Do you typically recommend initial therapy with a JAK inhibitor or systemic corticosteroids in acute extensive alopecia areata?

I typically treat acute extensive alopecia areata with a JAK inhibitor (at the highest relevant dose) rather than systemic corticosteroids, as I have found that patients tend to respond well with this approach. The JAK inhibitors work very quickly to reduce the inflammatory processes underlying alopecia areata flares, and short-term risks for JAK inhibitors on the order of a few months are very well characterized, and they are generally very well tolerated.