Alopecia Areata: A Complex Cytokine-Driven Disease

    Teresa Song, Emma Guttman‐Yassky
    TLDR Alopecia areata is a hair loss disease caused by complex immune reactions, and new targeted treatments show promise.
    The document from November 1, 2020, describes alopecia areata (AA) as an autoimmune disease characterized by hair loss, driven by complex immune mechanisms involving T-helper cells, particularly Th1/IFN-γ and Th2/IL-23. Jak inhibitors have shown clinical efficacy in AA, indicating the significance of these immune pathways. The disease is also associated with comorbidities like atopic and autoimmune thyroid diseases. Current treatments have limited efficacy, but new treatments, including Jak inhibitors, are promising, as evidenced by improvements in SALT scores in placebo-controlled trials. The document also notes that IL-15 and Th2-related biomarkers are upregulated in AA, with GWAS studies identifying Th2-related susceptibility loci. However, treatments targeting Th17 (IL-17A) and PDE4 showed limited efficacy in pilot trials with 11 and 20 patients, respectively. The document concludes that AA involves multiple immune axes and that targeted therapeutics are necessary to better understand and treat the disease.
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