Systemic Treatment of Moderate to Severe Alopecia Areata in Adults: Updated Australian Expert Consensus Statement

September 2025 in “ Australasian Journal of Dermatology ”

Daniella Kushnir‐Grinbaum, Laita Bokhari, John Frewen, Anthony Moussa, Daranporn Triwongwaranat, Ragini Ghiya, F. Dias, Shin Shen Yong, Bevin Bhoyrul, Zaidbi Dabbagh, Ahmed Kazmi, Adam Daunton, Jane Li, Leona Yip, Vivien Wai Yun Lai, Katherine York, William Cranwell, Dmitri Wall, Samantha Eisman, Rodney Sinclair

alopecia areata Janus Kinase inhibitors baricitinib ritlecitinib systemic JAKi treatment AA JAK inhibitors

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Baricitinib →

JAK inhibitor that reduces inflammation and immune attacks on hair follicles, leading to potential hair regrowth, especially in alopecia areata cases

Studysummary In this update, researchers incorporated TGA-approved Janus Kinase inhibitors into the Australian treatment guidelines for chronic, moderate to severe Alopecia areata, aiming to enhance recommended therapies by providing guidance on the use and management of these systemic medications. Our plain-language summary of this paper — not a Tressless recommendation.

The updated Australian expert consensus statement on the systemic treatment of moderate to severe alopecia areata (AA) in adults highlights the significant efficacy of Janus kinase (JAK) inhibitors, such as baricitinib and ritlecitinib, in promoting hair regrowth, with over two-thirds of patients responding positively. These treatments maintain effectiveness in approximately 90% of responders over 152 weeks. The statement emphasizes the importance of early treatment initiation and provides treatment algorithms for acute and chronic AA. It also discusses the cost-effectiveness of these new treatments compared to traditional therapies and underscores the need for systemic therapy to prevent disease progression. Additionally, the statement recommends vaccination prior to therapy and outlines conditions for treatment interruption.

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In this multicenter retrospective study, 61.5% of Italian patients with severe alopecia areata achieved significant hair improvement after 52 weeks of treatment with baricitinib, with no major safety issues reported, indicating long-term effectiveness in a real-world setting.

research Systematic Review and Indirect Treatment Comparisons of Ritlecitinib Against Baricitinib in Alopecia Areata

October 2024 in “Journal of the European Academy of Dermatology and Venereology”

This study reported that ritlecitinib 50 mg and baricitinib 4 mg showed similar efficacy in treating severe alopecia areata, with no significant difference in hair regrowth outcomes at Week 24, but there remains considerable uncertainty and a need for further research.

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In this study, ritlecitinib showed sustained effectiveness and a favorable safety profile in treating alopecia areata in patients aged 12 and older over 24 months, with improvements observed in hair and eyebrow regrowth and patient satisfaction.

research British Association of Dermatologists Living Guideline for Managing People with Alopecia Areata 2024

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7 citations , October 2024 in “Journal of the American Academy of Dermatology”

This source reported that patients who initially responded to ritlecitinib treatment showed sustained hair regrowth through week 48, with up to one-third of those not meeting target efficacy at week 24 also achieving a response with continued treatment.

research Baricitinib Withdrawal and Retreatment in Patients With Severe Alopecia Areata

August 2024 in “JAMA Dermatology”

In this study, withdrawal of baricitinib therapy in patients with severe alopecia areata who had achieved hair regrowth led to a loss of benefit in almost all patients, suggesting that continued treatment is necessary to maintain hair regrowth.

research Novel Investigational Drugs for Alopecia Areata and Future Perspectives

April 2024 in “Expert opinion on investigational drugs”

In this study, JAK inhibitors were reported as safe and effective treatments for moderate-to-severe chronic alopecia areata, although the appropriate duration of treatment remains uncertain, as stopping these medications often results in relapse.

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February 2024 in “Journal of the European Academy of Dermatology and Venereology”

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research Integrated Safety Analysis of Ritlecitinib, an Oral JAK3/TEC Family Kinase Inhibitor, for the Treatment of Alopecia Areata from the ALLEGRO Clinical Trial Program

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This study reports that ritlecitinib, when used for up to 24 months in patients aged 12 and older with alopecia areata, has an acceptable safety profile, with a similar proportion of adverse events in both ritlecitinib and placebo groups in the placebo-controlled cohort.

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This consensus statement outlines a treatment algorithm for alopecia areata, detailing systemic treatment indications and options, including EMA-approved medications baricitinib and ritlecitinib for severe cases, as well as other off-label treatments and adjuvant therapies like oral minoxidil.

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Expecting Scalp Hair Regrowth During Severe Alopecia Areata Treatment with Baricitinib: Insights from Patient Trajectories in Phase III Trials

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In this study, researchers identified subgroups of patients with severe alopecia areata treated with baricitinib who experienced early, gradual, or late hair regrowth, finding that response was influenced by baseline disease severity and duration of hair loss.

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$Apremilast Is Efficacious in Refractory Alopecia Areata$

research Apremilast Is Efficacious in Refractory Alopecia Areata

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research The Efficacy of Topical Minoxidil for Non-Scarring Alopecia: A Systematic Review

1 citations , February 2019 in “PubMed”

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66 citations , December 2018 in “Dermatology”

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