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Autoimmune-Induced Alopecia and Emerging Therapies in Hair Loss
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Autoimmune-Induced Alopecia and Emerging Therapies in Hair Loss

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 9540

Special Issue Editor

Dr. David Saceda-Corralo

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Guest Editor
Department of Dermatology, Universidad de Alcalá, Madrid, Spain
Interests: autoimmune-induced alopecia; clinical dermatology; hair loss

Special Issue Information

Dear Colleagues,

Autoimmune-induced alopecia, such as alopecia areata and cicatricial alopecia, occurs when the immune system mistakenly attacks hair follicles, leading to hair loss. Recent advances in treatment have focused on emerging therapies that aim to modulate immune responses and promote follicular regeneration and hair growth, spanning from medical therapies to surgical options.

The aim of this Special Issue is to review the pathophysiological mechanisms behind hair loss and to evaluate the efficacy and safety of emerging therapies in the management of this condition. It seeks to provide a comprehensive scope that includes patient management strategies and future directions in research and therapy.

Autoimmune-induced alopecia primarily includes alopecia areata, which itself can manifest in several forms such as patchy alopecia areata, where hair falls out in small patches, and alopecia totalis and universalis, where complete loss of hair occurs on the scalp or all over the body, respectively. Another type, scarring alopecia, involves the destruction of hair follicles and replacement with scar tissue, permanently impacting hair growth. Novel hair treatments have revolutionized patient management in dermatology by providing truly effective therapies. These advancements have not only improved clinical outcomes, with higher rates of hair regrowth, but have also enhanced the quality of life for patients by offering treatments with fewer side effects and better disease control.

This Special Issue spotlights novel insights into immunological underpinnings and genetic predispositions of autoimmune-induced alopecia. It also explores emerging therapies in hair loss, including new pharmacological interventions, gene therapy techniques and biotechnological advances, aiming to revolutionize treatment paradigms and patient outcomes in hair loss management.

We encourage the submission of papers focused on autoimmune-induced alopecia and new therapeutic options for any type of hair loss, including medical therapies and surgical approaches.

Dr. David Saceda-Corralo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • autoimmune-induced alopecia
  • alopecia areata
  • cicatricial alopecia
  • occurs
  • hair loss

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Published Papers (5 papers)

