Current and future pharmacotherapy for alopecia areata

Abstract

Introduction: Alopecia areata is a genetic and inflammatory disease that causes cosmetic and emotional distress. Current treatments are mainly focused in controlling inflammation, thus allowing hair regrowth, but not preventing relapse. Recent advances in the knowledge of the pathogenesis at the immunological and genetic level have provided new therapeutic approaches for this condition.

Areas covered: Literature regarding available and future treatment options for alopecia areata was reviewed. We describe the mechanisms involved in its physiopathology and discuss extensively existing evidence for current treatment and status of new drugs, which act on specific target molecules such as Janus kinase (JAK) inhibitors, abatacept, IL-2, Hu-Mik-β-1, anti-IFN-γ, platelet-rich plasma (PRP), stem cell educator therapy, ezetimibe/simvastatin and tianeptine.

Expert opinion: Advances in the knowledge of the physiopathology of alopecia areata have led to the discovery of new therapeutic targets for this illness. Treatments that have been successful in case reports or small studies are JAK inhibitors, abatacept, IL-2, anti-IFN-γ, PRP, ezetimibe/simvastatin and tianeptine. Even though these drugs have different mechanisms of action, their success will direct future research on drugs that act on a specific target. More clinical trials are needed to establish the safety and efficacy of these drugs, however, new treatment strategies are underway.

Keywords:

• abatacept
• alopecia totalis
• alopecia universalis
• IFN-γ inhibitors
• IL-2
• Janus kinase inhibitors
• methotrexate
• platelet-rich plasma
• ruxolitinib
• tofacitinib

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Notes

This box summarizes key points contained in the article.