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

The document describes a study where three patients with extensive alopecia areata (AA) were treated with ustekinumab, an IL-12/IL-23p40 blocker. The patients, two with 40% scalp involvement and one with alopecia universalis (100% scalp involvement), received three subcutaneous doses of 90 mg of ustekinumab at weeks 0, 4, and 16. After 20 weeks, all patients showed hair regrowth, with the alopecia universalis patient experiencing full scalp hair regrowth by week 49. The study found that this treatment decreased inflammatory markers and increased hair keratin expression, suggesting that IL-12/IL-23p40 antagonism can effectively reverse extensive AA. The document also calls for larger trials to confirm these results and to refine biomarkers for therapeutic response. It mentions the potential for expanding the ALADIN scores to measure disease improvement and acknowledges the authors' conflicts of interest and funding sources.