Our Research Manager Niels has brought together another research update with the latest news from Alopecia UK-funded projects, global research, and clinical trials testing new treatments.

Following on from the success with JAK inhibitors in alopecia areata, we’re excited to see that these are now also being explored as an option for scarring alopecias. In the clinical trials section, we’re excited to share news about a JAK inhibitor progressing to a phase 2b/3 trial for lichen planopilaris. The alopecia areata space also continues to be ‘hot’, with new types of treatments progressing along the clinical trial 'pipeline'. 

We were also encouraged to see some of the world’s leading experts explain how one day we may be able to ‘train’ the immune system so that it can keep itself under control. As if on cue, a group of researchers even published some very early evidence of such an approach in treating alopecia areata.

There has been a lot of activity this quarter, so this and more in the longest quarterly update so far. 

Alopecia UK-funded research

Immunometabolism in alopecia areata

In 2022, we gave funding to a project on ‘immunometabolism in alopecia areata’. The results of this have now been published in Experimental Dermatology. But what is ‘immunometabolism’ – I hear you ask? Metabolism is how cells in our body get energy and materials to carry out their functions. The hair follicle, which builds hair, is made up of many cells, which require a lot of energy. But energy production comes with waste products, and can release unstable molecules that can damage the environment around cells.

Immune cells are mostly known for fighting against infection. But they are also very important in cleaning up and healing damage in the body. If energy production causes too much damage, immune cells may not be able to deal with it properly, and this could trigger more serious immune reactions. So, immunometabolism is the complex relationship between energy production and immune cells.

This project studied if there are changes to metabolism in hair follicles of people affected by alopecia areata. The theory was that this may help explain what is happening around hair follicles when they are attacked by immune cells, as is the case in AA. The researchers looked at a range of substances, and did find that there were some changes, notably an increase in waste product 'uric acid'. They also found that blood vessels around the hair follicle appeared to be damaged. These were early indications that local changes in energy supply may be linked with immune reactions. Follow-up research will look at this further in people at varying stages of hair loss, in the hope that it can help identify new options for treatment in the future.

Recommendations for psychological support

In 2022 we also gave funding to a project aiming to ‘Determine the key components of psychological support for people with alopecia areata'. A scientific article describing the consensus study has now been published in the BMJ Open.

This project asked: what aspects of psychological support are most important to people with alopecia areata? By speaking to experts who had given psychological support, and people with AA who received support, a list of possible recommendations was created. They were then asked to decide which were most important, and most relevant to different support roles. People with AA may encounter different types of ‘support providers’ along their journey, and these can all play a role in helping people manage their condition:

• General Practitioners (GPs) and Dermatologists
• Mental health professionals
• Peer supporters (others affected by alopecia)
• Trichologists

One of the most important recommendations was ‘to validate and explore the emotional impact that AA can have on the people it affects’. The full recommendations are available via the project page above, as PowerPoint slide decks with notes, and as 2-page PDFs. They have been shared with organisations and practitioners in the hope that they will be implemented widely.

Global research news 

FOXP3 and regulatory T cells – the path to curing autoimmune disease?  

The Autoimmune Association (a US non-profit organisation) recently spoke with Dr Mary Brunkow and Dr Fred Ramsdell about their research on the immune system, which earned them the 2025 Nobel Prize in Physiology or Medicine (alongside Prof Shimon Sakaguchi). Back in 2001, they discovered that the FOXP3 gene controls a group of immune cells called ‘regulatory T cells’ (Tregs).

The immune system consists of many different types of immune cells. In many autoimmune diseases, including alopecia areata, immune cells called ‘CD8+ T cells’ attack healthy parts of the body. Tregs on the other hand, are a different subset of immune cells that naturally keep other immune cells in check. Researchers are now trying to find out if treatments targeting Tregs can help ‘calm down’ the immune system, and thereby control autoimmune disease.

In the podcast, Dr Ramsdell described how various companies, including his own, are trying to develop treatments based on Tregs. He speculates that you may even be able to ‘train’ the Treg cells, letting them zone in on the specific mechanisms causing disease. He suggests that in the future it should be possible to control autoimmune disease with a ‘curative’ or once every 5-10 year treatment. An exciting thought, but in our opinion, it is too early to say that this will be possible. Clinical trials are still in the early stages, so it remains to be seen if these types of treatments are safe and effective in humans.

