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

TLDR New medications could improve treatment for severe alopecia areata in Australia.

The updated 2025 Australian Expert Consensus Statement on the treatment of chronic, moderate to severe alopecia areata (AA) aims to enhance the 2018 treatment guidelines by incorporating newly TGA-approved Janus Kinase inhibitors (JAKi's), such as baricitinib and ritlecitinib, for severe AA. These medications, if reimbursed, could significantly change the treatment landscape in Australia. The update provides guidance on the initiation, continuation, and dose titration of systemic JAKi treatment, selection of appropriate agents, and criteria for evaluating treatment success or failure. This is crucial as AA affects over 5,000 new patients annually in Australia, with varying severity and significant psychological impacts.

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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”

Ritlecitinib and baricitinib are similarly effective for hair regrowth in severe alopecia areata.

research Baricitinib Withdrawal and Retreatment in Patients With Severe Alopecia Areata

August 2024 in “JAMA Dermatology”

Continuous baricitinib is needed to keep hair regrowth in severe alopecia areata.

research Novel Investigational Drugs for Alopecia Areata and Future Perspectives

April 2024 in “Expert opinion on investigational drugs”

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

research Long-Term Efficacy and Safety of Baricitinib in Patients With Severe Alopecia Areata: 104-Week Results From BRAVE-AA1 and BRAVE-AA2

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

Baricitinib is effective and safe for long-term use in severe alopecia areata, improving hair regrowth and quality of life with few side effects.

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

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

January 2024 in “American journal of clinical dermatology”

Ritlecitinib is safe and well-tolerated for treating alopecia areata in patients aged 12 and older.

research European Expert Consensus Statement on the Systemic Treatment of Alopecia Areata

4 citations , January 2024 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

Baricitinib and ritlecitinib are recommended for severe alopecia areata, with other treatments available off-label.

research Treatments for Alopecia Areata: A Network Meta-Analysis

October 2023 in “The Cochrane library”

The medicine baricitinib was found to notably improve hair regrowth in alopecia areata, but more research is needed on its side effects and other treatments.

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

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

September 2023 in “British Journal of Dermatology”

Hair regrowth from severe alopecia areata treatment with baricitinib can vary, with faster results in those with shorter hair loss duration.

research Clinical Outcomes for Uptitration of Baricitinib Therapy in Patients With Severe Alopecia Areata

1 citations , August 2023 in “JAMA Dermatology”

Increasing the dose of baricitinib to 4 mg helps more patients with severe alopecia areata regrow hair.

Incidence and Prevalence of Alopecia Areata in the Australian Primary Care Setting: A Retrospective Analysis of Electronic Health Record Data

research Incidence and Prevalence of Alopecia Areata in the Australian Primary Care Setting: A Retrospective Analysis of Electronic Health Record Data

July 2023 in “Australasian Journal of Dermatology”

The analysis found that alopecia areata, a hair loss condition, is not very common in Australia, affecting about 0.13% of people, with new cases most often seen in males aged 19 to 34 years.

research Baricitinib for the Treatment of Alopecia Areata

6 citations , May 2023 in “Drugs”

Baricitinib helps regrow hair in adults with severe alopecia better than a placebo and is approved for treatment, but long-term effects are still unknown.

research Switching Between Tofacitinib and Baricitinib in Alopecia Areata: A Review of Clinical Response

April 2023 in “Journal of the American Academy of Dermatology”

Switching between the medications tofacitinib and baricitinib can be effective for treating hair loss in alopecia areata.

research Efficacy and Safety of Baricitinib in Patients with Severe Alopecia Areata Over 52 Weeks in Phase III Trials

20 citations , March 2023 in “American Journal of Clinical Dermatology”

Baricitinib improved severe hair loss in adults over 52 weeks and was safe to use.

research Treatment of Alopecia Areata With the Janus Kinase Inhibitor Upadacitinib: A Retrospective Cohort Study

6 citations , February 2023 in “Journal of the American Academy of Dermatology”

Upadacitinib improved hair regrowth and quality of life in alopecia areata patients with minimal side effects.

research Signposts to the Promised Land in Alopecia Areata

September 2022 in “Journal of Investigative Dermatology”

Patient-reported outcomes better reflect the quality of life impact of alopecia areata than traditional severity scores.

research The Effect of Latanoprost 0.005% Solution in the Management of Scalp Alopecia Areata: A Randomized Double-Blind Placebo-Controlled Trial

2 citations , March 2022 in “Dermatologic Therapy”

Latanoprost 0.005% solution safely increases hair density and regrowth in scalp alopecia areata.

research Maintenance, Withdrawal, and Re-Treatment with Ritlecitinib and Brepocitinib in Patients with Alopecia Areata in a Single-Blind Extension of a Phase 2a Randomized Clinical Trial

20 citations , December 2021 in “Journal of the American Academy of Dermatology”

Continuous treatment with ritlecitinib and brepocitinib is needed to maintain hair regrowth in alopecia areata.

research Sublingual Tofacitinib for Alopecia Areata: A Roll-Over Pilot Clinical Trial and Analysis of Pharmacokinetics

9 citations , May 2021 in “International Journal of Dermatology”

The trial showed that a new under-the-tongue treatment for severe hair loss was somewhat effective in a small group of people.

research Topical Tofacitinib for the Treatment of Alopecia Areata Affecting Facial Hair

7 citations , April 2021 in “British Journal of Dermatology”

Topical tofacitinib may effectively and safely regrow facial hair in some people with alopecia areata.

