Genome-Wide Association Study in Alopecia Areata Implicates Both Innate and Adaptive Immunity

A user with alopecia totalis, borderline universalis, seeks advice on getting into a Xeljanz trial or appealing insurance for coverage. They experienced significant hair regrowth but are now seeing hair loss again and want to try Xeljanz.

A 35-year-old with alopecia areata has tried finasteride, topical and oral minoxidil, and dutasteride without success in stopping hair loss. The dermatologist suggests JAK inhibitors, but they are too costly, leading to uncertainty about the cause of hair loss.

Balding scalps have more androgen receptors, leading to increased TGF-beta, which causes blood vessel loss and hair follicle miniaturization. Blocking androgen signaling and TGF-beta may help prevent hair loss.

Topical tacrolimus is being considered for androgenetic alopecia, though its effectiveness is unproven. Other treatments mentioned include minoxidil, dutasteride, cyclosporine, and teicoplanin, with discussions on blocking the prolactin receptor for hair growth.

Corticosterone inhibits GAS6, affecting hair follicle stem-cell activity, with potential implications for stress-related hair loss. Ashwagandha and Vitamin K are suggested for reducing cortisol, but their effectiveness is debated.

PP405 is a promising experimental topical treatment for alopecia that reactivates dormant hair follicles by targeting cellular energy, with large-scale trials planned for 2026. While it shows potential, it cannot regenerate permanently destroyed follicles, making hair transplants the only guaranteed solution for advanced baldness currently.