Current options and treatment strategies for alopecia ateata in comorbidity with atopic diseases

Introduction. Alopecia areata (AA) associated with atopic diseases (AD) is characterized by specific clinical, epidemiological, and immunological features, allowing the identification of an “atopic type” of AA. Currently, certain treatment methods may be effective for both AA and AD.

Aim. To analyze current treatment options for “atopic” AA based on literature and clinical experience.

Materials and methods. Review of publications concerning the connection between AA and atopy and treatment methods; assessment of clinical and laboratory data and treatment outcomes for patients with AA and AD.

Results. Seventy-eight publications were analyzed, and two clinical cases were described. In the first case, a patient receiving dupilumab showed positive effects on universal AA, atopic dermatitis (AtD), and bronchial asthma. The second patient with AtD and subtotal AA achieved partial remission through combined therapy, including UVB 311 nm and antihistamines. Specific treatment options for comorbid AA and AD were identified. Notably, phototherapy used for AtD may aid in hair restoration; antihistamines used for AD symptoms are potentially effective for AA, particularly during active stage. For systemic therapy needs in AA and AtD, oral JAK inhibitors – baricitinib, upadacitinib, and abrocitinib – should be considered. Dupilumab may be the treatment of choice for AA with severe AtD and respiratory allergies, including in younger pediatric patients.

Conclusions. The treatment strategy for patients with concomitant AA and AD should focus on reducing pharmacological burden and improving quality of life. Modern therapeutic approaches provide options for addressing shared pathological mechanisms while considering diseases severity and patient age.

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