Alopecia areata

Benjamin Ungar^#¹, Yael Renert-Yuval^#^{2

3}, Ncoza C Dlova⁴, Ali Jabbari^{5

6}, Brett King⁷, Natasha A Mesinkovska⁸, Lidia Rudnicka⁹, Rodney Sinclair¹⁰, Emma Guttman-Yassky¹¹

Affiliations

¹ Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
³ Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
⁴ Dermatology Department, University of KwaZulu-Natal, Durban, South Africa.
⁵ Department of Dermatology, University of Iowa, Iowa City, IA, USA.
⁶ Iowa City VA Medical Center, Iowa City, IA, USA.
⁷ Dermatology Physicians of Connecticut-Fairfield, Fairfield, CT, USA.
⁸ Department of Dermatology, University of California, Irvine, CA, USA.
⁹ Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
¹⁰ University of Melbourne and Sinclair Dermatology, Melbourne, Victoria, Australia.
¹¹ Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. emma.guttman@mountsinai.org.

^# Contributed equally.

PMID: 41198704
DOI: 10.1038/s41572-025-00664-9

Review

Alopecia areata

Benjamin Ungar et al. Nat Rev Dis Primers. 2025.

. 2025 Nov 6;11(1):77.

doi: 10.1038/s41572-025-00664-9.

Authors

Benjamin Ungar^#¹, Yael Renert-Yuval^#^{2

3}, Ncoza C Dlova⁴, Ali Jabbari^{5

6}, Brett King⁷, Natasha A Mesinkovska⁸, Lidia Rudnicka⁹, Rodney Sinclair¹⁰, Emma Guttman-Yassky¹¹

Affiliations

¹ Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
³ Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
⁴ Dermatology Department, University of KwaZulu-Natal, Durban, South Africa.
⁵ Department of Dermatology, University of Iowa, Iowa City, IA, USA.
⁶ Iowa City VA Medical Center, Iowa City, IA, USA.
⁷ Dermatology Physicians of Connecticut-Fairfield, Fairfield, CT, USA.
⁸ Department of Dermatology, University of California, Irvine, CA, USA.
⁹ Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
¹⁰ University of Melbourne and Sinclair Dermatology, Melbourne, Victoria, Australia.
¹¹ Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. emma.guttman@mountsinai.org.

^# Contributed equally.

PMID: 41198704
DOI: 10.1038/s41572-025-00664-9

Abstract

Alopecia areata is a common cause of non-scaring autoimmune hair loss, associated with substantial psychosocial burden. Alopecia areata is an autoimmune disease in which loss of immune privilege in hair follicles leads to local hair follicle-associated inflammation. A chronic disease with uncertain course that is estimated to affect 2% of people over their lifetime, alopecia areata can present with a range of clinical features, from a single small round patch of hair loss to full scalp and body hair loss, and is associated with atopic, autoimmune and psychological comorbidities. Alopecia areata also has a major negative impact on quality of life, with a greater mental burden than physical burden. Since the 2010s, advances in understanding of disease pathogenesis have led to the identification of inflammatory pathways that can be successfully inhibited to produce substantial clinical responses. The therapeutic landscape has been transformed, with FDA approval of the first treatment for adults with severe alopecia areata in 2022 and for adolescents with severe alopecia areata in 2023, with multiple investigational treatments currently in phase II and phase III clinical trials.

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Conflict of interest statement

