Answers to Hair Questions: Alopecia Areata and Beyond

Natasha Atanaskova-Mesinkovska, MD, PhD, presented an engaging overview of both established and emerging treatments for hair loss. She began with a classic focus on minoxidil, highlighting dosing differences across men, women, and children. In addition to its well-known vasodilatory mechanism, Dr Mesinkovska emphasized that minoxidil also has anti-androgenic and anti-inflammatory properties, giving it therapeutic potential across several forms of hair loss. She addressed common concerns about blood pressure effects and rare complications such as pericardial effusion, presenting data and practical strategies to help clinicians manage these issues confidently.

She then discussed JAK inhibitors, reviewing their efficacy, mechanisms, and safety in conditions such as alopecia areata, frontal fibrosing alopecia, lichen planopilaris, and central centrifugal cicatricial alopecia. Dr Mesinkovska recommended a treatment trial of six to nine months before assessing hair regrowth outcomes.

Next, she addressed the connection between allergy and hair loss, encouraging clinicians to consider atopy in all patients with hair loss. She reviewed possibilities of allergic contact dermatitis and the role of patch testing in patients with unexplained alopecia. Her research suggests that environmental allergens, such as dust mites, may influence immune responses in alopecia areata and contribute to earlier onset and greater severity, particularly among patients of Chinese ancestry. Reflecting this allergic-immune link, she noted reports of hair regrowth with dupilumab in pediatric alopecia areata and with tralokinumab in adults who have both atopic dermatitis and alopecia areata.

Finally, Dr Mesinkovska highlighted several innovative therapies, including PP405, a topical small molecule in development, and exosome-based approaches. Exosomes are extracellular vesicles that carry bioactive molecules and act as natural biological messengers. They show promise for regenerative, anti-inflammatory, and hair-restorative applications in future dermatologic care.