Journal of Clinical and Aesthetic Dermatology • Hot Topics in Alopecia November 2025 • MEETING HIGHLIGHTS

The European Academy of Dermatology and Venereology held its 2025 annual meeting from September 17 to 21, 2025, in Paris, France. The conference gave researchers, physicians, and members of industry the opportunity to share and learn about the latest research in dermatology, including alopecia areata (AA). The event included speaker presentations on various clinical topics in dermatology, as well as posters reporting the latest data on AA characteristics and treatment options. Summaries of key abstracts from the meeting are included here.

Alopecia areata: epidemiological, clinical, dermoscopic, therapeutic, and prognostic aspects. This prospective study of 167 patients with alopecia areata (AA) identified a female predominance (54%) and average age at onset of 30.64 years. The patchy form of AA was most common, and dermoscopic findings frequently included yellow dots (83%), black dots (57%), vellus hairs (46%), and exclamation mark hairs (41%). Greater disease severity was associated with female sex, early onset, longer disease duration, and nail abnormalities. Over half of patients with less than 40 percent scalp involvement had a positive therapeutic response to therapy, while those with more than 40 percent had a therapeutic failure rate exceeding 70 percent. These findings underscore the importance of early diagnosis and individualized treatment in AA management.

Trauma-induced alopecia areata with poliosis: insights into hair regrowth and melanocyte dysfunction. This case report describes a 47-year-old male who developed AA following a stab wound, suggesting physical injury could trigger autoimmune hair loss. The patient later experienced spontaneous regrowth of depigmented white hairs, or poliosis, despite incomplete corticosteroid treatment due to elevated blood pressure. Dermoscopic findings included white terminal hairs and few exclamation mark hairs, consistent with active but regressing AA. The persistence of poliosis in regrown hair underscores the impact of inflammatory processes on follicular melanocytes. Recognition of this pattern may improve diagnosis and understanding of pigmentary changes in trauma-associated AA.

Longitudinal and Exploratory Genome-wide Analysis in Alopecia AreaTA (LEGAATA): a study of FinnGen participants. In a genome-wide association study (GWAS) of 1633 patients with AA from the FinnGen database, the HLA-DQA1 gene on chromosome 6 emerged as the most significant variant associated with AA (p=1.54×10–22; odds ratio [OR]: 0.70). Polygenic risk scores, which represent the estimated relative risk of developing a disease) revealed higher predisposition to hypothyroidism, vitiligo, allergic diseases, and major depressive disorder in the AA population. Phenome-wide association studies further confirmed increased rates of comorbid conditions including atopic dermatitis, thyroid disease, and mental health disorders. Patients with AA also had greater use of topical corticosteroids and calcineurin inhibitors, reinforcing current treatment patterns in Finland.

Real-world direct and indirect economic burden of alopecia areata among patients in the United States. A real-world analysis of 13568 patients with AA and 54272 matched controls found that patients with AA had $3725 higher annual healthcare costs compared with matched controls without AA (p<0.01). Among patients with moderate-to-severe AA, healthcare costs were $9120 greater than those with mild AA, primarily driven by pharmacy expenses. AA-related medical costs were also $2477 higher in moderate-to-severe cases (p<0.01) when compared with mild cases. Indirect costs due to lost wages were numerically higher in patients with AA ($14528 vs. $12722; p=0.058), with absenteeism contributing significantly to the difference. These findings underscore a substantial economic burden associated with AA, particularly with increasing disease severity.

Measurement instruments to assess quality of life in pediatric patients with alopecia areata: a systematic review. A systematic review of 12 studies identified 18 instruments used to measure quality of life (QoL) in pediatric patients with AA, with only two being AA-specific studies. The Children’s Dermatology Life Quality Index (CDLQI) was the most frequently used tool (58.3%, 7 of 12 studies), although it was designed for dermatologic conditions with common physical symptoms such as pain or pruritus. Instruments varied widely in domain coverage, with studies addressing a median of three out of ten QoL domains. Most data were self-reported (66.7%), and 44.4 percent (8 of 18) of the instruments were validated exclusively in pediatric populations. The lack of standardization highlights a critical need for comprehensive, AA-specific QoL tools that reflect all dimensions of life impacted by pediatric AA.

