Lorena Avila

Alopecia areata: An appraisal of new treatment approaches and overview of current therapies

Many therapies are available for the treatment of alopecia areata, including topical, systemic, and injectable modalities. However, these treatment methods produce variable clinical outcomes and there are no currently available treatments that induce and sustain remission. When making management decisions, clinicians must first stratify patients into pediatric versus adult populations. Disease severity should then be determined (limited vs extensive) before deciding the final course of therapy. The second article in this continuing medical education series describes the evidence supporting new treatment methods, among them Janus kinase inhibitors. We evaluate the evidence concerning the efficacy, side effects, and durability of these medications. An overview of conventional therapy is also provided with new insights gleaned from recent studies. Finally, future promising therapeutic options that have not yet been fully evaluated will also be presented.

Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis

Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss. Significant variations in the clinical presentation of AA have been observed, ranging from small, well-circumscribed patches of hair loss to a complete absence of body and scalp hair. Patients affected by AA encompass all age groups, sexes, and ethnicities, and may experience frustration with the unpredictable nature of their disease for which there is currently no definitive treatment. The cause of AA remains incompletely understood, though it is believed to result-at least in part-from a loss of immune privilege in the hair follicle, autoimmune-mediated hair follicle destruction, and the upregulation of inflammatory pathways. Patients with AA frequently experience marked impairment in psychological well-being, self-esteem, and may be more likely to suffer from psychiatric comorbidities. Part one of this two-part continuing medical education series describes the epidemiology, clinical evaluation, prognosis, and recent advancements in the understanding of the pathogenesis of AA.

Image Gallery: Treatment of refractory alopecia universalis with oral tofacitinib citrate and adjunct intralesional triamcinolone injections

DEAR EDITOR, A young man with alopecia universalis (top) refractory to methotrexate was started on tofacitinib (a Janus kinase inhibitor), which may promote hair regrowth in severe alopecia areata (AA). This was combined with monthly injections of corticosteroids into the eyebrows and scalp – a common therapy for AA – which, like Janus kinase inhibitors, reduces inflammation around hair follicles. After 10 months of tofacitinib treatment combined with triamcinolone injections (2 5 mg mL ) into the eyebrows from the start of treatment, and into the scalp starting after 7 months of treatment, the patient achieved near complete regrowth (bottom). His nails remained dystrophic with mild improvement. No adverse effects were observed. L .C . STRAZZUL LA L . AV I L A K . LO S I C CO J . SHA P I RO The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, U.S.A. Correspondence: Jerry Shapiro. E-mail: jerry.shapiro@nyumc.org

Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases

Alexander H. Fischer, MD, MPH, Daniel B. Shin, PhD, Joel M. Gelfand, MD, MSCE, and Junko Takeshita, MD, PhD, MSCE Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and the Department of Dermatology and the Department of Biostatistics Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

An Overview of the Biology of Platelet-Rich Plasma and Microneedling as Potential Treatments for Alopecia Areata

Platelet-rich plasma and microneedling have been investigated recently as potential therapeutic options for the treatment of hair disorders. Evidence from laboratory studies indicates that these treatments enhance growth factor production that in turn facilitates hair follicle development and cycling. Several small studies and case reports have presented encouraging findings regarding the use of these treatments for alopecia areata. Future investigations will be needed to validate these therapeutic techniques for patients with alopecia areata and further refine which subtypes of the disease these methods are best indicated for.