Current Trends and Emerging Paradigms in the Treatment of Alopecia Areata
DOI:
https://doi.org/10.12775/QS.2026.62.73248Keywords
Alopecia areata, Janus kinase inhibitors, Baricitinib, Ritlecitinib, Deuruxolitinib, JAK/STAT signaling pathway, Regenerative medicine, Exosomes, Platelet-rich plasma (PRP), TrichoscopyAbstract
Background: Alopecia areata (AA) is an unpredictable, immune-mediated form of non-cicatricial hair loss driven by the collapse of hair follicle immune privilege. Beyond its physical manifestation, the highly visible nature of AA inflicts a profound psychosocial and emotional burden on adult, adolescent, and pediatric populations, severely degrading their quality of life.
Aim: This review evaluates the current trends and major paradigm shifts in the therapeutic landscape of AA, analyzing the transition from traditional, non-specific immunosuppression to targeted molecular and regenerative interventions based on high-level evidence up to 2026.
Materials and methods: A comprehensive synthesis of peer-reviewed literature - including systematic reviews, network meta-analyses, and recent Phase III clinical trial data - was conducted to evaluate the comparative efficacy, safety profiles, and clinical positioning of established and emerging therapies.
Results: Janus kinase inhibitors (baricitinib, ritlecitinib, and deuruxolitinib) demonstrate superior efficacy in moderate-to-severe AA, achieving significant scalp hair regrowth (SALT score of 20 or less). Concurrently, regenerative therapies like exosomes and platelet-rich plasma (PRP) offer effective local alternatives, while structured psychological support significantly reduces patient anxiety and depression.
Conclusion: Targeted and regenerative modalities have fundamentally redefined AA care. However, long-term success is challenged by high relapse rates post-discontinuation and socioeconomic barriers, highlighting the need for personalized maintenance protocols.
References
Al-Dhubaibi, M. S., Alsenaid, A., Alhetheli, G., & Abd Elneam, A. I. (2023). Trichoscopy pattern in alopecia areata: A systematic review and meta-analysis. Skin Research and Technology, 29, 1–27. https://doi.org/10.1111/srt.13378
Alsaati, A. A., Kaliyadan, F., Alsaadoun, D., Alzakry, L. M., Alzabadin, R. A., Hakami, T. H., & Rubaian, N. F. B. (2026). Vitamin D and its analogs in treatment of mild to moderate alopecia areata: Systematic review and meta-analysis. Indian Dermatology Online Journal, 17(1), 10–20. https://doi.org/10.4103/idoj.idoj_958_24
Bulgaru-Iliescu, A. I., Moraru, D. C., Amarandei, A.-H., Avadanei-Luca, S., Constantinescu, M.-C., Rusu, A. C., & Pertea, M. (2026). Exosome-based therapies for alopecia areata: A systematic review of clinical and experimental evidence. International Journal of Molecular Sciences, 27(1), Article 21. https://doi.org/10.3390/ijms27010021
Cuper, P., Pawłucki, P., Maciak, A., Kozicz, M. A., Jastrzębska, I., Bilecki, K., Gugulski, H., Bado, M., Nowoświat, P., & Sekuła, M. (2024). Complex minoxidil and platelet-rich plasma therapy effectiveness and its impact on physical performance. Quality in Sport, 19, 53183. https://doi.org/10.12775/QS.2024.19.53183
De Sousa, V. B., Arcanjo, F. P., Aguiar, F., Vasconcelos, J., Oliveira, A. F., Honório, A., & Pontes, J. (2022). Intralesional betamethasone versus triamcinolone acetonide in the treatment of localized alopecia areata: A within-patient randomized controlled trial. Journal of Dermatological Treatment, 33(2), 875–877. https://doi.org/10.1080/09546634.2020.1788703
Egeberg, A., Linsell, L., Johansson, E., et al. (2023). Treatments for moderate-to-severe alopecia areata: A systematic narrative review. Dermatology and Therapy, 13, 2951–2991. https://doi.org/10.1007/s13555-023-01044-5
El-Ashmawy, A. A., El-Maadawy, I. H., & El-Maghraby, G. M. (2018). Efficacy of topical latanoprost versus minoxidil and betamethasone valerate on the treatment of alopecia areata. Journal of Dermatological Treatment, 29(1), 55–64. https://doi.org/10.1080/09546634.2017.1330527
