New Modalities in the Treatment of Refractory Alopecia Areata

May 2017 in “ InTech eBooks ”

Arzu Kılıç

refractory alopecia areata corticosteroids minoxidil JAK inhibitors tofacitinib ruxolitinib phototherapy laser therapy biologic agents dupilumab tralokinumab cytokines immune pathways Rogaine

From the encyclopedia

Minoxidil →

An essential vasodilator with some anti-androgenic effects

Tofacitinib →

a JAK inhibitor for alopecia areata and other autoimmune conditions

Studysummary This review summarizes current treatments for recalcitrant alopecia areata and recent therapeutic developments targeting specific immunological pathways, reporting no new clinical results.

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 new treatment modalities for refractory alopecia areata (AA), emphasizing the complexity and multifactorial nature of the disease. It highlighted the limited efficacy of conventional therapies like corticosteroids and minoxidil, especially in severe cases. Novel treatments, including JAK inhibitors (tofacitinib, ruxolitinib), showed promise in reversing hair loss by targeting specific immunological pathways. Phototherapy and laser therapy had mixed results, with some studies reporting high regrowth rates. Biologic agents like dupilumab and tralokinumab, targeting cytokines and immune pathways, were under investigation. The document stressed the need for more randomized controlled studies and personalized treatment plans due to heterogeneous patient responses, underscoring the importance of continued research to develop effective treatments for AA.

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Research cited in this study

57 / 57 results

research Intramuscular Triamcinolone Acetonide: An Undervalued Option for Refractory Alopecia Areata

12 citations , July 2016 in “Journal of dermatology”

This study found that intramuscular triamcinolone acetonide may be an effective and safe treatment option for managing refractory alopecia areata, showing a 63% response rate in patients and hair regrowth negatively correlated with initial scalp involvement.

research Efficacy of Tofacitinib in Treatment of Alopecia Universalis in Two Patients

51 citations , June 2016 in “Journal of the European Academy of Dermatology and Venereology”

In this study, tofacitinib treatment was associated with significant hair regrowth in two patients with alopecia universalis over eight months, with minimal adverse effects reported.

research A Novel Therapeutic Paradigm for Patients with Extensive Alopecia Areata

30 citations , May 2016 in “Expert Opinion on Biological Therapy”

This review discusses immune pathways involved in alopecia areata and explores emerging, more targeted therapeutic strategies, noting their potential for better safety and effectiveness compared to traditional immune suppressants.

research Treatment of an Alopecia Areata Patient with Tofacitinib Results in Regrowth of Hair and Changes in Serum and Skin Biomarkers

70 citations , April 2016 in “Experimental Dermatology”

In this study, oral tofacitinib treatment led to significant hair regrowth and changes in skin and blood biomarkers in a patient with alopecia areata.

research Transient Efficacy of Tofacitinib in Alopecia Areata Universalis

39 citations , April 2016 in “Case Reports in Dermatology”

This study observed initial hair regrowth in a businessman with alopecia areata universalis treated with tofacitinib, but the effect diminished, leading to renewed hair loss.

research Efficacy and Safety of Methotrexate Combined with Low- to Moderate-Dose Corticosteroids for Severe Alopecia Areata

28 citations , January 2016 in “Dermatology”

This study observed that methotrexate combined with low- to moderate-dose oral corticosteroids may effectively treat severe alopecia areata, though long-term maintenance is often necessary due to relapse after tapering.

research Biomarkers of Alopecia Areata Disease Activity and Response to Corticosteroid Treatment

65 citations , December 2015 in “Experimental dermatology”

This study found that both Th1 and Th2 immune responses, along with IL-23 and IL-32 cytokine pathways, are active in alopecia areata lesions, and corticosteroid injections significantly altered these immune markers.

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 Successful Treatment of Corticosteroid-Resistant Ophiasis-Type Alopecia Areata with Platelet-Rich Plasma

30 citations , August 2015 in “JAAD case reports”

This case report describes a patient with corticosteroid-resistant ophiasis alopecia areata who experienced prompt hair regrowth after receiving platelet-rich plasma injections.

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 Imbalance of T-Helper 17 and Regulatory T Cells in Patients with Alopecia Areata

62 citations , June 2015 in “The Journal of Dermatology”

This study found that patients with alopecia areata had higher levels of Th17 cells and lower levels of regulatory T cells compared to healthy controls, suggesting an immune imbalance in these patients.

research Contact Immunotherapy-Resistant Alopecia Areata Totalis/Universalis Reactive to Topical Corticosteroid

5 citations , May 2015 in “The Journal of Dermatology”

Topical corticosteroids can help treat severe alopecia areata when other treatments fail.

