New Treatments Could Finally Treat This Autoimmune Disease

But this all started to change in 2021. That year, Jones took part in a clinical trial for a new alopecia areata drug called Leqselvi, which was designed to treat the condition and help grow hair back. Flash forward four years, and Jones looks like she belongs in a shampoo commercial—her thick, layered locks cascade down in soft waves past her shoulders. “This year, I treated myself to the Dyson Airwrap,” she says.

Jones’s hair-regrowth success since she has been on the drug—which the FDA approved in July of 2024—has been particularly dramatic. The new drug joins two others used to treat alopecia areata, Litfulo and Olumiant, which have helped thousands of women and men see their hair restored in recent years. Although the medications, called Janus kinase (JAK) inhibitors, don’t cure alopecia areata—hair falls out again if patients stop taking it—they are revolutionizing treatment and making the impossible seem possible.

Brandi Jones, 54, was diagnosed with alopecia areata at just 18 months old and has lived with the disease for over half a century.

After taking these medications for a year and a half, up to 40 percent of patients have at least 80 percent of their scalp hair regrown, says Ross Kopelman, MD, a hair restoration surgeon in New York City and Palm Beach County, Florida. “This is life-changing for a lot of people who have significant hair loss.”

April Noel, 49, experienced this firsthand. The music teacher from Illinois started taking Litfulo about five years ago and has recovered about 90 percent of her scalp hair. “I’d always hoped I’d get my hair back,” she says. “The first time I drove with my windows down and felt the breeze in my hair, I thought I would cry.”

Immune System Overload

Before diving into the ins and outs of the new treatments, it’s helpful to understand exactly how alopecia areata impacts the body and your hair. At its most basic, this condition occurs when the immune system attacks the hair follicles—like an army mistakenly firing on its own troops.

“That attack doesn’t lead to the death of hair follicles, but it puts them in a dysfunctional state, so they don’t grow hair,” says Brett King, MD, PhD, a dermatologist at Dermatology Physicians of Connecticut, whose research has played a key role in bringing JAK inhibitors for alopecia areata to the market.

Although its cause is unknown, experts know that alopecia areata has a genetic component. “There’s some sort of environmental input that flips the switch and turns the disease on at a specific time in an individual’s life,” says Amy McMichael, MD, a professor in the department of dermatology at Wake Forest University School of Medicine. “But we don’t really know what that switch is.”

With alopecia, everyone’s hair loss pattern looks different. Some people develop circular bald patches, while others lose all the hair on their heads but have it elsewhere. Others grow no hair at all and resort to penciling in eyebrows and wearing fake lashes. Hair growth can wax and wane over the years, frustrating patients and their doctors who don’t know why this happens.

“One of the unique things about this condition is you can go into remission at any time,” says Deeann Graham, 53, an alopecia advocate and educator, author of Head-On, Stories of Alopecia and host of the podcast Alopecia Life. Graham was diagnosed at 7, had regrowth at 14, and then lost almost all of her hair between 28 and 32.

“When I was diagnosed, they said the most predictable thing about it is its unpredictability,” says Caitlin Riley-Klepac, 37, a mental health therapist in Lansing, Michigan, who, with the loss of hair on the sides and back of her head, likes to say she could pass for a punk rocker. She lost much of the hair on her body (one armpit would grow hair; the other wouldn’t) and has tattooed eyebrows.

Deeann Graham, 53, is an alopecia advocate and educator, author of Head-On, Stories of Alopecia and host of the podcast Alopecia Life.

Women are more likely to develop the condition, which typically starts in childhood. It’s also more common in Black, Hispanic, and Asian populations, says Dr. McMichael.

Alopecia areata patients also often have other autoimmune disorders. About three in 10 people with alopecia areata have autoimmune thyroid disease, and the same ratio stands with rates of eczema, says Dr. King. It’s not uncommon to also see patients with inflammatory bowel disease, psoriasis, and rheumatoid arthritis.

Shaking the Stigma

For the roughly 700,000 Americans who suffer from alopecia areata, the social and emotional consequences and stigma of a bald or patchy scalp are tough to contend with, which makes effective treatments like Litfulo revolutionary. In fact, the mental impact of the condition is on par with developing post-traumatic stress disorder, according to Dr. King.

