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derm.alopecia-areata.core.v1PRODUCTION
derm.alopecia-areata.core.v1

Alopecia areata (dermatology lens)

dermatologychronicadultpediatric
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12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Frame as a CHRONIC, unpredictable, relapsing T-cell-mediated NON-SCARRING autoimmune hair-loss disease (immune-privilege collapse) managed on an extent/SALT/age-stratified ladder with psychological support as a first-class outcome — NOT a one-off cosmetic complaint. EVERY patient is screened for the autoimmune (thyroid/vitiligo/T1DM) + atopic comorbidity cluster and for depression/anxiety. The not-to-miss is SCARRING (cicatricial) alopecia and tinea capitis masquerading as AA.

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chronic relapsing non-scarring framing set; comorbidity + psychosocial + scarring/tinea escape routes noted

Patient inputs (16)

Smooth skin with PRESERVED follicular ostia + exclamation-mark/yellow-dot trichoscopy distinguishes AA from SCARRING alopecia (lost ostia → biopsy) and other non-scarring mimics (Pratt et al PMID 28300084)

Recent-onset limited disease has high spontaneous regrowth; long-standing AT/AU and rapidly progressive disease have lower regrowth and steer earlier systemic therapy (Pratt et al PMID 28300084; Rudnicka et al JEADV 2024 PMID 38169088)

AA clusters with autoimmune thyroid disease, vitiligo, T1DM, and atopy — screened/co-managed (thyroid via panel.thyroid) at presentation (Pratt et al PMID 28300084)

AA carries major QoL impact and high depression/anxiety burden; screening + support is a core outcome and can accelerate the therapy decision (Craiglow et al PMID 38904749; Rudnicka et al JEADV 2024 PMID 38169088)

Extent (estimated SALT 0–100) + pattern (patchy vs totalis vs universalis vs ophiasis) is the primary severity axis gating limited-vs-systemic therapy (SALT ≥20 = systemic indication) (Rudnicka et al JEADV 2024 PMID 38169088)

Scaling, broken hairs, kerion, posterior cervical lymphadenopathy → tinea capitis (KOH/culture) — a treatable mimic that must not be immunosuppressed (Pratt et al PMID 28300084)

Loss of follicular ostia, perifollicular erythema/scale, scarring, atrophy → cicatricial alopecia (LPP/DLE/CCCA) — biopsy; irreversible if treated as AA (Pratt et al PMID 28300084)

Pediatric/adolescent dosing + agent age-cutoffs (ritlecitinib ≥12 y; baricitinib/deuruxolitinib adult; intralesional injections difficult in young children → topical-first); pediatric ladder + school/psychosocial differs (Rudnicka et al JEADV 2024 PMID 38169088; King et al Lancet 2023 PMID 37062298)

Pre-JAK latent-TB + hepatitis B/C screen + zoster-risk + immunisation review before oral JAK initiation; live vaccines avoided on JAK (Rudnicka et al JEADV 2024 PMID 38169088)

Oral-JAK baseline + periodic monitoring (cytopenia); also screens for occult cause/comorbidity (Rudnicka et al JEADV 2024 PMID 38169088; King et al NEJM 2022 PMID 35334197)

Oral-JAK baseline + on-treatment hepatotoxicity monitoring (Rudnicka et al JEADV 2024 PMID 38169088)

Autoimmune-thyroid screen at presentation (AA clusters with thyroid disease) — co-managed, does not by itself drive hair therapy (Pratt et al PMID 28300084)

Oral-JAK-class dyslipidaemia (LDL/HDL ↑) monitored at baseline then periodically (King et al NEJM 2022 PMID 35334197; Rudnicka et al JEADV 2024 PMID 38169088)

Oral JAK inhibitors are avoided in pregnancy/conception and lactation; topical/intralesional have limited safety data — gates the systemic ladder (Rudnicka et al JEADV 2024 PMID 38169088)

Oral-JAK boxed warning — VTE/MACE/malignancy/serious infection; prior VTE/MI/stroke, active smoker, age, or thrombotic risk shifts JAK selection and screening (Rudnicka et al JEADV 2024 PMID 38169088)

Baseline renal function before/with oral JAK + comorbidity (T1DM/CKD) context; CKD-EPI 2021 race-free eGFR (Inker NEJM 2021)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (8)

