Beard hair response in alopecia areata universalis treated with baricitinib.

Janus kinase inhibitors (JAKis) have emerged as effective treatments for several skin immune-mediated inflammatory diseases (IMIDs). However, safety concerns have been raised due to boxed warnings from rheumatoid arthritis trials, and whether these risks apply to skin IMIDs remains uncertain. This multinational retrospective cohort study used the TriNetX database to compare the real-world safety of JAKis and conventional immunomodulators (cIMs) in patients aged 12 years or older with skin IMIDs (psoriatic disease, atopic dermatitis, or alopecia areata). Patients newly prescribed JAKis (tofacitinib, upadacitinib, deucravacitinib, baricitinib, abrocitinib, or ritlecitinib) were propensity score-matched (1:1) with those prescribed cIMs (methotrexate or cyclosporine) based on demographics, baseline skin IMIDs, and comorbidities, yielding 17,068 matched patients. Over 2 years, the JAKi cohort showed lower incidences of all-cause mortality (0.28% vs. 0.62%; P = 0.015) and major adverse cardiovascular events (MACE; 1.15% vs. 1.95%; P = 0.005) than the cIM cohort, corresponding to reduced risks (mortality: HR, 0.47; 95% CI, 0.25-0.88; MACE: HR, 0.63; 95% CI, 0.46-0.88). Risks of venous thromboembolism (HR, 0.80; 95% CI, 0.43-1.48) and malignancy (HR, 0.85; 95% CI, 0.63-1.16) were not increased. Subgroup analyses, including older adults and those with cardiometabolic risk factors, showed no signal of increased risk, with consistent findings across available agent-level and sensitivity analyses. These results suggest that, over 2 years, JAKis are not associated with increased risks of mortality, MACE, venous thromboembolism, or malignancy compared with conventional systemic agents in patients with skin IMIDs.

Tape-strip RNA sequencing enables non-invasive molecular profiling of inflammatory skin diseases. However, its ability to capture immune activity, disease severity, and treatment response in alopecia areata (AA)-a follicle-centered autoimmune disorder-has not been systematically evaluated in relation to follicular immune activity and treatment response. To determine whether scalp tape-strip RNA sequencing captures immune pathways associated with disease severity and treatment response in AA, and to assess its concordance with matched scalp biopsies. We analyzed 61 RNA-seq profiles, including 46 scalp tape-strip samples (19 healthy controls, 17 active AA, and 10 post-baricitinib samples-five responders and five non-responders) and 15 lesional scalp biopsies. Nine tape-strip-biopsy pairs were obtained from the same scalp region. Batch-corrected expression data were analyzed using covariate-adjusted linear models and gene set-based enrichment analyses interrogating immune, cytotoxic, and follicular epithelial programs. Tape-strip RNA sequencing robustly recapitulated established AA-associated immune signatures, including activation of interferon/JAK-STAT signaling and cytotoxic T/NK cell pathways, together with suppression of follicular epithelial programs. Increasing disease severity was associated with progressive immune activation and epithelial loss. Baricitinib responders showed partial normalization of inflammatory signatures, whereas non-responders retained persistent immune activation, consistent with molecular non-response. Covariate-adjusted models identified treatment response-specific transcriptional changes. Tape-strip and biopsy transcriptomes demonstrated high concordance. Scalp tape-strip RNA sequencing captures clinically relevant immune and treatment-responsive molecular signatures in alopecia areata and represents a promising platform for longitudinal immune monitoring and biomarker-driven stratification of treatment response in follicle-centered autoimmune disease.

Ritlecitinib represents the sole therapeutic agent currently approved for adolescents aged 12 to 17 years with severe alopecia areata (AA). Despite its regulatory endorsement, real-world data characterizing treatment outcomes and tolerability profiles in pediatric populations remain conspicuously absent. To systematically assess clinical response trajectories and treatment-emergent adverse events among adolescent AA patients treated with ritlecitinib in a real-world clinical cohort. We conducted a retrospective review of electronic medical records from December 2023 to May 2025, including AA patients aged 12 to 17 years treated with ritlecitinib. Data collected included demographics, AA severity scores [Severity of Alopecia Tool (SALT)], Eyebrow Assessment, Eyelash Assessment, and safety outcomes. The study enrolled 30 patients aged 12 to 17 years, with a median baseline SALT score of 61.3 (interquartile range 40.5-88.25). Treatment was administered over a 36 week period. By week 36, clinically meaningful improvements in SALT scores were observed: 96.7% of patients achieved at least a 30% reduction, while 86.7% and 70.0% attained reductions of ≥50% and ≥80%, respectively. At this time point, 24 patients (80.0%) achieved SALT scores ≤20. Among patients with baseline eyebrow or eyelash involvement, sustained regrowth was observed throughout the treatment period. All 6 patients with eyebrow involvement and all 5 with eyelash involvement exhibited complete recovery. Adverse events were predominantly mild, with folliculitis representing the most frequently reported event (n = 7). Single-center, retrospective design. Real-world utilization of ritlecitinib demonstrated robust efficacy in AA while maintaining a favorable safety profile among adolescent populations, with no novel safety signals identified beyond established pharmacovigilance parameters.