Stigma can run deep within society’s psyche. For starters, humans seem hardwired to think something is “wrong” with a person missing hair—perhaps because it can be a sign of illness or aging. Case in point: When people in studies are shown photos of alopecia patients who still have eyebrows and scalp hair, they say that the patients look like normal people, according to Dr. McMichael. But when the scalp hair and eyebrows are removed, they say the person looks ill. “The patients are assumed to have some sort of really severe disease,” she says.

And this just increases the stigma people with alopecia feel. Lara Ziobro, a 45-year-old working in marketing and communications from New Jersey, was diagnosed in early 2024, and noticed that having no hair “makes it seem like you’re not taking care of yourself, like there’s something wrong with you.”

This shame and stigma can make people with alopecia hold back, avoiding activities that might expose them to humiliation—like going to a swimming pool or dating. Riley-Klepac kept her diagnosis from her closest friends and used to hide when anyone stopped by her home and she wasn’t wearing a wig. Since Graham was diagnosed while still in grade school, she remembers being teased in school and classmates pulling off her wig. When she first met her husband, she had only a few bald spots. And it took her a few weeks to build up her courage before sharing her diagnosis. “Thinking about telling him was pretty consuming,” she says. But she knew she’d have to break the news eventually, because you can’t hide alopecia.

Hair is also often part of self-expression. And Ziobro felt like she was losing a part of her identity after she started losing her hair. “I was always so proud of my hair. It was one of my trademarks,” she says. Where she used to switch up her hair—dyeing it red or blonde, going from long to short—she now switches her part from side to side or arranges her remaining hair to disguise bald spots.

JAK to the Rescue

So far, three JAK inhibitors have been approved for severe alopecia areata by the FDA. Olumiant (baricitinib) was approved in 2022 for adults, Litfulo (ritlecitinib) in 2023 for adults and adolescents age 12 and over, and Leqselvi (deuruxolitinib) in 2024 for adults. These treatments work by blocking Janus kinase enzymes, which play a role in a key immune system-signaling pathway that results in inflammation. By targeting these enzymes, the medication helps repress inflammatory responses in hair follicles, keeping them healthy. The first JAK inhibitors were designed to treat other conditions, such as rheumatoid arthritis (another autoimmune condition), and have also shown promise for some skin diseases including eczema and vitiligo. Other JAK inhibitors for alopecia areata are in the pipeline.

About half of people taking the approved new wonder drugs see significant hair growth, which is a high bar for any medication. “It’s really quite extraordinary,” says Dr. King.

But some patients see less-than-stellar results—or no results at all. Naomie Schreuder, 24, who lives in the Netherlands and participated in a clinical drug trial in Germany, gave up after a year and a half on a JAK inhibitor when she didn’t grow back any hair. “I was very hopeful,” she says. “I saw a lot of people who had great success.”

While there are exceptions, the drugs generally appear to be less effective in people who’ve had the disease for longer. (Schreuder has had alopecia areata for 21 years.)

Sandra Kelberlau, 51, an art conservator in Raleigh, North Carolina, has had moderate hair growth with Olumiant. But she’s noticed that if she has a virus or needs to take antibiotics, it triggers a flare of hair shedding. Missing doses can also cause problems, according to Amelia Anderson, 32, a web designer in Meridian, Idaho. When her prescription refill was briefly delayed four months into starting the medication, she began losing hair within a few days.

Currently, JAK inhibitors are only approved for people who have severe alopecia areata—those with 50 percent or more hair loss. Many people using the drugs have tried other treatment options in the past that didn’t work. Corticosteroids, either taken orally or injected directly into bald spots on the scalp, are a mainstay of treatment and help calm inflammation linked to the disease. But unlike JAK inhibitors, they are effective only at the injection sites, and are not systemic treatments. Steroid treatments are still used by patients with mild to moderate hair loss and an important option, Dr. McMichael says. And doctors may also use steroids at the same time as JAK inhibitors to help promote more hair growth.