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.

Efficacy and Safety of Diphenylcyclopropenone Alone or in Combination with Anthralin in the Treatment of Chronic Extensive Alopecia Areata: A Retrospective Case Series

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

44 citations , February 2015 in “Journal of the American Academy of Dermatology”

This study found that combination therapy with diphenylcyclopropenone and anthralin was more effective for complete hair regrowth in chronic extensive alopecia areata than diphenylcyclopropenone alone, despite more common side effects.

research The Genetics Of Alopecia Areata: New Approaches, New Findings, New Treatments

62 citations , January 2015 in “Journal of Dermatological Science”

This review summarizes the current genetic research on alopecia areata, including potential new therapeutic strategies, but reports no new clinical findings.

research Alopecia Areata: Overview and Treatment Options

16 citations , January 2015 in “Current problems in dermatology”

This article reviews treatment options and psychological impacts of alopecia areata and reports no new clinical findings.

research Role of Platelet-Rich Plasma in Chronic Alopecia Areata: Our Centre Experience

61 citations , January 2015 in “Indian Journal of Plastic Surgery”

This study found that platelet-rich plasma may have a role in treating chronic alopecia areata, but more long-term follow-up studies are needed to confirm its effectiveness and success rate.

research Treatment of Alopecia Areata with Squaric Acid Dibutylester

21 citations , December 2014 in “Clinics in dermatology”

This review discusses squaric acid dibutylester's use, effects, and safety in treating alopecia areata, but reports no new clinical results.

research The PDE4 Inhibitor, Apremilast, Suppresses Experimentally Induced Alopecia Areata in Human Skin In Vivo

52 citations , December 2014 in “Journal of Dermatological Science”

Apremilast may help treat hair loss in alopecia areata.

research Alopecia Universalis Successfully Treated With Adalimumab

37 citations , October 2014 in “JAMA dermatology”

This case report describes a woman with alopecia universalis, resistant to multiple treatments, who experienced successful hair regrowth with adalimumab, suggesting potential mechanisms for future investigation.

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 Alopecia Areata: An Evidence-Based Treatment Update

72 citations , July 2014 in “American journal of clinical dermatology”

This review analyzed randomized controlled trials on alopecia areata treatment and found that while several treatments showed effectiveness, most studies had limitations affecting their interpretability.

research Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis

185 citations , June 2014 in “Journal of Investigative Dermatology”

This case report describes complete hair regrowth in a patient with alopecia universalis and improved psoriasis after treatment with the oral Janus kinase inhibitor, tofacitinib.

How Effective Is Intralesional Injection of Triamcinolone Acetonide Compared with Topical Treatments in Inducing and Maintaining Hair Growth in Patients with Alopecia Areata? A Critically Appraised Topic

research How Effective Is Intralesional Injection of Triamcinolone Acetonide Compared with Topical Treatments in Inducing and Maintaining Hair Growth in Patients with Alopecia Areata? A Critically Appraised Topic

25 citations , February 2014 in “British journal of dermatology/British journal of dermatology, Supplement”

The authors concluded that intralesional triamcinolone acetonide may benefit patients with patch-type alopecia areata, but the evidence is limited due to small, bias-prone studies with variations in treatment protocols.

research Current Treatment of Alopecia Areata

71 citations , December 2013 in “The journal of investigative dermatology. Symposium proceedings/The Journal of investigative dermatology symposium proceedings”

This review discusses various treatments for alopecia areata, highlighting their limitations and individualized approach, and reports no new clinical results.

research Overview of Alopecia Areata

110 citations , December 2013 in “The journal of investigative dermatology. Symposium proceedings/The Journal of investigative dermatology symposium proceedings”

This article reviews current understanding of alopecia areata, its genetic and immune factors, and discusses ongoing research and treatment development, without presenting new experimental results.

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.

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 Recent Advances in the Pathogenesis of Autoimmune Hair Loss Disease Alopecia Areata

106 citations , January 2013 in “Clinical and Developmental Immunology”

This review discusses the pathogenesis of alopecia areata, highlighting the role of immune privilege collapse in hair follicles but reports no clinical results.