8 need judgement
  • informationalseverescarring_alopecia_lost_ostia_biopsy
    Loss of follicular ostia, perifollicular erythema/scale, scarring or atrophy of affected scalp (lichen planopilaris / discoid lupus / central centrifugal cicatricial alopecia) — NOT alopecia areata
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveresevere_psychosocial_distress_or_suicidality
    Marked depression/anxiety, social withdrawal, school refusal/bullying (children), or suicidality attributable to hair loss
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereextensive_totalis_universalis_or_rapidly_progressive
    Alopecia totalis / universalis, ophiasis, ≥50% scalp loss (SALT ≥20–50), or rapidly progressive extensive loss
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereoral_jak_safety_event
    On-treatment VTE / serious infection / herpes zoster / new malignancy concern / significant cytopenia or transaminitis on an oral JAK inhibitor
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatetinea_capitis_mimic_do_not_immunosuppress
    Scaling, broken hairs, black dots, kerion, posterior cervical lymphadenopathy (especially in a child) — dermatophyte infection masquerading as patchy AA
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderaterefractory_to_local_therapy
    Persistent/progressive disease despite an adequate trial of intralesional/topical corticosteroid ± topical immunotherapy
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatepediatric_extensive_disease_specialist_pathway
    Child/adolescent with extensive / AT-AU / rapidly progressive AA or severe psychosocial impact
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatepregnancy_lactation_systemic_gating
    Pregnant / planning-pregnancy / lactating patient requiring therapy for extensive AA
    Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

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TREATMENToptionalDrives dose adjustment
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Recommended regimen

Alopecia areata — extent/SALT/age-stratified ladder + psychological support (European consensus 2024)
axis: aa_extent_salt_age_stratified_ladderstep 1 - Step 1 — Psychological support + camouflage (every patient, every severity)
Selected step "Step 1 — Psychological support + camouflage (every patient, every severity)" — All patients, continuously — AA carries major QoL/psychiatric burden; support + camouflage are first-class outcomes, not afterthoughts
  • psychological_support_and_mental_health_screen
    first line
    supportive_care
    Rudnicka et al JEADV 2024 (PMID 38169088) + Craiglow et al (PMID 38904749) — AA has high depression/anxiety burden (children frequently bullied); screen mood, signpost psychological support; sustained regrowth improves HRQoL/anxiety/depression.
  • wigs_camouflage_and_eyelash_eyebrow_options
    first line
    supportive_care
    Pratt et al Nat Rev Dis Primers 2017 (PMID 28300084) — wigs/hairpieces/camouflage + eyebrow tattoo/eyelash prostheses are core management for the cosmetic/psychosocial impact, independent of pharmacotherapy response.
  • watchful_waiting_for_limited_recent_onset
    add on
    supportive_care
    triggers: limited_recent_onset_low_salt, patient_prefers_observation
    Pratt et al (PMID 28300084) — limited recent-onset patchy AA has high spontaneous regrowth; active observation ± topical adjunct is a legitimate option, avoiding overtreatment.

outpatient playbook — drug actions (4)

  1. 1. psychological support + wig/camouflage + (limited recent-onset) watchful waiting
    n/a • supportive • every visit
    trigger: All patients (core QoL/psychiatric outcome) (Rudnicka et al JEADV 2024 PMID 38169088; Craiglow et al PMID 38904749)
    AA has major psychosocial burden; support + camouflage are first-class outcomes; limited recent-onset has high spontaneous regrowth
  2. 2. intralesional triamcinolone (adult patchy) / clobetasol (pediatric or injection-intolerant) ± topical minoxidil adjunct
    rxcui 10761
    5 mg/mL IL / 0.05% topical • intralesional/topical • IL q4–6wk / topical daily
    trigger: Limited AA — low SALT, <25–50%, recent-onset, no AT/AU (Khan et al PMID 36566395; Pratt et al PMID 28300084)
    Intralesional steroid is adult-patchy first-line; high-potency topical for children; minoxidil supports/maintains regrowth
  3. 3. topical immunotherapy DPCP/SADBE or short-contact anthralin (chronic refractory patchy)
    rxcui 873
    sensitise-then-challenge / 0.5–1% short-contact • topical • weekly (immunotherapy) / daily short-contact
    trigger: Chronic extensive/refractory patchy AA not for systemic therapy (Singh & Lavanya PMID 21188022)
    Topical immunotherapy is the best-documented therapy for chronic extensive patchy AA; anthralin is a steroid-sparing alternative
  4. 4. oral JAK inhibitor — baricitinib (adult) / ritlecitinib (≥12 y) / deuruxolitinib (adult)
    rxcui 2047232
    baricitinib 2–4 mg daily • PO • once–twice daily by agent
    trigger: SALT ≥20 / extensive / AT-AU / ophiasis / rapidly progressive / refractory / severe psychosocial burden (Rudnicka et al JEADV 2024 PMID 38169088)
    Approved oral JAK inhibitors with RCT-grade SALT≤20 efficacy; ritlecitinib the only option ≥12 y; JAK boxed warning + pre-treatment screen + ~6-mo response counselling

