Non-scarring Alopecia Research Articles

Characteristics and predictive values of super-responders in alopecia areata under tofacitinib treatment: A single-center retrospective study.

Alopecia areata (AA) is an autoimmune disorder characterized by non-scarring hair loss, significantly impacting patients' quality of life. Rapid hair regrowth is the primary goal of treatment, particularly for super-responders (SRs), who demonstrate remarkable and swift improvement. The advent of Janus kinase (JAK) inhibitor has transformed AA management, yet predictors of SRs in AA remain underexplored. This study aimed to characterize SRs among AA patients treated with tofacitinib, identify clinical and demographic predictors of SRs, and analyze treatment outcomes over 12 months. We conducted a single-center, longitudinal retrospective analysis of 80 AA patients treated with tofacitinib at Xiangya Hospital, Central South University, from February 2021 to August 2024. Patients were classified as SRs if they achieved a ≥80% reduction in the Severity of Alopecia Tool (SALT) score by the 3rd month or a 100% reduction by the 6th month. Clinical data, treatment outcomes, and potential predictors of SR status were analyzed using binary logistic regression. SRs comprised 37.5% of the cohort. Significant predictors of SR status included older age and the absence of prior JAK inhibitor treatment. Female patients and those without previous corticosteroid use also trended toward higher SR rates, though these factors were not statistically significant. SRs demonstrated faster and more sustained hair regrowth, with 93.3% achieving SALT100 by 6 months, compared to 42% of non-super-responders (NSRs) at 12 months. This study is the first to define and characterize SRs in AA treated with JAK inhibitor, providing a reference for dermatologists to optimize AA management. Identifying SRs early may improve patient outcomes and inform treatment strategies, particularly in those with a history of JAK inhibitor use. Further research is warranted to validate these findings in larger, multicenter cohorts.

Management of Alopecia Areata with Individualized Homoeopathy: A Case Report

Alopecia areata (AA) is a chronic autoimmune disorder characterized by temporary, non-scarring hair loss while preserving follicular integrity. Its incidence is estimated at 0.1–0.2%, with a lifetime risk of 1-2%, though the exact prevalence remains unclear. This case report explores the effectiveness of individualized homoeopathy in treating AA. A 25-year-old male patient presented with patchy hair loss on the scalp and was treated at the National Homeopathy Research Institute in Mental Health, Kottayam. The diagnosis was clinically confirmed by the presence of exclamation mark hairs. Bacillinum was selected based on the totality of symptoms and prescribed according to the principles of individualized homeopathy with guidance from the Materia Medica. The patient demonstrated significant improvement, including hair regrowth and symptom relief. This case highlights the potential of individualized homoeopathic treatment as an alternative approach for AA. However, further studies are necessary to validate these findings and assess their broader applicability.

Management of Telogen Effluvium: A Survey among Dermatologists and Dermatology Residents of Nepal

Introduction: Telogen effluvium (TE) is a common form of non-cicatricial alopecia, marked by excessive shedding of hairs in the telogen phase. Despite its prevalence, there is no consensus on the best approach to diagnosing, investigating, and managing TE, leading to varying practices among dermatologists. This study aims to understand current practices in Nepal regarding the diagnosis and treatment of TE. Objectives: To explore the management modalities of TE among the dermatologists and dermatology residents of Nepal Materials and Methods: An online, questionnaire-based survey was conducted among Nepalese dermatologists and dermatology residents. The questionnaire consisted of twelve multiple-choice questions related to TE. The responses were recorded and analyzed. Results: A total of 150 responses were recorded, with 53.33% attending 5-10 hair loss patients weekly. Most (94%) diagnosed TE based on history and clinical examination, and 82% commonly ordered thyroid function tests. Iron and vitamin deficiency was identified as the leading cause by 78%, and 53.33% felt no treatment was necessary. Counseling (92.66%) and iron/vitamin supplements (88%) were the most frequent management strategies. TE was reported to have a "moderate" impact on Quality of Life (QoL) by 69.33%, and 50.67% of participants reported a “good level” of satisfaction among patients with the outcomes of their treatments. Conclusions: Telogen Effluvium is one of the most common causes of hair fall, with a moderate impact on the quality of life. Most dermatologists agree on many aspects of TE management. A consensus management guideline of TE would be handy.

