Introduction: Alopecia Areata (AA) is the second most common non-scarring hair loss disorder, with a prevalence of 1 in 1000 and a lifetime incidence of 2% worldwide. Data from a recent American study shows that from 68,121 patients with the diagnosis of AA, 37,995 (55.8%) were prescribed treatment for AA within a year of diagnosis, however there are still no therapies able to induce permanent remission, or treatments that guarantee hair regrowth/remissions in 100% of cases, especially in longstanding/severe AA. Recently, oral baricitinib has been approved for AA, being the first drug approved for this specific indication.
Areas covered: The current review will provide a summary of current pharmacological approaches and novel therapeutics in development.
Expert opinion: New and very effective drugs have become available for the treatment of severe AA, and many others are expected soon. However, even new, effective treatments are not effective in all patients and recurrence rates after treatment interruption are high. AA is a systemic disease with important impact on quality of life and should not be considered just as an aesthetic problem. Treatment of the disease should take in account and possibly also address treatment of comorbidities.
Keywords: Alopecia treatment; JAK inhibitors; alopecia; alopecia areata; baricitinib; daxdilimab; etrasimod; jaktinib; methotrexate; ritlecitinib; rosnilimab; ruxolitinib; steroids; tofacitinib; topical immunotherapy; upadacitinib.