A Delphi panel of 31 US alopecia areata experts completed three rounds of anonymous surveys in 2025, after systematic reviews of 29 treatments. Consensus was set at 70% agreement.
Oral JAK inhibitors were agreed as the primary long-term therapy for adults with severe disease. Dupilumab was an alternative where atopy coexists. Oral and topical minoxidil, intralesional, oral and high-potency topical corticosteroids, and topical JAK inhibitors and prostaglandins were supplements, each with site-specific uses. Patient support resources should be offered alongside treatment.
This is the first structured consensus to place JAK inhibitors as long-term backbone rather than rescue. It does not cover children, pregnancy, mild to moderate disease or patients with significant comorbidity. In India, baricitinib is available and generics have lowered cost, which makes this framework more usable here than it would have been two years ago.
- Grade severity by scalp involvement before choosing therapy; the consensus applies to severe disease only.
- Screen for TB, hepatitis B and C, lipids and blood count before starting a JAK inhibitor.
- Plan for long-term treatment; relapse after stopping is common.
- Use intralesional steroid or topical agents for residual patches, brows and beard.
- Offer patient support resources from the first visit.
Why it matters
It moves JAK inhibitors from last resort to backbone, which changes the conversation at the first severe presentation.
Don't overread it
This is expert consensus, not a trial — it ranks options by opinion informed by evidence, not by head-to-head data.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for dermatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free