Still, it is fantastic to see the world’s leading researchers are working to find new ways to treat autoimmune diseases. The full podcast by the Autoimmune Association can be found on their website.

Experiments with regulatory T cells in alopecia areata

In a very timely publication, Professor Amos Gilhar’s research group present evidence from experiments with regulatory T cells (Tregs) in the context of alopecia areata. Here, they describe experiments with a specific subset: γδ (gamma delta) Tregs.

They extracted some of these immune cells from people with AA, multiplied them in the laboratory, and activated them. For ethical reasons, they could not inject them back into humans. So, what they did instead was take small pieces of skin from the people with AA, and attached these onto mice (this is known as a ‘xenotransplant’). They then injected the immune cells into this transplanted human skin. The researchers saw that injecting γδ Tregs stopped the attack from immune cells on the hair follicle, allowed hair to regrow, and prevented new AA from developing.

In a parallel experiment, they grew hair follicles in a petri dish, together with γδ Tregs. The hair follicles were expressing a signal that normally attracts immune cells to attack (MICA/B). But, the presence of γδ Tregs appeared to prevent them from being attacked.

This early evidence is an exciting step towards possible ‘cell-based therapies’ – where whole cells are given to patients to treat disease. However, before any such treatment would become available to patients, they would need to be shown to be safe and effective through clinical trials, which can take many years.

Minoxidil toxicity in pets

Minoxidil is a treatment used for various forms of hair loss, particularly pattern hair loss. Often, it is applied to the skin directly as a spray or foam. However, researchers now urge people who use minoxidil to take caution if they have pets, as it is highly toxic to them.

They looked at cases of cats and dogs experiencing toxicity following exposure to topical minoxidil. Most cases of toxicity were because the pets orally ingested the medication by accident, including by rummaging through trash, licking skin, or getting it on themselves. For example, if they brush up against their human’s skin, or touch contaminated bedding, and then lick their fur.

Pet owners who use minoxidil are urged to store and dispose of their bottles and tissues in a safe way, and limit pets sleeping on the bed. If it is suspected that a pet has been exposed to minoxidil, they should be investigated by a veterinarian immediately.

Could the immune system cause Female Pattern Hair Loss (FPHL)?

In case you missed it, in February we shared a research update on FPHL. This described a study looking at immune cell activity around the hair follicles of women with pattern hair loss. For a long time, it has been believed that hormones are the driving factor. This new study gives early evidence that the immune system may be playing a major role. If this is indeed the case, it could open up a path for new types of treatments which target the immune system. 

Clinical trial updates

For general information on clinical trials, it may be useful to first read our explainer on ‘What is a clinical trial?’. 

Brepocitinib going to phase 2b/3 for Lichen Planopilaris

Currently, no approved treatments exist for lichen planopilaris, or other forms of scarring alopecia. But in recent years, several small trials of JAK inhibitors have shown promise in treating the inflammation and slowing down scarring processes in lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and central centrifugal cicatricial alopecia (CCCA).

In scarring alopecias, an area of the hair follicle storing stem cells comes under attack. Stem cells are important in letting the hair follicle regenerate through its growth and rest phases. When they are destroyed, this is no longer possible. It also leads to hair follicles being replaced by scar tissue. It is important to stop this process early, so that hair follicles are not permanently destroyed. So far, from the small trials, it looks like JAK inhibitors may be able to stop or at least slow down the attack from immune cells.

Priovant Therapeutics have now announced they will launch a phase 2b/3 trial of brepocitinib, focusing only on LPP. Medicine regulators like the FDA (US) and MHRA (UK) can only approve medicines for one condition at a time, and require a lot of high-quality data for this. This is likely why they are focusing only on one condition for now. The trial will likely also only be for people in the US, but we will keep monitoring developments.  

