Autoinmune Alopecia/Alopecia Areata

Autoimmune alopecia or alopecia areata (AA) is an autoimmune nonscarring alopecia characterized by sudden and patchy hair loss that can affect any hair-bearing area. The diagnosis of AA is clinical but can be supported by trichoscopy, and skin biopsy and histological examination are only performed in selected cases. Mild episodes with a duration of less than 12 months may resolve spontaneously; however, extensive alopecia areata is unlikely to remit without treatment. Classical management is guided by the degree of scalp and body involvement, with topical and intralesional steroid injections as primarily first-line for mild cases, and oral corticosteroids and broad immunosuppressants. However, the recent US FDA-approved Janus kinase (JAK) inhibitors for AA, baricitinib (2022) and ritlecitinib (2023), are a promising drug class for treating severe alopecia areata cases. Moreover, the landscape of treating still has the potential to be transformed, as several novel targeted drugs are currently undergoing clinical trials.