Background: Alopecia areata (AA) is an autoimmune hair-loss disorder driven by aberrant T-cell activation and immune–epithelial crosstalk. To identify actionable upstream regulators, we established a proteome-anchored multi-omics framework integrating genetic instruments, lesional transcriptomics, and single-cell immune profiling. Methods: Putative causal plasma proteins were prioritized using cis-pQTL–based inference across two large proteomic datasets (UKB-PPP; deCODE). Candidates were validated by differential expression in AA lesions, protein-interaction networks, and cell-type–resolved expression from scalp single-cell RNA-seq. Druggability was assessed using curated pharmacological resources, and PheWAS evaluated safety-relevant pleiotropy. Results: The pipeline identified 206 and 169 AA-associated proteins, with CD28, GZMB, and CD1C emerging as convergent immune regulators. Single-cell data showed enrichment of CD28⁺ effector T cells and CD1C⁺ myeloid subsets in lesions, linking circulating protein signals with local inflammation. Transcriptomic patterns implicated IL-2–modulated CD28 signaling and antihistamine-responsive pathways. Druggability analyses highlighted belatacept, a CD28-blocking biologic, while PheWAS indicated minimal adverse-phenotype enrichment. Conclusion: This proteome-driven framework uncovers druggable immune regulators of AA, positioning CD28 as an actionable target with a favorable safety profile and providing a generalizable strategy for autoimmune target discovery.

Alopecia areata (AA) is an inflammatory hair loss disorder, which negatively impacts health-related quality of life (HRQoL). This study investigates treatment patterns and HRQoL by AA disease severity. Data were drawn from the Adelphi Real World AA Disease Specific Programme™, a cross-sectional survey of dermatologists and patients in the USA from November 2023 to June 2024. Dermatologists reported patient demographics, clinical characteristics, treatment patterns, and mental health. Patients completed AA Symptom Impact Scale, Skindex-16 AA, and Work Productivity and Activity Impact questionnaires. Data were stratified by AA-Investigator Global Assessment (IGA) scores and physician-assessed disease severity. Overall, 65 physicians reported on 501 patients, of whom 81 self-reported data. In total, 211 patients had severe/very severe AA-IGA-scored AA, of whom 66% received oral Janus kinase and 31% received non-topical corticosteroids. Among 501 patients, 43% had concomitant conditions. Anxiety (74%) and depression (61%) were most prevalent in severe/very severe AA-IGA-scored AA. Patients with severe/very severe AA reported notably high mean (standard deviation) scores on the global AA Symptom Impact Scale (AA-IGA, 3.1 [2.5]; physician-assessed, 3.0 [2.4]), Skindex-16 Emotion subscale (AA-IGA, 59.5 [29.8]; physician-assessed, 59.8 [27.5]) and overall work impairment (AA-IGA, 16.2% [21.4]; physician-assessed, 17.5% [20.2]). This study showed that AA severity may correlate with HRQoL, highlighting the need for validated severity measures.

Alopecia areata (AA) is an autoimmune disease affecting hair follicles that results in nonscarring hair loss. AA impacts 0.1%-0.2% of the United States population, with pediatric patients accounting for 16.0%-27.7% of all cases. The Severity of Alopecia Tool (SALT), a method of quantifying scalp alopecia, helps guide clinical practice and determine response to therapies in clinical trials. Given the emerging role of image-based assessments of alopecia and growth of multimodal generative artificial intelligence (AI) in dermatology, we aimed to assess the "off-the-shelf" ability of a large-language model, GPT-4o, to automate the generation of image-based SALT scores. Chart review of patients with AA seen at the Children's Hospital of Philadelphia's Dermatology Clinic was conducted to identify 4-view images of patients' scalps and provider-derived SALT scores. One-hundred-and-four 4-view image sets were de-identified and provided to GPT-4o, which was prompted to generate SALT scores. Concordance between GPT-4o's and providers' scores was determined using intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC). ICC and CCC between GPT-4o and in-person provider assessments were 0.815 and 0.866. ICC and CCC between GPT-4o and image-based provider assessments were 0.833 and 0.817. ICC and CCC between two providers were 0.950 and 0.948. These high levels of concordance were confirmed on Bland-Altman plots. SALT scoring for AA can be challenging due to provider subjectivity, changing sphericity and growth of patients' scalps, particularly among pediatric patients. Our data show the potential adjunct role that "off-the-shelf" generative AI tools may play in SALT scoring without any prior additional explicit training.