Ziobro’s disease falls in the mild-to-moderate category. So, her dermatologist injected a steroid into bald areas as they appeared on her scalp, about once a month, which she says made it feel like they were playing whack-a-mole. (She is not currently doing injections since her bald spots have minimized but would resume if needed). Her head would hurt after the shots, and she’s experienced itching and redness, but, so far, the treatment has kept her bald spots to a minimum by helping her hair grow.

Topical and oral minoxidil (the active ingredient in Rogaine) can also help keep the hair follicle in the growth phase, allowing hair to increase in diameter and density, and is sometimes used in tandem with the new JAK inhibitors, says Dr. McMichael. And the immunosuppressant drug methotrexate can help treat alopecia areata by helping treat the inflammation that causes hair loss.

But so far, JAK inhibitors are the most promising long-term treatment doctors have seen for full hair regrowth.

Unwanted Effects

The side effects of these revolutionary medications can be a challenge, particularly in the beginning.

Early on, Anderson felt mild nausea and fatigue and also experienced mood swings and occasional headaches, but the effects gradually diminished as her body adjusted to the medication. The drugs also confer a greater risk for common infections such as colds and UTIs. They can also raise cholesterol levels, which means some patients may need to take cholesterol-lowering drugs, like statins, at the same time.

More concerning, the FDA imposed a black box warning on certain medications based on initial trials that used JAK inhibitors for conditions other than alopecia areata. Despite the fact that trials for JAK inhibitor Xeljanz—which is approved for inflammatory conditions such as rheumatoid arthritis and ulcerative colitis (among others)—had older, sicker subjects who were also taking another drug at the same time, results did show an increased risk of serious heart-related events such as heart attack or stroke, cancer, blood clots, and death. However, the American Academy of Dermatology says not all of these side effects occurred in all safety studies for different JAK inhibitors approved for alopecia areata. However, when a side effect was found in one type of JAK inhibitor, the FDA required it also be listed as a potential risk on the others that function similarly. Still, people with a history of cancer, blood clots, heart attack, stroke, or serious infection should have a conversation with their doctor about their risk.

Of course, not everyone who has alopecia areata can take the medications, and some people with the condition choose not to—or can’t afford it. These drugs can cost $20,000 to $30,000 a year, says Dr. Kopelman. “And with this condition you have to be on them forever.”

This is especially an issue for medically underserved minorities, often people of color, who may have trouble accessing any kind of health care, Dr. McMichael says. Private insurance may or may not cover the cost, and coverage through Medicaid varies from state to state. Pharma companies, however, have put in place several patient programs to try to make this treatment more accessible.

A Complex Choice

After decades of coming to terms with their hair loss, people with alopecia areata have mixed feelings about the new medications. Many feel that alopecia has become part of their identity and don’t necessarily feel the need to “fix” themselves to meet social expectations of what they “should” look like. They’ve also found strength in forming supportive communities with one another. Of course, no one would question a person’s right to pursue a powerful, effective treatment for a life-altering disease. But at the same time, Riley-Klepac, Graham, and others in the hair loss community are determined that people with alopecia be comfortable with themselves, whether or not they decide to use the drugs.

Some, like Graham—in league with actress Jada Pinkett Smith and bluegrass musician Molly Tuttle—are happy rocking their bald looks. “It took me years to go bald publicly,” Graham says. “Now there’s no other way for me to be.”

For Riley-Klepac, who started taking Olumiant at the end of last year, excitement about the possibility of growing hair is mixed with guilt. “I sometimes feel like I am cheating on my community,” she says.

In the summer before her senior year in high school in 2005, she attended a National Alopecia Areata Foundation conference in Tampa. “The sea of bald heads blew my mind,” she says. “At the end of the week, I felt so free without my wig, I got a second-degree sunburn on my head at the swimming pool. Meeting people like me gave me my life back.”

When Riley-Klepac returned to school, she finally shared her diagnosis with her principal and classmates, first in a public letter, then during an assembly, to great applause. “I got an overwhelmingly positive response,” she says. That year she was elected homecoming queen and proudly wore a special crown (one that didn’t require a comb to attach it) on her bare scalp.

“I want people to feel confident and happy just as they are,” she says, “with or without a full head of hair.”

Beth Howard writes about health and psychology from North Carolina. Her mother is among the 44 million caregivers in this country.