Overlapping features of atopic dermatitis and alopecia areata: from pathogenesis to treatment

September 2025 in “ Frontiers in Immunology ”

Jiayi Cheng, Yong Jiang, Qianqian Chen, Min Xiao

This review examines the overlapping features of atopic dermatitis (AD) and alopecia areata (AA), highlighting shared immunopathogenic pathways, genetic susceptibilities, and microbiome influences. Both conditions involve complex immune responses, including Th1, Th2, Th17, and Th22 cytokine imbalances, challenging traditional classifications. The review notes a bidirectional epidemiological link between AD and AA, with each being a risk factor for the other. Key pathways like JAK-STAT and OX40-OX40L are significant in both diseases, and genetic factors such as FLG mutations and IL-4/IL-13 polymorphisms contribute to their susceptibility. Targeted therapies, including IL-4/IL-13 inhibitors and JAK inhibitors, show promise, though responses vary. The review underscores the need for further research into shared mechanisms and therapeutic targets to improve treatment strategies.

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research Alopecia Areata Exhibits Cutaneous And Systemic OX40 Activation Across Atopic Backgrounds

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Alopecia areata patients show increased inflammation and OX40 activation, suggesting a new treatment target.

research Novel Investigational Drugs for Alopecia Areata and Future Perspectives

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JAK inhibitors are safe and effective for treating moderate-to-severe alopecia areata.

Abrocitinib Improved Dupilumab-Resistant Severe Atopic Dermatitis with Comorbid Mild Alopecia Areata in a 12-Year-Old Boy: A Case Report with 1-Year Follow-Up

research Abrocitinib Improved Dupilumab-Resistant Severe Atopic Dermatitis with Comorbid Mild Alopecia Areata in a 12-Year-Old Boy: A Case Report with 1-Year Follow-Up

April 2024 in “Journal of asthma and allergy”

Abrocitinib effectively treated severe atopic dermatitis and mild alopecia areata in a 12-year-old boy after dupilumab failed.

research Gut Microbiome, Metabolome and Alopecia Areata

2 citations , November 2023 in “Frontiers in microbiology”

The health of the gut may be important in developing new ways to prevent, diagnose, and treat alopecia areata.

research Inhibition of T-Cell Activity in Alopecia Areata: Recent Developments and New Directions

4 citations , November 2023 in “Frontiers in immunology”

New treatments targeting T-cell pathways are needed for better alopecia areata management.

research The Gut and Skin Microbiome in Alopecia: Associations and Interventions

October 2023 in “PubMed”

Changes in gut and skin bacteria are linked to different hair loss conditions, and treatments like fecal transplants and probiotics might help, but more research is needed.

research Novel Potential Therapeutic Targets of Alopecia Areata

1 citations , April 2023 in “Frontiers in Immunology”

New treatments for hair loss from alopecia areata may include targeting immune cells, using stem cells, balancing gut bacteria, applying fatty acids, and using JAK inhibitors.

Alopecia Universalis in an Adolescent Successfully Treated with Upadacitinib: A Case Report and Review of the Literature on the Use of JAK Inhibitors in Pediatric Alopecia Areata

research Alopecia Universalis in an Adolescent Successfully Treated with Upadacitinib: A Case Report and Review of the Literature on the Use of JAK Inhibitors in Pediatric Alopecia Areata

9 citations , January 2023 in “Dermatology and therapy”

A 14-year-old girl with severe hair loss regrew her hair using upadacitinib.

research A Case of Atopic Dermatitis with Alopecia Universalis in a Patient Treated with Abrocitinib

11 citations , February 2022 in “JAAD case reports”

Abrocitinib, a JAK inhibitor, may help treat atopic dermatitis and alopecia universalis together.

research The Role of Serum Th1, Th2, and Th17 Cytokines in Patients with Alopecia Areata: Clinical Implications

37 citations , December 2021 in “Cells”

Alopecia areata severity and treatment response are linked to specific cytokine levels.

research Ritlecitinib And Brepocitinib Demonstrate Significant Improvement In Scalp Alopecia Areata Biomarkers

36 citations , December 2021 in “The journal of allergy and clinical immunology/Journal of allergy and clinical immunology/The journal of allergy and clinical immunology”

Two drugs, ritlecitinib and brepocitinib, improved scalp hair loss condition markers.

research Alopecia Areata: An Update on Etiopathogenesis, Diagnosis, and Management

290 citations , August 2021 in “Clinical Reviews in Allergy & Immunology”

JAK inhibitors show promise for treating alopecia areata, but more research is needed.

research Dupilumab for the Treatment of Alopecia Areata in Children with Atopic Dermatitis

7 citations , July 2021 in “JAAD case reports”