Chronic, persistent alopecia areata (CPAA), defined by an episode duration >12 months, tends not to remit spontaneously and patients with CPAA are candidates for systemic therapy. The burden of CPAA is not entirely explained by the severity of scalp hair loss. CPAA widely affects physical and psychosocial aspects of health and well-being. Exploring patients' perspectives on these domains of impact among those commencing systemic treatments will shed light on patient expectations from systemic treatments and the most relevant patient-reported outcomes. To understand patients' perspective on the key impact domains of CPAA that are the most important motives for patients when deciding whether to commence a systemic therapy. Patients receiving systemic therapy for CPAA who completed an online survey that included two patient-reported questionnaires, the Quality of Life-8D (AQoL-8D) and the Patient Priority Outcomes (AAPPO), were invited to participate in a focus group to explore the key impact domains of AA, beyond scalp hair loss severity, that had led them to commence systemic therapy. Focus groups were transcribed and thematically analysed using NVivo. Quantitative data were analysed using SPSS. Quantitative data (n=44) revealed significant impairment in psychosocial dimensions, contrary to physical dimensions, in our patients, based on AQoL-8D. None of the health-related QoL (HRQoL) dimensions were associated with the extent of scalp hair loss, assessed by the AAPPO.Focus groups (n=31) revealed AA-related physical and psychosocial priorities emerged as thirteen subthemes within three main themes: physical, psycho-emotional, and social. Eyelash and eyebrow appearance were the most frequent physical impacts. Sense of frustration/despair and the impact of long-term camouflaging in social activities were the most frequent sub-themes within their attributed themes. Facial hair loss and various psychosocial domains of HRQoL are key impact domains of AA, other than scalp hair loss, in patients commencing systemic treatments. Perceived domains that were considered important by patients can serve as a foundation of patient-centred criteria of candidacy for systemic treatments, contributing to the timely initiation of systemic treatments in patients suffering from considerable disease burden. Further research should aim at the integration of our findings into the clinical setting.

Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss that may impact quality of life (QoL). After 2021, new therapies were approved to treat severe AA in Taiwan; however, there is no global definition of severe AA. Dermatologists may use other criteria in addition to scalp hair loss (SHL) when estimating severity. This study evaluates the impact of AA on patient QoL and how dermatologists assessed disease severity and managed AA in Taiwan prior to availability of new therapies. Dermatologists completed the Adelphi Real World AA Disease Specific Programme™ cross-sectional survey. Each provided their perspective on assessing AA severity and available AA treatments, and information on patients consulting with AA. Results were analyzed descriptively and stratified by dermatologist-assessed AA severity. Fifty dermatologists reported median (interquartile range) SHL of 45% (31-51%) and 76% (51-90%) as typical of "severe" and "very severe" AA, respectively, based on 285 patients. Multiple factors were considered, including SHL, disease duration, and prior treatment responses. Mean (SD) time on current therapy was 8.3 (13.0) months. Patients with severe/very severe disease received varied first- and second-line treatments and had more severe QoL impacts, including anxiety/worry, depression, and impairments in daily life and activities. Most dermatologists felt confident in diagnosing AA; however, few were satisfied with treatment options for patients with severe AA. Dermatologists in Taiwan did not define AA disease severity solely based on extent of SHL, and many felt there was an unmet need for effective treatments for severe disease.

