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.

Medicaid coverage of Janus kinase inhibitors for alopecia areata treatment

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.

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.

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

Background: Alopecia areata is an autoimmune disorder characterized by nonscarring hair loss, which can progress to alopecia totalis or universalis. While JAK inhibitors have shown efficacy in severe cases, evidence in pediatric and adolescent populations remains limited. This study evaluated the efficacy and safety of upadacitinib in pediatric patients with alopecia totalis and subtotalis. Methods: This is a retrospective case series that included eight patients aged 9 to 14 years treated with upadacitinib 15 mg daily and followed for up to two years. Clinical response, treatment duration, adverse effects, and laboratory results were monitored. Results: All patients demonstrated clinical improvement, with most achieving complete or near-complete regrowth of scalp, eyebrow, and eyelash hair. The median regrowth time was 3 months. Mild acne was observed in two patients; no serious side effects occurred. Conclusions: In this case series, upadacitinib was associated with encouraging clinical responses and was well-tolerated by most of our patients; however, larger-scale studies are needed to confirm its efficacy and long-term safety.

Emerging evidence suggests that the brain–gut–skin axis (BGSA) plays a critical role in the pathogenesis of inflammatory and disfiguring skin diseases. Conditions such as acne, atopic dermatitis, psoriasis, rosacea, vitiligo, and alopecia areata, once regarded as localized disorders driven mainly by cutaneous immune dysfunction, are now recognized as systemic conditions associated with neuroendocrine stress responses, gut microbial dysbiosis, and chronic low-grade inflammation. Mechanistic studies elucidate the intricate interorgan communication mediated by microbial metabolites (e.g., short-chain fatty acids and tryptophan derivatives), cytokine networks, neuropeptides, and hypothalamic–pituitary–adrenal (HPA) axis signaling. Building on these insights, therapeutic strategies are evolving rapidly. Microbiome-directed interventions (probiotics, postbiotics, dietary modification, and fecal microbiota transplantation), together with psychoneuroimmunological approaches, have shown potential to alleviate disease severity. Integrative therapies, including traditional herbal medicine, offer promising effects; however, we emphasize that mechanistic depth and robust clinical validation for these modalities are currently limited. This review integrates mechanistic findings, clinical correlations, and emerging therapeutic approaches, while critically distinguishing between correlation and causation. Future studies should emphasize longitudinal multi-omics analyses and standardized clinical trials to clarify causal pathways and guide precision, patient-centered management for systemic and cutaneous health.

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.

Alopecia areata (AA) is an autoimmune disorder characterized by γ-interferon (IFN-γ)-driven CD8 + T-cell infiltration and overactivation of the JAK-STAT pathway; however, safe and long-acting therapies are lacking. MicroRNA (miRNA)-based interventions hold promise as alternatives, but their clinical translation is hindered by poor stability and the absence of targeted delivery systems. We identified miR-665 as a key regulator of STAT3 in embryonic mesenchymal stem cell-derived extracellular vesicles via RNA sequencing and functional screening. An injectable, reactive oxygen species (ROS)-responsive hydrogel (PVA-TSPBA) was developed to enable localized and sustained delivery of miR-665. The physicochemical properties, miRNA release kinetics, and biocompatibility of the hydrogels were systematically characterized. Therapeutic efficacy was evaluated in an imiquimod-induced AA mouse model through macroscopic, histological, and immunohistochemical analyses. The PVA-TSPBA hydrogel exhibited excellent injectability, ROS-dependent degradation, and sustained release of miR-665. In vitro, miR-665 overexpression counteracted the IFN-γ-induced suppression of proliferation and migration in keratinocytes and dermal papilla cells by inhibiting STAT3 phosphorylation. In vivo, injection of PVA-TSPBA@miR-665 hydrogel resulted in prolonged miRNA retention, and significantly promoted hair regeneration, restored follicular structure, and reduced T-cell infiltration compared with the control groups. We developed a biocompatible, ROS-responsive hydrogel platform for the local delivery of miR-665, which effectively attenuated inflammatory signaling and stimulated hair follicle regeneration in AA. This study provides a novel miRNA-biomaterial combination strategy that holds promise for targeted, durable, and safe treatment of AA.

A Case Report of Alopecia Areata Triggered by Psychic Shock &amp; Its Homoeopathic Management.

Androgenetic alopecia (AGA) affects nearly 50% of women during their lifetime, representing the most prevalent form of chronic hair loss in this population. Despite its high incidence, AGA in women remains underdiagnosed and undertreated, with significant psychosocial consequences including diminished self-esteem, impaired social functioning, and reduced quality of life that often exceed impacts observed in men. AGA pathophysiology involves complex interactions between hormonal, genetic, and environmental factors. Androgens promote follicular miniaturization through progressive shortening of the anagen phase, while estrogens may provide protective effects. Genetic studies reveal sex-specific differences in disease mechanisms, and environmental factors like oxidative stress and pollution may contribute to disease progression. Clinical evaluation requires careful consideration of differential diagnoses including chronic telogen effluvium, diffuse alopecia areata, and scarring alopecias. Diagnostic tools include trichoscopy, pull testing, and trichometric measurements to assess hair density and miniaturization patterns. Currently, topical minoxidil is the only FDA-approved treatment for female AGA, also referred to as female pattern hair loss (FPHL). Off-label therapies include low-dose oral minoxidil, anti-androgens such as spironolactone and 5-alpha reductase inhibitors (finasteride and dutasteride), and hair transplantation. Adjunctive treatments like low-level light therapy and platelet-rich plasma may further augment improvement and are often best used in conjunction with medical therapies. Critical research gaps persist, including the paucity of randomized controlled trials for AGA that include female patients. There is an urgent need for additional FDA-approved therapies for AGA in women to increase treatment access and reduce its psychosocial burden.

