This quarter we have another big batch of updates from the alopecia research world, including activity from our funded researchers, and the wider UK and global alopecia research community. There also continues to be a lot of activity in the clinical trials space, particularly for alopecia areata, with results shared by a number of companies working on treatments. Further, European and UK health regulators also shared some updates, including the announcement that deuruxolitinib will become the second approved treatment for adults with severe alopecia areata on the NHS. 

We continue to be encouraged by the global research community's hard work to find answers to pressing questions, plus the number of clinical trials happening. Research progress can be slow, but we are hopeful that this momentum will be carried through to deliver real improvements to people's lives.  

Alopecia UK attends the second London ‘Hair Club’

Lay Research Panel members Wendy and Katie joined Research Manager Niels in attending the second scientific Hair Club at Imperial College London in May. The theme of the meeting was ‘links between the body and hair’, and it was a great opportunity to hear from those working on hair research around the UK. Wendy shared her thoughts about the day:

“The second meeting of Hair Club proved to be just as engaging as last year’s meeting.

There was a wide range of topics, all focused on increasing our understanding of alopecia with researchers and health professionals presenting on themes including the role of the gut microbiome and hair health; environmental factors and hair health; hair fibre as a biomarker of hair health and the role of the hair follicle in regulating body physiology.

Image – Lay Research Panel members Katie and Wendy, together with Research Manager Niels, were given a tour of the labs at Imperial College London by PhD student Min Waye.

A tour of the laboratories led by PhD student Min Waye gave us an opportunity to see her work, which focuses on the links between hair pigment and alopecia areata, and fellow PhD student Asia’s work on the role of stress in alopecia areata.

The researchers’ presentations and networking opportunities with researchers and other health professionals gave us a real sense of communality throughout the day which is encouraging for the AUK community.”

 

Alopecia UK-funded research

Madoc presents early data from the Rapid Access Clinic at World Congress

AUK-funded PhD student Madoc Dawson attended the World Congress for Hair Research in Seoul, where he presented a poster with early data from the 'Alopecia Areata Rapid Access Clinic' project, which investigates if early treatment can improve outcomes for people with alopecia areata. For this work, he compared skin of people with recent-onset to chronic alopecia areata. The findings so far suggest that memory cells of the immune system (called tissue resident memory cells), may build up in skin over time. These memory cells are thought to be involved in causing repeated episodes of hair loss in the same location.

Image – Madoc presenting his poster at the World Congress for Hair Research in Seoul.

The ‘Alopecia Areata Rapid Access Clinic’ project is ongoing and continues to recruit participants with recent-onset alopecia areata to further understand what happens in the early stages of this condition.

Microbiota signature of 6 types of alopecia

This AUK-funded project was set to start in 2020 but due to the COVID pandemic experienced delays and could not be completed entirely as planned. Still, it found some interesting differences between six different types of alopecia:  alopecia areata (AA), male/female pattern hair loss (M/FPHL), frontal fibrosing alopecia (FFA), lichen planopilaris (LPP), and telogen effluvium (TE).

In these different types, they took swabs from people’s scalp, and compared their ‘microbiota’. Our skin is populated by many different types of bacteria, fungi, and other small organisms, which in most cases are beneficial, and do us no harm. All of the microbes together are called our ‘microbiota’ (you may also have heard of ‘microbiome’, which is the local environment including all of the microbes and their products).

The researchers wanted to see if in different types of hair loss, there is a characteristic signature – are some types of microbes present in higher or lower numbers? This could then give hints about whether they may be involved in causing the hair loss.

By analysing the genetic material present in swabs taken from people’s scalps, they found the numbers of bacteria present from each species (Figure 1). In scarring alopecias (FFA and LPP) there were significantly more Proteobacteria and Firmicutes, and significantly less Actinobacteria, compared to the non-scarring alopecias (AA, M/FPHL and TE). By collaborating with another researcher they are now hoping to further explore what these changes mean and whether they can be linked to hair loss causes. A longer summary of the microbiota study can be found on the project page. 

Figure – Bar chart showing averages for the groups of bacteria present in scalp samples for each hair loss condition.

 

Global research

The role of gut health in alopecia areata

Microbes do not only live on our skin, there are also trillions of them inside our gut. There, they help maintain the lining of the gut, a barrier which stops bad things from getting into the rest of our body. They also influence our immune system and brain, by releasing molecules into the blood stream, and by stimulating our nervous system. Although there is still much to learn, we do know that it's important to feed these beneficial bacteria the right things, to support our overall health.

Eating high fibre and fermented foods, and avoiding high sugar and processed foods and excessive alcohol, are believed to be important for a thriving gut microbiome. However, many other factors also influence gut health like exposure to microbes (especially at a young age), antibiotic medications, smoking, pollution, exercise, genetics and other medical conditions.

