FDA and EMA approve baricitinib to treat severe alopecia areata in adults
Baricitinib, a Janus kinase (JAK) inhibitor, is the first systemic drug to be approved by the US Food and Drug Administration and the European Medicine Agency to treat adults with severe alopecia areata. The approval is based on two randomised, placebo-controlled phase 3 trials, which demonstrated that oral baricitinib increases hair regrowth at 36 weeks, compared with placebo, in people with severe alopecia areata. Adverse effects included acne, elevated levels of creatine kinase and increased levels of low and high density lipoprotein cholesterol.
Alopecia areata is an autoimmune disease that targets the hair follicle.
It is characterised by sudden onset of patchy hair loss.
The diagnosis is clinical. Characteristic physical findings are exclamation mark hairs (short, broken hairs tapering proximally at the scalp) and a positive pull test. A scalp biopsy shows perifollicular inflammation.
Topical or intralesional corticosteroids are appropriate for patients with limited hair loss. Skin atrophy can be a temporary side effect.
Alopecia areata (AA) is an autoimmune disease that causes inflammation of the hair follicles resulting in non-scarring hair loss, affecting scalp and body hair. Typically, one or more small round patch of hair loss without atrophy is noticed. This patchy hair loss may regrow spontaneously. In other cases there can be extensive patchy hair loss and in rare cases there is total body hair loss (alopecia areata universalis), or total scalp hair loss (alopecia totalis).
History and exam
Key diagnostic factors
- hair loss
- non-scarring alopecia
- exclamation mark hairs
- normal underlying skin in bare areas
- nail pitting
Other diagnostic factors
- autoimmune disease
- family history of autoimmune disease
1st investigations to order
- clinical diagnosis
- positive hair pull test
Investigations to consider
- skin biopsy
limited hair loss (treatment desired)
limited hair loss (no treatment desired)
extensive hair loss (treatment desired)
extensive hair loss (no treatment desired)
- Tinea capitis
- Telogen effluvium
- British Association of Dermatologists' guidelines for the management of alopecia areata 2012
- EEMCO guidance for the assessment of hair shedding and alopecia
Alopecia areataMore Patient leaflets
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