Guttman-Yassky, E., Renert-Yuval, Y., Bares, J., et al. (2022). Phase 2a randomized clinical trial of dupilumab (anti-IL-4Rα) for alopecia areata patients. Allergy, 77, 897–906. https://doi.org/10.1111/all.15071
Jafari, M. A., Bazgir, G., Hosseini-Baharanchi, F. S., Jafarzadeh, A., & Goodarzi, A. (2024). Efficacy and safety of laser therapy and phototherapy in cicatricial and noncicatricial alopecia: A systematic review study. Health Science Reports, 7, Article e70180. https://doi.org/10.1002/hsr2.70180
Joly, P., Lafon, A., Houivet, E., et al. (2023). Efficacy of methotrexate alone vs methotrexate plus low-dose prednisone in patients with alopecia areata totalis or universalis: A 2-step double-blind randomized clinical trial. JAMA Dermatology, 159(4), 403–410. https://doi.org/10.1001/jamadermatol.2022.6687
Jun, J. H., Lee, H. W., Choi, T.-Y., & Lee, M. S. (2026). Acupuncture for treating alopecia areata: A systematic review and meta-analysis. Medicine, 105(12), Article e48073. https://doi.org/10.1097/MD.0000000000048073
King, B., Mesinkovska, N., Senna, M., Luo, X., Minkiewicz, J., & Selfridge, A. (2025). Efficacy and safety of etrasimod in alopecia areata: A multicentre, randomized, double-blind, placebo-controlled, Phase 2 study. Journal of the European Academy of Dermatology and Venereology, 39, 1174–1184. https://doi.org/10.1111/jdv.20605
King, B., Mostaghimi, A., Shimomura, Y., et al. (2025). Safety of baricitinib in adults with severe alopecia areata from two phase III trials over a median of 2.3 years and up to 4 years of treatment. American Journal of Clinical Dermatology, 26, 611–622. https://doi.org/10.1007/s40257-025-00932-0
Li, M., Xiang, L., & Li, Y. (2025). Efficacy and safety of compound glycyrrhizin in patients with alopecia areata: A systematic review and meta-analysis. Annals of Medicine, 57(1). https://doi.org/10.1080/07853890.2025.2491659
Liu, M., Gao, Y., Yuan, Y., et al. (2023). Janus kinase inhibitors for alopecia areata: A systematic review and meta-analysis. JAMA Network Open, 6(6), Article e2320351. https://doi.org/10.1001/jamanetworkopen.2023.20351
Liu, Y., Li, J., Liang, G., et al. (2020). Association of alopecia areata with vitamin D and calcium levels: A systematic review and meta-analysis. Dermatology and Therapy, 10, 967–983. https://doi.org/10.1007/s13555-020-00433-4
Majewski, M., Gardaś, K., Waśkiel-Burnat, A., Ordak, M., & Rudnicka, L. (2024). The role of minoxidil in treatment of alopecia areata: A systematic review and meta-analysis. Journal of Clinical Medicine, 13(24), Article 7712. https://doi.org/10.3390/jcm13247712
Maloh, J., Engel, T., Natarelli, N., Nong, Y., Zufall, A., & Sivamani, R. K. (2023). Systematic review of psychological interventions for quality of life, mental health, and hair growth in alopecia areata and scarring alopecia. Journal of Clinical Medicine, 12(3), Article 964. https://doi.org/10.3390/jcm12030964
Mateos-Haro, M., Novoa-Candia, M., Sánchez Vanegas, G., Correa-Pérez, A., Gaetano Gil, A., Fernández-García, S., Ortega-Quijano, D., Urueña Rodriguez, M. G., Saceda-Corralo, D., Bennouna-Dalero, T., Giraldo, L., Tomlinson, J., Vaño-Galván, S., & Zamora, J. (2023). Treatments for alopecia areata: A network meta-analysis. Cochrane Database of Systematic Reviews, (10), Article CD013719. https://doi.org/10.1002/14651858.CD013719.pub2
Mesinkovska, N., King, B., Zhang, X., Guttman-Yassky, E., Magnolo, N., Sinclair, R., et al. (2024). Efficacy and safety of ritlecitinib, an oral JAK3/TEC family kinase inhibitor, in adolescent and adult patients with alopecia totalis and alopecia universalis. The Journal of Dermatology, 51, 1414–1424. https://doi.org/10.1111/1346-8138.17442