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18 pages, 4902 KiB  
Review
Frontal Fibrosing Alopecia in Men: A Review of the Literature
by Ana Melián-Olivera, Adrián Imbernón-Moya, María L. Porriño-Bustamante, Cristina Pindado-Ortega, Daniel Fernandes-Melo and David Saceda-Corralo
J. Clin. Med. 2025, 14(6), 1914; https://doi.org/10.3390/jcm14061914 - 12 Mar 2025
Viewed by 742
Abstract
Background: Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia, initially described in postmenopausal women but increasingly reported in men. The male form remains under-recognized, often misdiagnosed as androgenetic alopecia (AGA) or alopecia areata (AA), particularly in the beard. Objective: This review aims [...] Read more.
Background: Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia, initially described in postmenopausal women but increasingly reported in men. The male form remains under-recognized, often misdiagnosed as androgenetic alopecia (AGA) or alopecia areata (AA), particularly in the beard. Objective: This review aims to summarize the current literature on the epidemiology, clinical presentation, etiopathogenesis, diagnosis, and treatment of FFA in men. Epidemiology and Clinical Features: FFA in men typically presents at a younger age compared to women. Key features include frontal and temporal hairline recession, early involvement of the beard and sideburns, and a high prevalence of eyebrow alopecia (43–94.9%). Facial papules and body hair loss are more common in men than women. Occipital involvement varies widely across studies (8–45%). Clinical features like beard alopecia, often presenting as plaque or diffuse patterns, are highly suggestive of FFA in men but are not part of current diagnostic criteria. Etiopathogenesis: FFA is postulated to have an autoimmune basis influenced by genetic, hormonal, and environmental factors. Genetic studies have identified associations with HLA-B*07:02 and CYP1B1 loci. Environmental triggers include prolonged use of facial sunscreens and moisturizers, as demonstrated in case-control studies and meta-analyses. Diagnosis: Diagnosis is predominantly clinical, supported by trichoscopy and biopsy when needed, particularly in cases overlapping with AGA or AA. Unique presentations, such as beard alopecia and the “watch sign”, highlight the importance of considering FFA in atypical male cases. Treatment: Current treatment protocols in men mirror those for women and focus on disease stabilization. Oral 5-ARi (dutasteride) combined with topical corticosteroids and calcineurin inhibitors form the first line. Additional treatments include intralesional corticosteroids, oral isotretinoin for facial papules, and minoxidil for associated AGA. Surgical hair transplantation remains controversial, requiring disease control and careful patient counselling. Conclusions: FFA in men presents with distinct clinical features and challenges in diagnosis, often overlapping with other alopecia. Further studies are needed to validate diagnostic criteria and evaluate treatment efficacy in this underrepresented population. Full article
(This article belongs to the Special Issue Autoimmune-Induced Alopecia and Emerging Therapies in Hair Loss)
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16 pages, 1862 KiB  
Review
Hair Longevity—Evidence for a Multifactorial Holistic Approach to Managing Hair Aging Changes
by Gillian E. Westgate, Daniela Grohmann and Manuel Sáez Moya
J. Clin. Med. 2025, 14(6), 1894; https://doi.org/10.3390/jcm14061894 - 11 Mar 2025
Viewed by 1160
Abstract
Loss of hair density—hair thinning and balding— is typically referred to as male and female pattern alopecia. Causes include genetic predisposition and links to the impact of dihydrotestosterone on the follicle dermal papilla, which are typically characterized by an increase in the number [...] Read more.
Loss of hair density—hair thinning and balding— is typically referred to as male and female pattern alopecia. Causes include genetic predisposition and links to the impact of dihydrotestosterone on the follicle dermal papilla, which are typically characterized by an increase in the number of vellus follicles. Links to chronological aging are unclear. Proven treatments remain few in number and are still targeting and tested on those experiencing classical pattern hair loss. The way hair changes with aging, especially in women, can be considered as having a much broader scope. Trends in managing changes to hair density, length, and fiber quality with aging now mostly include cocktail approaches—whether topical, injected, or oral—recognizing that solutions are more likely to require a multifactorial strategy. This review examines the evidence for the more holistic approach to addressing unwanted hair loss, which includes nutrition, lifestyle, stress management, and scalp and hair care, as well as co-morbidities with other health concerns. We discuss the strengths and limitations of clinical study design to investigate efficacy using multifactorial holistic approaches. We propose that this strategy will contribute to the emerging concept of hair longevity in which follicle, scalp, and fiber are targeted and that maintaining anagen is the most appropriate route to achieving healthy hair with aging. Finally, we discuss the problem facing patients and consumers regarding the quantity of misinformation and how it influences choosing from a fast-growing market of solutions that bypass a pharmaceutical approach to hair thinning. Full article
(This article belongs to the Special Issue Autoimmune-Induced Alopecia and Emerging Therapies in Hair Loss)
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15 pages, 1235 KiB  
Review
Characterization and Management of Adverse Events of Low-Dose Oral Minoxidil Treatment for Alopecia: A Narrative Review
by Juan Jimenez-Cauhe, Kristen I. Lo Sicco, Jerry Shapiro, Angela Hermosa-Gelbard, Patricia Burgos-Blasco, Ana Melian-Olivera, Daniel Ortega-Quijano, Cristina Pindado-Ortega, Diego Buendia-Castaño, Daniel Asz-Sigall and Sergio Vaño-Galvan
J. Clin. Med. 2025, 14(6), 1805; https://doi.org/10.3390/jcm14061805 - 7 Mar 2025
Viewed by 2089
Abstract
Low-dose oral minoxidil (LDOM) has emerged as a widely used off-label treatment for different types of alopecia, showing a favorable safety profile and effectiveness. Despite its growing use, it is essential to understand the possible associated adverse events (AEs) and their appropriate management [...] Read more.
Low-dose oral minoxidil (LDOM) has emerged as a widely used off-label treatment for different types of alopecia, showing a favorable safety profile and effectiveness. Despite its growing use, it is essential to understand the possible associated adverse events (AEs) and their appropriate management to optimize this therapy. The aim of this article was to comprehensively review the AEs of LDOM treatment, describing their frequency, risk factors, affected anatomical sites, and management strategies. A search in the PubMed and EMBASE databases was performed for studies published before 31 December 2024, reporting the treatment of any type of hair loss with oral minoxidil. The most frequent AE is hypertrichosis, occurring in approximately 15% of patients, with a higher incidence in women and patients with higher doses. Fluid retention affects 1.3–10% of patients, particularly women, and typically occurs within 1–3 months of treatment. Other cardiovascular AEs, such as tachycardia or dizziness, occur in fewer than 5% of cases and are usually mild and transient. Severe AEs, including pericardial effusion, are extremely rare and often linked to compounding errors comprising an excessive dose. Management strategies include dose reduction, pharmacological interventions like diuretics for edema, and lifestyle measures such as sodium restriction. In most cases, AEs resolve without the need for treatment discontinuation. The favorable safety profile of LDOM makes it a valuable therapeutic option for alopecia, though careful patient selection, dose titration, and monitoring are essential to minimize risks. Full article
(This article belongs to the Special Issue Autoimmune-Induced Alopecia and Emerging Therapies in Hair Loss)
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18 pages, 2175 KiB  
Review
Physical Treatments and Therapies for Androgenetic Alopecia
by Siddhi Bianca Camila Lama, Luis Alfonso Pérez-González, Mehmet A. Kosoglu, Robert Dennis and Daniel Ortega-Quijano
J. Clin. Med. 2024, 13(15), 4534; https://doi.org/10.3390/jcm13154534 - 2 Aug 2024
Cited by 4 | Viewed by 5562
Abstract
Androgenetic alopecia, the most common cause of hair loss affecting both men and women, is typically treated using pharmaceutical options, such as minoxidil and finasteride. While these medications work for many individuals, they are not suitable options for all. To date, the only [...] Read more.
Androgenetic alopecia, the most common cause of hair loss affecting both men and women, is typically treated using pharmaceutical options, such as minoxidil and finasteride. While these medications work for many individuals, they are not suitable options for all. To date, the only non-pharmaceutical option that the United States Food and Drug Administration has cleared as a treatment for androgenetic alopecia is low-level laser therapy (LLLT). Numerous clinical trials utilizing LLLT devices of various types are available. However, a myriad of other physical treatments for this form of hair loss have been reported in the literature. This review evaluated the effectiveness of microneedling, pulsed electromagnetic field (PEMF) therapy, low-level laser therapy (LLLT), fractional laser therapy, and nonablative laser therapy for the treatment of androgenetic alopecia (AGA). It also explores the potential of multimodal treatments combining these physical therapies. The majority of evidence in the literature supports LLLT as a physical therapy for androgenetic alopecia. However, other physical treatments, such as nonablative laser treatments, and multimodal approaches, such as PEMF-LLLT, seem to have the potential to be equally or more promising and merit further exploration. Full article
(This article belongs to the Special Issue Autoimmune-Induced Alopecia and Emerging Therapies in Hair Loss)
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Other