In the earlier phase 2a trial of brepocitinib, participants with LPP, FFA or CCCA received 45mg oral brepocitinib per day for 52 weeks. The aims were to stop the inflammation and progression of scarring, so they did not measure and report hair regrowth. What they did see were reductions in disease activity, including reductions in itching, and improvements in patients’ quality of life. The study only included people who had developed the disease within the last 7 years. Better improvements were seen in people with shorter disease duration (<5 years) compared to longer disease duration (>5 years), which underscores the importance of treating scarring alopecia early.

The most common adverse events* seen were acne, viral infections, anemia, and increased blood creatinine levels. Two people had to discontinue the drug because of a serious adverse event.

*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.

Deuruxolitinib approved by MHRA for severe AA

In March, we shared the news that the Medicines and Healthcare Regulatory Agency (MHRA) approved deuruxolitinib (Leqselvi) for treating severe alopecia areata in adults. The MHRA regulates the sale and use of medicines in the UK. This means that deuruxolitinib will now become available privately. For it to also be available for people on the NHS, the National Institute for Health and Care Excellence (NICE) has to first decide that it is cost effective. This appraisal by NICE is ongoing, and an outcome is expected in October.

Deuruxolitinib is a JAK inhibitor. It blocks (switches off) JAK proteins in our body. Most cells in our body have these JAK proteins, including immune cells, and hair follicle cells. Their function is to relay signals from outside the cell to change how the cell works internally. In AA, the attack from immune cells is stopped when these signals are stopped. So, blocking the JAK proteins results in the immune cells backing off, which allows hair to regrow.

There are four different types of JAK proteins: JAK1, JAK2, JAK3, and TYK2. Ritlecitinib (Litfulo), currently the only treatment available for severe AA on the NHS, mostly reduces the activity of JAK3. Deuruxolitinib on the other hand reduces the activity of the JAK1, JAK2 and TYK2 proteins.

There is another difference: medicines are broken down in the liver by different enzymes. Deuruxolitinib is broken down by CYP2C9, whereas ritlecitinib is broken down by CYP3A4. This could mean that different people may respond better to one medicine than another. Because deuruxolitinib is not suitable for people whose bodies are not able to break it down well, we understand that people will be asked to do a genetic test before starting treatment. For safety, the test will check what version of the CYP2C9 enzyme someone has, to see if their body can handle deuruxolitinib properly.

The safety and effectiveness of deuruxolitinib was tested in two large phase 3 clinical trials, THRIVE-AA1 and THRIVE-AA2. This showed that it is safe and resulted in hair growth for a large number of adults with severe alopecia areata, who had >50% scalp hair loss before starting. They were given 8mg deuruxolitinib, 12mg deuroxolitinib, or placebo, twice-daily for 24 weeks. Across the two trials:

• On the 8mg dose, 30-33% of people regrew hair to the point where more than 80% of their scalp was covered, and 21-25% had more than 90% coverage.
• On the 12mg dose, 38-41% of people regrew hair to the point where more than 80% of their scalp was covered, and 27-34% had more than 90% coverage.
• 54-74% of people experienced “mild” adverse events on either dose of deuruxolitinib, compared to 48-70% on placebo. “Moderate” adverse events were seen in 25-32% on deuruxolitinib, compared to 16-26% on placebo. And 2-6% experienced “severe” adverse events on deuroxolitinib, compared to 1-3% on placebo.
• The most common adverse events seen were viral infections (such as COVID or flu), headache (10-12%), acne (9-12%), and increased blood creatine kinase levels (4-11%).
• It was not possible to say whether these were all due to the medication, but around 31-47% of adverse events were “possibly”, “probably” or “definitely” related to the treatment.
• 2-3% of people on either deuruxolitinib dose had to stop treatment due to an adverse event, compared to 1% on placebo.

We now await the decision from NICE, and hope they recommend deuruxolitinib for use on the NHS, so that everyone who is eligible can benefit from it, and not just those who are able to afford it privately.

