Alopecia areata (AA) is an autoimmune, genetic disease that causes relapsing and remitting nonscarring hair loss, affecting up to 2% of the global population. AA is a condition where the psychological burden has been less widely recognized. Patients with AA have reported lower health-related quality of life scores compared to patients with other skin conditions, including psoriasis or atopic dermatitis. Until recently, there were no FDA-approved therapies for AA, using an assortment of topical, intralesional, and systemic agents as the central management strategy. Cytokines have critical roles in the pathogenesis of immunological and inflammatory diseases and can be targeted therapeutically. Targeted, small-molecule therapies that inhibit Janus kinase (JAK) proteins (essential signaling mediators that act downstream of pro-inflammatory cytokines) have gained traction as efficacious options for treating inflammatory disorders, including alopecia areata.
With the introduction of the first US Food and Drug Administration (FDA)–approved medication for alopecia areata (AA)—the Janus kinase (JAK) inhibitor, baricitinib—there is an essential focus on this disease in the literature.
Learning the use of JAK inhibitors in children, dealing with refractory patients, adverse drug reactions, and planning a maintenance dose in successful cases are some everyday problems dermatologists may encounter. A comprehensive review of the different JAK inhibitors addressing those conundrums will help practicing dermatologists.
Dr. Amy McMichael is a dermatologist with over 28 years of experience running a busy hair loss clinic focusing on research on central centrifugal cicatricial alopecia, alopecia areata, and lichen planopilaris. Dr. McMichael has performed single-site and collaborative research in hair disorders, with over 40 Pharmaceutical-sponsored clinical trials, many of which were testing alopecia medication.
Dr. Raúl Cabrera is the Chairman and Chief of the Postgraduate Program of Dermatology at the School of Medicine, Universidad del Desarrollo-Clínica Alemana, Santiago de Chile. He did a fellowship in Dermatology (Immunodermatology) at the Department of Dermatology at the University of Minnesota, U.S.A. He has published many articles in prestigious medical journals in the fields of Immunodermatology, Skin Cancer, and Dermatoscopy. Dr. Cabrera was awarded “Master of Dermatology of the Ibero-Latin America College” in 2022 in recognition of his academic career and investigation into Dermatology. He joined the board of directors of the International League of Dermatologic Societies (I.L.D.S.) and became chair of the I.L.D.S. Guidelines Steering Committee (2016-2019).
Disclosures: Dr. McMichael has consulted for Lilly, Janssen, Pfizer, Arcutis, Almirall, Abbvie, Galderma, Bristol Meyers Squibb, Sanofi-Genzyme, UCB, Revian, Johnson & Johnson, L’oreal, and Nutrafol.