Global Burden of Alopecia Areata and Associated Diseases: A Trend Analysis From 1990 to 2021.

Alopecia areata (AA) is a chronic autoimmune disorder characterized by non-scarring hair loss, affecting approximately 2% of the global population. Its etiology involves genetic, immunological, and environmental factors, with significant psychological impacts such as anxiety and depression. However, international trends and comorbidity associations remain poorly understood. This study aims to analyze global trends in the incidence and prevalence of AA and assess its associations with major comorbidities across different demographic and regional groups. Using data from the Global Burden of Disease Study (GBD) 2021, AA incidence, prevalence, and years lived with disability (YLDs) from 1990 to 2021 were analyzed by age, sex, geographic region, and socioeconomic indices (SDI and HDI). Temporal trends were evaluated with Pearson's correlation and Joinpoint regression, and comorbidities were assessed against 22 conditions. From 1990 to 2021, global AA incidence increased in absolute terms, though age-standardized incidence rates (ASIR) slightly declined. Incidence was highest in North America, Southeast Asia, and Australia, with females and individuals aged 30-34 most affected. Significant associations were found with atopic dermatitis, iron deficiency, and depressive disorders, with regional variations in comorbidity patterns. This study highlights rising AA cases with stable ASIRs, reflecting improved awareness and reporting. Findings underscore the complex interplay of socioeconomic factors, healthcare access, and AA burden. Further research should investigate mechanisms underlying comorbidities and guide targeted interventions to mitigate the physical and psychological impacts of AA.

Assessment of Alopecia Areata Disease Severity inPediatric Patients.

Alopecia areata (AA) is an autoimmune disorder that causes nonscarring hair loss and significantly impacts quality of life, particularly in pediatric patients. Since the early 2000s, AA severity has been evaluated using the Severity of Alopecia Tool (SALT), which quantifies scalp hair loss. However, recent advancements in the assessment tools provide a more comprehensive evaluation of AA, which is important for both measuring improvement during clinical trials and for a more holistic assessment in routine care. This review examines the development and implementation of assessment tools for AA, including newer tools that incorporate findings beyond the scalp, psychosocial impact, and chronicity. Through these tools, clinicians can gain a more detailed understanding of the multifaceted impact of AA, leading to improved individualized treatment strategies and advancing research in pediatric dermatology.

Clinical Presentations and Comorbidities of Pediatric Alopecia Areata.

Alopecia areata (AA) is an autoimmune disease that targets hair follicles and leads to non-scarring hair loss. AA can present at any age, although the level of evidence for data describing pediatric-onset AA is poor and mostly limited to case reports and series. The available data demonstrates a large variation in the average age of presentation in the pediatric population, with reports ranging from 6 to 12 years of age. This review will outline the clinical presentation of AA in the pediatric population and contrast this to adult-onset AA.

Pathophysiology of Alopecia Areata in the Pediatric Patient.

Alopecia areata (AA) is an autoimmune non-scarring hair loss that arises in genetically susceptible individuals, potentially in combination with environmental triggers or inciting events, of which the exact mechanism is not yet fully understood. Genome wide association studies have demonstrated an association between AA and variants in HLA haplotypes on chromosome 6 which correlate with other autoimmune conditions as well as other gene variants. Familial and twin studies also confer additional evidence to a genetic component. AA pathogenesis relies on immune privilege collapse at the hair follicle (HF) bulb in the anagen hair cycle phase. Immune privilege collapse is associated with upregulation of IFN-γ, ultimately activating JAK-STAT pathway resulting in upregulation of MHC class I and II in the HF and subjecting it to attack by NKG2D+ CD8 T cells. The complex interplay between pro-inflammatory cytokines such as IFN-γ, IL-2, IL-15 and their use of JAK-STAT signaling are important in perpetuation of AA.

