Prof. Dr. Sadoughifar Roxanna

Doctor Sadoughifar Roxanna
Bidar Skin Center, Teheran, Iran

Advances in the treatment of Alopecia Areata: Emerging therapies and future perspectives

Author: Roxanna Sadoughifar
Bidar Skin Center, Tehran, Iran

Alopecia areata (AA) is a chronic, immune-mediated disorder characterized by non-scarring hair loss, which can range from localized patches to complete scalp (alopecia totalis) or body hair loss (alopecia universalis). The pathogenesis of AA is primarily driven by autoreactive CD8+ T cells and the interferon-gamma (IFN-γ) signaling pathway, leading to an inflammatory attack on hair follicles. Until recently, treatment options were limited and often ineffective for severe cases. However, novel targeted therapies, particularly Janus kinase (JAK) inhibitors, have revolutionized the management of AA, offering new hope for patients with extensive or recalcitrant disease. Emerging Therapies: 1. JAK Inhibitors: These small-molecule inhibitors block the JAK-STAT signaling pathway, which plays a crucial role in the immune dysregulation seen in AA. The FDA has recently approved baricitinib, an oral JAK1/2 inhibitor, for severe AA, marking a major milestone in treatment. 2. Biologic Therapies: Targeted monoclonal antibodies, such as dupilumab (IL-4/IL-13 inhibitor) and secukinumab (IL-17 inhibitor), are being explored for their potential role in modulating the inflammatory response in AA. 3. Low-Dose Oral Minoxidil: Traditionally used for androgenetic alopecia, low-dose oral minoxidil has shown promise as an adjunct therapy in AA, potentially enhancing hair regrowth through its vasodilatory and pro-survival effects on hair follicles. 4. Platelet-Rich Plasma (PRP) and Exosome Therapy: Regenerative approaches such as PRP and mesenchymal stem cell-derived exosomes have demonstrated potential in reducing inflammation and promoting hair regrowth in AA patients. While not first-line treatments, they may be beneficial as adjuncts, especially for patients seeking non-systemic options. 5. Microbiome-Based and Immunomodulatory Approaches: The role of the gut-skin axis in AA is an emerging area of interest. Probiotic therapy and microbiome modulation may hold potential for immune regulation, though clinical evidence is still limited. Future Directions and Challenges: The advent of JAK inhibitors represents a paradigm shift in AA management; however, long-term safety, risk of relapse, and optimal patient selection remain key concerns. Combination therapies, such as JAK inhibitors with PRP, minoxidil, or biologics, may enhance treatment outcomes. Additionally, predictive biomarkers for treatment response and disease progression are needed to personalize therapeutic strategies. Conclusion: Alopecia areata treatment has entered a new era, with JAK inhibitors offering the first FDA-approved systemic therapy for severe disease. Ongoing research into biologics, regenerative medicine, and immunomodulation will further expand treatment options. As we refine our understanding of AA pathophysiology, personalized approaches integrating emerging therapies will likely become the standard of care, improving long-term outcomes for patients.

Scurt CV

WORK EXPERIENCE
Professor – Pediatric Dermatology Department
University of Marconi, Rome, Italy

09/2014 – Present
Owner
Bidar skin center Tehran-Iran

2000 – 2002
Head of the clinical education sector
Medical University of Qom, Iran

2000 – 2003
University Lecturer
Medical University of Qom, Iran

2020 – 2021
Associated editor
Dermatologic therapy by Wiley

Member:

Honorary president
International Dermatolgy and Cosmetology Congress

Faculty
IMCAS Paris

President
World Health Academy Medical Aesthetic section

Founder
Fatemiyeh University Journal

Editor
Hair and Scalp disorders book,Springer,Nature

Iran Representative
FUE ASIA
Facial Aesthetic Dermatology Society