New and Emerging Therapies for Alopecia Areata

April 2020 in “ Drugs ”

Aunna Pourang, Natasha Atanaskova Mesinkovska

alopecia areata cytokine antagonism JAK inhibitors baricitinib tofacitinib immune pathways diphenylcyclopropenone cyclosporine platelet-rich plasma laser treatments mesenchymal stem cell therapy PRP

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 Emerging therapies like JAK inhibitors show promise for hair regrowth in alopecia areata.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The document reviewed various emerging therapies for alopecia areata, emphasizing the potential of cytokine antagonism and JAK inhibitors, such as baricitinib and tofacitinib, in reversing the condition by targeting immune pathways. Studies, including one with 90 patients treated with tofacitinib, showed promising results in inducing hair regrowth. However, not all trials were successful, as seen with the phase 2 trial of ATI-502. Other treatments explored included topical agents like diphenylcyclopropenone, systemic treatments such as cyclosporine, and innovative approaches like platelet-rich plasma, laser treatments, and mesenchymal stem cell therapy. The document highlighted the complexity of alopecia areata and the need for targeted therapeutic strategies, noting the evolving landscape of potential treatments.

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Research cited in this study

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research Meta-Analysis of Photobiomodulation for the Treatment of Androgenetic Alopecia

10 citations , November 2019 in “Journal of Dermatological Treatment”

This study revealed that photobiomodulation significantly improved hair density in androgenetic alopecia patients, with laser treatments being more effective than combined laser/LED treatments, while device style did not significantly affect outcomes.

research Alopecia Areata in 2 Patients Treated with Dupilumab: New Onset and Worsening

26 citations , July 2019 in “JAAD Case Reports”

This study reports two cases of hair loss outcomes in patients using dupilumab for atopic dermatitis, with one showing improvement in alopecia universalis and another experiencing worsening of alopecia totalis.

research Efficacy and Safety of Anthralin in Combination with Diphenylcyclopropenone in the Treatment of Alopecia Areata: A Retrospective Case Series

20 citations , June 2019 in “Archives of dermatological research”

In this study, combination therapy with DPCP and anthralin promoted hair regrowth in 40.62% of alopecia areata patients who were unresponsive to DPCP alone, with response improving over longer treatment durations.

research Cyclosporine for Moderate-to-Severe Alopecia Areata: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial of Efficacy and Safety

44 citations , April 2019 in “Journal of the American Academy of Dermatology”

This study observed that cyclosporine showed a trend toward improving alopecia areata symptoms compared to placebo, but the difference was not statistically significant.

research Scalp Bacterial Shift in Alopecia Areata

48 citations , April 2019 in “PloS one”

This study observed a microbial shift on the scalp of Alopecia areata patients, characterized by an increase in Propionibacterium acnes and a decrease in Staphylococcus epidermidis, compared to healthy controls.

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 Dupilumab Improved Alopecia Areata in a Patient with Atopic Dermatitis: A Case Report

33 citations , January 2019 in “Acta Dermato Venereologica”

This case report suggests potential effectiveness of dupilumab for alopecia areata, though hair regrowth may result from indirect effects on inflammation in atopic dermatitis.

research Vitamin D and Alopecia Areata: Possible Roles in Pathogenesis and Potential Implications for Therapy

14 citations , January 2019 in “PubMed”

This review examines the potential roles of vitamin D in the pathogenesis of alopecia areata and suggests that vitamin D analogs like calcipotriol may have therapeutic potential.

research Janus Kinase Inhibitors for the Treatment of Severe Alopecia Areata: An Open-Label Comparative Study

66 citations , December 2018 in “Dermatology”

This study found that oral JAK inhibitors, ruxolitinib and tofacitinib, are effective and well-tolerated for treating severe alopecia areata, with a similar degree of hair regrowth and relapse rates, but ruxolitinib induced faster initial hair regrowth.