Clinical Efficacy of Medicinal Plants Formulations for the Prevention of Androgenetic Alopecia in Korean Individuals

Androgenetic alopecia (AGA) is the most prevalent form of nonscarring alopecia, characterized by a distinct pattern of gradual hair loss. Despite its non-lethal nature, AGA can exert a profound psychosocial impact, particularly on women and younger men, affecting their quality of life. Standard therapeutic approaches for AGA commonly involve the use of finasteride and minoxidil; however, these treatments are often associated with adverse side effects, particularly with prolonged use. In this study, we present the successful management of AGA in a cohort of Korean individuals, comprising both male and female subjects (totaling 52 participants, with 12 exclusions). Significant reductions in the affected AGA area were observed across the cohort, yielding highly satisfactory outcomes. These findings suggest that the treatment modality employed in this study offers a promising alternative for AGA management in the population, demonstrating efficacy irrespective of gender.

Deciphering of Anti-Alopecia Activity of Polyphenol from Beta vulgaris Root against 5α-reductase: Molecular Insight

Background: Androgenetic alopecia (AGA) is the predominant form of nonscarring alopecia, characterized by a progressive and predictable loss of hair. Androgenetic alopecia (AGA) is influenced by genetic susceptibility and heightened follicular sensitivity to androgens, predominantly in males, resulting in the gradual transformation of scalp terminal hair into vellus hair. Despite its great prevalence, it is not lethal but may exert a significant emotional influence, particularly on females and younger boys. Substantial progress has been achieved in comprehending the epidemiology and pathophysiology of AGA; nonetheless, only two medications have received FDA approval: finasteride and minoxidil. Extended administration of these medications is essential for improved therapeutic response. Nonetheless, this results in inadequate medication adherence and negative consequences from prolonged use, such as the "post-finasteride syndrome," which endures after discontinuation of the medicine. Consequently, research is required to identify more effective alternative treatments for AGA that exhibit less adverse effects. Prior study demonstrated the effectiveness of polyphenols in addressing metabolic disorders. The root of Beta vulgaris was considered for the current inquiry. Purpose: Current work was designed to check efficacy of root extract and their bioactive for anti-alopecic potential. Methodology: Scientific validation of the current investigation was done by computational based molecular docking study of lead molecules of Beta vulgaris root against 5α-reducatase (SRD5As) enzyme. Result: The root of Beta vulgaris has been identified as an effective anti-alopecic drug, with its lead compounds, 4-picoline and Betalain, demonstrating effective binding to the target protein 5α-reductase (SRD5As) with binding energies of -4.09 and -7.93 kcal/mol, respectively. Conclusion: The findings indicated that each selected lead chemical for additional investigation shown significant inhibitory activity against 5'-reductase (SRD5 As), hence revealing its anti-alopecic potential.

Diagnostic Accuracy of Polarized and Ultraviolet Fluorescence-Induced Dermoscopy in Scarring and Nonscarring Alopecias: a Retrospective Observational Multicentric Study.

There is growing evidence that ultraviolet-induced fluorescence (UVF) dermoscopy may improve diagnostic accuracy in non-neoplastic dermatoses, yet data on hair disorders are scarce. The aim of this observational retrospective study was to compare the accuracy of polarized dermoscopy and UVF-dermoscopy in characterizing and distinguishing scarring and nonscarring alopecias. A total of 84 patients were enrolled, with 43 and 41 patients suffering from nonscarring and scarring alopecias, respectively. Analyzed variables included scarring findings (i.e., dotted/globular, structureless or perifollicular bright white areas on both polarized and UVF-dermoscopy) and follicular unit (i.e., hair or follicular ostia, with the latter appearing as empty follicular openings and follicular red/blue fluoresce on polarized and UVF-dermoscopy, respectively). Comparative analysis between polarized and UVF-dermoscopy in detecting the abovementioned features and differentiating scarring from nonscarring alopecias were performed, also assessing possible differences according to the skin tone. Interobserver agreement was evaluated for both dermoscopic settings. UVF-dermoscopy was superior (p < 0.01) to polarized dermoscopy in detecting follicular ostia and white bright areas in general and fair-skinned patients, while only follicular ostia were better seen under this setting in skin of color. Additionally, UVF-dermoscopy was found to be more accurate (p < 0.01) in differentiating nonscarring from scarring alopecias when considering all and light phototypes. Finally, Kappa values were 0.57 and 0.83 for polarized and UVF-dermoscopy, respectively. UVF-dermoscopy may be a valuable and reliable complementary tool in differentiating scarring and nonscarring alopecias, especially in light phototypes.

