REVIEW article
Front. Med.
Sec. Dermatology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1614455
Immune Cell-Targeting Biologics for Alopecia Areata: A New Paradigm in Precision Medicine
Provisionally accepted
- 1Department of Biochemistry and Molecular Biology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
- 2Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
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Alopecia areata (AA) is a chronic autoimmune disorder characterized by non-scarring hair loss, with severe cases progressing to alopecia totalis or universalis. Immune dysregulation, particularly involving B and T cells (CD8+ cytotoxic, CD4+ helper, and regulatory T cells), plays a central role in AA pathogenesis. Emerging immune-modulating biologics offer more targeted alternatives to traditional treatments, such as JAK inhibitors or corticosteroids. A review of clinical trials, case series, and case reports sourced from PubMed was conducted to evaluate the efficacy of immune cell-modulating biologics in treating AA. Key data regarding their mechanism of action, clinical outcomes, and safety profiles were extracted and analyzed. Abatacept, Alefacept, Efalizumab, Nivolumab, Aldesleukin, and Rituximab were included. Nivolumab and rituximab achieved complete remission of AA in case reports. Alefacept showed modest efficacy, with only two patients achieving ≥50% SALT improvement in a clinical trial, while partial to complete regrowth was observed in all patients in the case reports. Aldesleukin led to a 50% SALT reduction in 14.3% of patients in a randomized trial and partial hair regrowth in 80% in a pilot study, as evidenced by a median 13-point SALT reduction. Abatacept and efalizumab had mixed results, with 3-91% regrowth in 70% of patients for abatacept, and no significant benefit in a trial, but 70-100% regrowth in case reports for efalizumab. Further investigation into immunological endotypes, disease modulation through immune cell-targeting biologics, and potential combination strategies is critical to developing tailored therapies that optimize treatment outcomes for AA patients.
Keywords: Alopecia Areata, biologics, monoclonal antibodies, immune, T cells, B cells, IL-2
Received: 18 Apr 2025; Accepted: 09 Jun 2025.
Copyright: © 2025 Gaumond, Opstal, Kamholtz and Jimenez. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Simonetta I Gaumond, Department of Biochemistry and Molecular Biology, Leonard M. Miller School of Medicine, University of Miami, Miami, 33136, Florida, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.