A Randomized Placebo-Controlled Single-Center Pilot Study of the Safety and Efficacy of Apremilast in Subjects with Moderate-to-Severe Alopecia Areata

research A Randomized Placebo-Controlled Single-Center Pilot Study of the Safety and Efficacy of Apremilast in Subjects with Moderate-to-Severe Alopecia Areata

42 citations , November 2018 in “Archives of dermatological research”

Apremilast was not effective in treating moderate-to-severe alopecia areata.

research Effects of Mesenchymal Stem Cell Therapy on Alopecia Areata in Cellular and Hair Follicle Organ Culture Models

16 citations , October 2018 in “Experimental Dermatology”

This study suggests that mesenchymal stem cell therapy may improve cell viability and regulate key signaling pathways in vitro for treating alopecia areata.

research Response to Ustekinumab in Three Pediatric Patients with Alopecia Areata

25 citations , October 2018 in “Pediatric dermatology”

In this study, three pediatric patients with alopecia areata demonstrated hair regrowth after being treated with ustekinumab.

research Treatment of Alopecia Universalis with Topical Janus Kinase Inhibitors – A Double Blind, Placebo, and Active Controlled Pilot Study

49 citations , August 2018 in “International Journal of Dermatology”

In this phase I study, partial hair regrowth was observed in patients with alopecia universalis using topical JAK inhibitors, though more research is needed to confirm potential as a treatment alternative to clobetasol.

research Role of Janus Kinase Inhibitors in the Treatment of Alopecia Areata

53 citations , July 2018 in “Drug design, development and therapy”

This review summarizes existing evidence on the efficacy and safety of JAK inhibitors for treating alopecia areata and emphasizes the need for improved topical formulations.

research Alopecia Areata and the Gut: The Link Opens Up for Novel Therapeutic Interventions

48 citations , May 2018 in “Expert Opinion on Therapeutic Targets”

This review discusses how modern lifestyle factors affecting gut health may contribute to Alopecia Areata in genetically predisposed individuals, reporting no new results but suggesting the need for long-term interventions.

research Cellular Therapy with Human Autologous Adipose-Derived Adult Cells of Stromal Vascular Fraction for Alopecia Areata

45 citations , May 2018 in “Stem Cell Research & Therapy”

In this study, patients receiving adipose-derived stromal vascular cell transplantation for alopecia areata experienced significant hair regeneration, increased growth, and improved hair quality after 3 and 6 months, indicating potential efficacy of this stem cell-based therapy for hair loss.

research Retrospective Analysis of the Application of Fumaric Acid Esters in 13 Patients with Alopecia Areata

4 citations , May 2018 in “European journal of dermatology/EJD. European journal of dermatology”

Fumaric acid esters might help treat alopecia areata, but more research is needed.

research Nail Involvement in Patients with Moderate-to-Severe Alopecia Areata Treated with Oral Tofacitinib

9 citations , April 2018 in “Journal of Dermatological Treatment”

This study found that oral tofacitinib monotherapy improved nail changes in 73.3% of adults with moderate-to-severe alopecia areata over a median period of 5 months, but nail improvement was not linked to the severity of hair loss or hair regrowth.

An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

research An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

130 citations , February 2018 in “Journal of Investigative Dermatology”

This study found that tofacitinib led to ≥50% hair regrowth in eight out of twelve patients with moderate to severe alopecia areata, suggesting a potential benefit for using JAK inhibitors in treating this condition.

research Vitamin D Deficiency in Patients With Alopecia Areata: A Systematic Review and Meta-Analysis

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

Alopecia areata patients often have low vitamin D levels.

research Tofacitinib 2% Ointment, a Topical Janus Kinase Inhibitor, for the Treatment of Alopecia Areata: A Pilot Study of 10 Patients

48 citations , November 2017 in “Journal of the American Academy of Dermatology”

Tofacitinib 2% ointment helped hair regrow in 3 out of 10 patients with alopecia areata, but caused side effects like scalp irritation and raised cholesterol in some.