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5 pages, 549 KiB  
Viewpoint
Iron Chelators in the Management of Autoimmune-Induced Alopecia: A Focus on Hypoxia-Inducible Factor 1 Modulation and Hair Restoration
by Andrea Pagani, Dominik Thor, Adriana C. Panayi, Silvan M. Klein, Sebastian Geis, Leonard Knoedler, Samuel Knoedler, Filippo A. G. Perozzo, Giuseppe Sofo, Rafael Loucas, Lukas Prantl and Dominik Duscher
J. Clin. Med. 2025, 14(7), 2133; https://doi.org/10.3390/jcm14072133 - 21 Mar 2025
Viewed by 364
Abstract
Autoimmune-induced alopecia, such as alopecia areata, involves immune-mediated damage to hair follicles, leading to significant hair loss. Emerging therapies that stabilize hypoxia-inducible factor 1-alpha (HIF-1α) show promise in counteracting follicular degradation and supporting hair regrowth. This communication highlights the potential of iron chelators, [...] Read more.
Autoimmune-induced alopecia, such as alopecia areata, involves immune-mediated damage to hair follicles, leading to significant hair loss. Emerging therapies that stabilize hypoxia-inducible factor 1-alpha (HIF-1α) show promise in counteracting follicular degradation and supporting hair regrowth. This communication highlights the potential of iron chelators, specifically deferoxamine (DFO) and deferiprone (DFP), to stabilize HIF-1α by reducing iron availability, thereby promoting vascularization, cellular proliferation, and a regenerative environment in the hair follicle niche. Clinical trials with iron chelators demonstrated improvements in hair density, thickness, and elasticity, as well as a reduction in hair loss by up to 66.8% over six months. These findings underscore the therapeutic potential of iron chelators in autoimmune alopecia management. Future research should explore the synergistic use of iron chelators with immune-modulating therapies, positioning them as viable options in the evolving field of alopecia treatment. Full article
(This article belongs to the Special Issue Autoimmune-Induced Alopecia and Emerging Therapies in Hair Loss)
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