Alopecia Areata: Burden of Disease, Approach to Treatment, and Current Unmet Needs

March 2023 in “ Clinical, Cosmetic and Investigational Dermatology ”

Lina Alhanshali, Michael Buontempo, Kristen I. Lo Sicco, Jerry Shapiro

Alopecia Areata autoimmune attack hair follicle topical steroids intralesional steroids topical immunotherapies Janus Kinase inhibitors systemic corticosteroids betamethasone valerate baricitinib tofacitinib AA JAK inhibitors

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Betamethasone Valerate →

Baricitinib →

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

Studysummary This review discusses recent advances in understanding and treating alopecia areata, emphasizing the ongoing challenges and unmet needs in disease management; it reports no new clinical findings.

Automatically generated from the study's abstract, not written by a person, and not a review of the full paper. Not medical advice or a treatment recommendation. Read the original study, and consult a qualified healthcare professional before changing treatment. Full disclaimer

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Research cited in this study

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research The Efficacy and Safety of JAK Inhibitors for Alopecia Areata: A Systematic Review and Meta-Analysis of Prospective Studies

37 citations , August 2022 in “Frontiers in pharmacology”

This study found that oral JAK inhibitors are effective and generally well-tolerated for treating alopecia areata, but high recurrence rates after stopping treatment suggest the need for continuous use.

research Microneedling Combined With Compound Betamethasone in Treatment of Severe Alopecia Areata: A Case Report

2 citations , August 2022 in “Frontiers in Immunology”

This study reported significant hair regeneration in a 3-year-old with severe alopecia areata after six months of treatment with microneedling and compound betamethasone.

research Low-Dose Oral Minoxidil for Treatment of Androgenetic Alopecia and Telogen Effluvium in a Pediatric Population: A Descriptive Study

6 citations , April 2022 in “Journal of The American Academy of Dermatology”

In this study, low-dose oral minoxidil was found to improve hair density in 80% of pediatric patients with androgenetic alopecia or telogen effluvium, with mild side effects primarily reported.

A Potential Predictive Role of the Scalp Microbiome Profiling in Patients with Alopecia Areata: Staphylococcus Caprae, Corynebacterium, and Cutibacterium Species

research A Potential Predictive Role of the Scalp Microbiome Profiling in Patients with Alopecia Areata: Staphylococcus Caprae, Corynebacterium, and Cutibacterium Species

3 citations , April 2022 in “Microorganisms”

This study found that the scalp microbiome was more diverse in alopecia areata patients than in healthy controls, and distinctive microbial profiles may be linked to disease severity and prognosis.

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 Low-Dose Oral Minoxidil Increases Hair Density and Thickness in Androgenetic Alopecia: A Retrospective Analysis of 60 Patients

4 citations , October 2021 in “Journal of The European Academy of Dermatology and Venereology”

Low-dose oral minoxidil increases hair density and thickness in people with hair loss.

research Evaluation of the Level of Serum Interleukins (IL-2, IL-4, IL-15, and IL-17) and Its Relationship with Disease Severity in Patients with Alopecia Areata

14 citations , July 2021 in “Anais brasileiros de dermatologia/Anais Brasileiros de Dermatologia”

This study found that alopecia areata patients had higher baseline interleukin levels, which significantly decreased with tofacitinib treatment, though this change did not correspond to disease severity improvement.

research The Epidemiology of Alopecia Areata: A Population-Based Cohort Study in UK Primary Care

117 citations , July 2021 in “British Journal of Dermatology”

This study reports that the incidence of alopecia areata is 0.26 per 1000 person-years in the UK, with higher rates among Asian ethnic groups, socially deprived populations, and urban residents.

research Treatment of Pediatric Alopecia Areata: A Systematic Review

48 citations , April 2021 in “Journal of the American Academy of Dermatology”

This study found that topical corticosteroids are the most supported first-line treatment for pediatric alopecia areata, with contact immunotherapy as the next best option.

research Patient Perspectives of the Social, Emotional and Functional Impact of Alopecia Areata: A Systematic Literature Review