$Oral Tofacitinib Monotherapy in Korean Patients with Refractory Moderate-to-Severe Alopecia Areata: A Case Series$

research Oral Tofacitinib Monotherapy in Korean Patients with Refractory Moderate-to-Severe Alopecia Areata: A Case Series

44 citations , October 2017 in “Journal of the American Academy of Dermatology”

In this study, tofacitinib monotherapy was effective in achieving hair regrowth in over half of Korean patients with moderate-to-severe and refractory alopecia areata, though treatment discontinuation typically led to hair loss recurrence.

research Efficacy of Topical Tofacitinib in Promoting Hair Growth in Non-Scarring Alopecia: Possible Mechanism via VEGF Induction

27 citations , September 2017 in “Archives of Dermatological Research”

In this study, topical tofacitinib significantly increased hair regrowth in mice compared to minoxidil or vehicle, potentially due to elevated VEGF levels and reduced inflammation.

research The Changing Landscape of Alopecia Areata: The Therapeutic Paradigm

77 citations , June 2017 in “Advances in Therapy”

This review discusses recent advances and ongoing clinical trials in novel therapeutics for alopecia areata, despite the lack of current FDA-approved treatments for severe cases, and reports no new results.

research Management of Alopecia Areata: Updates and Algorithmic Approach

47 citations , June 2017 in “Journal of dermatology”

This review highlights the diverse prognoses and limited long-term efficacy of current alopecia areata treatments, discussing existing and emerging therapies—including biologics—and proposing an algorithmic management approach based on specific disease characteristics.

research Treatment of Alopecia Areata With Tofacitinib

78 citations , March 2017 in “JAMA Dermatology”

Tofacitinib helped regrow hair in people with severe alopecia, but side effects occurred and benefits stopped after treatment ended.

research Efficacy and Safety of Topical Calcipotriol in Management of Alopecia Areata: A Pilot Study

39 citations , January 2017 in “Dermatologic Therapy”

This study found that topical calcipotriol lotion resulted in hair regrowth in 59.1% of alopecia areata patients, with better response observed in those with lower serum vitamin D levels.

research Simvastatin/Ezetimibe Therapy for Recalcitrant Alopecia Areata: An Open Prospective Study of 14 Patients

13 citations , January 2017 in “Annals of dermatology/Annals of Dermatology”

In this study, simvastatin/ezetimibe treatment led to partial hair regrowth in about 29% of patients with recalcitrant alopecia areata, suggesting it may be a viable alternative therapy for this condition.

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 Tofacitinib for the Treatment of Alopecia Areata and Variants in Adolescents

139 citations , November 2016 in “Journal of the American Academy of Dermatology”

In this retrospective review, tofacitinib treatment was associated with clinically significant hair regrowth in most adolescent patients with alopecia areata, though limitations suggest further studies are needed to confirm these findings.

research Tofacitinib for the Treatment of Severe Alopecia Areata and Variants: A Study of 90 Patients

238 citations , November 2016 in “Journal of The American Academy of Dermatology”

In this study, tofacitinib was reported to improve scalp hair regrowth in patients with severe alopecia areata, alopecia totalis, and alopecia universalis, showing a higher response in alopecia areata.

research Platelet-Rich Plasma Versus Minoxidil 5% in Treatment of Alopecia Areata: A Trichoscopic Evaluation

62 citations , October 2016 in “Dermatologic Therapy”

This study found that platelet-rich plasma was more effective for treating alopecia areata than topical 5% minoxidil, leading to earlier hair regrowth and reduction in hair abnormalities.

