What’s New and Upcoming in Alopecia Areata Treatment?

Alopecia areata is an autoimmune skin condition that causes patches of hair loss on your scalp and other parts of your body with hair. Those can include the eyebrows, eyelashes, beard, and elsewhere.

Alopecia areata is a non-scarring type of hair loss. That means your hair follicles — the tiny openings in your skin through which hairs grow — aren’t permanently damaged, and in some people, hair eventually grows back.

Until recently, treatments for alopecia areata were limited, and none were specifically approved by the U.S. Food and Drug Administration (FDA). But that’s rapidly changing: There are now three FDA-approved treatments for moderate-to-severe alopecia areata, one poised for approval, and others in early clinical trials.

It’s an exciting time, says Arash Mostaghimi, MD, MPH, vice chair of clinical trials and innovation, and associate professor of dermatology at Harvard Medical School in Boston.

“We went from having no FDA-approved medications to three approvals in as many years, and more are likely on the way,” says Dr. Mostaghimi.

Keep reading to learn more about the effectiveness of new medications that can help stop hair loss and promote hair growth. Plus, find out about exciting potential therapies that may be available soon.

Janus kinase (JAK) inhibitors are oral medications that interfere with an overactive immune pathway called JAK-STAT, which normally helps regulate inflammation throughout the body. In alopecia areata, this pathway becomes dysregulated, causing your immune system to mistakenly attack hair follicles. By blocking JAK signaling, these drugs break that feedback loop, allowing hair to regrow.

“The JAK-STAT pathway acts like an on-switch for the immune system. When we block it, we prevent the immune system from recruiting more inflammatory cells to attack the hair,” says Mostaghimi.

Right now, there are three FDA-approved JAK inhibitors to treat moderate-to-severe alopecia areata:

Baricitinib (Olumiant)

Baricitinib had already been approved for rheumatoid arthritis and atopic dermatitis, which means doctors had long-term safety data even before its alopecia indication.

“It’s a well-studied medication — if a patient or clinician is concerned about long-term risks, baricitinib has the most-established safety record of the three,” says Mostaghimi.

Ritlecitinib (Litfulo)

This medication targets proteins called JAK3 and TEC kinases, a slightly different way of working that may influence the side effects it can cause. “It may have less impact on cholesterol than some other JAK inhibitors,” says Mostaghimi.

Ritlecitinib is the only approved treatment for adolescents right now, he adds.

Deuruxolitinib (Leqselvi)

Deuruxolitinib is metabolized differently from the other approved JAK inhibitors, and you need to have a genetic test before starting treatment to ensure safe metabolism, says Mostaghimi.

Deuruxolitinib and baricitinib target the same pathways, but some people respond better to one than the other, he says. It’s a reminder that “switching between drugs in the same class can still work,” he adds.

“What’s exciting is that it appears to have a speed and depth of efficacy that may be better than the JAK inhibitors currently on the market, meaning patients may see more hair regrowth and see it sooner,” says Mostaghimi, who was involved in the clinical trials for the drug.

The drug’s multiple indications may be helpful for people with alopecia areata who have other skin conditions.

“Around 15 to 25 percent of people with alopecia areata also have atopic dermatitis (eczema), and some may have other autoimmune skin conditions such as vitiligo. (Rinvoq is in phase 3 trials for that indication.) For patients with multiple skin diseases, a single medication that can treat more than one condition at the same time could be an advantage,” he says.

Topical JAK inhibitors that go on the skin are appealing because they could provide local benefit with fewer systemic side effects.

The challenge with these therapies is that the inflammation in alopecia areata occurs deep around the hair follicle, making it difficult for most creams or ointments to reach the target effectively, says Mostaghimi.

Scientists are trying to figure out the right formulations and concentrations that can actually get to where the immune response is happening, he says.

For now, topical alopecia areata treatments may be most helpful for small, localized patches or sensitive areas like the eyebrows, says Mostaghimi.

Researchers are also testing novel, non–JAK topical compounds that stimulate hair growth through different processes. Two of the most promising areas are antibody-based treatments and cell-based therapies.

Antibody therapies work by precisely blocking or activating specific proteins that affect the hair growth cycle, potentially reducing side effects seen with broader medications.

For decades, people with alopecia areata had few reliable options beyond corticosteroids or topical immunotherapy. Now, for the first time, there are multiple effective treatments, and more are coming.

If you’re thinking about trying one of these new medications, there may be some benefit to starting earlier rather than waiting, says Mostaghimi.

“As with other skin conditions, there’s an increasing amount of collective data that suggests that earlier treatment of alopecia areata leads to better outcomes,” he says.

But even if you’ve had long–term hair loss due to alopecia areata, you may still respond to medication, says Mostaghimi. If you aren’t sure whether you can take an approved JAK inhibitor, ask your healthcare provider what your options are.

Depending on where you live, you may be eligible to participate in a clinical trial for an upcoming treatment. Talk with your provider and visit clinicaltrials.gov to find ongoing alopecia areata trials that are recruiting participants.

Take care of your emotional health as well. The National Alopecia Areata Foundation (NAAF) offers in-person and online support groups that can help people navigate living with hair loss.

• After years with no FDA-approved treatments, there are now effective and approved treatments for moderate-to-severe alopecia areata.
• These treatments target the immune response that causes hair loss and can help many people regrow hair.
• More treatments are being researched, including topical approaches for people who can’t or don’t want to take a JAK inhibitor.
• With rapid progress in research, the outlook for people with alopecia areata has never been more hopeful.