Clinical guidelines of ukrainian hair research society. diagnosis and treatment of alopecia areata

ABSTRACT. Alopecia areata is an immune-mediated disease resulting from the interaction of genetic factors and exogenous triggers, leading to the activation of the Janus Kinases - Signal Transducer and Activator of Transcription signaling pathway, the formation of non-specific autoimmune inflammation and disruption of immune tolerance of hair follicles. Alopecia areata has an unpredictable course with a non-scarring type of hair loss, it can affect the hair part of the head and/or hair in other areas, it can be manifested by damage to the nail plates. The psychotraumatic impact of this disease can be compared to the consequences of life-threatening or disabling diseases. For this reason, the degree of negative impact of alopecia areata on the quality of life may not correlate with the objective condition of patients, which is often not taken into account in the diagnosis and treatment of the disease. Despite the variety of treatment options available, achieving effective and safe disease control is not always straightforward. Treating patients with alopecia areata and comorbid conditions can be particularly challenging and may require close collaboration between specialists from various fields. For these and other reasons, there is significant dissatisfaction among patients regarding alopecia areata and its treatment. The systematic organization, unification, and adaptation of modern knowledge about alopecia areata have led to the creation of two algorithms: a diagnostic algorithm and a therapeutic algorithm. These algorithms provide a differentiated approach to patient management, with age, disease severity, clinical form, disease activity stage, comorbid pathology, prognostic factors, and patient quality of life taken into account. Agents with immunosuppressive action belong to the main group of drugs in the treatment of alopecia areata, according to the antigenic concept of the pathogenesis of the disease. Ongoing work is being done to update treatment protocols to include JAK inhibitors and other preparations, taking into based on new developments and the expanding pharmaceutical market.