Alopecia Areata: From Pathophysiology to Therapeutic Innovation

    April 2023 in “ Portuguese Journal of Dermatology and Venereology ”
    Nuno Lourenço, Margarida Gonçalo
    From the encyclopedia
    Alopecia Areata →

    autoimmune disorder causing patchy hair loss

    Baricitinib →

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

    Tofacitinib →

    a JAK inhibitor for alopecia areata and other autoimmune conditions

    Studysummary This review examines the pathophysiological mechanisms and emerging targeted treatments for alopecia areata, particularly highlighting the efficacy of oral JAK inhibitors over other less effective alternatives.
    Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer
    Alopecia areata (AA) is a chronic condition marked by non-scarring hair loss due to the breakdown of immune privilege in hair follicles, primarily driven by increased interferon-gamma (IFN-γ) production and the JAK-STAT pathway. This understanding has led to the development of JAK inhibitors as a targeted treatment for AA. First-generation oral JAK inhibitors like baricitinib, tofacitinib, and ruxolitinib, and second-generation inhibitors such as ritlecitinib and brepocitinib, have shown efficacy and safety. Notably, baricitinib (Olumiant) was approved on 13th June 2022, following successful BRAVE-AA1 and BRAVE-AA2 studies. However, topical JAK inhibitors and other therapies like phosphodiesterase-4 inhibitors and biologics generally show limited efficacy, except potentially dupilumab. The article reviews these pathophysiological insights and therapeutic innovations, emphasizing JAK inhibitors.
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