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Abrupt well-circumscribed round/oval patch(es) of non-scarring scalp/beard hair loss with smooth skin + preserved follicular ostia (Pratt et al, Nat Rev Dis Primers 2017 PMID 28300084); Trichoscopy pivots — exclamation-mark hairs, yellow dots, black dots, broom/tapered hairs, short regrowing vellus at patch periphery (Pratt et al PMID 28300084); Extensive (≥50% scalp), alopecia totalis (whole scalp), alopecia universalis (all body hair), or ophiasis-pattern loss → systemic-ladder entry (European consensus, Rudnicka et al, JEADV 2024 PMID 38169088).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Alopecia areata (dermatology lens)** (derm.alopecia-areata.core.v1).
Phenotype framing: Terminal non-scarring-alopecia differential with named pivots: alopecia areata (abrupt well-circumscribed patch + preserved ostia + exclamation-mark/yellow-dot trichoscopy + nail pits + peripheral pull-test pivot) vs androgenetic alopecia (patterned bitemporal/vertex + follicular miniaturisation + gradual pivot) vs telogen effluvium (diffuse global shed + trigger 3 mo prior + diffuse positive pull-test pivot) vs tinea capitis (scaling + broken hairs + KOH/culture+ pivot — route derm.tinea-dermatophytosis.core.v1) vs trichotillomania (irregular, varying-length broken hairs + behavioural pivot) vs SCARRING alopecia / LPP-DLE-CCCA (LOSS of follicular ostia + perifollicular change + biopsy pivot — NOT AA) vs traction alopecia (marginal + tension-hairstyle pivot) vs secondary-syphilis moth-eaten alopecia (RPR/TPPA pivot) vs anagen effluvium (chemotherapy timeline pivot) vs drug-induced telogen effluvium (new-drug temporal pivot).
Scope: Frame as a CHRONIC, unpredictable, relapsing T-cell-mediated NON-SCARRING autoimmune hair-loss disease (immune-privilege collapse) managed on an extent/SALT/age-stratified ladder with psychological support as a first-class outcome — NOT a one-off cosmetic complaint. EVERY patient is screened for the autoimmune (thyroid/vitiligo/T1DM) + atopic comorbidity cluster and for depression/anxiety. The not-to-miss is SCARRING (cicatricial) alopecia and tinea capitis masquerading as AA.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Alopecia areata — extent/SALT/age-stratified ladder + psychological support (European consensus 2024)** — step "Step 1 — Psychological support + camouflage (every patient, every severity)".
1. psychological_support_and_mental_health_screen (supportive_care, first line) — Rudnicka et al JEADV 2024 (PMID 38169088) + Craiglow et al (PMID 38904749) — AA has high depression/anxiety burden (children frequently bullied); screen mood, signpost psychological support; sustained regrowth improves HRQoL/anxiety/depression.
2. wigs_camouflage_and_eyelash_eyebrow_options (supportive_care, first line) — Pratt et al Nat Rev Dis Primers 2017 (PMID 28300084) — wigs/hairpieces/camouflage + eyebrow tattoo/eyelash prostheses are core management for the cosmetic/psychosocial impact, independent of pharmacotherapy response.
3. watchful_waiting_for_limited_recent_onset (supportive_care, add on) — Pratt et al (PMID 28300084) — limited recent-onset patchy AA has high spontaneous regrowth; active observation ± topical adjunct is a legitimate option, avoiding overtreatment.

