Alopecia Areata Update at WCM25

Alopecia areata is a complex autoimmune condition with profound physical and emotional impacts on patients. Natasha Mesinkovska, MD, PhD, opened her presentation with a fascinating discussion on mortality rates in patients with alopecia areata and vitiligo, noting that these rates are lower than in the general population. She then delved into factors beyond autoimmunity that may contribute to alopecia areata, including stress, reduced antioxidant activity, low levels of vitamin D and zinc, associated celiac disease, and imbalances in serum Th1, Th2, and Th17 levels.

Dr Mesinkovska provided updates on treatment innovations, particularly the expanding role of JAK inhibitors such as baricitinib, ritlecitinib, and deuruxolitinib, which have demonstrated significant efficacy in clinical trials. She highlighted the need for sustained, long-term treatment to maintain hair regrowth and emphasized the importance of weighing safety and side effect considerations. Additionally, she addressed challenges regarding the use of JAK inhibitors in pediatric patients and during pregnancy, as most JAK inhibitors cross the placental barrier (with deucravacitinib being a notable exception). Despite these challenges, she advocated for maintaining JAK inhibitors as an option for patients of reproductive age.

The presentation also explored the strong association between alopecia areata and atopic dermatitis, the most common comorbidity in these patients. She reviewed treatment approaches for concurrent conditions, including dupilumab, tralokinumab, and lebrikizumab, each showing varying levels of success. Dr Mesinkovska concluded with an exciting potential treatment: localized injections of baricitinib-loaded mesenchymal stem cell exosomes, which may represent a novel approach for managing alopecia areata.