Hair follicles as immune targets: unraveling cellular players, cytokine crosstalk, and precision pathways for future therapy of alopecia areata

July 2026 in “ Expert Review of Clinical Immunology ”

Kimia Heidari, Seyedshayan Shojaei, Arash Azari Matin, Devendra K. Agrawal

TLDR New therapies aim to improve long-term hair regrowth in alopecia areata by targeting immune responses.

Alopecia areata (AA) is an autoimmune disorder characterized by the collapse of immune privilege in anagen hair follicles, leading to targeted damage to the hair bulb. Recent studies using multi-omics approaches have identified three immune endotypes—IFN-γ-dominant, IL-17-skewed, and mixed Th1/Th17—that influence treatment responses. JAK inhibitors have shown effectiveness in inducing hair regrowth, but relapses are common due to persistent tissue-resident memory T-cell activity. Emerging therapies, such as IL-15 blockade, antigen-specific Treg expansion, and nanoparticle-based delivery systems, aim to achieve more durable immune reprogramming. Topical nano-JAK formulations may enhance follicular penetration and support long-term maintenance with reduced systemic exposure.

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Hair follicles are normally protected from the immune system, but when this protection fails, it can cause hair loss in alopecia areata.

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