Key Takeaways
- Baricitinib was the first medication approved by the FDA to treat severe alopecia areata throughout the body, working by blocking immune system pathways that cause inflammation and hair follicle damage.
- Research has identified that the JAK pathway plays a central role in triggering the autoimmune response in alopecia areata. This discovery has led to the development of targeted JAK inhibitor medications that show promise in restoring hair growth.
- Emerging studies suggest a possible connection between gut microbiome imbalances and alopecia areata, with early case reports indicating that fecal transplants may support hair regrowth in some individuals.
Alopecia areata is an autoimmune condition that causes patchy hair loss. With alopecia areata, your immune system mistakenly attacks the hair follicle, leading to inflammation. This causes the hair to fall out.
Alopecia areata can affect anyone at any stage of life. Having a family member with this condition may increase your chances of developing it. You may also be
But for many people with an alopecia diagnosis, there’s no family history or obvious trigger.
Alopecia areata is an unpredictable condition. Some people living with this condition may experience periods of hair loss only once or twice in their life. Others may experience it more frequently. Although there is usually some hair regrowth, it’s impossible to predict how much hair will grow back or whether it will fall out again.
Alopecia areata has different treatment options, but not all treatments work for everyone. Ongoing research helps build out a knowledge base for alopecia and how to treat it.
Here’s what to know about the latest in alopecia research and treatments.
Alopecia areata is an autoimmune condition. Each type of autoimmune condition affects different parts of the body.
Typically, the immune system is designed to protect your body from harmful invaders (like bacteria and cancer). For some reason, the immune system in a person with an autoimmune condition gets mixed up. It attacks an otherwise healthy part of the body, leading to inflammation, which damages the area.
In alopecia areata, the immune system mistakenly attacks the hair follicles, causing hair to fall out.
The immune system is complicated. Many treatments for autoimmune conditions work to reduce the overactive immune response. They can be helpful but don’t always fully address the underlying issue.
Targeted treatments modify a specific immune response. There was hope that the targeted treatment of biologic drugs could help treat alopecia areata. These medications are used to manage other autoimmune and inflammatory conditions. So far, biologics research has been mixed when it comes to treating alopecia areata.
However, recent research found that a part of the immune system called the
With this knowledge, researchers were able to move forward by creating more targeted treatments, known as Janus kinase (JAK) inhibitors, to help with alopecia areata.
In June 2022, a medication called baricitinib (Olumiant) received approval from the Food and Drug Administration (FDA) to treat severe cases of alopecia areata.
It’s the first FDA-approved systemic treatment for alopecia areata. This type of systemic treatment helps treat hair loss all over the body.
Before this drug’s approval, alopecia treatments only targeted a specific area of hair loss. Treating one area of hair loss does not prevent hair loss or promote hair growth in other parts of the body. This can be a very frustrating part of living with alopecia areata.
Baricitinib is a JAK inhibitor that’s taken orally.
Researchers have since identified how the JAK pathway is involved in alopecia areata. Cytokines are small proteins released by the immune system. In alopecia areata, cytokines activate the JAK pathway, causing inflammation that damages hair follicles. JAK inhibitors, like baricitinib, help block cytokines from reaching the JAK pathway. This supports hair regrowth. There are several types of JAK inhibitors. Baricitinib specifically targets tyrosine kinase receptors and reduces the release of several pro-inflammatory cytokines.
Baricitinib was approved based on scalp hair recovery after 36 weeks. Adequate scalp hair coverage was defined as 80% of the scalp. This was achieved in
Alopecia areata is a new indication for this drug. Baricitinib has been used to treat rheumatoid arthritis since 2018.
Deuruxolitinib was FDA-approved for the treatment of severe alopecia areata in 2024.
The medication was known as CTP-543 in clinical trials. It is another JAK inhibitor that inhibits Janus kinases JAK1 and JAK2. This is in the same drug class as baricitinib, but works differently.
Results from the clinical trials showed that “by week 24, approximately one-third of patients achieved greater than or equal to 80% scalp hair coverage, with some reaching 90%.” Further studies have supported this.
You may already be familiar with the term “gut microbiome.” It refers to the colonies of microscopic living things that reside in your digestive system. They play a part in digesting your food and protecting your health.
There’s still debate about what a “healthy” gut microbiome looks like. In general, more
When the gut microbiome gets out of balance, it’s known as dysbiosis. Dysbiosis has been linked to a variety of health conditions. It’s unclear what comes first: Does a disease cause dysbiosis? Or does something shift in the gut microbiome that contributes to disease development?
Most of our immune system actually lives in the digestive system. About
Gut dysbiosis is seen in alopecia as well as other inflammatory skin conditions.
Fecal transplants have been used to restore the gut microbiome in other conditions. It’s a known treatment for Clostridioides difficile (C. diff).
Clinical trials are essential for learning more about alopecia areata and its treatments. After promising findings in a lab setting, clinical trials are a chance to see how a treatment works in real people.
If you’re interested in joining a clinical trial or just want to stay in the loop with the latest research, check out ClinicalTrials.gov.
Doctors use several other types of treatments for alopecia areata. The goal of alopecia treatment is to regrow hair or slow or prevent hair loss.
There are a few approaches. One is to stimulate hair growth in areas where the hair has fallen out. The other is to reduce the immune system activity that causes hair to fall out.
Current treatment options include:
- topical steroid foams
- topical immunotherapy
- anthralin ointment or cream
- steroid injections
- oral corticosteroids
- immune-suppressing oral medications
- Minoxidil
Alopecia areata can be challenging to treat. There’s no way to predict which type of treatment will work best for you. It’s also possible that hair will fall out again after treatment.
Not everyone with alopecia areata will decide to treat their alopecia. It’s a very personal decision. Discuss treatment options with your doctor. It’s important to understand the benefits and side effects to determine which treatment is right for you.
Alopecia areata is an autoimmune condition that can cause hair loss anywhere on the body, including eyebrows and eyelashes. Related hair loss and regrowth can be unpredictable. As a result, alopecia areata can be challenging to treat. Talk with your doctor to determine which treatment is best for you.
Research into alopecia areata has led to new treatment options and others on the horizon. The hope is that new knowledge can continue to lead to new treatments and ultimately a cure.