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Alopecia Areata, Dermatological Conditions CE/CME accredited

A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

Understanding alopecia areata: Current perspectives and emerging therapies for a complex disease

  • A practice aid is available for this activity in the Toolkit
  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Recognize the risk factors, symptoms, and burden of alopecia areata
  • Describe the pathophysiology and immunological mechanisms involved in alopecia areata
  • Evaluate how emerging therapies for alopecia areata may be incorporated into the current landscape and change clinical practice

Dr Maryanne Senna and Dr Anna Waśkiel-Burnat engage in conversation on the current understanding of alopecia areata, its burden and pathophysiology, and the potential for emerging therapies to improve clinical outcomes. The discussion is stimulated by questions posed by healthcare professionals involved in the management of alopecia areata.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of dermatologists, paediatric dermatologists, dermatology nurse practitioners and dermatology physicians’ assistants involved in the care of people with alopecia areata.


USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.


Dr Maryanne Senna discloses: Advisory board or panel from Arena Pharmaceuticals, Eli Lilly, Follica and Pfizer. Consultancy fees from L’Oreal. Grants/research support from Eli Lilly, Follica and Pfizer (relationships terminated). Speaker’s bureau from Eli Lilly.

Dr Anna Waśkiel-Burnat has no financial interests/relationships or affiliations in relation to this activity.

Content reviewer

Adam Bennett, MD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Anne Nunn has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact



This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 20 September 2022. Date credits expire: 20 September 2023.

If you have any questions regarding credit please contact

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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  • A practice aid is available for this activity in the Toolkit
  • Downloads including slides are available for this activity in the Toolkit

Topics covered in this activity

Alopecia Areata / Dermatological Conditions
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Understanding alopecia areata: Current perspectives and emerging therapies for a complex disease
0.75 CE/CME credit

Question 1/5
Approximately, what proportion of patients with AA are likely to have a family history of AA?

AA, alopecia areata.

The exact cause of AA is still unknown, though the current body of evidence supports an autoimmune origin with a strong genetic contribution, further modified by unknown environmental influences. A positive family history is evident in approximately 10–25% of cases.1–3 


AA, alopecia areata.


  1. Spano F, Donovan JC. Can Fam Physician. 2015;61:751–5.
  2. Wang S, et al. Dermatol Online J. 2018;24:14.
  3. American Academy of Dermatology Association. Alopecia areata causes. Available at: (accessed 1 September 2022).
Question 2/5
You have a new patient with AA who presents with 30% scalp hair loss and no eyelash or eyebrow involvement. In addition to the extent of hair loss, which of the following do you also need to establish to understand the severity of her disease?

AA, alopecia areata.

AA has been shown to impair patients’ emotional and psychological wellbeing, relationships, and lifestyles.1 Furthermore, patients’ perception of their current AA as moderate to severe consistently predicts scores on QoL (Skindex-16) and daily impairment (WPAI).2 A framework for understanding disease severity has been proposed, whereby disease severity is anchored in the amount of scalp hair loss and then modified depending on the presence of either non-scalp hair loss (eyebrows, eyelashes), inadequate treatment response, multifocal diffuse positive hair pull test (indicating poor prognosis), and negative impact on psychosocial functioning.3 


AA, alopecia areata; QoL, quality of life; WPAI, Work Productivity and Activity Impairment.


  1. Aldhouse NVJ, et al. J Patient Rep Outcomes. 2020;4:76.
  2. Senna M, et al. J Invest Dermatol. 2022;
  3. King BA, et al. Dermatol Ther (Heidelb). 2022;12:825–34.
Question 3/5
Which of the following has been implicated in the collapse of immune privilege in hair follicles and the onset of AA during periods of stress?

AA, alopecia areata; IL, interleukin; JAK, Janus kinase; STAT, signal transducer and activator of transcription.

AA is caused by the destruction of immune privilege in healthy hair follicles. Substance P is a stress-associated neuropeptide believed to play a significant role in the expression of proinflammatory signals associated with AA. Recent evidence supports the hypothesis that interaction between perifollicular mast cells and substance P activation induces neurogenic inflammation, resulting in immune privilege collapse. Additionally, substance P has also been shown to prevent hair growth and induce keratinocyte apoptosis. 


AA, alopecia areata. 


Kim C, et al. Ann Dermatol. 2022;34:270–7.

Question 4/5
You have been treating a patient with baricitinib (4 mg daily) for 8 months and they have responded well to the treatment with almost full hair regrowth from 85% hair loss with eyelash/eyebrow involvement. However, they have also developed treatment-related mild acne. They are getting married in 2 months and would like to take a treatment holiday to reduce signs of acne prior to the wedding. What do you recommend?

Currently, there is no consensus on the optimal duration of maintenance of treatment with JAK inhibitors in AA, although several studies suggest that to maintain hair regrowth, continuous treatment should be considered where it is effective and well tolerated.1–3 

Patients with nearly complete or complete scalp hair loss, with or without substantial eyelash or eyebrow hair loss, can be treated with baricitinib 4 mg once daily.4 Dosing should be reduced to the recommended dose of 2 mg daily when an adequate response has been achieved.4 This recommendation reflects findings from a randomized down-titration period in the BRAVE-AA2 trial, where 75% of patients who achieved an adequate response (SALT ≤20) to baricitinib 4 mg once daily were shown to maintain that response following an additional 24 weeks’ treatment with baricitinib 2 mg once daily versus 98% of patients remaining on baricitinib 4 mg once daily.4 


AA, alopecia areata; JAK, Janus kinase; SALT, Severity of Alopecia Tool.


  1. Kennedy Crispin M, et al. JCI Insight. 2016;1:e89776.
  2. Almutairi N, et al. Dermatology. 2019;235:130–6.
  3. Peeva E, et al. J Am Acad Dermatol. 2021;87:390–3.
  4. FDA. Baricitinib PI. Available at: (accessed 30 August 2022).
Question 5/5
You are considering prescribing baricitinib to a patient with moderate-to-severe AA. What do you do as part of your patient assessment?

AA, alopecia areata.

Baricitinib lowers the ability of the immune system to fight infection. Patients with evidence of active hepatitis B or C infection were excluded from clinical trials and the risk of chronic viral hepatitis reactivation during treatment with baricitinib is unknown. It is, therefore, recommended that patients be screened for viral hepatitis in accordance with clinical guidelines, before starting treatment; if positive for hepatitis antibody but negative for active disease, they should be monitored during treatment for evidence of reactivation. 


FDA. Baricitinib PI. Available at: (accessed 30 August 2022).

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