Advances to Alopecia Areata Treatment and Diagnostics

With the US Food and Drug Administration (FDA) approval of baricitinib for alopecia areata earlier this year, dermatologists now have what one expert described as “the goal” for treating the common hair-loss condition.

But just as much a single novel agent has positively altered the capability of care in alopecia, it’s shifted how clinicians much approach patients seeking a first-ever prescription.

In the next segment of an interview with HCPLive during the 2022 Fall Clinical Dermatology Meeting this week, Brett King, MD, PhD, associate professor of dermatology at Yale School of Medicine, discussed the importance of clinicians learning the distinction of what patients may or may not benefit from baricitinib.

“We just described the whole spectrum of folks who are coming in to see us now, and it includes the people who have had severe loss for 10, 15, 20 years,” King said. “I’m not saying you can’t try baricitinib in those people, but you don’t expect it to work the same as people who have had hair loss for 5 years.”

He recommended colleagues begin asking key questions to every potential patient with alopecia, including, “What is the duration of your current episode of severe disease?”

“In the past we had no reason to ask that question because we had nothing to offer them,” King said. “Now, we want to be sure that we’re optimizing our patient’s chances of success, and it requires us asking that question.”

Little will change in diagnostics, King said—though the rate of biopsies may increase to ensure patients with lichen planopilaris (LPP) are distinctly identified from baricitinib-eligible patients with alopecia.

“Thinking of the patients with less disease, we don’t want to miss or confuse the patient with LPP that we decide is alopecia areata, because our goal there is not to regrow hair—our goal is to arrest progression of disease,” King said.