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”

Ritlecitinib and brepocitinib effectively regrow hair in alopecia areata patients.

research A Randomized Comparative Study of the Efficacy of Topical Latanoprost Versus Topical Betamethasone Dipropionate Lotion in the Treatment of Localized Alopecia Areata

2 citations , January 2021 in “Indian Journal of Dermatology, Venereology and Leprology”

Betamethasone is more effective for hair regrowth than latanoprost but has more side effects.

research Efficacy of Systemic Minoxidil and Tofacitinib Combination in Treatment-Resistant Alopecia Universalis

1 citations , October 2020 in “Journal of Cosmetic Dermatology”

Using minoxidil and tofacitinib together can effectively treat severe hair loss.

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 Cyclosporine With and Without Systemic Corticosteroids in Treatment of Alopecia Areata: A Systematic Review

13 citations , April 2020 in “Dermatology and therapy”

Cyclosporine combined with corticosteroids is more effective for severe alopecia areata than cyclosporine alone.

research Efficacy of Different Concentrations of Intralesional Triamcinolone Acetonide for Alopecia Areata: A Systematic Review and Meta-Analysis

19 citations , April 2020 in “Journal of the American Academy of Dermatology”

5 mg/mL of triamcinolone acetonide is most effective for hair regrowth with fewer side effects.

research Response of Alopecia Areata of the Beard to Oral Tofacitinib

11 citations , November 2019 in “Journal of the American Academy of Dermatology”

Oral tofacitinib is a promising treatment for beard hair loss in alopecia areata.

research Combination Tofacitinib and Oral Minoxidil Treatment for Severe Alopecia Areata

23 citations , September 2019 in “Journal of The American Academy of Dermatology”

Tofacitinib and oral minoxidil together effectively regrow hair in severe alopecia areata patients.

research Reactivation of Alopecia Areata After Dupilumab Therapy for Atopic Dermatitis

12 citations , August 2019 in “Dermatitis”

Dupilumab for skin problems might reactivate hair loss in some patients.

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.

$Apremilast Is Efficacious in Refractory Alopecia Areata$

research Apremilast Is Efficacious in Refractory Alopecia Areata

9 citations , May 2019 in “Journal of dermatological treatment”

Apremilast helps regrow hair in hard-to-treat alopecia areata.

research Cyclosporine for Moderate-to-Severe Alopecia Areata: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial of Efficacy and Safety

44 citations , April 2019 in “Journal of the American Academy of Dermatology”

Cyclosporine showed some improvement in alopecia areata but results were not statistically significant.

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”

JAK inhibitors are effective for treating alopecia areata, with most patients seeing hair growth after treatment.

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

1 citations , February 2019 in “PubMed”

Minoxidil is effective in treating various types of hair loss and can improve quality of life, with combination therapies showing increased effectiveness.

research Weekly Azathioprine Pulse Versus Betamethasone Oral Mini-Pulse in the Treatment of Moderate-to-Severe Alopecia Areata

10 citations , January 2019 in “Indian Journal of Dermatology”

Weekly azathioprine pulse is a better alternative to corticosteroids for treating alopecia areata due to fewer side effects.

research Janus Kinase Inhibitors for the Treatment of Severe Alopecia Areata: An Open-Label Comparative Study

66 citations , December 2018 in “Dermatology”

Both ruxolitinib and tofacitinib are effective and safe for treating severe alopecia areata, but relapses are common.

research Drug-Induced Alopecia After Dupilumab Therapy

49 citations , December 2018 in “JAAD case reports”

Dupilumab may cause significant hair loss, which can reverse after stopping the drug.

A Randomized Placebo-Controlled Single-Center Pilot Study of the Safety and Efficacy of Apremilast in Subjects with Moderate-to-Severe Alopecia Areata

research A Randomized Placebo-Controlled Single-Center Pilot Study of the Safety and Efficacy of Apremilast in Subjects with Moderate-to-Severe Alopecia Areata

42 citations , November 2018 in “Archives of dermatological research”

Apremilast was not effective in treating moderate-to-severe alopecia areata.

research Treatment of Alopecia Areata: An Australian Expert Consensus Statement

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

Alopecia areata treatment varies, with no optimal method established yet.

research Topical Tofacitinib Solution for the Treatment of Alopecia Areata Affecting Eyelashes

24 citations , October 2018 in “JAAD Case Reports”

A woman's eyelash regrowth was successful using tofacitinib solution for alopecia areata.

research Treatment of Alopecia Universalis with Topical Janus Kinase Inhibitors – A Double Blind, Placebo, and Active Controlled Pilot Study

49 citations , August 2018 in “International Journal of Dermatology”

Topical JAK inhibitors may help treat alopecia universalis by promoting hair regrowth.

research Alopecia Areata: Treatment Options and Efficacy

182 citations , December 2017 in “Journal of the American Academy of Dermatology”

Some treatments can help with a hair loss condition called alopecia areata, but none ensure lasting results; choices depend on the person, with JAK inhibitors showing promise for severe cases.