67 citations , March 2021 in “Dermatology and Therapy”

This review discusses the substantial impact of alopecia areata on patients' health-related quality of life, highlighting issues such as personality changes, emotional and social difficulties, and a common occurrence of alexithymia, and emphasizes the need for more specific assessment tools.

research New Onset of Alopecia Areata in a Patient with SARS-CoV-2 Infection: Possible Pathogenetic Correlations

32 citations , March 2021 in “Journal of cosmetic dermatology (Print)”

This letter to the editor discusses a potential link between new onset alopecia areata and SARS-CoV-2 infection, but reports no new clinical results.

research Evaluation of Stigma Toward Individuals With Alopecia

38 citations , March 2021 in “JAMA Dermatology”

This cross-sectional survey study found that stigmatizing attitudes toward people with alopecia are present in various social and professional settings, with stigma levels varying by alopecia severity and perceptions of its medical nature.

research Safety of Low-Dose Oral Minoxidil for Hair Loss: A Multicenter Study of 1404 Patients

39 citations , February 2021 in “Journal of The American Academy of Dermatology”

In this study, low-dose oral minoxidil for hair loss was associated with infrequent systemic adverse effects, and only 1.7% of patients discontinued treatment due to these effects.

research Efficacy of Systemic Minoxidil and Tofacitinib Combination in Treatment-Resistant Alopecia Universalis

1 citations , October 2020 in “Journal of Cosmetic Dermatology”

This study presents a case of treatment-resistant alopecia universalis that successfully responded to a combination of tofacitinib and oral minoxidil, highlighting a potential therapeutic approach for challenging cases of alopecia areata.

research Stigmatization Caused by Hair Loss – A Systematic Literature Review

19 citations , October 2020 in “Journal der Deutschen Dermatologischen Gesellschaft”

This review found that despite varied levels of stigmatization reported in studies, hair loss generally leads to stigmatization and a reduced quality of life, but specific research on this stigma is limited.

research Hair Follicle Immune Privilege and Its Collapse in Alopecia Areata

134 citations , July 2020 in “Experimental dermatology”

This review discusses immune privilege in anagen hair follicles and its collapse in alopecia areata, emphasizing the importance of restoring this function for effective management and disease relapse prevention.

Efficacy of Antihistamines in Combination with Topical Corticosteroid and Superficial Cryotherapy for Treatment of Alopecia Areata: A Retrospective Cohort Study

research Efficacy of Antihistamines in Combination with Topical Corticosteroid and Superficial Cryotherapy for Treatment of Alopecia Areata: A Retrospective Cohort Study

5 citations , July 2020 in “Journal of the American Academy of Dermatology”

This study suggests that using antihistamines alongside a regimen of topical corticosteroid and superficial cryotherapy may enhance hair regrowth in patients with mild to moderate alopecia areata.

research Oral Minoxidil Treatment for Hair Loss: A Review of Efficacy and Safety

59 citations , July 2020 in “Journal of The American Academy of Dermatology”

This study concluded that oral minoxidil is an effective and well-tolerated alternative to topical minoxidil for healthy patients struggling with application-related compliance issues.

research Low-Dose Oral Minoxidil as Treatment for Non-Scarring Alopecia: A Systematic Review

19 citations , June 2020 in “International Journal of Dermatology”

In this systematic review, oral minoxidil was found to be a safe and effective treatment for androgenetic alopecia and alopecia areata, with additional benefits for female pattern hair loss and other types of alopecia, although common side effects included hypertrichosis and postural hypotension.

research Joint Study of the Associations of HLA-B and the Transmembrane Short Tandem Repeat Polymorphism of MICA Protein with Alopecia Areata Shows Independent Associations of Both with the Disease

7 citations , February 2020 in “Clinical and Experimental Dermatology”

This study identified an association between alopecia areata and the MICA*009 and HLA-B14 genetic markers, highlighting the importance of studying them together to better understand their role in this condition.

research Very-Low-Dose Oral Minoxidil in Male Androgenetic Alopecia: A Study with Quantitative Trichoscopic Documentation