A review article from Dr Eric McMullen and colleagues explores what we know about links between the gut microbiome and alopecia areata. There is a theory that if the gut is not healthy, this could upset the body’s immune system, which may make someone more likely to develop an autoimmune disease. Research suggests there may be links between an unhealthy gut and some autoimmune conditions like type 1 diabetes, ulcerative colitis, and multiple sclerosis. However, strong evidence for a link with alopecia areata is not yet there.

At the moment, there is little evidence to suggest that AA can be treated through improving gut health. Some studies suggest that there are changes in the gut microbiome of people with alopecia areata, although this has not been shown consistently. It’s not clear if changes exist before people develop AA, and so may be part of causing it. Or, whether these changes develop alongside the AA because of something else, like the immune system being upset.

One study asked 20 people with alopecia areata totalis or universalis to follow a mediterranean diet with butyrate supplementation for 6+ months, but did not see improvements. This was a small study without a control group, and it is not clear how closely people followed the diet.

A few individuals with AA have received faecal microbiota transfers (FMT), where gut bacteria are transplanted into their intestine. This was primarily to treat diarrheal infections, but some of them saw that their AA also improved to some degree. However, it’s not clear if the improvements in hair growth were because of the FMT itself, or because the infection and its effects on the immune system were resolved.

To be able to recommend a particular treatment, there has to be strong evidence. The researchers conclude that at present, no testing or treatments focusing on the microbiome can be recommended for AA. More research that follows people for a longer time is needed to see how gut health links with AA. Still, we do know that eating a healthy diet, high in fibre, is important for overall health.

Metformin as a potential treatment for Central Centrifugal Cicatricial Alopecia

Experts are starting to believe that changes in how the body handles blood sugar levels may be important in central centrifugal cicatricial alopecia (CCCA). While the causes of CCCA are unknown, recent research suggests that CCCA is a ‘fibroproliferative disorder’. This means that there is an overreaction of the body to inflammation, which results in excessive scarring.

Treatments in use today focus on reducing inflammation, but this may not be enough to fully stop or reverse any scarring. Metformin is one treatment that is used to manage blood sugar levels, for people with type 2 diabetes. In addition, it also reduces scarring processes. However, it is not a treatment routinely used for CCCA.

Small studies with individual patients affected by mid/late stage CCCA suggest that hair regrowth may be possible when metformin is used in combination with other treatments. In some studies, the metformin was topical (applied to the skin) while in others it was taken orally (by mouth), and in all cases the treatment lasted for 6 months or more. However, the studies were only in one or a few patients at a time, did not use consistent ways to measure the hair growth, and used a variety of other treatments and durations. So, while these small case studies give hope that metformin could be a useful treatment, larger, controlled studies are needed, to see if these results are really because of the metformin.

We thank Dr Oluwamayowa Aboluwarin for sharing her article reviewing available evidence for the use of metformin for CCCA.

Japanese researchers discover new group of cells important for hair growth

Hair follicles are the mini-organs in the skin that grow strands of hair. As they cycle through their phases of growth (anagen) and rest (telogen), the entire follicle is reshaped – being broken down in the resting phase, and then building up again to start creating a new hair. This involves many different types of cells which all have their own functions, with some giving structure, and some giving pigment (colour).

Researchers have now discovered a new group of cells, which are important in this process. A type of stem cell, they help the follicle regenerate. The researchers found that these cells enable the hair follicle to grow downwards into the skin.

Before, researchers had not been able to create hair follicles in the laboratory that fully cycle (between growth and rest phases) in the same way that they do in human skin. With this discovery, they hope to create better models to study the biology of the hair follicle. The research was recently mentioned in a BBC article on chemotherapy-induced hair loss, which speculated it may help researchers find new ways to treat some forms of hair loss.

Dupilumab treatment for eczema reduces the risk of developing AA

Dupilumab is a biologic treatment approved for moderate-to-severe atopic dermatitis (AD, also known as eczema) in adults. It is not approved for treating alopecia areata (AA). However, people with alopecia areata often also have atopic dermatitis, and researchers believe these conditions may share common mechanisms. Genetic research has shown that AA often has an earlier age of onset, and is more severe, when people also have an allergic condition such as AD, bronchial asthma, or Hashimoto’s thyroiditis.

US researchers looked at health records of 3.3 million people with active AD. They compared three different groups: those treated with dupilumab, with topical steroids, or with prednisone.  

Around 2 years before starting treatment, people with dupilumab had a higher risk for developing AA, compared to those starting topical steroids (2.11x) or prednisone (1.76x).

Dupilumab is typically only started when other treatments have failed. So, people who are starting dupilumab likely have more severe and prolonged symptoms of AD. Potentially, this high disease activity may also make someone more likely to develop AA.

