Immune therapies for alopecia areata: evidence and new perspectives

Heterogeneity in AA clinical presentation, molecular pathogenesis, and variable treatment responses suggests a biomarker-driven patient stratification system is needed to optimize drug selection, reduce trial-and-error therapy, and minimize side-effect risk. In the longer term, approaches that couple rapid immunosuppression with strategies to regenerate follicular immune privilege and tolerize autoreactive memory T cells are likely to shift AA therapeutic approaches away from chronic immune suppression toward true disease-modifying or curative interventions.