24 citations , September 2019 in “Journal of The American Academy of Dermatology”

This study found that using very-low-dose oral minoxidil (0.25 mg/d) led to improvement or stabilization of hair parameters in 40% to 60% of men with androgenetic alopecia, although results were not statistically significant for the overall group.

research Combination Tofacitinib and Oral Minoxidil Treatment for Severe Alopecia Areata

23 citations , September 2019 in “Journal of The American Academy of Dermatology”

In this retrospective analysis, combination therapy with tofacitinib and oral minoxidil led to significant scalp hair regrowth in patients with severe alopecia areata, with 67% achieving at least 75% regrowth, although the small sample size limits the findings.

Integrative Analysis of Rare Copy Number Variants and Gene Expression Data in Alopecia Areata Implicates an Etiological Role for Autophagy

research Integrative Analysis of Rare Copy Number Variants and Gene Expression Data in Alopecia Areata Implicates an Etiological Role for Autophagy

20 citations , June 2019 in “Experimental Dermatology”

This study identified 14 genes affected by copy number variants that may contribute to alopecia areata, including four genes notably involved in autophagy and chromatin remodeling.

research All-Cause and Cause-Specific Mortality Risks Associated With Alopecia Areata

19 citations , May 2019 in “JAMA dermatology”

This study found that patients with alopecia areata had an increased risk of mortality from self-harm, psychiatric diseases, and lung cancer compared to the general population.

research Minoxidil for Patchy Alopecia Areata: Systematic Review and Meta-Analysis

20 citations , March 2019 in “Journal of The European Academy of Dermatology and Venereology”

In this study, 5% minoxidil significantly improved outcomes for children and adults with patchy alopecia areata compared to placebo, with moderate quality evidence and no severe adverse events reported, though more research is needed to address remaining uncertainties.

research JAK Inhibitors for Alopecia Areata: A Systematic Review and Meta-Analysis

130 citations , February 2019 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This study found that JAK inhibitors for alopecia areata showed promising response rates, with 72.4% of 289 cases responding, and oral administration achieving better outcomes than topical treatment, but recurrence occurred when treatment stopped. Further large-scale studies are needed to confirm these findings.

research Monotherapy for Alopecia Areata: A Systematic Review and Network Meta-Analysis

16 citations , January 2019 in “Skin appendage disorders”

This study used a network meta-analysis to compare alopecia areata treatments, finding that intralesional corticosteroids are most effective for mild cases, while diphenylcyclopropenone ranks highest for moderate to severe cases; further research on oral tofacitinib is needed.

research What Is Behind the 'Swarm of Bees' in Alopecia Areata

7 citations , November 2018 in “British Journal of Dermatology”

Alopecia areata is caused by immune system issues, and JAK inhibitors might help treat it.

research An Integrated Model of Alopecia Areata Biomarkers Highlights Both TH1 and TH2 Upregulation

58 citations , July 2018 in “Journal of Allergy and Clinical Immunology”

Alopecia areata severity is linked to increased TH1 and TH2 activity.

research Role of Hair Prostheses (Wigs) in Patients with Severe Alopecia Areata

15 citations , January 2018 in “Annals of Dermatology”

Wigs significantly improve the well-being of people with severe hair loss.

research Emerging Unconventional Therapies for Alopecia Areata

14 citations , December 2017 in “Journal of Investigative Dermatology Symposium Proceedings”

This review discusses unconventional therapies for managing alopecia areata, highlighting antihistamines, cryotherapy, and low-dose naltrexone, but reports no new clinical results and emphasizes the need for further research.

research Alopecia Areata: Treatment Options and Efficacy

182 citations , December 2017 in “Journal of the American Academy of Dermatology”

This article reviews current and emerging treatments for alopecia areata, including Janus kinase inhibitors, highlighting variability in clinical outcomes and the lack of sustained remission.

research Microneedling for the Treatment of Hair Loss

58 citations , December 2017 in “Journal of The European Academy of Dermatology and Venereology”

