Pediatric Alopecia Areata Treatment With Baricitinib, Combination Therapies, Patient Adherence

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Brittany Craiglow, MD, FAAD, dermatologist at the Dermatology Physicians of Connecticut in Fairfield, discussed combination therapies for pediatric alopecia areata, emphasizing the benefits of combining baricitinib with other treatments like oral minoxidil and intralesional corticosteroids to enhance efficacy.

She highlighted the need for more research to personalize treatment, noting that patients may respond differently to various Janus kinase (JAK) inhibitors, and addressed adherence to baricitinib. Craiglow explained how adolescents with alopecia areata tend to be highly motivated and adherent due to the visible and significant impact of hair regrowth. AJMC interviewed Craiglow at the American Academy of Dermatology annual conference that took place from March 7-11, 2025, in Orlando, Florida.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

How do you see the future of combination therapies, using baricitinib in conjunction with other treatments, for pediatric alopecia areata?

As you know, in the real world, we don't have to do monotherapy like you have to do in a clinical trial. I think when you're able to combine agents, especially in alopecia areata, often we get better outcomes. I use a lot of combination oral minoxidil, along with JAK inhibitors in my practice, and that really tends to boost efficacy.

Another thing that we can sometimes do, if patients respond well, but they have stubborn patches, we can do intralesional corticosteroids to those little areas. I think in real life, we often get better results than we see in the trials, which I think for patients is just great.

What are the most significant knowledge gaps in our understanding of alopecia areata and its treatment in children and adolescents, and how do you think future research should address these gaps?

We've really come a long way in alopecia areata in terms of our understanding of the pathogenesis, which has really kind of paved the way for these FDA-approved treatments that are very targeted, but still not everybody responds to those.

One thing that's interesting that we're seeing in practice is that some patients will not respond to one JAK inhibitor, for example, and then they will respond to another. We certainly don't have big enough numbers of patients to be able to kind of identify who is going to benefit from drug X vs drug Y, but I think as we go along, we may be able to move towards a place of more kind of personalized medicine: “You have these features, and so maybe this medication makes more sense for you.”

I think while we've learned a lot and we made a lot of progress, there's still a lot to learn in terms of identifying the right therapy for the right patient. These questions about, “What happens long term? Are people able to dose reduce? Are there cases in kids where we actually can sort of modify the disease?” These are all questions that we're kind of thinking about, and we just sort of need more time to explore.

How do you approach the challenge of patient adherence to baricitinib therapy, particularly in adolescents?

It's funny, adolescents in general, I think we do sometimes have issues with adherence to treatments, but I will say that in alopecia areata, most of these kids are very adherent, because they are really motivated to have their hair.

I think one thing that's really different in alopecia areata compared with other disease states is that the stakes are high. If you have atopic dermatitis and you're taking a medication and you fall off, your skin flares, and then probably you go back on and you get better.

Whereas in alopecia areata, if you've had a good response, meaning you've grown hair, and then you stop taking the medicine, or you do it a lot less frequently, if you do that for long enough, you'll probably lose hair. Patients understand this and so because of that, I think adherence is actually really great in this population, and it's not really something that in practice we find to be an issue.