Alopecia Areata: From Pathophysiology to Therapeutic Innovation

Alopecia areata (AA) is a chronic condition marked by non-scarring hair loss due to the breakdown of immune privilege in hair follicles, primarily driven by increased interferon-gamma (IFN-γ) production and the JAK-STAT pathway. This understanding has led to the development of JAK inhibitors as a targeted treatment for AA. First-generation oral JAK inhibitors like baricitinib, tofacitinib, and ruxolitinib, and second-generation inhibitors such as ritlecitinib and brepocitinib, have shown efficacy and safety. Notably, baricitinib (Olumiant) was approved on 13th June 2022, following successful BRAVE-AA1 and BRAVE-AA2 studies. However, topical JAK inhibitors and other therapies like phosphodiesterase-4 inhibitors and biologics generally show limited efficacy, except potentially dupilumab. The article reviews these pathophysiological insights and therapeutic innovations, emphasizing JAK inhibitors.