Issue 7/2026
Yanev, K., Drenovska K.
Department of Dermatology and Venerology, Medical University – Sofia
Alopecia areata (AA) is an immune-mediated, non-scarring alopecia whose pathogenesis involves collapse of hair follicle immune privilege and activation of the JAK-STAT signaling pathway. This has established Janus kinase (JAK) inhibitors as a pathogenically targeted therapy for severe and chronic AA. This review examines the clinical response and safety profile of JAK inhibitors in AA. Three oral agents, baricitinib, ritlecitinib, and deuruxolitinib, are approved for severe AA and produce substantial hair regrowth in pivotal trials, with a progressive positive response that increases over time in a subset of patients. Response is variable, and discontinuation leads to relapse, defining treatment as chronic rather than course-based. Beyond the approved agents, tofacitinib, ruxolitinib, and upadacitinib are used off-label; the latter is particularly relevant in the Bulgarian setting given its accessibility through the atopic dermatitis indication. The class carries a warning for serious adverse events derived from an older rheumatologic population, yet real-world reactions in AA are predominantly mild. With appropriate dosing, baseline screening, and systematic monitoring, JAK inhibitors are well tolerated and represent a substantial advance in the management of severe and chronic AA.
Key words: alopecia areata (АА), JAK inhibitors, baricitinib, ritlecitinib, upadacitinib.
Address for correspondence:
Yanev K.
Department of Dermatology and Venereology,
MU – Sofia UMHAT “Alexandrovska” EAD
1, „St. Georgi Sofiiski”, Str.
1431, Sofia
e-mail: dr_k.yanev@yahoo.com