Cinainu going to phase 3 for AA

Cinainu is a topical treatment under development for moderate to severe alopecia areata (AA) in children and adolescents (ages 2-17). Moderate alopecia areata is typically defined as 25-50% scalp hair loss, and severe as >50% scalp hair loss. People who have been following treatment updates for some time may recognise this medicine under its former name, Coacillium. It is a combination of four plant extracts: onion, lemon, guarana and cacao. A phase 2/3 trial of Cinainu was completed in 2022 which showed that 26.2% of children had at least a 40% improvement in scalp hair growth, compared to 5% on placebo treatment. The treatment was given for 24 weeks and then stopped. After another 24 weeks without treatment, sustained improvements in hair growth were seen in those who had received the treatment. On the treatment, 39% experienced at least one 'adverse event', compared to 47% on the placebo. The most common ones included acne, eczema, cough, and fever. One person on Cinaunu developed severe eczema of the face and scalp, which resolved after treatment was stopped. 

Legacy Healthcare have now announced that they will launch a larger phase 3 trial to test Cinainu for AA. At this point it is not yet clear if there will be any UK sites, but we will keep monitoring developments.

Rezpegaldesleukin going to phase 3 for severe AA

Nektar Therapeutics announced that they will launch a phase 3 trial for rezpegaldesleukin (rezpeg for short). This is a new treatment being tested for severe alopecia areata. Whereas JAK inhibitors block activity of the immune system broadly, rezpeg is in the class of medicines called ‘biologics’. These medicines are able to target very specific mechanisms in the immune system.

They do this by influencing the signals immune cells and other cells in our body use to ‘talk’ to each other. These signals, called cytokines, travel around the body and change how cells behave. There are hundreds of different cytokines which each control specific functions.

Rezpeg is thought to influence a mechanism which controls the growth and activation of a group of immune cells called ‘regulatory T cells’ (Tregs). It does this by mimicking one specific signal, interleukin-2 (IL-2), which stimulates the activity of Tregs.  

Tregs are important because they can keep other immune cells in check. In alopecia areata, ‘CD8+ T cells’ are attacking the hair follicles. If Tregs can be stimulated, it is hoped that this can help calm down these CD8+ T cells and stop the attacks.

In the phase 2b ‘REZOLVE-AA’ trial, people with >50% scalp hair loss at baseline were given an injection every 2 weeks, for 36 weeks in total. They received either a high (24 microgram per kilogram of body weight) or low (18 microgram per kilogram of body weight) dose, or placebo. On both doses, people had on average a 30% improvement in scalp hair coverage. About 15% reached more than 80% scalp hair coverage, and 8-11% reached more than 90% scalp hair coverage. The full results are not published yet, but the company reported that side effects were mostly ‘mild-to-moderate’ in severity and resolved by themselves.

Those who had some hair regrowth, but not yet reached the target (<20% scalp hair loss) at 36 weeks, were allowed to continue rezpeg on to 52 weeks. Of these people, 30% of them did reach <20% scalp hair loss at 52 weeks. This highlights how people differ in their responses to treatments and sometimes it may take longer to achieve the desired outcome.

Rezpeg will now be going to a larger phase 3 trial, which we expect to be global, although it is not yet clear if there will be UK sites. It was previously granted 'Fast Track' status for the treatment of severe alopecia areata in those 12 years and older. With this designation, the FDA can speed up the regulatory process, acknowledging the significant unmet need for this population. 

Early phase studies of ATI-2138 for AA

Aclaris Therapeutics announced results of their pre-clinical study. The treatment is called ATI-2138, which we understand to be an ‘Interleukin-2 inducible T-cell kinase (ITK) and JAK3 inhibitor’. Basically, it aims to reduce the activaty of immune cells, similar to a JAK inhibitor. However, besides blocking one of the JAK proteins, it also aims to stop T-cells from multiplying. T-cells are the group of immune cells that attack the hair follicles in AA, so if their numbers can be reduced, this may allow hair to regrow.

In mice with autoimmune hair loss, the company tested two different doses, and they said both increased hair growth. They are now planning a phase 2 clinical trial to find a safe and effective dose to use in humans. Most likely, this will just be in the United States, but we will keep an eye on it.

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That wraps up the Spring 2026 Research Update. For earlier updates, please visit our Research Blog. 

This article mentions research involving animals. Alopecia UK supports the Association of Medical Research Charities (AMRC) position statement on research involving animals. This states that animals should only be used when necessary, to advance understanding and treatment of serious health conditions, where there is no alternative that can be used. And, that discomfort should be minimised, and the use of animals should be reduced, replaced and refined (the 3Rs).