After 2 years on dupilumab, people’s risk for developing AA reduced, relative to topical steroids (1.73x) and prednisone (1.38x). This reduction was consistent irrespective of people’s sex, race, age, IgE levels (antibodies in the blood associated with allergy), and whether people had other allergic conditions (like asthma and food allergies). The risk for developing AA did not change during treatment with steroids or prednisone.

This suggests that dupilumab may target mechanisms involved in triggering AA, in people that have AD. Dupilumab targets interleukin-4 (IL-4) and interleukin-13 (IL-13), two messaging molecules (called cytokines) used by the immune system. A small phase 2a clinical trial of dupilumab showed that it may stimulate hair regrowth in children with AA who also have an allergic condition. Further clinical trials are ongoing in the US, with dupilumab in children, and dupilumab in adults, for people with severe AA plus allergic conditions.

 

Clinical trial updates

Positive results from phase 3 trial of extended-release oral minoxidil

Currently, only topical forms of minoxidil (applied directly to the skin as a foam or spray) are approved for treating pattern hair loss. Oral minoxidil is not approved for treating hair loss, only for high blood pressure, however doctors may still prescribe it ‘off-label’ to treat various forms of hair loss. Although we don't really know how it works, a low dose is often used in combination with other treatments to make them more effective, potentially by improving blood flow. 

VDPHL01 is a new extended-release form of minoxidil being developed specifically for pattern hair loss by Veradermics. By releasing the drug slowly, it is hoped it stays in the body for longer and has a better effect. The company also hope this will reduce the risk of cardiovascular side effects, as it is slowly released into the bloodstream over time rather than as one immediate spike.

Veradermics have now announced results from their phase 2/3 clinical trial of 519 men with pattern hair loss. They took either 8.5mg VDPHL01 once per day, 8.5mg VDPHL01 twice per day, or a placebo.

In pattern hair loss, hair follicles ‘miniaturise’ over time, gradually shrinking and producing thinner hairs that don’t grow as long. Thick, pigmented hairs are known as terminal hairs, and thin, unpigmented ones as vellus hairs.

In the trial, improvements in hair growth were tracked by counting the number of terminal and vellus hairs in an area. The company state that on average, there was an increase of 30.3 non-vellus hairs/cm² in the once-daily dose, and an increase of 33.0 non-vellus hairs/cm² in the twice-daily dose, compared to a 7.3 non-vellus hairs/cm² increase in the placebo. The company further state that 79% of people on the once-daily dose and 86% of people on the twice-daily dose felt their hair coverage improved after 6 months, compared to 36% on the placebo treatment. The number of adverse events* and people discontinuing treatment were similar between VDPHL01 and placebo, and there were no serious adverse events related to the treatment.

A second trial to confirm these results in men is ongoing and the company say they plan to ask for approval from US health regulators (FDA) in 2027. Any potential approvals in the UK would follow some time after this.

A trial of VDPHL01 for Female Pattern Hair Loss is still active and so it not yet clear when data for this will be available.  

HCW Biologics announce positive results from phase 1 trial for AA

HCW9302 is a new treatment being developed for alopecia areata by HCW Biologics. It is injected into the skin and contains interleukin-2 (IL-2). IL-2 is a messaging molecule used by the immune system, that stimulates regulatory T cells (Tregs). These Tregs are important for keeping the immune system in check, so it is thought that stimulating them may help control autoimmune diseases such as alopecia areata.

In this phase 1 trial, they tested a single injection containing increasing doses from 1 microgram per kg bodyweight, to 3 μg/kg, to 8 μg/kg. HCW Biologics have now announced early results from the first two groups (1 μg/kg and 3 μg/kg). They state that in people with “mild” alopecia areata who received 3 μg/kg of the study medicine, some improvements in hair growth were seen 4-9 weeks after the treatment. All adverse events were mild in severity and resolved by themselves. The company now hope to establish the optimal dose to take forward to a phase 2 study. 

Amlitelimab phase 2 trial for alopecia areata terminated

A phase 2 trial of amlitelimab for treating severe alopecia areata was launched in 2024, however this has now been terminated. Amlitelimab is a treatment being developed by Sanofi that blocks OX40L. This molecule is found on the surface of active T cells that are more than 24 hours old, and so is associated with a prolonged immune response. When OX40 combines with OX40L, it sends a signal to other immune cells to keep the immune response going. So, it was thought that switching this mechanism off may help reduce the immune attack in autoimmune diseases, such as alopecia areata. 

It is not clear why the trial has been terminated, although the trial registration page states that it was not due to safety concerns. Clinical trials are done to see if treatments are successful, so it is expected that they don't always work out. Still, there is potential for even unsuccessful trials to improve our understanding of disease mechanisms. 