Combination Therapy with Cyclosporine and Psoralen Plus Ultraviolet A in Patients with Severe Alopecia Areata: A Retrospective Study with a Self-Controlled Design

research Combination Therapy with Cyclosporine and Psoralen Plus Ultraviolet A in Patients with Severe Alopecia Areata: A Retrospective Study with a Self-Controlled Design

21 citations , January 2013 in “Annals of dermatology/Annals of Dermatology”

In this study, combination therapy with cyclosporine and PUVA for severe alopecia areata resulted in a majority of patients showing only fair to poor responses, though some improvements were noted.

research Alopecia Areata Update

85 citations , October 2012 in “Dermatologic Clinics”

This article reviews recent updates on alopecia areata, focusing on its causes, clinical presentation, and treatment options, and provides treatment plans by patient age and disease extent, but reports no new clinical results.

research British Association of Dermatologists’ Guidelines for the Management of Alopecia Areata 2012

218 citations , April 2012 in “British Journal of Dermatology”

This updated guideline from the British Association of Dermatologists discusses current recommendations for managing alopecia areata but reports no new clinical research findings.

research Alopecia Areata: An Autoimmune Disease Causing Hair Loss

421 citations , April 2012 in “The New England Journal of Medicine”

Alopecia Areata is an autoimmune condition causing hair loss with no cure and treatments that often don't work well.

research Interest of High-Dose Pulse Corticosteroid Therapy Combined with Methotrexate for Severe Alopecia Areata: A Retrospective Case Series

39 citations , January 2012 in “Dermatology”

In this study, the combination of pulse intravenous corticosteroids and methotrexate was associated with positive hair regrowth in severe alopecia areata patients, with half achieving total regrowth.

research Comparison of Treatment with Clobetasol Propionate 0.05% and Topical Pimecrolimus 1% in Alopecia Areata

13 citations , July 2011 in “Journal of Dermatological Treatment”

This study found that topical pimecrolimus is as effective as clobetasol propionate for treating alopecia areata, with better tolerability in terms of side effects.

research Alopecia Areata: Clinical Presentation, Diagnosis, and Unusual Cases

109 citations , May 2011 in “Dermatologic Therapy”

This article reviews the characteristics, associations, and diagnostic criteria for alopecia areata and reports no new clinical findings; the authors note the disease's unpredictable course and variable prognosis.

research Hair Follicle as a Target of Stress Hormones and Autoimmune Reactions

61 citations , September 2010 in “Journal of Dermatological Science”

This review discusses the interplay between hormonal and immune systems in hair follicles and reports no new results, highlighting the need for further research on their role in skin biology and alopecia areata.

research Alopecia Areata as Another Immune-Mediated Disease Developed in Patients Treated with Tumor Necrosis Factor-Alpha Blocker Agents

61 citations , June 2010 in “Journal of the European Academy of Dermatology and Venereology”

This study highlights cases of alopecia areata that developed during anti-TNF-α therapy, suggesting a potential link or increased frequency, particularly among individuals with a personal or family history of autoimmune diseases.

Diphencyprone and Topical Tacrolimus as Two Topical Immunotherapeutic Modalities: Are They Effective in the Treatment of Alopecia Areata Among Egyptian Patients? A Study Using CD4, CD8, and MHC II as Markers

research Diphencyprone and Topical Tacrolimus as Two Topical Immunotherapeutic Modalities: Are They Effective in the Treatment of Alopecia Areata Among Egyptian Patients? A Study Using CD4, CD8, and MHC II as Markers

13 citations , June 2010 in “Journal of dermatological treatment”

This study found that diphencyprone showed a significant clinical response for treating alopecia areata, while tacrolimus was not effective.

research Alopecia Areata Update

244 citations , January 2010 in “Journal of the American Academy of Dermatology”

This review discusses treatment options for alopecia areata and suggests tailored treatment plans, noting the challenges posed by spontaneous remission and limited high-quality clinical trials.

research Alopecia Areata Update

391 citations , January 2010 in “Journal of The American Academy of Dermatology”

This article reviews the clinical presentation and histopathologic features of alopecia areata and proposes a hypothesis for its development, but it reports no new clinical results.

research Latanoprost in the Treatment of Eyelash Alopecia in Alopecia Areata Universalis

50 citations , December 2009 in “Journal of The European Academy of Dermatology and Venereology”