Alopecia areata (AA) is an autoimmune condition marked by non-scarring, patchy hair loss of the scalp which progresses in <10% of cases to alopecia totalis (AT), which is marked by complete hair loss from the scalp, eyebrows, and eyelashes. AA is prevalent in pediatric patients and is associated with atopic dermatitis (AD). The interleukin (IL)-4 and IL-13 antagonist dupilumab is approved for use in both pediatric and adult patients with AD and asthma. However, in some cases, dupilumab has shown promising results in regrowing hair in patients with concurrent AA. We report a 13-year-old male patient with a past medical history of AD and food atopy, who presented with AA to the scalp. The patient's hormonal lab work-up was within normal limits, and he was treated and failed typical therapies for AA. Within nine months of treatment, the hair loss progressed to AT of the scalp and eyebrows. Dupilumab was then initiated as monotherapy for the patient's AD and AT, leading to regrowth of hair on the scalp and eyebrows within several months and sustained complete hair regeneration after 17 months post dupilumab initiation. This case demonstrates the potential use of dupilumab, which has a well-established safety profile, for pediatric patients with AA and its ability to initiate and sustain hair growth for the long term. Dermatologists may consider dupilumab for patients with AA and comorbid AD that have failed a variety of treatments from several drug classes. &nbsp.

Alopecia areata (AA) is a chronic autoimmune disease characterized by a breakdown of immune privilege, resulting in an inflammatory response to hair follicles that can cause hair loss. Beyond its visible manifestations, AA imposes a considerable psychosocial burden and substantial economic impact due to increased health care utilization. There is no cure for AA, and management may be challenging due to the heterogeneic and recurrent nature of the disease. Attenuating the autoimmune response to hair follicles and stimulating hair regrowth in affected areas are key goals of AA treatment. Given its central role in mediating AA-related inflammation, the JAK-STAT pathway is a common target of current pharmacological strategies. Three JAK inhibitors are currently FDA-approved for severe AA: baricitinib, ritlecitinib, and deuruxolitinib. The safety and efficacy of these agents have been demonstrated in phase 3 trials. To support optimal outcomes for patients, there is an opportunity to recognize AA as a complex, immune-mediated condition rather than just a cosmetic concern. Aligning managed care coverage criteria with this clinical perspective and facilitating timely access to therapy may help mitigate the long-term clinical and economic consequences of the disease.

Molecular crosstalk between lncRNA H19, miR-29a, and JAK2/STAT3 signaling in alopecia areata: a preliminary study.

Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss on the scalp and body, leading to a reduced quality of life and psychosocial burden for patients. The only US Food and Drug Administration–approved treatments for severe AA are the Janus kinase inhibitors (JAKis) baricitinib, ritlecitinib, and deuruxolitinib. Herein, we discuss the efficacy, safety, and real-world aspects of JAKi treatment for patients with AA for an advanced practice provider audience. We review the clinical characteristics and diagnosis of AA and discuss treatment expectations for patients using JAKis. &nbsp.

Baricitinib Provides Higher Efficacy in Adolescents Relative to Adults With Alopecia Areata Despite More Severe Disease at Baseline: 36-Week Outcomes From BRAVE-AA Trials

Alopecia areata: A clinical review of the changing landscape with Janus kinase inhibitors

Psychosocial Impact of Severe Alopecia Areata in Children and Evidence-Based Support Strategies

Stigmatization and Mental Health Impact of Alopecia Areata

Risk for attention deficit hyperactivity disorder in alopecia areata patients: A nationwide case-control study.

Weight Loss-Associated Alopecia Areata.

Alopecia areata (AA) in children is associated with comorbidities such as atopy, vitiligo, psoriasis, and thyroid disease, but reported data are lacking. Our objective is to estimate the frequency of comorbidities present in children with AA, as well as their relationship with age of onset, specific subtype, and treatment efficacy. We retrospectively reviewed clinical records of patients treated at the National Institute of Pediatrics between 2008 and 2018. Patients were categorized into subgroups: localized versus non-localized AA, onset in preschool age (< 7 years) versus school age (≥ 7 years), and treatment response as good (≥ 50% regrowth) versus suboptimal (< 50%). Comorbidities were classified as autoimmune, inflammatory/reactive, congenital, psychological, infectious, and neoplastic. We included 105 patients diagnosed with AA. The most prevalent subtype was localized in 78 (74.3%) patients. Ninety-five (90%) patients had comorbidities, with allergic rhinitis (n = 12, 11.4%) and atopic dermatitis (n = 11, 10.4%) being the most frequent. Autoimmune comorbidities occurred in 16 patients (15.2%), with autoimmune thyroid disease being the most prevalent in 8 patients (7.6%). Localized AA was associated with better outcomes, shorter duration, fewer relapses, and fewer treatments, as well as inflammatory and congenital diseases. The association of AA with atopic, autoimmune, and psychiatric comorbidities is consistent with literature reports. Our findings support intentionally seeking associated diseases in pediatric patients with AA to identify them and treat them timely.