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Alopecia areata (AA) is a chronic, relapsing autoimmune disease characterized by non-scarring hair loss. It can affect the scalp, beard, eyebrows, eyelashes and other body hair. The disease affects individuals of both sexes, all ages and different ethnicities.
The clinical presentation is very variable, from single to multiple plaques, involving the entire scalp (total areata) or the entire hair and body hair (universal areata). These patients are at increased risk of autoimmune diseases such as systemic lupus erythematosus, vitiligo, and thyroid disorders.
Read too: Alopecia areata: review and update
The treatment of mild and localized cases consists of topical and intralesional corticosteroid therapy associated with minoxidil. In extensive cases, topical diphenyprone, oral corticosteroids and immunosuppressants such as methotrexate, cyclosporine and azathioprine can be used.
In refractory cases, there is still no curative treatment that changes its long-term course. However, several drugs that act on the various pathways involved in the pathogenesis of AA have shown promise. The pathophysiology of the disease is not completely understood, but it is known that the hair follicle receives an autoimmune attack by CD8+ T cells in the hair bulb area, generating peribulbitis.
Several cytokines dependent on Janus kinase signaling were related to AA, such as interleukins (IL)-2, IL-7, IL-15, IL-21. This fact makes Janus inhibitors treatment options supported by clinical trials.
Baricitinib is an oral drug that selectively and reversibly inhibits Janus kinases 1 and 2, which can interrupt cytokine signaling implicated in alopecia areata. Recent phase 2 and 3 studies involving patients with severe conditions demonstrated that medication at a dose of 2 or 4 mg was superior to placebo in terms of hair growth at week 36.
The drug was considered safe and well toleratedbut some Side effects described were acne, increased creatine kinase and increase in low- and high-density lipoprotein. More studies are needed to determine their long-term efficacy and safety, but perhaps in the near future JAK inhibitors could be added to the therapeutic arsenal.
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# King B. Efficacy and safety of the oral Janus kinase inhibitor baricitinib in the treatment of adults with alopecia areata: phase two results from The randomized controlled study. J love academy Dermatol. 2021 Oct;85(4):847-853.
# King B. two phase 3 trials of baricitinib for Alopecia Areata. No English J Med. 2022 May 5;386(18):1687-1699.
# Zheng Ç, Tosti A. Alopecia Areata: new treatment options including janus kinase inhibitor. Dermatol clinic. 2021 Jul;39(3):407-415.