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 Lack of Efficacy of Apremilast in 9 Patients with Severe Alopecia Areata

23 citations , September 2017 in “Journal of the American Academy of Dermatology”

Apremilast did not work for treating severe alopecia areata.

research Complete Regrowth of Beard Hair with Ruxolitinib in an Alopecia Universalis Patient

22 citations , September 2017 in “Skin appendage disorders”

Ruxolitinib helped a man regrow his beard after years of hair loss.

research Ruxolitinib Found to Cause Eyelash Growth: A Case Report

9 citations , July 2017 in “Journal of medical case reports”

Ruxolitinib treatment may cause eyelash growth.

research SALT II: A New Take on the Severity of Alopecia Tool for Determining Percentage Scalp Hair Loss

44 citations , November 2016 in “Journal of The American Academy of Dermatology”

The updated SALT II tool offers a more precise way to measure scalp hair loss.

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

196 citations , September 2016 in “JCI insight”

Ruxolitinib effectively regrows hair in most patients with severe hair loss.

research An Evaluation of the Safety and Efficacy of Bimatoprost for Eyelash Growth in Pediatric Subjects

16 citations , March 2016 in “Clinical ophthalmology”

Bimatoprost is safe and improves eyelash growth in healthy kids but not in those with eyelash loss from chemotherapy or alopecia.

research Topical Ruxolitinib for the Treatment of Alopecia Universalis

96 citations , December 2015 in “JAMA dermatology”

Topical Ruxolitinib may safely treat severe hair loss.

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”

Alopecia areata involves immune activation in the scalp, suggesting treatments targeting TH1, TH2, and IL-23 pathways.

research Bimatoprost Versus Mometasone Furoate in the Treatment of Scalp Alopecia Areata: A Pilot Study

36 citations , January 2015 in “Dermatology”

Bimatoprost was found to be safer and more effective than mometasone furoate for treating scalp hair loss.

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”

Intralesional triamcinolone acetonide can regrow hair in alopecia areata but often has temporary effects and side effects.

research The Role of Hair Follicle Immune Privilege Collapse in Alopecia Areata: Status and Perspectives

79 citations , December 2013 in “Journal of Investigative Dermatology Symposium Proceedings”

Alopecia areata may be treated by restoring hair follicle immune privilege and adjusting immune responses.

research Clobetasol Propionate, 0.05%, vs Hydrocortisone, 1%, for Alopecia Areata in Children

49 citations , November 2013 in “JAMA dermatology”

Clobetasol propionate, 0.05%, is more effective and safe for treating childhood alopecia areata than hydrocortisone, 1%.

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.

Randomized Comparison of Topical Betamethasone Valerate Foam, Intralesional Triamcinolone Acetonide, and Tacrolimus Ointment in Management of Localized Alopecia Areata

research Randomized Comparison of Topical Betamethasone Valerate Foam, Intralesional Triamcinolone Acetonide, and Tacrolimus Ointment in Management of Localized Alopecia Areata

48 citations , January 2011 in “International journal of trichology”

Intralesional triamcinolone acetonide is the most effective treatment for localized alopecia areata.

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

717 citations , June 2010 in “Nature”

Alopecia areata involves both innate and adaptive immunity, with specific genes linked to the disease.

research Alopecia Areata Update

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

The document says current treatments for alopecia areata do not cure or prevent it, and it's hard to judge their effectiveness due to spontaneous remission and lack of studies.

research Bimatoprost in the Treatment of Eyelash Universalis Alopecia Areata

37 citations , January 2010 in “International Journal of Trichology”

Bimatoprost helped eyelash growth in nearly half of the patients with a type of eyelash hair loss.

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”

Latanoprost can effectively treat eyelash hair loss, with 45% of patients showing hair regrowth and no reported side effects.

research Twice Weekly 5 mg Betamethasone Oral Pulse Therapy in the Treatment of Alopecia Areata

22 citations , August 2006 in “Journal of the European Academy of Dermatology and Venereology”

Twice-weekly 5 mg betamethasone helps hair regrowth in alopecia areata.

research Twice Weekly 5 mg Dexamethasone Oral Pulse in the Treatment of Extensive Alopecia Areata

65 citations , September 1999 in “The Journal of Dermatology”

Twice-weekly 5 mg dexamethasone can effectively treat extensive alopecia areata in many patients.

research Topical Minoxidil Therapy and Hair Regrowth

20 citations , February 1985 in “Archives of Dermatology”

Minoxidil helps hair regrowth, especially with more indeterminate hairs.

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research Overview of Alopecia Areata

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Alopecia areata is a genetic and immune-related hair loss condition that is often associated with other autoimmune diseases and does not typically cause permanent damage to hair follicles.