Alopecia Areata: Current Understanding and Management

Alopecia areata (AA) is a chronic, immune-mediated disease causing non-scarring hair loss, affecting 2% of the global population. It is characterized by the collapse of the immune privilege of the hair follicle, possibly due to genetic and external factors. Current treatments are mostly symptom-based, using immunosuppressant or immune modulating approaches. However, the Janus kinases (JAKs) signaling pathway has been identified as a potential therapeutic target. AA has an unpredictable prognosis, often with relapses and remissions. The disease results in non-permanent hair loss, as the hair regeneration depends on the preservation of hair follicle stem cells. The document also discusses various treatments for AA, including topical corticosteroids, intralesional injection of corticosteroids, systemic corticosteroids, topical sensitization with DPCP, anthralin, methotrexate, and others. The efficacy of oral zinc and vitamin D supplementation, and JAK inhibitors in the treatment of AA is also discussed. Clinical trials have shown promising results with JAK inhibitors, with oral administration of tofacitinib and ruxolitinib showing significant hair regrowth in patients with severe AA.