A Three-Step Diagnostic Algorithm for Alopecia: Pattern Analysis in Trichoscopy.

Background/Objectives: Alopecia is a common and distressing hair loss condition that poses a major diagnostic challenge. While histopathology is the gold standard, its invasive nature limits its routine use. Trichoscopy, a non-invasive imaging technique, has shown promises in diagnosing and differentiating the various alopecia subtypes. However, existing diagnostic algorithms primarily rely on dermoscopic findings. To address this, we developed a novel, three-step algorithm that integrates clinical and trichoscopic features and employs pattern analysis as a diagnostic tool. Methods: A comprehensive literature review was conducted to identify key trichoscopic features associated with different alopecia types. The gathered data were used as a base for the description of trichoscopic features and patterns for each subtype of alopecia, either scarring or non-scarring. Results: The proposed algorithm is analyzed into three steps. In the first step, alopecia is categorized by distribution into: patchy, patterned, or diffuse. In the second step, it distinguishes between scarring and non-scarring alopecia based on the absence or presence of follicular ostia, respectively. Lastly, in the third step, alopecias are distinguished based on specific trichoscopic clues, allowing for the identification of distinct trichoscopic patterns. Conclusions: The three-step diagnostic algorithm for alopecia, utilizing clinical and dermoscopic findings, performs a pattern analysis in trichoscopy, leading to a dermoscopic diagnosis with great confidence, and minimizing the need for invasive diagnostic procedures.

Patient-reported outcome improvements following scalp hair regrowth among patients with Alopecia Areata: analysis of the ALLEGRO-2b/3 trial

Purpose: Alopecia areata (AA), an autoimmune disorder characterized by non-scarring hair loss, is detrimental to the psychological health and quality of life of people living with AA. Clinically meaningful hair regrowth is possible, but the relationship with downstream patient-reported outcomes (PROs) is complex. Materials and methods: This post hoc analysis of ALLEGRO-2b/3 (NCT03732807) longitudinal data from Weeks 24–48 compared improvements in PROs between patients who achieved (responders) or did not achieve (non-responders) clinically meaningful scalp hair regrowth. Responders were defined by a Week 24 Severity of Alopecia Tool (SALT) score ≤20 (SALT20) or ≤10 (SALT10). Across 6 PROs assessing multiple AA-related health domains, response proportions and mean changes from baseline were estimated for Weeks 24–48. Results: Among 650 included participants, 114 (17.5%) were SALT20 responders, of which 76 (11.7%) were also SALT10 responders. Generally, more responders than non-responders reported improvements in AA and related symptoms or limitations and satisfaction with hair regrowth. Responders additionally reported greater improvement from baseline than non-responders for measures of AA-related emotional symptoms, mental health, and work or activity limitations. Conclusions: These results support a positive relationship between scalp hair regrowth and downstream PROs—including satisfaction and psychosocial burden—demonstrating an association between clinically meaningful hair regrowth and patient-reported treatment benefits.

The Frequency of Non-Scarring Alopecia in Autoimmune Connective Tissue Diseases.