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 Extensive Alopecia Areata Is Reversed by IL-12/IL-23p40 Cytokine Antagonism

68 citations , November 2015 in “The Journal of Allergy and Clinical Immunology”

In this study, three patients with extensive alopecia areata showed varying degrees of hair regrowth after 20 weeks of treatment with ustekinumab, a cytokine-targeting therapy.

research Therapy for Alopecia Areata in Mice by Stimulating the Hair Cycle with Parathyroid Hormone Agonists Linked to a Collagen-Binding Domain

12 citations , November 2015 in “Journal of Investigative Dermatology Symposium Proceedings”

PTH-CBD helps reduce hair loss in mice by stimulating hair growth directly.

research Clinical Efficacy of Diphenylcyclopropenone in Alopecia Areata: Retrospective Data Analysis of 50 Patients

41 citations , November 2015 in “The journal of investigative dermatology. Symposium proceedings/The Journal of investigative dermatology symposium proceedings”

This study found that diphenylcyclopropenone therapy resulted in over 50% hair regrowth in 71% of alopecia totalis patients, with a significant relapse association with thyroid disease, suggesting treatment could be viable but should continue for at least two years.

research Pharmacologic Inhibition of JAK-STAT Signaling Promotes Hair Growth

159 citations , October 2015 in “Science Advances”

This study observed that applying JAK-STAT pathway inhibitors to mouse and human skin led to rapid hair growth by inducing the anagen phase of hair follicles.

research Alopecia Areata Profiling Shows TH1, TH2, and IL-23 Cytokine Activation Without Parallel TH17/TH22 Skewing

176 citations , August 2015 in “The journal of allergy and clinical immunology/Journal of allergy and clinical immunology/The journal of allergy and clinical immunology”

This study identified a distinct cytokine activation signature in alopecia areata, involving TH2, TH1, IL-23, and IL-9/TH9 pathways, suggesting potential targeting strategies similar to those in psoriasis and atopic dermatitis.

research Epidemiology and Burden of Alopecia Areata: A Systematic Review

144 citations , July 2015 in “Clinical, Cosmetic and Investigational Dermatology”

This review reports that alopecia areata affects about 2% of people globally and is linked with psychiatric and medical comorbidities, highlighting its significant disease burden.

research Topical Calcipotriol Therapy for Mild-to-Moderate Alopecia Areata: A Retrospective Study

38 citations , June 2015 in “PubMed”

This study found that topical calcipotriol may safely and effectively treat mild-to-moderate patchy alopecia areata, with significant hair regrowth observed in the majority of participants over 12 weeks.

research Reversal of Alopecia Areata Following Treatment With the JAK1/2 Inhibitor Baricitinib

184 citations , February 2015 in “EBioMedicine”

This study observed that baricitinib treatment led to significant improvement in a patient's alopecia areata symptoms and suggests further clinical trials to explore its potential as a treatment.

research Alopecia Areata Is Driven by Cytotoxic T Lymphocytes and Is Reversed by JAK Inhibition

701 citations , August 2014 in “Nature medicine”

This study found that JAK inhibitors promote hair regrowth in both mice and human alopecia areata cases by blocking key immune pathways involved in disease development.

research Potential Relationship Between the Canonical Wnt Signaling Pathway and Expression of the Vitamin D Receptor in Alopecia

21 citations , March 2014 in “Clinical and experimental dermatology”

This study observed a potential relationship between the canonical Wnt signalling pathway and the expression of the vitamin D receptor in alopecia, suggesting a link worth further exploration.

research Limited Effectiveness of Platelet-Rich Plasma Treatment on Chronic Severe Alopecia Areata

15 citations , January 2014 in “Hair therapy & transplantation”

This study found that treatment with platelet-rich plasma showed some hair re-growth in patients with severe alopecia areata, but results were not sustained and treatment was associated with pain and discomfort.

research The Effect of Oral Cyclosporine in the Treatment of Severe Alopecia Areata

33 citations , October 2013 in “Cutaneous and ocular toxicology”

This article discusses the autoimmune pathogenesis of alopecia areata and reviews the use of immunosuppressive therapies in its treatment, but it does not provide new clinical results.

research Successful Treatment of Alopecia Totalis with Hydroxychloroquine: Report of 2 Cases

11 citations , May 2013 in “Journal of the American Academy of Dermatology”

Hydroxychloroquine helped two people regrow hair lost from alopecia totalis.

