Alopecia Areata: Time for Position Statement to Include New Systemic Therapeutic Advances
TLDR New treatments for severe alopecia areata, especially JAK inhibitors, are recommended as first-line therapy.
The document discusses the recent advances in the treatment of severe alopecia areata (AA), a condition that significantly impacts the quality of life. The understanding of the immune mechanisms of the disease has led to the development and approval of new systemic treatments, particularly systemic JAK inhibitors like baricitinib and ritlecitinib. These have been validated in randomized control trials for treating moderate to severe AA, marking a significant milestone in managing the disease. A European group of experts has produced a consensus statement prioritizing systemic JAK inhibitors as a first-line therapy for patients requiring a systemic agent. Other immunomodulating agents are considered as next lines in case of contraindications, failure, and/or side effects of systemic JAK inhibitors. The document also notes that systemic steroids can still be used in case of acute flare, and low-dose oral minoxidil could be added as an adjuvant therapy. The statement also suggests treating patients for at least 6–12 months after complete remission to prevent the risk of relapse. Children from the age of 12 can also be treated with systemic therapies, specifically ritlecitinib.