This review highlights that microneedling shows some promise for improving hair growth in alopecia, particularly when used with other treatments, though more research is needed to establish its efficacy and protocols.

research Alopecia Areata: Current Situation and Perspectives

34 citations , October 2017 in “Archivos Argentinos De Pediatria”

This review discusses the clinical characteristics, diagnosis, and treatment of alopecia areata, exploring potential environmental, immunological, and genetic factors involved in its development, but reports no new research findings.

research Evaluation of the Relationship Between Alopecia Areata and Viral Antigen Exposure

19 citations , August 2017 in “American journal of clinical dermatology”

This analysis reports that hepatitis B surface protein antigen exposure is associated with an increased risk of alopecia areata.

research Intestinal Dysbiosis and Biotin Deprivation Induce Alopecia Through Overgrowth of Lactobacillus Murinus in Mice

82 citations , August 2017 in “Cell Reports”

This study found that antibiotic-induced gut dysbiosis, particularly overgrowth of Lactobacillus murinus, can lead to hair loss in mice by depleting biotin.

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 Mechanisms of Tolerance and Potential Therapeutic Interventions in Alopecia Areata

12 citations , May 2017 in “Pharmacology & therapeutics”

This review discusses the mechanisms underlying immune tolerance failure in alopecia areata and highlights potential therapeutic avenues for restoring hair growth and achieving sustained remission, but reports no new clinical results.

research Efficacy of Topical Latanoprost Versus Minoxidil and Betamethasone Valerate on the Treatment of Alopecia Areata

15 citations , May 2017 in “Journal of Dermatological Treatment”

In this study, patients with alopecia areata experienced significant hair regrowth using topical latanoprost, minoxidil, or betamethasone valerate, with the addition of latanoprost enhancing the effectiveness of betamethasone valerate, showcasing these treatments as safe and effective options.

research Use of Lasers in the Treatment of Alopecia Areata

4 citations , December 2016 in “Medical lasers”

This review article discusses the use of various laser treatments in dermatology, including excimer lasers, fractional non-ablative photothermolysis lasers, and low-level laser therapy, highlighting their applications in enhancing drug delivery and addressing different skin conditions. Results are not reported.

research Safety and Efficacy of the JAK Inhibitor Tofacitinib Citrate in Patients with Alopecia Areata

222 citations , September 2016 in “JCI insight”

This research overview highlights that although JAK inhibitors show promise as potential treatments for alopecia areata based on recent insights into the disease mechanism, their efficacy has not yet been thoroughly evaluated in a systematic manner.

research Oral Ruxolitinib Induces Hair Regrowth in Patients with Moderate-to-Severe Alopecia Areata

196 citations , September 2016 in “JCI insight”

This study explored the effectiveness of the oral JAK1/2 inhibitor ruxolitinib in treating patients with moderate-to-severe alopecia areata, building on prior success with JAK inhibitors in mice, but results are not reported in this abstract.

research Genomewide Analysis of Copy Number Variants in Alopecia Areata in a Central European Cohort Reveals Association with MCHR2

29 citations , June 2016 in “Experimental Dermatology”

This study provides suggestive evidence that duplications in the MCHR2 gene may be involved in the pathogenesis of alopecia areata.

research Familial Aggregation of Alopecia Areata

295 citations , May 2016 in “Journal of the American Academy of Dermatology”

This review examines the immunological aspects of alopecia areata, focusing on genetic, neuroimmunological, and immune privilege factors, but does not report new clinical findings.

research ULBP3: A Marker for Alopecia Areata Incognita

15 citations , May 2016 in “Archives of Dermatological Research”

This study found significantly higher levels of the protein ULBP3 in patients with alopecia areata incognita compared to other hair loss conditions and healthy controls, suggesting ULBP3's potential as a diagnostic marker for AAI.

research Retrospective Review of Diphencyprone in the Treatment of Alopecia Areata

27 citations , December 2015 in “Clinical and Experimental Dermatology”

This study found that hair regrowth occurred in 72.2% of alopecia areata patients treated with diphencyprone, with disease extent at baseline and duration affecting outcomes.