Autoimmune connective tissue diseases (ACTDs) are relatively rare systemic diseases featured by immune dysregulation and often have prominent cutaneous manifestations. The most common is systemic lupus erythematosus (SLE), dermatomyositis (DM), systemic sclerosis (SSc), Sjogren syndrome (SJO), undifferentiated connective tissue disease (UCTD), and mixed connective tissue disease (MCTD). Alopecia is one of the most common symptoms of these diseases, with significant impact on the quality of life of these patients. Our aim is to better characterize non-scarring alopecia in ACTDs. A retrospective chart review study of patients seen at the Autoimmune Connective Tissue Diseases clinic at Massachusetts General Hospital, Boston, MA, was conducted from November 2012 to January 2018. The study was reviewed and approved by Partners IRB. A total number of 1486 visits where 734 were new patients, and 241 patients with ACTDs included in our analysis. Of the new patients, 80% were female and 20% were male, with an average age of 51 years. Of patients with MCTD, 46.6% presented with non-scarring alopecia at their initial evaluation. Of patients with SLE, 36% presented with non-scarring alopecia. Of the 32 patients with SJO, 28% reported diffuse non-scarring alopecia. Of patients with UCTD, 22% presented with diffuse non-scarring alopecia. Only 9.5% of our patients with DM and 9% of our patients with SSc presented with diffuse non-scarring alopecia. Alopecia is common in all ACTDs and often under evaluated. Treatment of alopecia in ACTDs can be challenging, and oftentimes patients require joint management and work-up. J Drugs Dermatol. 2025;24(3):246-249. doi:10.36849/JDD.7750.

An international multicenter, retrospective cohort study of 203 patients with pediatric androgenetic alopecia.

An international multicenter, retrospective cohort study of 203 patients with pediatric androgenetic alopecia.

Retrospective Review of 2851 Female Patients With Telogen Effluvium: A Single-Center Experience.

Telogen effluvium, the most common cause of diffuse and non-scarring alopecia in women, is frequently diagnosed in dermatology outpatient clinics and can be caused by various etiological factors such as medications, trauma, emotional, and physiological stress. In patients presenting with complaints of telogen effluvium, we aimed to investigate abnormal levels of serum ferritin, vitamin B12, folic acid, thyroid function tests, and hemoglobin and determine which of these abnormal values might be significantly associated with telogen effluvium. In this study, 2851 female patients diagnosed with telogen effluvium who applied to the Dicle University Dermatology outpatient clinic between January 1, 2010 and June 30, 2024 were retrospectively evaluated. The relationship between these laboratory abnormalities and telogen effluvium, as well as their significance in different age groups, was analyzed using the SPSS-27.0 program. Associations were analyzed using Kolmogorov-Smirnov test, dependent t-test, Wilcoxon test, Pearson chi-square (χ2) test, Yates chi-square (χ2) test, Fisher chi-square (χ2) test analysis, Mc-Nemar test, Pearson/spearman correlation analysis, and logistic regression analysis. A p value of < 0.05 was considered statistically significant. The mean age of 2851 female patients included in our study was 26.33 years, 12.8% (n = 366) were under 18 years of age, 83.5% (n = 2380) were between 18 and 45 years of age, and 3.7% (n = 105) were over 45 years of age. Hemoglobin values were determined in 2496 of 2851 patients and values below the reference range were found in 317 patients (11.1%). Ferritin was found to be low in 1123 (46.5%) of 2413 patients. Vitamin 12 deficiency was detected in 150 (5.8%), folic acid deficiency in 8 (0.6%), and iron deficiency in 685 (29.5%) patients. As can be seen in our study, deficiency of laboratory parameters, especially ferritin and serum iron, is a common finding in female patients presenting with TE. This study showed that biochemical tests, complete blood counts, and hormonal tests are important tools in investigating the etiology and guiding the treatment in patients diagnosed with telogen effluvium, as various etiological factors may be present. Furthermore, it was determined that parameters such as vitamin B12, ferritin, TSH, and T3 hold varying levels of importance during significant phases of women's physiological development, such as adolescence and post-menopausal periods.

Alopecia as an Adverse Event of Immune Checkpoint Inhibitor Therapies: Clinical Evidence and Outcomes.

Immunotherapy utilizing immune checkpoint inhibitors (ICIs) such as PD-1, PD-L1, and CTLA-4 inhibitors has revolutionized cancer therapy by enhancing T cell recognition and attack against cancer cells.1 Immune-related adverse events (irAEs) are a limitation of ICI therapy, encompassing various manifestations such as colitis and cutaneous adverse events such as dermatitis, alopecia, and vitiligo.2 Hair loss is a common concern of cancer patients as they embark on their therapeutic paths. The evidence on alopecia from isolated clinical trials with ICI therapies is limited and largely lacks diagnostic and prognostic details to help guide patients.3,4 In this systematic review, we examined the types of alopecia as part of the irAEs of ICI therapy, timing of onset, prognosis, and treatment approaches. Our analysis includes 19 studies describing new-onset non-scarring or scarring alopecia following ICI treatment. Alopecia was a rare adverse event in the setting of ICIs (n=26) with the onset of alopecia occurring within one year of initiating treatment. Slightly over half of the affected patients reported some degree of hair regrowth after attempted alopecia-directed treatments. We discuss available data to increase awareness of this rare but potentially permanent side effect of ICI therapy. Further research is warranted to enhance our understanding of alopecia as an irAE and to optimize patient management strategies. J Drugs Dermatol. 2025;24(3):255-260. doi:10.36849/JDD.7828.

