Do you consider JAK inhibitors, such as baricitinib, a reasonable option for FFA?

In general, I think that use of JAK inhibitors is reasonable for FFA after discussion with patients about the potential risks/boxed warning and the fact that it's an off-label treatment. Particularly for patients who don't respond to first-line treatments, JAK inhibitors can be effective in reducing the active inflammatory process driving the hair loss (profiling studies have shown increased JAK/STAT signaling, so this mechanism may not be surprising). Although each JAK inhibitor is different, this recent study shows promise in FFA (as well as in CCCA and LPP): David et al., PMID 39461505.

Agree would work - but FFA may have a higher risk of cardiac disease so would need to discuss this with patient - especially since most are postmenopausal women.

So would start with at topical JAK first - either samples or compounded.

• Kim et al., PMID 37989400
• Oulad Ali et al., PMID 37274389
• Desai et al., PMID 39148634