research Benefit of Different Concentrations of Intralesional Triamcinolone Acetonide in Alopecia Areata: An Intrasubject Pilot Study

50 citations , July 2015 in “Journal of the American Academy of Dermatology”

This study found that 2.5 mg/mL triamcinolone acetonide injections were as effective as higher doses for treating limited, patchy alopecia areata, while minimizing side effects like skin atrophy.

research Scalp Roller Therapy in Resistant Alopecia Areata

14 citations , January 2014 in “Journal of Cutaneous and Aesthetic Surgery”

Scalp Roller therapy helped improve hair growth in patients with hard-to-treat alopecia areata.

research Alopecia Areata: Successful Outcome with Microneedling and Triamcinolone Acetonide

53 citations , January 2014 in “Journal of Cutaneous and Aesthetic Surgery”

Microneedling combined with triamcinolone can safely stimulate faster hair regrowth in people with Alopecia Areata.

research Psychosocial Impact of Wigs or Hairpieces on Perceived Quality of Life in Female Patients with Alopecia Areata

9 citations , December 2012 in “The Journal of Dermatology”

Wearing wigs or hairpieces improves self-esteem, adaptability, and competence in women with alopecia areata.

research Trichohyalin Is a Potential Major Autoantigen in Human Alopecia Areata

66 citations , July 2010 in “Journal of Proteome Research”

This study suggests that an immune response to trichohyalin and keratin 16 may contribute to the pathogenesis of alopecia areata.

research Genome-Wide Association Study in Alopecia Areata Implicates Both Innate and Adaptive Immunity

717 citations , June 2010 in “Nature”

This study identified key genetic regions associated with alopecia areata, highlighting both acquired and innate immune involvement, with a novel link to the upregulation of ULBP ligands in autoimmune disease.

Photodynamic Therapy with Methyl 5-Aminolevulinate Acid Might Be Ineffective in Recalcitrant Alopecia Totalis Regardless of Using a Microneedle Roller to Increase Skin Penetration

research Photodynamic Therapy with Methyl 5-Aminolevulinate Acid Might Be Ineffective in Recalcitrant Alopecia Totalis Regardless of Using a Microneedle Roller to Increase Skin Penetration

27 citations , May 2010 in “Dermatologic surgery”

This study found that photodynamic therapy with methyl 5-aminolevulinic acid was ineffective for treating alopecia totalis, even with microneedle rolling to enhance drug delivery.

research Latanoprost in the Treatment of Eyelash Alopecia in Alopecia Areata Universalis

50 citations , December 2009 in “Journal of The European Academy of Dermatology and Venereology”

This study found that latanoprost may be effective for treating eyelash alopecia areata, achieving cosmetically acceptable regrowth in 45% of patients.

research The Efficacy of Latanoprost in the Treatment of Alopecia Areata of Eyelashes and Eyebrows

20 citations , November 2009 in “European Journal of Dermatology”

This study found that topical latanoprost was not effective in treating alopecia areata in eyebrows and eyelashes.

research Treatment of Severe Alopecia Areata with Intralesional Steroid Injections

60 citations , October 2009 in “PubMed”

This study reports that intralesional triamcinolone acetonide was effective and well-tolerated for treating extensive alopecia areata in patients who often showed specific initial hair characteristics.

Lack of Efficacy of Topical Latanoprost and Bimatoprost Ophthalmic Solutions in Promoting Eyelash Growth in Patients with Alopecia Areata

research Lack of Efficacy of Topical Latanoprost and Bimatoprost Ophthalmic Solutions in Promoting Eyelash Growth in Patients with Alopecia Areata

55 citations , March 2009 in “Journal of The American Academy of Dermatology”

This study found that latanoprost and bimatoprost, when applied cutaneously to the eyelids, did not induce appreciable eyelash regrowth in patients with alopecia areata over 16 weeks.

research Use of the Pulsed Infrared Diode Laser (904 nm) in the Treatment of Alopecia Areata

63 citations , January 2006 in “Journal of cosmetic and laser therapy”