A Randomized, Double-Blind, Placebo- and Active-Controlled, Half-Head Study to Evaluate the Effects of Platelet-Rich Plasma on Alopecia Areata

research A Randomized, Double-Blind, Placebo- and Active-Controlled, Half-Head Study to Evaluate the Effects of Platelet-Rich Plasma on Alopecia Areata

205 citations , April 2013 in “British Journal of Dermatology”

In this study, platelet-rich plasma significantly increased hair regrowth and reduced symptoms of alopecia areata compared to triamcinolone acetonide or placebo, with no observed side effects.

research Case of Intractable Ophiasis Type of Alopecia Areata Presumably Improved by Fexofenadine

6 citations , May 2012 in “The Journal of Dermatology”

This letter reports on a case of intractable ophiasis-type alopecia areata that was presumably improved by fexofenadine, but no new clinical results are presented.

research Autologous Platelet-Rich Plasma: A Potential Therapeutic Tool for Promoting Hair Growth

270 citations , March 2012 in “Dermatologic Surgery”

This study found that autologous platelet-rich plasma increased hair growth potential by enhancing dermal papilla cell proliferation and stimulating key signaling pathways in both cell cultures and mice models.

research Dihydrotestosterone-Inducible IL-6 Inhibits Elongation of Human Hair Shafts by Suppressing Matrix Cell Proliferation and Promotes Regression of Hair Follicles in Mice

173 citations , September 2011 in “Journal of Investigative Dermatology”

IL-6 contributes to hair loss by shortening the growth phase and causing hair follicles to regress.

research Intralesional Steroids for Alopecia Areata

36 citations , January 2010 in “International Journal of Trichology”

Intralesional steroids can help regrow hair in some alopecia areata patients but have side effects.

research Two Cases of Alopecia Areata Responsive to Fexofenadine

13 citations , December 2007 in “The Journal of Dermatology”

This study reports two cases of alopecia areata that responded to the antihistamine fexofenadine.

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.

research Restoration of Hair Growth in Mice with an Alopecia Areata-Like Disease Using Topical Anthralin

29 citations , January 2004 in “Experimental Dermatology”

In this study, anthralin treatment led to hair regrowth in alopecia areata-like affected C3H/HeJ mice, suggesting it may be an effective therapy for this condition.

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 Gene Array Profiling and Immunomodulation Studies Define a Cell-Mediated Immune Response Underlying the Pathogenesis of Alopecia Areata in a Mouse Model and Humans

114 citations , August 2002 in “Journal of Investigative Dermatology”

Alopecia areata is caused by an immune response, and targeting immune cells might help treat it.

research Efficacy of Topical Sensitizers in the Treatment of Alopecia Areata

132 citations , November 1998 in “Journal of the American Academy of Dermatology”

This review evaluates the efficacy and safety of topical sensitizers in treating alopecia areata but reports no new clinical findings.

research Interleukin 6: Insights Into Its Function in Skin by Overexpression in Transgenic Mice

221 citations , June 1992 in “Proceedings of the National Academy of Sciences”

In this study, IL-6 expression in transgenic mice thickened the stratum corneum without causing increased epidermal proliferation or inflammation, suggesting it may enhance skin protection rather than directly induce inflammation.

research Topical Photochemotherapy for Alopecia Areata

63 citations , April 1985 in “Journal of the American Academy of Dermatology”

This study observed that topical PUVA treatment led to excellent or good hair regrowth in 45.4% of patients with alopecia areata, though many experienced relapse after treatment stopped.

research Topical Minoxidil in the Treatment of Alopecia Areata

80 citations , October 1983 in “BMJ”

This study found that 1% topical minoxidil induced significant hair regrowth in patients with alopecia areata, though it was less effective for those with extensive hair loss such as alopecia totalis and universalis.