Dupilumab may help treat alopecia areata in children with atopic dermatitis, but it can also cause new hair loss.

research Dupilumab Therapy for Alopecia Areata in Pediatric Patients with Concomitant Atopic Dermatitis

19 citations , January 2021 in “Journal of the American Academy of Dermatology”

Dupilumab may help children with alopecia areata and atopic dermatitis regrow hair.

research Hair Follicle Immune Privilege and Its Collapse in Alopecia Areata

134 citations , July 2020 in “Experimental dermatology”

Hair follicles are normally protected from the immune system, but when this protection fails, it can cause hair loss in alopecia areata.

research Hair Regrowth Following Fecal Microbiota Transplantation in an Elderly Patient with Alopecia Areata: A Case Report and Review of the Literature

40 citations , September 2019 in “World journal of clinical cases”

An elderly man's hair grew back after a treatment that transferred healthy gut bacteria.

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

26 citations , July 2019 in “JAAD Case Reports”

Dupilumab for atopic dermatitis may cause new or worsen existing alopecia areata.

Alopecia Areata Is Characterized by Dysregulation in Systemic Type 17 and Type 2 Cytokines, Which May Contribute to Disease-Associated Psychological Morbidity

research Alopecia Areata Is Characterized by Dysregulation in Systemic Type 17 and Type 2 Cytokines, Which May Contribute to Disease-Associated Psychological Morbidity

57 citations , April 2019 in “British journal of dermatology/British journal of dermatology, Supplement”

Alopecia areata involves immune system imbalances that may lead to depression and anxiety.

research The Role of the Microbiome in Scalp Hair Follicle Biology and Disease

73 citations , April 2019 in “Experimental Dermatology”

The scalp's microorganisms significantly affect hair health and disease.

research Scalp Bacterial Shift in Alopecia Areata

48 citations , April 2019 in “PloS one”

Alopecia areata patients have more Propionibacterium acnes and less Staphylococcus epidermidis on their scalps.

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

33 citations , January 2019 in “Acta Dermato Venereologica”

Dupilumab may help regrow hair in people with atopic dermatitis.

research Alopecia Areata: A Multifactorial Autoimmune Condition

148 citations , December 2018 in “Journal of autoimmunity”

Alopecia areata is an autoimmune disease causing patchy hair loss, often with other autoimmune disorders, but its exact causes are unknown.

research Response to Tofacitinib Therapy of Eyebrows and Eyelashes in Alopecia Areata

11 citations , November 2018 in “Journal of the American Academy of Dermatology”

Tofacitinib therapy can effectively regrow eyebrows and eyelashes in some alopecia areata patients.

research Alopecia Areata: A Review of Disease Pathogenesis

191 citations , May 2018 in “British journal of dermatology/British journal of dermatology, Supplement”

Alopecia areata is likely an autoimmune disease with unclear triggers, involving various immune cells and molecules, and currently has no cure.

research Association of Alopecia Areata with Atopic Dermatitis and Chronic Spontaneous Urticaria

27 citations , March 2018 in “Allergy and asthma proceedings”

People with alopecia areata often have higher rates of allergies and autoimmune diseases.

research Alopecia Areata: Overview and Insights from January 2018

290 citations , December 2017 in “Journal of The American Academy of Dermatology”

Alopecia areata is an autoimmune condition causing hair loss, influenced by genetics, stress, and diet, and may be prevented by a high soy oil diet.

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 Alopecia Areata: Current Situation and Perspectives

34 citations , October 2017 in “Archivos Argentinos De Pediatria”

Alopecia Areata is a complex, unpredictable autoimmune hair loss condition with limited treatment options and a significant psychological impact.

research The Role of Micronutrients in Alopecia Areata: A Review

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

People with alopecia areata often have lower levels of vitamin D, zinc, and folate, but more research is needed to understand if supplements can help treat it.

research Th1/Th2 Peripheral Blood Balance and CD200 Expression in Patients with Active Severe Alopecia Areata

12 citations , April 2017 in “Experimental and Therapeutic Medicine”

Patients with severe active alopecia areata have lower CD200 expression and an imbalance in their immune system.

The Contributory Roles of Th17 Lymphocyte and Cytotoxic T Lymphocyte at the Hair Bulge Region and Hair Bulb Area in Chronic Alopecia Areata Patients

research The Contributory Roles of Th17 Lymphocyte and Cytotoxic T Lymphocyte at the Hair Bulge Region and Hair Bulb Area in Chronic Alopecia Areata Patients

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

Certain immune cells contribute to severe hair loss in chronic alopecia areata, with Th17 cells possibly having a bigger impact than cytotoxic T cells.

Oral Ruxolitinib Induces Hair Regrowth in Patients with Moderate-to-Severe Alopecia Areata

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