New Therapies for Alopecia Areata

October 2021 in “ Bőrgyógyászati és Venerológiai Szemle ”

Adriána Evelin Csernus, Rolland Gyulai

alopecia areata pathomechanism therapeutic strategies European Medicines Agency treatment protocols

Studysummary This paper reviews current and developing treatments for severe alopecia areata but reports no new clinical findings; the authors highlight the need for standardized treatment protocols.

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

The document discussed advancements in understanding the pathomechanism of alopecia areata, which led to new treatment opportunities that could potentially revolutionize therapeutic strategies for this unpredictable and heterogeneous disease. Despite the significant impact on quality of life, there were no standardized treatment protocols approved by the European Medicines Agency (EMA) at the time, posing challenges for therapists in selecting appropriate treatments. The paper summarized recent and emerging therapies specifically for severe cases of alopecia areata.

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Efficacy and Safety of the Oral Janus Kinase Inhibitor Baricitinib in the Treatment of Adults with Alopecia Areata: Phase 2 Results from a Randomized Controlled Study

research Efficacy and Safety of the Oral Janus Kinase Inhibitor Baricitinib in the Treatment of Adults with Alopecia Areata: Phase 2 Results from a Randomized Controlled Study

66 citations , June 2021 in “Journal of The American Academy of Dermatology”

In this phase 2 study, baricitinib at 2 mg and 4 mg doses significantly improved hair regrowth in adults with alopecia areata and ≥50% scalp hair loss compared to placebo, without new safety concerns, although the small sample size limits the results' generalizability.

research A Comprehensive Literature Review of JAK Inhibitors in the Treatment of Alopecia Areata

40 citations , June 2021 in “Clinical, cosmetic and investigational dermatology”

This review explores the efficacy and outcomes of using JAK inhibitors for treating alopecia areata, noting advancements in understanding the disease's pathomechanisms and suggesting that JAK inhibitors may offer targeted therapeutic benefits by blocking specific inflammatory pathways involved in this chronic condition.

research A Phase 2a Randomized, Placebo-Controlled Study to Evaluate the Efficacy and Safety of the Oral Janus Kinase Inhibitors Ritlecitinib and Brepocitinib in Alopecia Areata: 24-Week Results

138 citations , March 2021 in “Journal of the American Academy of Dermatology”

This study found that treatment with ritlecitinib or brepocitinib was effective in improving scalp hair loss for patients with alopecia areata over 24 weeks compared to placebo.

research Immunological Properties of Atopic Dermatitis-Associated Alopecia Areata

57 citations , March 2021 in “International Journal of Molecular Sciences”

This study found that type 2 immunity may play a role in the development of alopecia areata in patients with extrinsic atopic dermatitis, indicating different immunological states compared to non-atopic patients.

research Rapidly Progressive Alopecia Areata Totalis in a COVID-19 Patient, Unresponsive to Tofacitinib

14 citations , February 2021 in “Journal of the European Academy of Dermatology and Venereology”

This article reports a case of rapidly progressive alopecia areata totalis in a COVID-19 patient that did not respond to treatment with tofacitinib; no new clinical results are discussed.

research Hair Follicle Immune Privilege and Its Collapse in Alopecia Areata

134 citations , July 2020 in “Experimental dermatology”

This review discusses immune privilege in anagen hair follicles and its collapse in alopecia areata, emphasizing the importance of restoring this function for effective management and disease relapse prevention.

research New and Emerging Therapies for Alopecia Areata

46 citations , April 2020 in “Drugs”

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

research Italian Guidelines in Diagnosis and Treatment of Alopecia Areata

37 citations , December 2019 in “Giornale italiano di dermatologia e venereologia”

This Italian guideline discusses the diagnosis and treatment of alopecia areata but reports no new clinical trial results; the authors highlight the need for well-designed studies.

research Scoping Review on the Use of Drugs Targeting JAK/STAT Pathway in Atopic Dermatitis, Vitiligo, and Alopecia Areata

55 citations , October 2019 in “Dermatology and therapy”

This review found that JAK/STAT pathway inhibitors, such as tofacitinib and ruxolitinib, led to symptom improvement in all observed atopic dermatitis cases, but responses were mixed for vitiligo and alopecia areata, with a generally mild safety profile reported.