Real-world impact of disease severity on disease progression and mental health among patients with alopecia areata in the United States. A United States (US) real-world study using AA-Investigator Global Assessment (IGA) scores found that patients with severe AA experienced greater disease progression and higher psychological burden. Among 501 patients, 35.7 percent had severe-to-very severe AA, with 21 percent showing disease worsening since diagnosis. These patients were more likely to have eyebrow (39%), eyelash (25%), and body hair (20%) loss than those with moderate or limited AA. Dissatisfaction with disease control was highest among patients with severe-to-very severe AA (40%). Severe anxiety and depression were reported by 20 percent and 16 percent of this group, respectively, with 68 percent attributing symptoms directly to AA. Findings highlight the need for mental health support, especially in patients with severe AA.

Interesting associations between alopecia areata and iron deficiency anemia. A retrospective study of 33401 patients with AA and 66802 matched controls found a significantly higher prevalence of iron deficiency anemia (IDA) among AA patients (15% vs. 10%; OR: 1.61; 95% confidence interval [CI]: 1.55–1.67; p<0.01). This association held across all age groups. In 40 percent of cases, IDA preceded AA diagnosis, suggesting a potential role for iron dysregulation in AA pathogenesis. The study proposed several mechanisms for the association, including disrupted iron metabolism from chronic inflammation, immune impairment from iron deficiency leading to anemia, and coexisting autoimmune conditions. Although causality cannot be determined, findings support the importance of screening for IDA in AA patients. Identifying and managing such comorbidities may improve long-term outcomes in individuals with AA.

Examining the impact of a mindfulness program on anxiety in pediatric alopecia areata. In a prospective study of 18 pediatric patients with AA, use of a mindfulness app over one month showed no statistically significant improvement in anxiety, insomnia, or bullying scores. Participants, with a mean age of 14.2 years and mean severity of alopecia tool (SALT) score of 76.2 percent, experienced mild anxiety and mild sleep disturbances at baseline. No correlation was found between disease extent and psychosocial distress measures. Most patients reported feeling calmer after app use, although adherence was inconsistent due to forgetfulness and lack of motivation. The findings suggest mindfulness interventions may offer short-term emotional support but require further study to determine optimal use in pediatric AA.

Understanding the experience of healthcare access and health-related impacts among diverse populations with alopecia areata. A cross-sectional survey of 156 US adults with self-reported AA revealed racial and ethnic disparities in disease burden, healthcare access, and provider concordance. Severe AA (≥50% scalp hair loss [SHL]) was reported by 69 percent of White, 65 percent of Black/African American (B/AA), and 42 percent of Hispanic/Latino respondents. B/AA participants were least likely to report eyebrow or eyelash involvement (47%) and least likely to feel their healthcare provider was able to effectively treat their AA (4%, vs. 16% among Whites). Nonmedical approaches to flare-ups were more common among B/AA (38%), Hispanic/Latino (50%), and Asian (60%) participants than White individuals (15%). Most Asian (100%) and B/AA (38%) participants reported never seeing a provider who shared their race, religion, or native language, despite many expressing the importance of culturally similar care. These findings highlight disparities in AA care and emphasize the need for greater cultural competence and equity in dermatologic practice.

Dermatologist perceptions and experiences treating alopecia areata in Saudi Arabia and the United Arab Emirates. A survey of 103 dermatologists explored clinical perspectives on managing AA. While 94 percent expressed confidence in diagnosing AA, 80 percent found managing severe cases challenging due to limited treatment efficacy. SHL greater than 50 percent was a common benchmark for severe disease, with dermatologists identifying 56 percent SHL as typical of severe AA and 77 percent SHL as very severe. Notably, 45 percent considered QoL impact the most important factor when determining severity. Treatment success was primarily defined by hair regrowth, with 50 percent regrowth considered successful. Reduced patient QoL was the leading reason for considering a change in therapy (72%).