Posted by: Skin and Cancer Institute in Medical Dermatology

Man with alopecia

Alopecia areata is a condition where people lose their hair in patches and it can be frustrating and embarrassing for those who are affected. The FDA’s approval of baricitinib is an important step forward for alopecia areata patients and offers an effective therapy for this hair loss condition.

In June 2022, the FDA ended the wait for a specific treatment for alopecia areata with its approval of the novel oral Janus Kinase (JAK) inhibitor baricitinib. It’s the first systemic treatment specifically for severe alopecia areata and has been proven effective in clinical trials. 

What Causes Alopecia Areata? 

Alopecia areata happens when the immune system stops the production of new hair by attacking the hair follicles, causing hair to fall out on the scalp, face, and sometimes on other body parts. 

Who Can Get Alopecia Areata?

Alopecia Areata can affect men and women alike and can occur at any age. Approximately 7 million people in the United States are affected by alopecia areata, and the lifetime risk is about 2 percent. It is believed to be caused by genetic and environmental factors.

Types of Alopecia Areata

Alopecia areata comes in several forms, and the diagnosis is often made based on the pattern of hair loss.

Patchy Alopecia Areata

There are several different alopecia areata types, each with its own set of symptoms and patterns of hair loss. The most common type is patchy alopecia areata, in which round patches of hair loss appear on some areas of the scalp. 

Diffuse Alopecia Areata

Another type, diffuse alopecia areata, is characterized by abrupt and intense hair loss that is more widespread than patchy alopecia areata.

Ophiasis Alopecia Areata 

Ophiasis alopecia areata specifically affects the hair on the sides and back of your head, leaving a band-shaped area of baldness. 

Alopecia Areata Can Affect Different Parts of the Body

Alopecia Areata Totalis

Alopecia areata is a condition that causes patchy hair loss on the scalp. However, in some cases, the hair loss can be more severe, causing complete baldness on the scalp. This form of alopecia areata is known as alopecia areata totalis.

Alopecia Areata Universalis 

The most severe form of this condition is alopecia areata universalis, which affects the entire body. People with alopecia areata universalis do not have any hair on their body or head. This includes the loss of eyelashes and eyebrows. 

Symptoms of Alopecia Areata

The first symptom of Alopecia Areata is typically the sudden onset of round, smooth patches of hair loss. These patches are usually bald but can also have fine hairs. In some cases, hair loss could be accompanied by itching or burning. 

Alopecia Areata Risk Factors

We don’t know the exact cause of alopecia areata, but several factors may increase your risk of developing the condition. Family history is one of the most important risk factors for alopecia areata. If you have a close relative with the condition, you are more likely to develop it yourself. Other risk factors include certain conditions such as vitiligo, thyroid disease, seasonal allergies, asthma, Down Syndrome, or pernicious anemia. 

Diagnosing Alopecia Areata

It is essential to see a dermatologist for an evaluation if you think you might have alopecia areata. They will take a close look at the places where you have hair loss and may gently pull on hairs near bald areas to see if they come out easily.

In some cases, a biopsy (removal of a small piece of skin for microscopic examination) may be necessary to confirm the diagnosis. Your doctor will also want to rule out other potential causes of hair loss, such as fungal infections or thyroid, hormone, or immune system disorders.

Regrowing Hair

It’s possible for hair to regrow on its own in people affected by alopecia areata. Often, though, alopecia areata sufferers choose treatment to speed the hair regrowth process. Although there is no cure for alopecia areata, specific treatments can help promote hair growth. 

Baricitinib 

Baricitinib is a medication that inhibits Janus kinase (JAK) proteins and calms your immune responses. In a study of patients with alopecia areata, baricitinib was found to be effective in promoting hair growth. Additionally, baricitinib was well-tolerated.

Minoxidil 

Minoxidil (Rogaine) is a medication that is used to treat hair loss. It is available as a topical solution, foam, or spray and increases the length of the hair-growth cycle.

Corticosteroids 

Corticosteroids are anti-inflammatory drugs commonly used to treat autoimmune diseases. They can be given as an injection into the scalp or other areas, or they can be taken orally as a pill. Corticosteroids can also be applied to the skin as an ointment, cream, or foam. The downside of corticosteroids is that they may take a while to work.

Topical immunotherapy 

Topical immunotherapy is a hair loss treatment involving applying chemicals to the scalp to produce an allergic reaction. If the treatment is successful, the allergic reaction will trigger new hair growth. Topical immunotherapy can be an effective treatment for hair loss, but it can also cause an itchy rash and must be applied regularly to maintain the new hair growth.

If You Have Alopecia Areata

Alopecia areata is unpredictable and can wax and wane over time, and it is not currently possible to predict when or how extensively it may affect an individual. While it is not life-threatening, it can be emotionally devastating for those affected. If you have alopecia areata, it is essential to seek medical attention to receive the support and treatment you need.

If you think you might have Alopecia Areata, schedule an appointment with a dermatologist at the Skin and Cancer Institute. There are a variety of treatments available that can help to improve the appearance of your hair, and many people find that their hair grows back over time.