Monitoring the Response to JAK Inhibitor Treatment in Alopecia Areata Using Reflectance Confocal Microscopy and Videotrichoscopy: A 60-Week Observational Study
- 1Department of Dermatology, Faculty of Medicine, Medical College, University of Rzeszów, Szopena 2, 35-055 Rzeszow, Poland
- 2The Doctoral School, University of Rzeszów, Rzeszow, Poland
Abstract
Introduction: Alopecia areata (AA) is an autoimmune disease affecting approximately 2.1% of the population. JAK inhibitors represent a therapeutic breakthrough for severe AA, yet objective tools for monitoring treatment response remain limited. The objective of this study was to correlate trichoscopic and reflectance confocal microscopy (RCM) features with clinical changes in patients with severe AA treated with JAK inhibitors (upadacitinib and baricitinib) over 60 weeks.
Methods: Twenty patients with severe AA were enrolled. Patients were treated with upadacitinib 15 mg/day or baricitinib 4 mg/day. Clinical (Severity of Alopecia Tool score), trichoscopic, and RCM evaluations were performed at baseline and every 12 weeks thereafter.
Results: Mean Severity of Alopecia Tool (SALT) decreased from 85% at baseline to 17% at week 60. Upadacitinib treated patients showed faster early response (32.6%% SALT reduction at week 12 vs. 5.2% increase with baricitinib), though both groups achieved comparable outcomes by week 60 (SALT 17%). Trichoscopy showed progressive reduction of activity markers: (yellow dots, black dots, broken hairs, and exclamation mark hairs) with characteristic regrowth sequence: short vellus hairs, upright regrowing hairs, terminal hairs. RCM identified three parameter categories: (1) inflammatory activity markers (epidermal infiltration, bright rimming, luminal bright material, cadaverised hairs), with persistent diffuse follicular inflammation and perifollicular muffle; (2) transient collagen remodelling features without fibrosis; and (3) recovery markers, including follicular normalisation (strongest RCM predictor of response) and vellus-to-terminal transition.
Conclusions: JAK inhibitors demonstrated sustained efficacy in severe AA. Multimodal assessment combining SALT, trichoscopy, and RCM enables precise biological response monitoring. RCM uniquely detects subclinical perifollicular inflammation persisting despite clinical improvement, potentially predicting relapse risk after treatment discontinuation.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s13555-026-01928-2.
Related
- Clinical, metabolic, dermoscopic, and reflectance confocal microscopy features of prurigo pigmentosa: a retrospective case series.
- AI-Assisted Quantitative Reflectance Confocal Microscopy Reveals Modulation of Senescence-Associated Epidermal Morphometric Features by a Topical TGF-β Mimetic, XEP™-716 Miniprotein™
- P017 Serial DXA Monitoring in Aromatase Inhibitor-Induced Bone Loss: A Decade of Progressive Bone Loss, Stabilisation with Bisphosphonate Therapy and Recovery Following Endocrine Therapy Cessation
- Gastrolaryn® Stick Following Proton Pump Inhibitor Treatment in Patients with Gastroesophageal Reflux Disease: A Multicenter Real-World Observational Survey
- Retrospective observational study of transcatheter arterial chemoembolization (TACE) combined with PD-1 inhibitor and tyrosine kinase inhibitor (TKI) in advanced hepatocellular carcinoma.
BibTeX
@article{kolcz2026monitoring,
title = {{Monitoring the Response to JAK Inhibitor Treatment in Alopecia Areata Using Reflectance Confocal Microscopy and Videotrichoscopy: A 60-Week Observational Study}},
author = {Kinga Kołcz and Jagienka Włodyka and Adam Reich},
journal = {Dermatology and Therapy},
year = {2026},
month = oct,
doi = {10.1007/s13555-026-01928-2},
url = {https://doi.org/10.1007/s13555-026-01928-2},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Monitoring the Response to JAK Inhibitor Treatment in Alopecia Areata Using Reflectance Confocal Microscopy and Videotrichoscopy: A 60-Week Observational Study
AU - Kinga Kołcz
AU - Jagienka Włodyka
AU - Adam Reich
PY - 2026
DA - 2026/10/02
JO - Dermatology and Therapy
DO - 10.1007/s13555-026-01928-2
UR - https://doi.org/10.1007/s13555-026-01928-2
AB - Introduction: Alopecia areata (AA) is an autoimmune disease affecting approximately 2.1% of the population. JAK inhibitors represent a therapeutic breakthrough for severe AA, yet objective tools for monitoring treatment response remain limited. The objective of this study was to correlate trichoscopic and reflectance confocal microscopy (RCM) features with clinical changes in patients with severe AA treated with JAK inhibitors (upadacitinib and baricitinib) over 60 weeks. Methods: Twenty patients with severe AA were enrolled. Patients were treated with upadacitinib 15 mg/day or baricitinib 4 mg/day. Clinical (Severity of Alopecia Tool score), trichoscopic, and RCM evaluations were performed at baseline and every 12 weeks thereafter. Results: Mean Severity of Alopecia Tool (SALT) decreased from 85% at baseline to 17% at week 60. Upadacitinib treated patients showed faster early response (32.6%% SALT reduction at week 12 vs. 5.2% increase with baricitinib), though both groups achieved comparable outcomes by week 60 (SALT 17%). Trichoscopy showed progressive reduction of activity markers: (yellow dots, black dots, broken hairs, and exclamation mark hairs) with characteristic regrowth sequence: short vellus hairs, upright regrowing hairs, terminal hairs. RCM identified three parameter categories: (1) inflammatory activity markers (epidermal infiltration, bright rimming, luminal bright material, cadaverised hairs), with persistent diffuse follicular inflammation and perifollicular muffle; (2) transient collagen remodelling features without fibrosis; and (3) recovery markers, including follicular normalisation (strongest RCM predictor of response) and vellus-to-terminal transition. Conclusions: JAK inhibitors demonstrated sustained efficacy in severe AA. Multimodal assessment combining SALT, trichoscopy, and RCM enables precise biological response monitoring. RCM uniquely detects subclinical perifollicular inflammation persisting despite clinical improvement, potentially predicting relapse risk after treatment discontinuation. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s13555-026-01928-2.
SN - 2193-8210
SN - 2190-9172
ER -