Setting playbook (outpatient) — Confirm clinical + trichoscopic non-scarring AA (exclude scarring alopecia + tinea capitis + AGA/telogen mimics), stage by SALT × pattern × duration × psychosocial impact, screen EVERY patient for the autoimmune + atopic comorbidity cluster and mood, deliver psychological support + camouflage as core outcomes, and escalate the extent/SALT/age-stratified ladder gated on pregnancy/age/thrombotic-CV/comorbidity (Rudnicka et al JEADV 2024 PMID 38169088; Pratt et al PMID 28300084)
4. psychological support + wig/camouflage + (limited recent-onset) watchful waiting n/a supportive every visit — All patients (core QoL/psychiatric outcome) (Rudnicka et al JEADV 2024 PMID 38169088; Craiglow et al PMID 38904749) (AA has major psychosocial burden; support + camouflage are first-class outcomes; limited recent-onset has high spontaneous regrowth)
5. intralesional triamcinolone (adult patchy) / clobetasol (pediatric or injection-intolerant) ± topical minoxidil adjunct 5 mg/mL IL / 0.05% topical intralesional/topical IL q4–6wk / topical daily — Limited AA — low SALT, <25–50%, recent-onset, no AT/AU (Khan et al PMID 36566395; Pratt et al PMID 28300084) (Intralesional steroid is adult-patchy first-line; high-potency topical for children; minoxidil supports/maintains regrowth)
6. topical immunotherapy DPCP/SADBE or short-contact anthralin (chronic refractory patchy) sensitise-then-challenge / 0.5–1% short-contact topical weekly (immunotherapy) / daily short-contact — Chronic extensive/refractory patchy AA not for systemic therapy (Singh & Lavanya PMID 21188022) (Topical immunotherapy is the best-documented therapy for chronic extensive patchy AA; anthralin is a steroid-sparing alternative)
7. oral JAK inhibitor — baricitinib (adult) / ritlecitinib (≥12 y) / deuruxolitinib (adult) baricitinib 2–4 mg daily PO once–twice daily by agent — SALT ≥20 / extensive / AT-AU / ophiasis / rapidly progressive / refractory / severe psychosocial burden (Rudnicka et al JEADV 2024 PMID 38169088) (Approved oral JAK inhibitors with RCT-grade SALT≤20 efficacy; ritlecitinib the only option ≥12 y; JAK boxed warning + pre-treatment screen + ~6-mo response counselling)

Non-pharmacologic actions:
- Counsel the unpredictable relapsing course + realistic regrowth expectations (lower for long-standing AT/AU) + relapse-on-JAK-discontinuation (Rudnicka et al JEADV 2024 PMID 38169088)
- Wig/hairpiece/scalp-micropigmentation + eyebrow tattoo / eyelash prosthesis signposting; sun/ocular protection where brows/lashes lost (Pratt et al PMID 28300084)
- Mental-health referral for significant depression/anxiety/suicidality; peer-support / patient-organisation signposting (Craiglow et al PMID 38904749)
- Scalp biopsy ONLY for diagnostic uncertainty or to exclude scarring alopecia; KOH/fungal culture if tinea plausible (Pratt et al PMID 28300084)

AVOID / contraindication checks:
- Oral jak boxed warning vte mace malignancy serious infection (Rudnicka et al JEADV 2024 PMID 38169088 — risk stratify prior VTE/MI/stroke, active smoker, age, malignancy/infection history before baricitinib/ritlecitinib/deuruxolitinib; ORAL Surveillance extrapolation)
- Oral jak avoided in pregnancy conception and lactation (Rudnicka et al JEADV 2024 PMID 38169088 — defer JAK; topical/intralesional have limited safety data; effective contraception while on JAK)
- Latent tb and hbv hcv screen and zoster immunisation review before oral jak (Rudnicka et al JEADV 2024 PMID 38169088)
- Live vaccines avoided on oral jak immunosuppression (Rudnicka et al JEADV 2024 PMID 38169088)
- Against chronic systemic corticosteroids for aa relapse on withdrawal and cumulative harm (Rudnicka et al JEADV 2024 PMID 38169088)
- Ritlecitinib is the only approved option down to age 12 baricitinib deuruxolitinib adult only (King et al Lancet 2023 PMID 37062298; King et al NEJM 2022 PMID 35334197; King et al JAAD 2024 PMID 39053611)
- Scarring alopecia and tinea capitis must be excluded not immunosuppressed (Pratt et al PMID 28300084 — biopsy if lost ostia; KOH/culture + antifungal for tinea; route OUT)

