A 52-Week Real-Life Study of Baricitinib in Moderate to Severe Alopecia Areata: Clinical, Trichoscopic Assessment and Patient Reported Outcomes

Background/Objectives: Alopecia areata is an autoimmune condition characterized by rapid hair loss in the scalp, eyebrows, and eyelashes, for which treatments are limited. Baricitinib, an oral inhibitor of Janus kinases 1 and 2, has been recently approved to treat alopecia areata. Methods: A total of 23 patients affected by severe alopecia areata (SALT > 50) for more than 6 months were enrolled, including 14 with AU, 3 with AT, and 6 with ophiasis, and all of whom were treated with baricitinib for a minimum of 52 weeks. Clinical and trichoscopic assessments were performed at each visit, and the impact on quality of life, anxiety, and depression was evaluated using the Skindex-16 and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: A total of 23 patients were enrolled, with a mean age of 44.62 years and a mean SALT of 83.66. The mean value of the SALT score decreased to 51.23 at 6 months and 42.41 after one year. Psychological well-being and quality of life also improved, as demonstrated by the decrease in Skindex-16 and HADS scores. Trichoscopic signs showed a decrease in yellow dots and black dots and an increase in vellus hairs and hair regrowth. Adverse events during the treatment period were reported in 18.75% patients. No drop-outs were registered. Conclusions: Data on the effectiveness and safety of baricitinib are promising and support the use of this drug in severe forms of AA, also in the early stages. We also suggest performing trichoscopy in response to therapy.