Mostaghimi, A., Napatalung, L., Sikirica, V., et al. (2021). Patient perspectives of the social, emotional and functional impact of alopecia areata: A systematic literature review. Dermatology and Therapy, 11, 867–883. https://doi.org/10.1007/s13555-021-00512-0
Nowaczyk, J., Makowska, K., Rakowska, A., et al. (2020). Cyclosporine with and without systemic corticosteroids in treatment of alopecia areata: A systematic review. Dermatology and Therapy, 10, 387–399. https://doi.org/10.1007/s13555-020-00370-2
Piliang, M., Soung, J., King, B., Shapiro, J., Rudnicka, L., Farrant, P., Magnolo, N., Piraccini, B. M., Luo, X., Wolk, R., Woodworth, D., Schaefer, G., & Lejeune, A. (2025). Efficacy and safety of the oral Janus kinase 3/tyrosine kinase expressed in hepatocellular carcinoma family kinase inhibitor ritlecitinib over 24 months: Integrated analysis of the ALLEGRO phase IIb/III and long-term phase III clinical studies in alopecia areata. British Journal of Dermatology, 192(2), 215–227. https://doi.org/10.1093/bjd/ljae365
Sowińska, T., Łabuda, M., Słojewska, A., Kotkowiak, A., Mentel, O., Bogucka, A., ... Knychalska, K. (2025). Hair loss: Pathogenesis and prevention: A literature review. Quality in Sport, 41, 59999. https://doi.org/10.12775/QS.2025.41.59999
Tan, I. J., & Jafferany, M. (2024). Psychosocial impact of alopecia areata in paediatric and adolescent populations: A systematic review. Journal of Paediatrics and Child Health, 60, 778–782. https://doi.org/10.1111/jpc.16678
Tejapira, K., Yongpisarn, T., Sakpuwadol, N., & Suchonwanit, P. (2022). Platelet-rich plasma in alopecia areata and primary cicatricial alopecias: A systematic review. Frontiers in Medicine, 9, Article 1058431. https://doi.org/10.3389/fmed.2022.1058431
Tsianakas, A., Passeron, T., Magnolo, N., Blume-Peytavi, U., Kelly, V., Day, I., Serrao, R., Guttman-Yassky, E., Sticherling, M., Csernus, A., Moreno-Arrones, O., Hamilton, C., & Cassella, J. (2025). Efficacy and safety of deuruxolitinib, an oral selective Janus kinase 1/2 inhibitor, in adults with alopecia areata: Results from the THRIVE-AA2 Phase 3, randomized, double-blind, controlled trial. Journal of the American Academy of Dermatology, 94, 1134–1143. https://doi.org/10.1016/j.jaad.2025.11.070
Tziotzios, C., Sinclair, R., Lesiak, A., Mehlis, S., Kinoshita-Ise, M., Tsianakas, A., et al. (2025). Long-term safety and efficacy of ritlecitinib in adults and adolescents with alopecia areata and at least 25% scalp hair loss: Results from the ALLEGRO-LT phase 3, open-label study. Journal of the European Academy of Dermatology and Venereology, 39, 1152–1162. https://doi.org/10.1111/jdv.20526
Van Caelenberg, E., Belpaire, A., van Geel, N., & Speeckaert, R. (2025). A meta-analysis of chemokines in alopecia areata: Recruiting immune cells toward the hair follicle. Frontiers in Immunology, 16, Article 1648868. https://doi.org/10.3389/fimmu.2025.1648868
Wei, D., Chen, Y., Shen, Y., Xie, B., & Song, X. (2023). Efficacy and safety of different JAK inhibitors in the treatment of alopecia areata: A network meta-analysis. Frontiers in Immunology, 14, Article 1152513. https://doi.org/10.3389/fimmu.2023.1152513
Yan, T., Wang, T., Tang, M., & Liu, N. (2024). Comparative efficacy and safety of JAK inhibitors in the treatment of moderate-to-severe alopecia areata: A systematic review and network meta-analysis. Frontiers in Pharmacology, 15, Article 1372810. https://doi.org/10.3389/fphar.2024.1372810
Yu, D. A., Kim, Y. E., Kwon, O., & Park, H. (2021). Treatment outcome of oral tofacitinib and ruxolitinib in patients with alopecia areata: A systematic review and meta-analysis. Indian Journal of Dermatology, Venereology and Leprology, 87, 621–627. https://doi.org/10.25259/ijdvl_975_19
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Hubert Feretycki, Anhelina Kaminskaya, Aleksandra Kurek, Aladdin Salama, Aleksandra Głowacka, Tetiana Savchak, Patryk Górecki, Sofiia Ivanchuk , Dominika Domińczak, Shafea Abdulla
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 77
Number of citations: 0
