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Alopecia Areata: Current Treatments and New Directions

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Abstract

Alopecia areata is an autoimmune hair loss disease that is non-scarring and is characterized by chronic inflammation at the hair follicle level. Clinically, patients’ presentation varies from patchy, circumscribed scalp involvement to total body and scalp hair loss. Current management is guided by the degree of scalp and body involvement, with topical and intralesional steroid injections as primarily first-line for mild cases and broad immunosuppressants as the mainstay for more severe cases. Until recently, the limited number of blinded, randomized, placebo-controlled clinical trials for this disease had made establishing an evidence-based treatment paradigm challenging. However, growing insights into the pathogenesis of alopecia areata through blood and tissue analysis of human lesions have identified several promising targets for therapy. T-helper (Th) 1/interferon skewing has traditionally been described as the driver of disease; however, recent investigations suggest activation of additional immune mediators, including the Th2 pathway, interleukin (IL)-9, IL-23, and IL-32, as contributors to alopecia areata pathogenesis. The landscape of alopecia areata treatment has the potential to be transformed, as several novel targeted drugs are currently undergoing clinical trials. Given the recent US FDA approval of baricitinib and ritlecitinib, Janus kinase (JAK) inhibitors are a promising drug class for treating severe alopecia areata cases. This article will review the efficacy, safety, and tolerability of current treatments for alopecia areata, and will provide an overview of the emerging therapies that are leading the revolution in the management of this challenging disease.

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Authors and Affiliations

  1. Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA

    Dante Dahabreh, Seungyeon Jung, Jonathan Bar, Ester Del Duca & Emma Guttman-Yassky

  2. School of Medicine, Vanderbilt University, Nashville, TN, USA

    Seungyeon Jung

  3. Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA

    Yael Renert-Yuval

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  1. Dante Dahabreh
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Conflicts of interest

Emma Guttman-Yassky is an employee of Mount Sinai, has received research funds (grants paid to the institution) from AbbVie, Celgene, Eli Lilly, Janssen, Medimmune/Astra Zeneca, Novartis, Pfizer, Regeneron, Vitae, Glenmark, Galderma, Asana, Innovaderm, Dermira, UCB, and is also a consultant for Sanofi Aventis, Regeneron, Stiefel/GlaxoSmithKline, MedImmune, Celgene, Anacor, AnaptysBio, Dermira, Galderma, Glenmark, Novartis, Pfizer, Vitae, Leo Pharma, AbbVie, Eli Lilly, Kyowa, Mitsubishi Tanabe, Asana Biosciences, and Promius. Dante Dahabreh, Seungyeon Jung, Yael Renert-Yuval, Jonathan Bar, and Ester Del Duca declare that they have no conflicts of interest to disclose.

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Author contributions

DD: first author, writer, editor, organization, and concept planning for all sections of review of the manuscript; developed Table 1 and Fig. 1. SJ: writer and editor, and contributed to 30% of the text; developed Table 2. YR-Y: editor for the paper, and cross-source checking. JB: editor for the paper, and cross-source checking; table design. EDD: editor for content, and concept check. EG-Y: editor and concept organization. All authors read and approved the final manuscript.

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Dahabreh, D., Jung, S., Renert-Yuval, Y. et al. Alopecia Areata: Current Treatments and New Directions. Am J Clin Dermatol 24, 895–912 (2023). https://doi.org/10.1007/s40257-023-00808-1

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  • DOI: https://doi.org/10.1007/s40257-023-00808-1

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