Off-label use of biologics and janus kinase (JAK) inhibitors for scarring alopecias: a narrative review

Abstract

Scarring alopecias, including lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, central centrifugal cicatricial alopecia, discoid lupus erythematosus, and dissecting cellulitis cause permanent destruction of hair follicles, resulting in patches of hair loss that can be devastating for patients. Treatment options for scarring alopecias focus on disease stabilization and currently include corticosteroids and immunosuppressive agents, which often offer inconsistent disease improvements with waning patient satisfaction, especially in severe stages of the condition. Recent advances in therapeutics such as biologics and JAK inhibitors may offer some potential for disease stabilization and resolution through modulation of the inflammatory and immune-mediated pathways of scarring alopecias. This review examines literature reporting the off-label use of biologics and JAK inhibitors for the treatment of scarring alopecias. We find that TNF-α, IL-17, and JAK inhibitors demonstrate the most potential of currently available agents, with IL-23 and Interferon Alpha Receptor 1 inhibitors also showing some benefit.

Keywords: Biologics; Central centrifugal cicatricial alopecia; Discoid lupus erythematosus; Dissecting cellulitis; Folliculitis decalvans; Frontal fibrosing alopecia; IFNAR1 inhibitors; IL-17 inhibitors; IL-23 inhibitors; JAK inhibitors; Lichen planopilaris; Scarring alopecia; TNF-α inhibitors.