New APAC Consensus Guides Alopecia Areata Care Across 8 Countries

An 18-member panel of dermatologists from 8 Asia-Pacific countries and regions reached consensus on 140 statements covering the epidemiology, diagnosis, and management of alopecia areata, aiming to fill a regional guidance gap left by the recent approval of Janus kinase (JAK) inhibitors for the disease, according to a modified Delphi consensus published in the International Journal of Dermatology.¹

APAC Guidance Had Not Kept Pace With Newly Approved Treatments

No treatments were specifically indicated for alopecia areata until 2022 through 2024, when the FDA approved baricitinib, ritlecitinib, and deuruxolitinib, in that order, for adults, adolescents, or both with severe disease. While China, Japan, the Republic of Korea, and Taiwan have their own national alopecia areata guidelines, many countries in the broader Asia-Pacific region lack disease-specific guidance altogether or have not updated existing guidelines to reflect these approvals.²

The expert panel set out to close that gap with a region-focused consensus rather than relying on guidance developed for North American or European health systems.

The panel comprised 18 dermatologists from Australia, China, India, the Republic of Korea, Malaysia, Singapore, Taiwan, and Thailand, each with at least 10 years of experience in alopecia areata. Over 3 rounds, an initial online survey was followed by in-person discussion and then additional online voting, with consensus on Likert-type and multiple-choice statements defined as 70% or greater agreement or disagreement.¹

Of 183 statements considered, 140 reached consensus and 43 did not, with the unresolved statements concentrated in areas where regional practice, treatment access, or evidence remained unsettled.

Panel Defined Disease Severity and Endorsed JAK Inhibitors as First-Line Therapy

The panel agreed that moderate alopecia areata involves 21% to 49% scalp hair loss and severe disease 50% or more, though eyebrow, eyelash, or beard involvement with significant quality-of-life impairment can qualify a patient as moderate to severe regardless of scalp percentage. Trichoscopy was deemed essential for diagnosing and monitoring the disease, while skin biopsy was reserved for cases in which the cause of hair loss was unclear, and the panel noted that no validated diagnostic biomarkers yet exist.

For adults with moderate disease, the panel agreed that intralesional corticosteroids, dosed at intervals of 3 to 6 weeks, should be the first-line treatment, while patients 12 and older with active mild disease should primarily receive intralesional corticosteroids alone or combined with a topical corticosteroid. For patients 12 and older with severe disease, JAK inhibitors approved for alopecia areata should be used as first-line systemic therapy rather than reserved as a last resort; short-term systemic corticosteroids were endorsed only to temporarily halt rapidly progressing, widespread disease, and adjuvant minoxidil was endorsed for chronic cases.

“This modified Delphi-based consensus provides a practical, region-focused framework to standardize the diagnosis and management of AA across diverse APAC healthcare settings in hope of improving patient outcomes,” the researchers wrote.

Treatment Access Varies Widely

The panel could not agree on using short-term systemic corticosteroids as a first-line option in children younger than 12 with severe disease, citing a lack of real-world evidence in that age group, a notable departure from a separate international consensus that had recommended oral corticosteroids as first-line therapy for children aged 7 to 12 years with an acute flare. The panel also reached no consensus on whether a multidisciplinary care model was necessary or on the use of topical immunotherapy and other off-label local treatments, several of which are not widely available in the represented countries.

The authors cautioned that their recommendations assume all treatments approved by the FDA or the European Medicines Agency are accessible throughout the Asia-Pacific region, when regulatory approval status, health care infrastructure, and cost vary considerably by country. Lead author Rodney Sinclair, MD, disclosed extensive industry relationships, including serving as director of a company holding patents on minoxidil for hair loss and as an investigator or advisor for dozens of pharmaceutical companies; several coauthors also reported industry ties.

For clinicians across the Asia-Pacific region, the consensus offers a treatment algorithm tailored to local practice patterns rather than one borrowed from Western guidelines, with JAK inhibitors now explicitly positioned as first-line rather than last-resort therapy for severe disease. For payers and health systems, the panel's own caveat is the key limitation: reaching consensus on which treatments should be used is a different question from whether patients across the region can actually access them.

References

1. Sinclair R, Yang CC, Chung WH, et al. Epidemiology, diagnosis and management of alopecia areata: an Asia-Pacific modified Delphi expert panel recommendations. Int J Dermatol. 2026;65(10):2091-2101. doi:10.1111/ijd.70335
2. The FDA approves deuruxolitinib for severe alopecia in adults. Dermatology Times^®️. July 26, 2024. Accessed October 12, 2026. https://www.dermatologytimes.com/view/the-fda-approves-deuruxolitinib-for-severe-alopecia-in-adults