Alopecia Areata Clinical Case Review

Maryanne Senna, MD, assistant professor of dermatology at Harvard Medical School, discusses the treatment options for the case:

"So, what are our treatment options for this patient with severe alopecia areata? Well, as I mentioned previously when patients develop complete or near complete scalp hair loss, the likelihood of spontaneous regrowth without treatment is exceedingly low. So, we know that these patients, if they're not treated, will not spontaneously regrow their hair. Additionally, like I mentioned, patients with severe alopecia areata commonly experience depression, anxiety and other major psychosocial and functional comorbidities. The treatments that we have that can work well in cases of mild and even moderate alopecia areata — such as topical steroids, intralesional steroids, other oral medications — don't work as well in this patient population. So really the treatment that we reach for in these cases are Janus kinase inhibitors, or JAK inhibitors. And these are a class of medications that can result in clinically meaningful hair regrowth for patients with severe alopecia areata. These medications work by blocking that part of the inflammatory pathway that I introduced earlier, which causes T-cell infiltration of the hair follicle bulb, and therefore associated hair loss, namely the JAK-STAT pathway. So, by blocking the activation of JAKs, it leads to a reduction in this activation of stats signaling in the nucleus, and reduces the production of those pro-inflammatory cytokines that lead to hair loss, allowing a reduction in the inflammation and a cessation of that pro-inflammatory cycle that I showed you earlier to allow the hair to grow. Two JAK inhibitors were recently approved by the United States Food and Drug Administration for severe alopecia areata. Baricitinib, or Olumiant (Eli Lilly/Incyte), was approved for severe alopecia areata in adults 18 years and older. And Ritlecitinib, or Litfulo (Pfizer), was approved for severe alopecia areata in patients 12 years of age and older."