For decades there was no reliably effective treatment for severe alopecia areata. That changed with JAK inhibitors — medicines that interrupt the immune signalling driving the attack on the hair follicle.
In the UK:
- Ritlecitinib (Litfulo) was authorised by the MHRA for severe alopecia areata in people aged 12 and over, acting on JAK3 and TEC kinases. NICE subsequently recommended it for NHS use, estimating up to 14,000 people in England could benefit.
- Deuruxolitinib (Leqselvi) was authorised in March 2026 for severe alopecia areata in adults, acting on JAK1, JAK2 and TYK2 relative to JAK3.
- Baricitinib has also been appraised by NICE for severe alopecia areata.
How Well They Work
In the deuruxolitinib trials, across 1,223 adults with at least 50% scalp hair loss for six months or more, around 30% reached 80% or more scalp hair coverage at 24 weeks, and around 23% reached 90% or more.
For ritlecitinib, NICE noted that response rates continued to improve for people taking it for up to two years.
Read those numbers honestly: a substantial minority get a dramatic result, which is transformative for a condition that previously had nothing. It is not a treatment that works for everyone.
Who Qualifies
These are treatments for severe alopecia areata, defined by the extent of hair loss — trials generally used 50% or more scalp involvement measured on the Severity of Alopecia Tool. NHS access follows the NICE recommendation and its criteria, through dermatology services.
This is not a treatment for pattern hair loss, and it is not for mild patchy alopecia areata that may resolve on its own.
What Treatment Involves
These are oral tablets taken daily, and they are immune-modulating medicines, so monitoring is part of the deal:
- Blood tests before starting and periodically thereafter
- Screening for infections, including tuberculosis and hepatitis, before starting
- Vaccination status review, since live vaccines are generally avoided
- Ongoing specialist supervision
Reported common side effects include headache and acne. JAK inhibitors as a class carry warnings around serious infections, blood clots, cardiovascular events and malignancy, which is why prescribing sits with specialists who assess individual risk.
Do They Cure It?
No. They suppress the process while taken. Hair loss commonly returns after stopping, which makes this — like most hair loss treatment — an ongoing commitment rather than a course.
Getting Assessed
The route is a GP referral to dermatology. This is not something to pursue through an online hair-loss service: those are built around finasteride and minoxidil for pattern loss, and neither the assessment nor the monitoring these medicines require exists there.
If you have severe alopecia areata and have previously been told there was nothing to be done, that advice is now out of date. It is worth asking again.
The Psychological Side
Alopecia areata, particularly when it takes eyebrows and lashes or progresses to total loss, has an impact that the word "cosmetic" badly understates. NICE's appraisals considered quality-of-life evidence directly. If it is affecting you, say so during assessment — it is relevant clinical information, and support beyond medication exists through patient organisations and dermatology services.