Alopecia Areata: A Review of the Role of Oxidative Stress, Possible Biomarkers, and Potential Novel Therapeutic Approaches

The review paper discusses the role of oxidative stress in the development of Alopecia Areata (AA), a condition causing non-scarring hair loss. It suggests that oxidative stress markers are altered in AA patients, indicating a pro-oxidative status. Oxidative stress is found to induce MHC class I chain-related A (MICA) expression in hair follicle keratinocytes, leading to destabilization of the hair follicle immune-privileged site, and activates the KEAP1-NRF2 pathway, an antioxidant system contributing to skin homeostasis. Potential biomarkers of oxidative stress in AA, such as malondialdehyde (MDA), advanced glycation end-products (AGEs), and ischemic-modified albumin (IMA) are identified. The review also highlights potential treatment options, including JAK inhibitors and nutraceuticals that modulate the oxidative stress balance, as promising therapeutic tools. However, more studies with larger groups are needed to define the exact mechanism.