The Burden of Alopecia Areata and Management with Baricitinib in the United Arab Emirates: A Narrative Review

Alopecia areata is an inflammatory autoimmune disease that presents as non-scarring hair loss in adults and children and causes substantial psychological distress, economic burden, and reduced quality of life for those affected. Although steroids and immunosuppressants are common treatments for alopecia areata, results from studies of Janus kinase inhibitors in the systemic management of alopecia areata, including those from long-term efficacy and safety studies on the Janus kinase 1/2 inhibitor baricitinib, show promising results. Despite alopecia areata placing a burden on healthcare systems in the Middle East, published data on the overall prevalence, patient characteristics, and treatment landscape for alopecia areata across the region are sparse, and a lack of approved therapies and insufficient access to treatment are treatment obstacles. Herein, we describe the burden of alopecia areata on patients and healthcare systems, review publications from the United Arab Emirates (UAE) on alopecia areata, highlight gaps in the data, and review clinical trial publications on the management of alopecia areata with baricitinib, the first Janus kinase inhibitor approved for the treatment of alopecia areata in the UAE. A regional expert assessment of the burden of alopecia areata and unmet medical needs in the UAE is provided, along with an expert opinion on treating patients with severe alopecia areata. Alopecia areata is a disease in which the immune system attacks healthy hair follicles, leading to hair loss. It occurs in both adults and children and can have a negative effect on mental health, cause financial worries, and lead to a reduced quality of life. For Middle Eastern countries, including the United Arab Emirates, there is a lack of published data that specifically describe the number of people affected by alopecia areata in the region, their features and medical needs, and the treatment options available to them. Several medications are licensed for the treatment of alopecia areata, including steroids, creams, and a group of medications called Janus kinase inhibitors. Baricitinib is a Janus kinase inhibitor. Even though baricitinib is approved for severe alopecia areata and expert dermatologists use it to successfully treat alopecia areata, the costs of Janus kinase inhibitors cannot be reimbursed for many patients in need globally, including many countries in the Middle East. This is because alopecia areata is not recognised as a dermatological immunological disease. This article highlights the need for more data from the Middle East and United Arab Emirates to support patients with alopecia areata to access the treatment they need to manage their condition.