In this video blog, Jerry Shapiro, MD, discusses highlights from his lecture, Update on Alopecia Areata on July 27, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.
In this video
Dr. Shapiro describes how variable alopecia areata can be — from a single small patch to many patches anywhere hair grows, including eyebrows, eyelashes, and beard, and on to the more extensive variants of alopecia totalis (loss of all scalp hair) and alopecia universalis (loss of hair everywhere on the body). On JAK inhibitors, he notes they're typically reserved for patients with more than 50% scalp involvement, in part because insurers often require that extent, though exceptions can be made when eyebrow and eyelash loss is affecting a patient psychologically. He stresses selecting healthy patients — without a history of cancer or strokes — and monitoring them carefully.
He's "ecstatic" that the therapeutic cupboard now holds three options for adults, with the newly approved deuruxolitinib joining the field and showing results that "look really good." On down-titration, he cautions that lowering the dose carries a real risk of hair loss; he'll do it for patients willing to accept that risk, but is equally comfortable keeping patients on a higher dose as long as they return for follow-up and stay monitored.
- Alopecia areata is highly variable — ranging from a single patch to totalis (all scalp hair lost) and universalis (all body hair lost).
- JAK inhibitors are generally used at more than 50% scalp involvement, partly driven by insurance criteria, with exceptions for eyebrow/eyelash loss causing psychological impact.
- Select healthy candidates without a history of cancer or stroke, and monitor for side effects.
- Adults now have three JAK options, including newly approved deuruxolitinib — if one doesn't work, you can move to another.
- Down-titrating risks hair loss; warn patients, respect those who prefer to stay on a higher dose, and keep everyone monitored.
