Alopecia areata – Current understanding and management

Abstract

Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.

Janus Kinase inhibitors in dermatology: a review

“…Alopecia areata (AA) is a chronic immune-mediated disease characterized by nonscaring hair loss with clinical heterogeneity 16 . The exact etiology of this disease Currently, OPZELURA ® (1.5% RUX cream) is approved in the United States (US) but not in Europe for the treatment of AD, which configurated a major milestone for the treatment of these patients.…”

“…is not yet elucidated, and it is thought that the hair follicle bulb immune privilege collapse is critical in the pathophysiology of the disease. Although it is not yet fully understood what causes immune privilege to collapse, triggering factors suppress immune privilege guardian expression and locally activate the innate immune system mostly via CD8 + NKG2D T cells, leading to subsequent interferon-g (IFN-g) production and major histocompatibility complex class I upregulation that further contribute to immune privilege breakdown 16 .…”

Pharmacology of inhibitors of Janus kinases – Part 1: Pharmacokinetics

“…Given the ubiquity of the JAK/STAT signaling pathway and its involvement in many regulatory mechanisms, especially in inflammatory processes, the use of various JAK inhibitors has been considered or already examined in clinical trials for many chronic inflammatory diseases involving the skin [44][45][46][47]. The most comprehensive data are available for indications of atopic dermatitis [38,48,49], psoriasis and psoriatic arthritis [34,50], alopecia areata [51][52][53], hand eczema [54] and vitiligo [55]. Apart from the development of additional drugs as JAK inhibitors, it is anticipated that evidence for additional indications with dermatological relevance will be established.…”

Pharmakologie der Januskinase‐Inhibitoren – Teil 1: Pharmakokinetik

“…Durch das ubiquitäre Vorkommen des JAK/STAT-Signalwegs und dessen Einbindung in vielfältige Regulationsmechanismen, insbesondere bei Entzündungsprozessen, wurde der Einsatz verschiedener Arzneistoffe aus der Gruppe der JAK-Inhibitoren bei einer Vielzahl chronisch-entzündlicher Erkrankungen mit Beteiligung des Hautorgans erwogen oder bereits in klinischen Studien untersucht [44][45][46][47]. Die umfangreichste Studienlage gibt es in den Indikationen atopische Dermatitis [38,48,49], Psoriasis und Psoriasisarthritis [34,50], Alopecia areata [51][52][53], Handekzem [54] und Vitiligo [55]. Es ist davon auszugehen, dass nicht nur weitere Arzneistoffe als JAK-Inhibitoren entwickelt, sondern auch Evidenzen für weitere Indikationen mit dermatologischer Relevanz geschaffen werden.…”