Further positive results from phase 2 trial of Bempikibart for AA

Bempikibart is a new treatment under development by Q32 Bio for severe alopecia areata in adults. It is a ‘biologic’ which targets signalling molecules Interleukin-7 (IL-7) and Thymic Stromal Lymphopoietin (TLSP). These two signals regulate immune system activity, including the production of new immune cells and supporting survival of existing immune cells. By blocking these molecules, it is hoped an overactive immune system can be calmed down.

Positive results from Part A of the phase-2 clinical trial, called SIGNAL-AA, were announced in March 2025. People with severe AA (>50% scalp hair loss) received an injection of 200 mg bempikibart or placebo every 2 weeks for 24 weeks. After 24 weeks, people receiving bempikibart on average experienced a 16% reduction in scalp hair loss (measured by SALT score) compared to a 2% reduction in the placebo group. At follow-up, 12 weeks after stopping treatment, continued improvements were seen, with an average reduction of 20% scalp hair loss. The company believes this is because the treatment can rebalance the immune system.

Q32 Bio have now announced positive results from Part B of their clinical trial. In Part B, 33 people with severe AA received bempikibart for 36 weeks. This part was an open-label trial, meaning everyone knew what treatment they were receiving, so no-one was on a placebo. The dosing regimen was slightly different too, with an injection every week for the first four weeks, followed by an injection every other week for 32 weeks. After 36 weeks, people had an average reduction in scalp hair loss (SALT score) of 35.3%, with 30-40% of people reaching more than 80% scalp hair coverage (SALT-20). No serious adverse events were reported and the most common adverse event was a skin reaction at the injection site.

Long-term follow-up with participants is ongoing and this data is not available yet. But the company say they wish to take the treatment further, to gather the necessary evidence on safety and effectiveness for health regulators, starting in 2027. This likely means we will see a phase 3 trial.

News from health regulators

MHRA updates guidance for Finasteride and Dutasteride

The Medicines and Health Regulatory Authority (MHRA), the UK organisation that oversees medicine safety, has updated their guidance for finasteride and dutasteride.

These two treatments are ‘5-alpha reductase inhibitors’ used for treating male pattern hair loss. They block the activity of the 5-alpha reductase enzyme, stopping the conversion of testosterone to a stronger version – dihydrotestosterone (DHT). DHT interacts with the hair follicles and causes them to shrink over time (known as miniaturisation). So, by blocking the production of DHT, these treatments can slow down pattern hair loss in men.

However, these treatments carry a risk of side effects including depression, suicidal ideation and sexual dysfunction. These effects may not go away after treatment is stopped. The new guidance from MHRA urges healthcare professionals to inform patients of these risks, to ask about their mental health, and regularly review their mental health and any sexual side effects during treatment. They also advise patients to read the patient cards that were introduced in 2024. People who experience negative effects during treatment are asked to report these to the MHRA Yellow Card Scheme, as this will help them monitor the safety of these medicines.

Deuruxolitinib approved for routine NHS use

On the 26^th of June, it was announced by NICE that deuruxolitinib has been recommended for the treatment of adults with severe alopecia areata on the NHS in England. This means it is set to become the second JAK inhibitor, after ritlecitinib, available to adult patients on the NHS. The Scottish Medicines Consortium decides separately, and we are still awaiting their decision.

Read our announcement of the deuruxolitinib news and when the medicine can be expected to be available in practice.

Upadacitinib receives positive opinion from European Medicines Agency

The European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP) have recommended the approval of upadacitinib (brand name Rinvoq®) for the treatment of adults and adolescent patients with severe alopecia areata. This is an important step for a medicine to be approved for use in a particular health condition across the European Union. For it to now become a treatment option for AA in Europe, the European Commission still needs to approve it. This decision is expected in the coming months.

The UK uses a separate process overseen by the Medicines and Healthcare Regulatory Authority (MHRA) for the approval of medicines. It is not yet clear when AbbVie will seek approval to market the treatment for alopecia areata in the UK. But we hope in due course it will become another treatment option for people in the UK affected by severe alopecia areata.

Upadacitinib is a JAK inhibitor medicine developed by AbbVie. Its safety and effectiveness were evaluated in the UP-AA clinical trials, two large phase-3 studies with adolescents and adults affected by severe alopecia areata (>50% scalp hair loss). We previously shared a summary of the UP-AA clinical trial results (August 2025).

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* An adverse event is an unintended symptom that happens during treatment, no matter what causes it. These are reported because it is not always possible to know if something happened because of the treatment or is unrelated. This is different from a side effect, which is a direct result of the medicine.

See also:

What is a clinical trial?

How is alopecia areata severity graded? (SALT scores explained)

Research blog – including previous quarterly updates