Monitoring

Regimen monitoring:
- SALT response at 3 6 9 months — regrowth is slow; counsel ~6 mo before judging adequacy (King et al NEJM 2022 PMID 35334197; Rudnicka et al JEADV 2024 PMID 38169088)
- oral JAK: CBC + LFT + lipids at baseline then periodically; VTE/MACE/serious-infection/herpes-zoster/malignancy vigilance; CK + acne class effects (King et al NEJM 2022 PMID 35334197)
- pre oral JAK: latent-TB + HBV/HCV screen + immunisation/zoster review (Rudnicka et al JEADV 2024 PMID 38169088)
- psychosocial mood re screen — sustained regrowth improves HRQoL/anxiety/depression (Craiglow et al PMID 38904749)
- autoimmune thyroid vitiligo T1DM and atopy comorbidity surveillance (Pratt et al Nat Rev Dis Primers 2017 PMID 28300084)
- relapse on oral JAK discontinuation is common especially AT AU — counsel + plan continuity (Rudnicka et al JEADV 2024 PMID 38169088)

Setting (outpatient) monitoring:
- Reassess SALT at 3/6/9 mo (slow regrowth — counsel ~6 mo before judging) (Rudnicka et al JEADV 2024 PMID 38169088)
- Oral-JAK class safety labs on schedule (CBC/LFT/lipids) + VTE/MACE/infection/zoster vigilance; mood + autoimmune comorbidity re-screen (King et al NEJM 2022 PMID 35334197)

Follow-up plan: Chronic-disease maintenance: counsel the unpredictable relapsing course + realistic regrowth expectations (lower for long-standing AT/AU; high spontaneous regrowth for limited recent-onset), relapse-on-JAK-discontinuation, lifelong autoimmune (thyroid/vitiligo/T1DM) + atopic + mental-health surveillance, wig/camouflage + peer-support signposting, eyelash/eyebrow care, sun/ocular protection where brows/lashes lost, and step-up/step-down criteria. Dermatology continuity for any systemic agent; re-evaluate diagnosis (biopsy) if the course is atypical or scarring features emerge.
- Close-out criterion: course/relapse + regrowth-expectation counselling + comorbidity + mental-health surveillance + camouflage/support documented

Monitoring phase: Disease: SALT response at 3 / 6 / 9 mo (regrowth is slow — counsel ~6 mo before judging adequacy; meaningful response often by ~3–6 mo on JAK). Drug safety on oral JAK: CBC + LFT + lipids at baseline then periodically; VTE/MACE/serious-infection/herpes-zoster/malignancy vigilance; CK/acne class effects. Psychosocial: re-screen mood — sustained regrowth improves HRQoL/anxiety/depression (BRAVE-AA QoL data). Counsel relapse on discontinuation (common, especially AT/AU).

Disposition

Current setting: outpatient — Confirm clinical + trichoscopic non-scarring AA (exclude scarring alopecia + tinea capitis + AGA/telogen mimics), stage by SALT × pattern × duration × psychosocial impact, screen EVERY patient for the autoimmune + atopic comorbidity cluster and mood, deliver psychological support + camouflage as core outcomes, and escalate the extent/SALT/age-stratified ladder gated on pregnancy/age/thrombotic-CV/comorbidity (Rudnicka et al JEADV 2024 PMID 38169088; Pratt et al PMID 28300084)

Disposition criteria:
- Manage entirely outpatient with dermatology continuity for any systemic agent (Rudnicka et al JEADV 2024 PMID 38169088)
- Step up the ladder by extent/SALT after adequate trial + adherence; pediatric extensive → pediatric-dermatology + ritlecitinib-eligibility pathway
- Route mimics OUT (tinea → dermatophyte engine; scarring alopecia → biopsy/cicatricial-alopecia care); refer mental-health as indicated

Escalation triggers (move to higher acuity):
- Tinea capitis features (scaling/broken hairs/kerion/child) → KOH/culture + systemic antifungal; route derm.tinea-dermatophytosis.core.v1 — do NOT immunosuppress
- Loss of follicular ostia / perifollicular scale-erythema-atrophy → urgent scalp biopsy for scarring alopecia (LPP/DLE/CCCA) before any AA-directed therapy (irreversible if missed)
- Severe psychosocial distress / suicidality → urgent mental-health + accelerate definitive therapy (Rudnicka et al JEADV 2024 PMID 38169088)
- Oral-JAK safety event (VTE / serious infection / herpes zoster / new malignancy concern) → hold JAK + investigate + risk-reassess

