Rethinking Alopecia Areata: When, Why, and How to Treat

At the Masterclasses in Dermatology APP Institute, Oyetewa Asempa, MD, FAAD, led a practical and compassionate session titled “Alopecia Areata: Treatment Considerations,” offering a fresh look at managing this unpredictable autoimmune disease.

“Alopecia areata (AA) is a chronic, non-scarring autoimmune condition,” she explained, “with variable hair loss ranging from patchy areas to complete scalp (alopecia totalis) or body (alopecia universalis) involvement.”

The disease affects up to 2% of the population and often presents alongside other autoimmune or atopic conditions. But for patients, it is more than hair loss. Dr Asempa emphasized the psychosocial burden, noting the “bidirectional association between major depressive disorder and AA” and calling for mental health support to be part of comprehensive care.

Dr Asempa laid out a treatment approach based on severity. For limited patchy disease, she recommended “potent topical corticosteroids or intralesional triamcinolone acetonide,” which can yield regrowth but often with relapse risk.

For moderate to severe AA, systemic corticosteroids, immunosuppressants, and topical immunotherapy are options, although many remain off label. Dr Asempa emphasized weighing “the uncertainty of achieving sustained hair regrowth” and “potential adverse effects of treatment” against patient goals and preferences.

The session spotlighted major advances with US Food and Drug Administration-approved Janus kinase (JAK) inhibitors, including baricitinib and ritlecitinib, which “demonstrate significant efficacy in randomized trials.” Still, Dr Asempa advised caution given “uncertainty about long-term safety” due to boxed warnings for infection, malignancy, and cardiovascular events.

She also reviewed emerging treatments, including investigational oral agents like brepocitinib and CTP-543, and acknowledged the mixed evidence for topical JAKs. “The efficacy of topical JAK inhibitors [is] uncertain,” she noted, although select agents like tofacitinib 2% ointment have shown promise in small studies and pediatric use.

There is no universal algorithm for AA but according to Dr Asempa, that is all the more reason to tailor treatment thoughtfully.

“Careful consideration of patients’ preferences [and] possibility of spontaneous regrowth… should guide treatment decisions.”

With more tools than ever and patients seeking real answers, APPs are positioned to lead with both clinical skill and empathy.

Reference

Asempa OB. Alopecia areata: treatment considerations. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.