Publisher's Note: British Association of Dermatologists living guideline for managing people with alopecia areata 2024.

Alopecia, which encompasses disorders such as androgenetic alopecia, alopecia areata, and telogen effluvium, is a complex condition influenced by genetic, hormonal, immunological, and environmental factors. Recent research has highlighted the importance of the gut-hair axis, whereby gut microbiota and their metabolites impact systemic immunological balance, oxidative stress, and nutritional bioavailability. Dysbiosis is associated with increased inflammation, impaired epithelial barrier function, and altered metabolite synthesis, which contribute to hair follicle shrinkage and a disruption of the hair cycle. Modulating gut microbiota with probiotics, prebiotics, postbiotics, synbiotics, and parabiotics has shown promise in preclinical and early clinical investigations. Probiotic strains, including Lactobacillus and Bifidobacterium, exhibit immunoregulatory, antioxidant, and barrier-enhancing properties. Similarly, postbiotic metabolites, such as short-chain fatty acids, bacteriocins, and exopolysaccharides, have shown anti-inflammatory and cytoprotective activities. Furthermore, nutritional components influence microbial communities to enhance hair health. Although, additional randomized controlled studies are necessary, microbiota-targeted approaches represent an innovative paradigm in alopecia treatment, advancing towards individualized, root-cause-driven therapies.

Alopecia areata (AA) affects all ages, genders, and ethnicities. AA severely impacts patients' quality of life. Treatments indicated for AA have only been approved since 2022/2023. While some Asia Pacific (APAC) countries/regions have national or regional guidelines, many lack AA-specific guidance or have not updated existing guidelines to incorporate recently approved treatments. To better inform treatment decisions, 18 dermatologists from Australia, China, India, Korea, Malaysia, Singapore, Taiwan, and Thailand completed a three-round Delphi-based consensus process involving survey completion, open discussion, and statement voting. A consensus for Likert-type and multiple-choice statements was defined as ≥ 70% agreement or disagreement. Consensus was achieved on 140 statements. The panel recognizes that AA is clinically heterogeneous and imposes a considerable burden on patients and their families. Trichoscopy is deemed essential for diagnosing and monitoring AA, while skin biopsy is reserved for when the cause of hair loss is unclear. In terms of disease severity, moderate AA is defined as 21%-49% hair loss and severe AA as ≥ 50% hair loss. Regarding treatment, topical corticosteroids are recommended in children < 12 years. For patients aged ≥ 12 years, topical and intralesional corticosteroids could be used for mild-to-moderate AA, while Janus kinase inhibitors and systemic corticosteroids have a role in moderate-to-severe AA. Adjuvant minoxidil could also be used in chronic AA. This modified Delphi-based consensus provides a practical, region-focused framework to standardize the diagnosis and management of AA across diverse APAC healthcare settings in hope of improving patient outcomes.

While international studies have assessed the economic burden of alopecia areata (AA), its societal costs have not been quantified in a Nordic context. We conducted a cross-sectional survey among adults with self-reported AA in Norway and Sweden, recruited via a patient organization and social media. A total of 329 respondents (263 from Norway, 66 from Sweden) provided information on demographics, disease characteristics, healthcare utilization, out-of-pocket expenses, productivity losses and treatment satisfaction. Costs were estimated from a societal perspective, combining direct medical, direct non-medical and indirect costs from reduced productivity. The annual mean total cost of AA was €7,677 in Norway and €12,582 in Sweden, with indirect costs (61-64% of the total) as the largest component, primarily driven by presenteeism and long-term sick leave. A notable finding is the significant out-of-pocket costs. In Norway, individuals paid about 65% of direct costs themselves, in Sweden about 50%. Dissatisfaction with treatment and healthcare support was widespread. Only a minority received systemic therapies, and treatment frequency with Janus kinase inhibitors was low, likely due to lack of reimbursement. AA imposes a considerable societal and individual economic burden in Norway and Sweden, underscoring the need for better therapies, healthcare support and policy recognition of its impact.

Vitamins and Hair: Sham or Science?

Tape-strip RNA-seq is increasingly used as a non-invasive approach for molecular profiling of inflammatory skin diseases, yet its anatomical reach within the human hair follicle remains unclear. By anchoring tape-strip transcriptomic data to a human hair follicle atlas, we show that tape strips primarily capture surface-connected epithelial compartments, while deeper follicular programs remain biopsy-dependent. Notably, alopecia areata uniquely expands follicular accessibility, enabling broader recovery of follicular inflammatory signatures.

Ritlecitinib for the treatment of severe alopecia areata: real-world experience from a UK tertiary centre.