Non-Immunosuppressant options for Advanced Alopecia Areata

I’m afraid to start JAK inhibitors. What options are available?

I’ve selected this question below for this week’s question of the week. It allows us to review options for advanced alopecia areata.

Question

I am 25 year old and have alopecia universalis. I have used methotrexate and cylosporine and had steroid injections and nothing much has worked. I’m not sure I want to use JAK inhibitors yet.

Can you provide me with some options that one can at least consider in this kind of scenario?

I realize that everyone is just throwing their hands up and telling me to take the JAK inhibitor or give up - what else if anything might there be?

Answer

Thanks for the great question. You are correct that the traditional immunosuppressants are first line for patients with more advanced types of alopecia areata.

There are several non immunosuppressant options that are helpful sometimes. These include dupilumab (if there is evidence of ezecma), oral minoxidil and statin cholesterol medications (simvastatin/ezetimibe). These may be all combined with antihistamines like fexofenadine and cetirizine. I would like to point out that these tend to be less effective that the immunosuppressants you mentioned earlier. Diphenyprone and squaric acid are options but they only help the scalp and not eyebrows and eyelashes. They help 10 % of those with very advanced alopecia areata compared to 30 % with the JAK inhibitors.

You'll want to discuss these options with a dermatologist who specializes in hair loss as these are all more advanced options.