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [SEVERE] Loss of follicular ostia, perifollicular erythema/scale, scarring or atrophy of affected scalp (lichen planopilaris / discoid lupus / central centrifugal cicatricial alopecia) — NOT alopecia areata
- [SEVERE] Marked depression/anxiety, social withdrawal, school refusal/bullying (children), or suicidality attributable to hair loss
- [SEVERE] Alopecia totalis / universalis, ophiasis, ≥50% scalp loss (SALT ≥20–50), or rapidly progressive extensive loss

Citations

- European expert consensus statement on the systemic treatment of alopecia areata (Rudnicka et al, J Eur Acad Dermatol Venereol 2024; PMID 38169088, DOI 10.1111/jdv.19768 — SALT ≥20 / moderate–severe AAS systemic indication; baricitinib + ritlecitinib EMA/FDA-approved; off-label glucocorticoid/ciclosporin/MTX/azathioprine; oral minoxidil adjuvant; against chronic systemic steroids) anchored by pivotal RCTs: BRAVE-AA1/AA2 baricitinib (King et al, NEJM 2022; PMID 35334197), ALLEGRO 2b/3 ritlecitinib ≥12 y (King et al, Lancet 2023; PMID 37062298), THRIVE-AA1 deuruxolitinib (King et al, JAAD 2024; PMID 39053611); disease primer (Pratt et al, Nat Rev Dis Primers 2017; PMID 28300084); topical immunotherapy review (Singh & Lavanya, Int J Trichology 2010; PMID 21188022); intralesional-steroid RCT (Khan et al, JAMC 2022; PMID 36566395) + comparative (Ragaie et al, J Cosmet Laser Ther 2024; PMID 39139085); baricitinib QoL/anxiety-depression (Craiglow et al, Dermatol Ther 2024; PMID 38904749) [PMID:38169088](https://pubmed.ncbi.nlm.nih.gov/38169088/)
- Cited evidence (PMID 35334197) [PMID:35334197](https://pubmed.ncbi.nlm.nih.gov/35334197/)
- Cited evidence (PMID 37062298) [PMID:37062298](https://pubmed.ncbi.nlm.nih.gov/37062298/)
- Cited evidence (PMID 39053611) [PMID:39053611](https://pubmed.ncbi.nlm.nih.gov/39053611/)
- Cited evidence (PMID 28300084) [PMID:28300084](https://pubmed.ncbi.nlm.nih.gov/28300084/)

Last reconciled with current guidelines: 2026-05-22.
References
  • European expert consensus statement on the systemic treatment of alopecia areata (Rudnicka et al, J Eur Acad Dermatol Venereol 2024; PMID 38169088, DOI 10.1111/jdv.19768 — SALT ≥20 / moderate–severe AAS systemic indication; baricitinib + ritlecitinib EMA/FDA-approved; off-label glucocorticoid/ciclosporin/MTX/azathioprine; oral minoxidil adjuvant; against chronic systemic steroids) anchored by pivotal RCTs: BRAVE-AA1/AA2 baricitinib (King et al, NEJM 2022; PMID 35334197), ALLEGRO 2b/3 ritlecitinib ≥12 y (King et al, Lancet 2023; PMID 37062298), THRIVE-AA1 deuruxolitinib (King et al, JAAD 2024; PMID 39053611); disease primer (Pratt et al, Nat Rev Dis Primers 2017; PMID 28300084); topical immunotherapy review (Singh & Lavanya, Int J Trichology 2010; PMID 21188022); intralesional-steroid RCT (Khan et al, JAMC 2022; PMID 36566395) + comparative (Ragaie et al, J Cosmet Laser Ther 2024; PMID 39139085); baricitinib QoL/anxiety-depression (Craiglow et al, Dermatol Ther 2024; PMID 38904749) — PMID:38169088
  • Cited evidence (PMID 35334197) — PMID:35334197
  • Cited evidence (PMID 37062298) — PMID:37062298
  • Cited evidence (PMID 39053611) — PMID:39053611
  • Cited evidence (PMID 28300084) — PMID:28300084