This study found that latanoprost may be effective for treating eyelash alopecia areata, achieving cosmetically acceptable regrowth in 45% of patients.

research Phase I/II Randomized Bilateral Half-Head Comparison of Topical Bexarotene 1% Gel for Alopecia Areata

44 citations , October 2009 in “Journal of the American Academy of Dermatology”

This study reported that 1% bexarotene gel was well tolerated and possibly effective for inducing partial hair regrowth in alopecia areata, but more rigorous trials are needed to confirm its efficacy.

research 308-nm Excimer Laser for the Treatment of Alopecia Areata in Children

79 citations , September 2009 in “Pediatric dermatology”

This study found that the 308-nm Excimer laser was effective and safe for treating patchy alopecia areata in children, with hair regrowth observed in 60% of treated scalp patches.

research Letter

9 citations , April 2009 in “Dermatologic surgery”

Infrared light might help treat stubborn alopecia areata.

Lack of Efficacy of Topical Latanoprost and Bimatoprost Ophthalmic Solutions in Promoting Eyelash Growth in Patients with Alopecia Areata

research Lack of Efficacy of Topical Latanoprost and Bimatoprost Ophthalmic Solutions in Promoting Eyelash Growth in Patients with Alopecia Areata

55 citations , March 2009 in “Journal of The American Academy of Dermatology”

This study found that latanoprost and bimatoprost, when applied cutaneously to the eyelids, did not induce appreciable eyelash regrowth in patients with alopecia areata over 16 weeks.

research Treatment of Persistent Alopecia Areata with Sulfasalazine

45 citations , July 2008 in “International Journal of Dermatology”

This study found that oral sulfasalazine led to varying hair regrowth outcomes in patients with persistent alopecia areata, with 56.3% showing moderate to good responses.

research Interventions for Alopecia Areata

164 citations , April 2008 in “Cochrane library”

This review of interventions for alopecia areata found no significant treatment benefits for hair growth compared to placebo, indicating a need for larger, well-conducted studies.

research Lack of Response of Alopecia Areata to Pimecrolimus Cream

26 citations , March 2007 in “Clinical and experimental dermatology”

Pimecrolimus cream is not effective for treating alopecia areata.

research Alopecia Areata: Overview and Treatment Options

151 citations , February 2007 in “International Journal of Dermatology”

This review explores the causes and mechanisms of alopecia areata and discusses current treatments, reporting no new clinical findings.

research Development of Alopecia Areata Universalis in a Patient Receiving Adalimumab

69 citations , December 2006 in “Archives of dermatology”

This entry contains no research abstract, so no scientific findings or conclusions are reported.

research Use of the Pulsed Infrared Diode Laser (904 nm) in the Treatment of Alopecia Areata

63 citations , January 2006 in “Journal of cosmetic and laser therapy”

This study found that pulsed infrared diode laser therapy (904 nm) was effective in promoting hair regrowth in 94% of patients with resistant patches of alopecia areata.

research Lack of Efficacy of Topical Latanoprost in the Treatment of Eyebrow Alopecia Areata

36 citations , November 2005 in “Journal of The American Academy of Dermatology”

This article discusses the potential of latanoprost for treating alopecia areata, but notes that well-controlled studies are still needed to confirm its effectiveness.

research Alopecia Areata: A Tissue-Specific Autoimmune Disease of the Hair Follicle

185 citations , August 2005 in “Autoimmunity Reviews”

This review discusses alopecia areata as a model for studying tissue-directed autoimmune diseases and reports no new clinical findings.

research 308-Nm Excimer Laser Therapy in Alopecia Areata

85 citations , November 2004 in “Journal of the American Academy of Dermatology”

The 308-nm excimer laser helps hair regrowth in some alopecia areata cases but not all.

research PUVA Treatment of Alopecia Areata Partialis, Totalis, and Universalis: Audit of 10 Years' Experience at St John's Institute of Dermatology

105 citations , December 1995 in “British journal of dermatology/British journal of dermatology, Supplement”

This retrospective study concluded that PUVA treatment is generally ineffective for alopecia areata, with low effective success rates for partialis, totalis, and universalis types.

research Evaluation of Anthralin in the Treatment of Alopecia Areata

109 citations , November 1987 in “Archives of dermatology”

In this study, 0.5%-1.0% anthralin cream led to a cosmetic response in 25% of patients with severe alopecia areata, despite common side effects like pruritus and erythema.