The treatment landscape for alopecia areata has changed more in the past three years than in the previous three decades. The approval of JAK inhibitors for moderate to severe alopecia areata represents the first genuinely effective pharmacological treatments for this condition, shifting the management paradigm significantly.
Baricitinib (Olumiant) became the first JAK inhibitor specifically approved for alopecia areata in the UK and was followed by ritlecitinib (Litfulo), approved for patients aged twelve and over. These medications work by inhibiting JAK signalling pathways that mediate the autoimmune attack on hair follicles. Clinical trials have shown significant hair regrowth in approximately 30 to 40% of patients — meaningful improvement in a condition that previously had no approved treatments with this level of efficacy.
Traditional treatments that remain in use include: corticosteroids (topical, intralesional injection, or systemic courses for severe cases), topical immunotherapy with diphencyprone (DPCP), dithranol, contact sensitisers, and minoxidil as an adjunct. These remain relevant, particularly for patients with limited or patchy disease who may not meet criteria for JAK inhibitor therapy.
The emergence of JAK inhibitors has also reopened the question of hair transplant surgery for patients who achieve sustained remission on these medications. If JAK inhibitor therapy produces durable regrowth that remains stable for two or more years, the surgical candidacy criteria for alopecia areata patients may be met — though this requires careful individual assessment.
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