Competing interests: B.U. is an employee of Mount Sinai and has received research funds (grants paid to the institution) from Bristol Myers Squibb, Incyte, Rapt Therapeutics, Pfizer and Sanofi. He is also a consultant for AbbVie, Arcutis Biotherapeutics, Bristol Myers Squibb, Botanix Pharmaceuticals, Castle Biosciences, Fresenius Kabi, Galderma, J&J, Leo Pharma, Lilly, Pfizer, Primus Pharmaceuticals, Sanofi and UCB. N.C.D. is a consultant for, performs clinical trials for and receives honoraria from Sanofi, Pfizer, Unilever, Direct Relief, L’Oréal, Galderma, Avene and Tricholab. A.J. has received institutional grants from Arena Pharmaceuticals, InSilico Medicine and Pfizer and honoraria and/or consultation fees from Pfizer. B.K. has served on advisory boards and/or is a consultant and/or is a clinical trial investigator and/or is on a Data Monitoring Committee for AbbVie, AltruBio Inc., Almirall, Amgen, AnaptysBio, Apogee Therapeutics, Aquestive, Aslan Pharmaceuticals, Bristol Myers Squibb, Concert Pharmaceuticals Inc., Eli Lilly and Company, Equillium, Galderma, GSK, Horizon Therapeutics, Incyte Corp., Janssen Pharmaceuticals, LEO Pharma, Merck, Novartis, Otsuka/Visterra Inc., Pfizer Inc., Q32 Bio Inc., Regeneron, Sanofi–Genzyme, Soterios, Sun Pharmaceutical, Takeda, TWi Biotechnology Inc. and Ventyx Biosciences Inc. He has served on speaker bureaux for AbbVie, Incyte, Eli Lilly, Pfizer, Regeneron and Sanofi–Genzyme. He is a scientific adviser for BiologicsMD. N.A.M. is a consultant, advisory board member and principal investigator for AbbVie, Lilly, Pfizer, Sun Pharma and Merck. She is also a member of the speakers’ bureaux for Lilly and Pfizer. L.R. has given medical lectures for Leo Pharma, Novartis and UCB Pharma; participated in advisory board meetings of Leo Pharma, Novartis, Pfizer, Sanofi and UCB Pharma; and participated in the advisory board of the EMA. R.S. has been an investigator for and/or provided professional services to AbbVie, Aerotek Scientific, Akeso Biopharma, Amgen, Arcutis, Arena Pharmaceuticals, Ascend Laboratories, AstraZeneca, Bayer Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus BioSciences, Connect Biopharma, Cutanea, Dermira, Eli Lilly and Company, Galderma, GlaxoSmithKline, Janssen, LEO Pharma, MedImmune–AstraZeneca, Merck Sharp & Dohme, Novartis, Oncobiologics, Pfizer, Regeneron, Reistone Biopharma, Roche, Samson Medical Technologies, Sanofi, Sun Pharma and UCB Pharma. E.G.-Y. has research grants from Boehringer Ingelheim, LEO Pharma, Pfizer, Cara Therapeutics, UCB, Kyowa Kirin, RAPT, Amgen, GSK, Incyte, Sanofi, Bristol Myers Squibb, ASLAN, Regeneron, AnaptysBio, Concert and Janssen; and has been a consultant for AbbVie, Almirall, Amgen, AnaptysBio, Apogee Therapeutics, Apollo Therapeutics, Artax Biopharma, AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Cara Therapeutics, Centrexion Therapeutics, Connect Biopharm, Eli Lilly, Enveda Biosciences, Escient Pharmaceuticals, Fairmount Funds Management, Galderma, Gate Bio, Google Ventures, GSK Immunology, Horizon Therapeutics USA, Incyte, Inmagene, Janssen Biotech, Japan Tobacco, Jasper Therapeutics, Kyowa Kirin, LEO Pharma, Merck, Nektar Therapeutics, Novartis Pharmaceuticals, NUMAB Therapeutics, OrbiMed Advisors, OTSUKA Pfizer, Pharmaxis, Pioneering Medicine VII, Proteologix US, RAPT, Regeneron Pharmaceuticals, Ribon Therapeutics, Sanofi, SATO, Schrödinger, Sun Pharma Advanced Research Company (SPARC), Teva Branded Pharmaceutical Products R&D and UCB. Y.R.-Y. declares no competing interests.

References

1. Mirzoyev, S. A., Schrum, A. G., Davis, M. D. P. & Torgerson, R. R. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990-2009. J. Invest. Dermatol. 134, 1141–1142 (2014). - PubMed - DOI
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1. Huang, K. P., Mullangi, S., Guo, Y. & Qureshi, A. A. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States. JAMA Dermatol. 149, 789–794 (2013). - PubMed - DOI
1. Lee, H. et al. Racial characteristics of alopecia areata in the United States. J. Am. Acad. Dermatol. 83, 1064–1070 (2020). - PubMed - DOI

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Alopecia areata

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Alopecia areata

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