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 Alopecia Areata Predictive Score: A New Trichoscopy-Based Tool to Predict Treatment Outcome in Patients with Patchy Alopecia Areata

19 citations , July 2019 in “Journal of Cosmetic Dermatology”

This study found that in patients with patchy alopecia areata, certain trichoscopic features like upright regrowing hairs and pigtail hairs are positive predictive markers for treatment success.

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 JAK Inhibitors and Alopecia Areata

56 citations , January 2019 in “Lancet”

This review discusses the emerging use of JAK inhibitors in alopecia areata treatment and reports no new clinical results; it highlights hair regrowth despite symptom recurrence after stopping therapy.

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.

research Drug-Induced Alopecia After Dupilumab Therapy

49 citations , December 2018 in “JAAD case reports”

This case report describes a patient who developed alopecia after 18 weeks of treatment with dupilumab for atopic dermatitis.

research Treatment of Alopecia Areata: An Australian Expert Consensus Statement

95 citations , November 2018 in “Australasian journal of dermatology”

This consensus statement outlines a treatment algorithm for alopecia areata, discussing when to consider systemic treatment and how to assess outcomes, without providing new clinical results.

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 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 Efficacy of Diphenylcyclopropenone in Alopecia Areata: A Comparison of Two Treatment Regimens

10 citations , January 2018 in “Postępy Dermatologii i Alergologii”

This study found that 21 out of 39 patients with alopecia areata experienced more than 50% hair regrowth after six months of DPCP treatment, with better outcomes observed in those treated at 3-week intervals compared to weekly intervals.

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.

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 Alopecia Areata: A Comprehensive Review of Pathogenesis and Management

99 citations , July 2017 in “Clinical Reviews in Allergy & Immunology”

This review noted that alopecia areata is an autoimmune disease impacting hair follicles and offered insights into its complex pathogenesis involving immune responses, while highlighting ongoing research into new treatments such as Janus kinase inhibitors and other immunomodulatory drugs.

research Alopecia Areata: An Update on Treatment Options for Children

21 citations , May 2017 in “Paediatric drugs”

Individualized treatment plans are crucial for children with alopecia areata, with promising options like JAK inhibitors showing significant hair regrowth.

research The Role of Micronutrients in Alopecia Areata: A Review

63 citations , May 2017 in “American Journal of Clinical Dermatology”

This review found that patients with alopecia areata may have lower levels of vitamin D, zinc, and folate, but conflicting evidence precludes definitive clinical recommendations for micronutrient supplementation.

research Review of Treatment for Alopecia Totalis and Alopecia Universalis

44 citations , April 2017 in “International Journal of Dermatology”

This study reviewed treatment options for alopecia areata totalis and universalis, finding no completely effective therapy. Promising treatments with quality data include diphenylcyclopropenone, squaric acid dibutylester, and photodynamic therapy, but larger, high-quality trials are needed.

research JAK Inhibitors in Dermatology: The Promise of a New Drug Class

355 citations , January 2017 in “Journal of the American Academy of Dermatology”

This review reports no new results and highlights existing research suggesting JAK inhibitors may be effective in treating inflammatory skin conditions like alopecia areata, atopic dermatitis, psoriasis, and vitiligo.

research Topical Ruxolitinib for the Treatment of Alopecia Universalis

96 citations , December 2015 in “JAMA dermatology”

This article discusses the potential of topical ruxolitinib as a treatment for alopecia universalis and acknowledges the need for alternatives to systemic JAK inhibitors due to the risk of serious side effects.

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 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 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 in the Elderly: A 10-Year Retrospective Study

9 citations , January 2015 in “Annals of dermatology/Annals of Dermatology”

This retrospective study concluded that alopecia areata in elderly patients showed mild severity and a favorable treatment response, with no link found between hair graying and the extent of hair loss.

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.

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 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.