No association between low-dose oral minoxidil and pericardial effusion in a large retrospective cohort study of non-scaring alopecia patients.

No association between low-dose oral minoxidil and pericardial effusion in a large retrospective cohort study of non-scaring alopecia patients.

Predictive factors for treatment responses to baricitinib in severe alopecia areata: A retrospective, multivariate analysis of 70 cases from a single center.

Alopecia areata (AA) is a chronic, autoimmune skin disease characterized by non-scarring hair loss. Baricitinib, a Janus kinase inhibitor (JAKi), prevents hair loss and promotes hair regrowth by inhibiting the inflammatory Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway involved in cytotoxic T cell responses targeting hair follicles. The introduction of JAKi has transformed treatment against severe AA. However, treatment responses to JAKi are highly variable among patients, and the predictors of responsiveness remain insufficiently elucidated. This study aimed to identify independent predictive factors for the efficacy of baricitinib in patients with severe AA using multivariate analyses. A retrospective study was conducted on 70 severe AA patients who started baricitinib treatment at Tohoku University Hospital between July 2022 and August 2023. The primary outcome was the percentage of patients achieving a Severity of Alopecia Tool (SALT) score of ≤20 after 9 months of baricitinib treatment. Multivariate analysis assessed potential predictors of baricitinib treatment responses, including AA type, sex, age, disease duration, history of atopic dermatitis, intravenous methylprednisolone pulse (IVMP) therapy, and Clinician-Reported Outcome (ClinRO) measures for eyebrows and eyelashes. Achievement of a SALT score of ≤20 and SALT score improvement rates were used as objective variables in the multivariate analyses. Among the 70 patients completing 9 months of baricitinib treatment, 41% achieved a SALT score of ≤20. Multivariate analyses identified several independent predictors for positive outcomes, including shorter disease duration (≤4 years), history of IVMP, therapy SALT score of ≤95 at baricitinib initiation, and female sex. Further, we found differential response patterns based on AA type and sex. Specifically, AA type significantly influenced treatment responses, with ophiasis alopecia (OA) associated with the poorest improvement rate. In summary, the response to baricitinib in AA is significantly influenced by sex, AA type, disease duration, history of IVMP, and pre-treatment SALT score.

A case of non-scarring alopecia with follicular accentuation at the limbs of a paediatric patient.

A case of non-scarring alopecia with follicular accentuation at the limbs of a paediatric patient.

Pathogenesis and regenerative therapy in vitiligo and alopecia areata: focus on hair follicle.

Vitiligo is an autoimmune disease characterized by the loss of functional melanocytes in the hair follicles and epidermis, leading to white patches on the skin and mucous membranes. Alopecia areata (AA) is a common immune-mediated condition in which autoimmune attack on hair follicles cause non-scarring hair loss. Both diseases significantly impact patients's physical and mental health. Hair follicles, dynamic mini-organs, house diverse stem cell populations that form hair structures. Melanocyte stem cell (McSCs) and hair follicle stem cells (HFSC) located in the hair follicle bulge contribute to follicular structures during each anagen phase of the hair cycle, synchronizing periodic activities to impact color to the hair. Hair follicle dysfunction may contribute to hair loss and could potentially interfere with repigmentation efforts in vitiligo lesions. This article reviews the role of hair follicles in the pathogenesis, clinical manifestations, and therapeutic options for vitiligo and AA, aiming to deepen clinicians' understanding of follicular involvement in these diseases and explore potential treatment avenues.