Sequential immunotherapy for alopecia areata: phase-driven immune rebalancing

Alopecia areata (AA) is an immune-mediated non-scarring alopecia characterized by T lymphocytes attacking hair follicles (HFs), which has a seriously harmful impact on physical and mental health. The challenges in the treatment of AA lie in the recurrence after drug withdrawal and the treatment-resistant cases. Sequential immunotherapy may be able to address some of these issues.

As a new treatment model, sequential immunotherapy employs temporally coordinated immunomodulatory interventions with distinct therapeutic focuses. For patients with recurrence, the purpose of sequential immunotherapy is to restore the immune privilege and immune homeostasis of HFs. For cases that are difficult to treat, alternative strategies are needed to promote hair regrowth. Based on systematically selected articles from the PubMed database, this review, in conjunction with the immune pathogenesis of AA, carefully evaluated the sequential immunotherapy strategies.

The efficacy and safety of AA treatment remain pressing challenges in current clinical practice. The sequential immunotherapy strategy, which combines initial intensive immunosuppression with subsequent maintenance therapy, demonstrates significant potential for addressing the dynamic nature of disease progression. This is achieved through stage-specific modulation of inflammatory cascades and restoration of immune tolerance.