and pigtail hairs are positive predictive markers for treatment success.

research Treatment of Alopecia Areata: An Australian Expert Consensus Statement

95 citations , November 2018 in “Australasian journal of dermatology”

This consensus statement outlines a treatment algorithm for alopecia areata, discussing when to consider systemic treatment and how to assess outcomes, without providing new clinical results.

research Trichoscopy of Alopecia Areata: An Update

89 citations , March 2018 in “The Journal of Dermatology”

This review presents various trichoscopic findings for diagnosing alopecia areata but reports no new clinical results, emphasizing that no single marker is pathognomonic and multiple features should be considered together.

research Alopecia Areata: A Comprehensive Review of Pathogenesis and Management

99 citations , July 2017 in “Clinical Reviews in Allergy & Immunology”

This review noted that alopecia areata is an autoimmune disease impacting hair follicles and offered insights into its complex pathogenesis involving immune responses, while highlighting ongoing research into new treatments such as Janus kinase inhibitors and other immunomodulatory drugs.

research Methotrexate for the Treatment of Pediatric Alopecia Areata

22 citations , June 2017 in “Journal of dermatological treatment”

This case series observed that 57% of pediatric patients with alopecia areata experienced significant hair regrowth with methotrexate treatment, which was generally safe, although some results were inconclusive due to follow-up issues.

research Late-Onset Alopecia Areata: A Retrospective Cohort Study

7 citations , January 2017 in “Dermatology”

In this study, late-onset alopecia areata in Israeli patients was predominantly observed in females with mild disease, showing a high rate of complete hair regrowth but frequent relapses.

research Pulse Corticosteroid Therapy With Oral Dexamethasone for the Treatment of Adult Alopecia Totalis and Universalis

31 citations , April 2016 in “Journal of the American Academy of Dermatology”

Oral dexamethasone may help regrow hair in adults with alopecia totalis and universalis.

research Efficacy and Safety of Methotrexate Combined with Low- to Moderate-Dose Corticosteroids for Severe Alopecia Areata

28 citations , January 2016 in “Dermatology”

This study observed that methotrexate combined with low- to moderate-dose oral corticosteroids may effectively treat severe alopecia areata, though long-term maintenance is often necessary due to relapse after tapering.

research Efficacy and Safety of Methotrexate in Alopecia Areata

44 citations , August 2014 in “Anais brasileiros de dermatologia/Anais Brasileiros de Dermatologia”

This study found that methotrexate may be an effective and safe treatment option for severe alopecia areata, with better regrowth results when combined with corticosteroids.

research Alopecia Areata Update

85 citations , October 2012 in “Dermatologic Clinics”

This article reviews recent updates on alopecia areata, focusing on its causes, clinical presentation, and treatment options, and provides treatment plans by patient age and disease extent, but reports no new clinical results.

research Efficacy and Tolerability of Methotrexate in Severe Childhood Alopecia Areata

70 citations , April 2011 in “British journal of dermatology/British journal of dermatology, Supplement”

This retrospective study found that methotrexate had variable efficacy in treating severe alopecia areata in children, with successful hair regrowth observed in five out of thirteen assessable cases.

research Placebo-Controlled Oral Pulse Prednisolone Therapy in Alopecia Areata

141 citations , February 2005 in “Journal of the American Academy of Dermatology”

In this study, oral prednisolone pulse therapy led to significant hair regrowth in some patients with extensive alopecia areata, whereas no improvement was seen in the placebo group.