This study found that pulsed infrared diode laser therapy (904 nm) was effective in promoting hair regrowth in 94% of patients with resistant patches of alopecia areata.

research Lack of Efficacy of Topical Latanoprost in the Treatment of Eyebrow Alopecia Areata

36 citations , November 2005 in “Journal of The American Academy of Dermatology”

This article discusses the potential of latanoprost for treating alopecia areata, but notes that well-controlled studies are still needed to confirm its effectiveness.

research Minoxidil: Mechanisms of Action on Hair Growth

397 citations , February 2004 in “British Journal of Dermatology”

This article reviews the mechanisms by which minoxidil stimulates hair growth and reports no new clinical findings.

Efficacy of Betamethasone Valerate Foam Formulation in Comparison with Betamethasone Dipropionate Lotion in the Treatment of Mild-to-Moderate Alopecia Areata: A Multicenter, Prospective, Randomized, Controlled, Investigator-Blinded Trial

research Efficacy of Betamethasone Valerate Foam Formulation in Comparison with Betamethasone Dipropionate Lotion in the Treatment of Mild-to-Moderate Alopecia Areata: A Multicenter, Prospective, Randomized, Controlled, Investigator-Blinded Trial

66 citations , July 2003 in “International Journal of Dermatology”

This study found that betamethasone valerate foam was more effective and well-tolerated than betamethasone dipropionate lotion in treating mild-to-moderate alopecia areata, with higher hair regrowth rates observed.

research Clobetasol Propionate 0.05% Under Occlusion in the Treatment of Alopecia Totalis/Universalis

146 citations , July 2003 in “Journal of the American Academy of Dermatology”

In this study, clobetasol propionate 0.05% ointment was found to induce hair regrowth in 28.5% of patients with severe alopecia areata under occlusive conditions, though long-term benefit was limited to 17.8%.

research The Pattern and Profile of Alopecia Areata in Singapore: A Study of 219 Asians

275 citations , November 2002 in “International Journal of Dermatology”

This study found that among an Asian population with alopecia areata, commonly first episodes occurred before age 40, with severe cases linked to psychological effects and treatments showing significant regrowth.

research Experimental Induction of Alopecia Areata-Like Hair Loss in C3H/HeJ Mice Using Full-Thickness Skin Grafts

131 citations , November 1998 in “The journal of investigative dermatology/Journal of investigative dermatology”

This study observed that alopecia areata can be induced and serially transferred in C3H/HeJ mice using skin grafts, providing a useful model for studying the disease in humans.

research Profile of Alopecia Areata: A Questionnaire Analysis of Patients and Families

161 citations , March 1992 in “International Journal of Dermatology”

This study analyzed survey responses from 800 alopecia areata patients and found a possible genetic association with increased insulin-dependent diabetes mellitus in relatives but not in the patients themselves.

research Evaluation of Oral Minoxidil in the Treatment of Alopecia Areata

34 citations , November 1987 in “Archives of Dermatology”

This study found that oral minoxidil showed limited cosmetic effectiveness in treating severe alopecia areata, with only 18% of patients experiencing a noticeable response.

research Topical Minoxidil Solution (1% and 5%) in the Treatment of Alopecia Areata

101 citations , March 1987 in “Journal of The American Academy of Dermatology”

Minoxidil solution helps hair regrowth in alopecia areata, with 5% being more effective.

research Double-Blind, Placebo-Controlled Evaluation of Topical Minoxidil in Extensive Alopecia Areata

104 citations , March 1987 in “Journal of The American Academy of Dermatology”

Minoxidil helps hair growth in 63.6% of alopecia patients, with 27.3% having excellent results.

research Immunohistochemical Characterization of the Cellular Infiltrate in Severe Alopecia Areata Before and After Minoxidil Treatment

31 citations , January 1987 in “Dermatology”

This study reports that topical minoxidil led to normalization of hair follicle characteristics in 36 of 47 severe alopecia areata patients, and indicated a shift in T cell populations, suggesting potential immunomodulatory effects.