A Novel Therapeutic Paradigm for Patients with Extensive Alopecia Areata

The document from May 30, 2016, presents a comprehensive overview of emerging therapeutic strategies for extensive alopecia areata (AA), a T-cell mediated hair loss disease. It reviews the role of various immune pathways in AA, including Th1, Th2, Th9, PDE4, and IL-23, and discusses the potential of targeting these pathways with novel treatments. The paper highlights the promise of Janus kinase (JAK) inhibitors like ruxolitinib, tofacitinib, and baricitinib, which have shown encouraging results in hair regrowth but require monitoring due to immunosuppressive effects. Other treatments such as T-cell modulators, blockers, and IL-2 modulation are also reviewed, with varying efficacy and safety profiles. The document emphasizes the importance of ongoing and future clinical trials to better understand the efficacy of these treatments and the pathogenic roles of different cytokines in AA. It concludes that a new therapeutic paradigm is emerging, with the potential for safer and more efficacious drugs, which could lead to improved treatment for AA, including severe forms like alopecia totalis (AT) and alopecia universalis (AU).