Incorporating New Hair Loss Treatments in Your Clinic, With Luiza Kalil, MD

At the 2025 New Wave Dermatology meeting in Aventura, Florida, on May 16, 2025, Luiza Kali, MD, assistant professor at Yale School of Medicine, presented “Innovative Treatments for Hair Loss.” As a part of HCPLive’s on-site coverage, we spoke with Kalil about therapies she prioritizes for hair loss and the evolving hair loss treatment landscape.

“It's really exciting to be here today because, for a long time, people just thought about hair loss disorder as a cosmetic thing, and we know for patients [it’s] much more than that,” Kalil said. “It's emotional—they get anxiety, they get depression. It’s really good to have more things now and more treatments for that, but there are a lot of new research coming, so we have to understand the new research to try to use the new treatments in our daily lives and to know their efficacy and their safety to make sure we’re doing the best for our patients.”

During her session, Kalil discussed emerging treatments for frontal fibrosing alopecia and androgenetic alopecia.

Alopecia Areata

Mild alopecia areata treatments include topical corticosteroids, IL-TAC, topical/oral minoxidil, and immunotherapy. Moderate cases are treated with topical/systemic corticosteroids, oral minoxidil, JAK inhibitors, immunosuppressants, and immunotherapy. Severe cases are treated with JAK inhibitors, oral minoxidil, dupilumab, or immunosuppressants.

FDA-approved treatments include:

• Baricitinib (2022): 2–4 mg/day for ≥18 years
• Ritlecitinib (2023): 50 mg/day for ≥12 years
• Deuruxolitinib (2024): 8 mg twice daily for ≥18 years (not yet available)

Ongoing trials are evaluating:

• Upadacitinib (≥12 years, phase 3)
• Ivarmacitinib (≥18 years, phase 3)
• Baricitinib (ages 6–18, phase 3)
• Ritlecitinib (ages 6–12, phase 1 completed)
• Deuruxolitinib (≥12 years, phase 3 underway)

Although no head-to-head JAK inhibitor comparisons exist, a 2024 systematic review found ritlecitinib 50 mg and baricitinib 4 mg similarly effective.¹

Emerging treatments for alopecia areata include dupilumab and biologics. A placebo-controlled trial evaluated dupilumab (300 mg weekly) in 60 adults with SALT ≥30.² Bempikibart, which rebalances T effector and T regulatory cells, achieved SALT ≤20 in 21% of patients at week 26.³

Frontal Fibrosing Alopecia

First-line treatments for frontal fibrosing alopecia include steroids, 5-α reductase inhibitors, hydroxychloroquine, and doxycycline. Second-line therapies include minoxidil and immunosuppressants.

Emerging treatments include topical (tofacitinib 2% cream QD, Ruxolitinib cream 1.5% BID or QD, Delgocitinib cream 2% BID) and oral (tofacitinib 5mg twice daily, Baricitinib 4mg daily, Upadacitinib 15mg daily, Brepocitinib) Jak inhibitors. Phase 2 trials are complete.^4,5,6,7

Androgenetic Alopecia

Another condition touched upon was androgenetic alopecia. First-line treatments include minoxidil and antiandrogen (5-alpha-reductase inhibitors, including finasteride/dutasteride), spironolactone, and bicalutamide. Second-line treatments include mesotherapy, micro needling, platelet-rich plasma, and lasers and low-level light therapy.

Microneedling targets affected areas with minimal systemic adverse events, but it’s painful, less effective than oral options, and lacks standardization. Platelet-rich plasma improves density and thickness with chemical activation but requires ≥3 sessions and stronger scientific backing.

Photobiomodulation is non-invasive and safe but costly, limited as monotherapy, and the benefits may fade post-discontinuation. Ablative lasers may damage follicles.

Emerging treatments for androgenetic alopecia include Botulinum toxin, new antiandrogens, prostaglandin analogs, and drugs targeting the prostaglandin pathway, stem cell therapy, and micelle inhibitory RNA.^8,9,10,11

What Treatment Should You Give Patients

“For now, I would keep with the first line treatments, the ones that we have already used for a long time,” Kalil said. “We have been using minoxidil for a long time with good results. We just started using the oral form of it, which is really good, and I really like it for non-scarring and for scarring alopecia. There are new anti-androgen therapies that are really good, but I will keep [with] a first line for now, until we have more data for the new, innovative treatments.”

Kalil has no relevant disclosures.

References

1. Aceituno D, Fawsitt CG, Power GM, Law E, Vaghela S, Thom H. Systematic review and indirect treatment comparisons of ritlecitinib against baricitinib in alopecia areata. J Eur Acad Dermatol Venereol. Published online October 24, 2024. doi:10.1111/jdv.20372

2. Guttman-Yassky E, Renert-Yuval Y, Bares J, et al. Phase 2a randomized clinical trial of dupilumab (anti-IL-4Rα) for alopecia areata patients. Allergy. 2022;77(3):897-906. doi:10.1111/all.15071

3. King B, et al. Initial Results From The SIGNAL-AA Study: Randomized Placebo Controlled Phase 2a Trial of a Bempikibart. Late-breaking data presented at the 2025 AAD Meeting. March 8, 2025

4. Dunn C, Griffith V, Coican A, et al. Janus kinase inhibition for the treatment of refractory frontal fibrosing alopecia: A case series and review of the literature. JAAD Case Rep. 2023;40:47-52. Published 2023 Aug 11. doi:10.1016/j.jdcr.2023.07.037

5. Williams KN, Perez SM, Burroway B, Tosti A. Topical ruxolitinib in the management of frontal fibrosing alopecia and/or lichen planopilaris: A single-center retrospective cohort study. J Am Acad Dermatol. 2025;92(1):170-172. doi:10.1016/j.jaad.2024.09.032

6. Chen LC, Ogbutor C, Kelley KJ, Senna MM. Topical tofacitinib for patients with lichen planopilaris and/or frontal fibrosing alopecia. J Am Acad Dermatol. 2024;90(6):1260-1262. doi:10.1016/j.jaad.2024.01.060

7. Nohria A, Desai D, Shapiro J, Bordone L, Lo Sicco K. Review of the use of Janus kinase inhibitors in the treatment of scarring alopecia. Int J Dermatol. 2024;63(6):e105-e110. doi:10.1111/ijd.17153

8. English RS Jr, Ruiz S. Skin Appendage Disord. 2022 Mar;8(2):93-100.

9. Müller Ramos P, et al. An Bras Dermatol. 2023 Jul-Aug;98(4):506-519

10. DuBois J, et al. Clin Cosmet Investig Dermatol. 2021 Oct 15;14:1507-1517.

11. Piraccini BM, et al.. J Eur Acad Dermatol Venereol. 2022 Feb;36(2):286-294. Erratum in: J Eur Acad Dermatol Venereol. 2023 Feb;37(2):452.