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Here's the latest article from myself and colleagues. Open access so you can download it for free:
Lai, H. J., Ye, Z. M., Chen, S. Q., McElwee, K. J., & Guo, H. W. (2025). Immune therapies for alopecia areata: evidence and new perspectives. Expert Review of Clinical Immunology, 21(10), 1421–1446. doi.org/10.1080/174466…
Plain Language Summary
Alopecia areata (AA) causes sudden, patchy hair loss because the body’s own immune cells mistakenly attack hair follicles. Hair follicle proteins are normally hidden from the immune system behind a physical and biochemical barrier. Genes, stress and other triggers, appear to disturb this ‘immune-privileged’ zone, letting immune cells inside hair follicles. Finding proteins they have never seen before activates immune cells, causing inflammation that blocks hair growth.
Doctors still rely on treatments such as steroid creams or scalp skin injections to regrow hair in AA patches, but not everyone responds and there are side effect risks. Contact-sensitizing chemicals, such as DPCP or SADBE, create a mild allergic rash. This skin irritation can promote hair growth in some patients with moderate AA. Light therapy and older drugs like methotrexate or cyclosporine are alternatives in some clinics, but the benefits are unpredictable and side-effects restrict long-term use.
New science is reshaping care. JAK inhibitor drugs block key switches inside immune cells and enable hair regrowth, though relapse after stopping treatment and infection risk remain issues. Drugs that block specific immune signals or checkpoints are also in trials. AA is a spectrum that varies by age, hair loss extent, allergy history, and immune profile. Methods are needed that calculate the best treatment option to use for each patient, based on clinical data and blood tests, to avoid trial-and-error treatment and cut side-effect risks. In the future, treatments that quickly calm inflammation and then restore the follicle’s natural protection may provide a lasting cure.
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