Consensus Statement: JAK Inhibitors Emerge as Primary Therapy for Severe Alopecia
Key Takeaways
- A US Delphi consensus published in JAMA Dermatology positions oral Janus kinase (JAK) inhibitors as primary, long-term therapy for adults with severe alopecia areata (AA).
- The panel supported dupilumab as an alternative for patients with active atopic disease or a history of atopy, along with several site-specific adjunctive therapies.
- The recommendations apply specifically to adults with severe AA and do not extend to children, pregnant patients, patients with mild to moderate disease, or those with underlying comorbidities.
A US expert consensus provides a standardized treatment framework for adults with severe alopecia areata (AA), placing oral Janus kinase (JAK) inhibitors at the center of long-term disease management.
"This joint NAAF and AHRS Delphi consensus statement introduces the, what is to our knowledge, first standardized treatment recommendations for adults with severe AA in the US," the authors wrote in the paper, published in JAMA Dermatology. "This clinical framework aims to inform and guide clinicians to improve treatment outcomes and enhance accessibility to effective AA treatment."
Expert Consensus Positions JAK Inhibitors as Primary Therapy for Severe Alopecia Areata
Investigators conducted systematic literature reviews of AA therapies in PubMed from inception through December 2024, followed by 3 rounds of anonymous Delphi surveys between May and November 2025. Thirty-one US-based AA experts participated Consensus was predefined as at least 70% agreement, and Severe AA was defined according to the Alopecia Areata Scale incorporating scalp hair loss and additional disease-severity factors.
According to the analysis, after three roundfs, 24 of 27 of the experts (88.9%) agreed on an a treatment approach for adults with severe AA, and 23 of 27 (85.2%) agreed on a longitudinal management model. Oral JAK inhibitors won out as the primary, long-term therapy, with US Food and Drug Administration–approved JAK inhibitors preferred. The panel recommended continuous treatment at the same dose as long as response is maintained with appropriate treatment.
Dupilumab received concensus as a potential alternative for patients with active atopic disease or a history of atopy. Supplemental or adjunctive options included oral and topical minoxidil, intralesional and topical corticosteroids, short-term oral corticosteroids, and site-specific topical JAK inhibitors and prostaglandins.
Source
Gregoire S, et al. JAMA Dermatology. 2026. DOI:10.1001/jamadermatol.2026.2336