Use of JAK Inhibitors in Central Centrifugal Cicatricial Alopecia

JAK inhibitors (JAKis) are medications that target overactive immune and inflammatory pathways through inhibition of the JAK/STAT pathway. Different topical and oral JAKis are FDA-approved for a variety of conditions from eczema to alopecia areata, a non-scarring alopecia. However, there are no FDA-approved treatments for scarring alopecias such as central centrifugal cicatricial alopecia (CCCA) at this time. A contributing factor to this is the lack of understanding of pathogenesis of scarring alopecias.

In September 2023, the first and only report of hair regrowth in a patient with CCCA after treatment with an oral JAKi was published.¹ The patient, a 42-year-old Black woman, presented with a 5-year history of hair loss along with burning and itching of the scalp. Two scalp biopsies revealed CCCA in the medial parietal scalp and changes of female pattern hair loss (FPHL) in the frontal scalp. She was treated with several oral, topical, and injection therapies including - doxycycline 40 mg daily, oral minoxidil 2.5 mg daily, topical halcinonide 0.1% solution twice daily as needed for symptoms, and monthly intralesional triamcinolone 5 mg/mL injections. Over several months, her alopecia stabilized on this regimen; however, despite treatment compliance, two years after the initial presentation, her symptoms returned. Oral JAKi, baricitinib 4 mg daily, was initiated alongside monthly intralesional triamcinolone injections. The patient’s symptoms resolved after one month of JAKi therapy and regrowth of hair in the medial parietal scalp was observed after 2 months.

Soon after publication of this report, in December 2023, a study investigating the role of JAK/STAT pathway activation in CCCA was published.² Immunohistochemistry for phosphorylated STAT3 was performed on scalp biopsy specimens from 6 Black female patients with CCCA and results were compared with those of 7 biopsy specimens from age-matched Black women with FPHL as controls. JAK/STAT activation was demonstrated in CCCA specimens compared to FPHL specimens, suggesting that JAKis may potentially be effective agents for CCCA.

In conclusion, while these studies suggest that oral JAKis is a promising treatment for CCCA, larger controlled trials and further mechanistic studies are needed to corroborate these findings.

Article by Tejashri Venkatesh, MD Candidate 2025, Chicago Medical School at Rosalind Franklin University | Reviewed by Jorge Larrondo, MD

References:

1. Workman K, Kindred C. Hair regrowth in a patient with central centrifugal cicatricial alopecia after a 2-month trial of baricitinib. JAAD Case Rep. 2023;39:109-111. Published 2023 Jul 28. doi:10.1016/j.jdcr.2023.07.016
2. Roche FC, Hedberg ML, Fischer AS, et al. Activation of STAT3 in lymphocytes associated with central centrifugal cicatricial alopecia. J Am Acad Dermatol. 2023;89(6):1245-1246. doi:10.1016/j.jaad.2023.01.045