A safety review of JAK inhibitors for managing alopecia areata.

INTRODUCTION: Alopecia areata (AA) is a chronic immune-mediated disorder associated with substantial psychosocial burden. Janus kinase (JAK) inhibitors have transformed the treatment of moderate-to-severe AA, but concerns regarding their long-term safety remain, particularly because class warnings are largely derived from higher-risk rheumatologic populations.

AREAS COVERED: This review evaluates the safety of JAK inhibitors used for AA in adults, with emphasis on baricitinib, ritlecitinib, and deuruxolitinib, alongside relevant evidence for other JAK inhibitors. PubMed/MEDLINE, Embase, and Scopus were searched from database inception through April 2026 for relevant clinical trials, long-term studies, meta-analyses, real-world studies, and pharmacovigilance reports. Adolescent data were considered only when reported within mixed adult-adolescent populations or pooled safety analyses. Infection, malignancy, cardiovascular and thromboembolic risk, laboratory abnormalities, special populations, and practical monitoring considerations are reviewed.

EXPERT OPINION: Current evidence suggests that serious adverse outcomes are uncommon in appropriately selected adults with AA and that risks observed in older, comorbidity-enriched rheumatologic populations should not be directly extrapolated to AA. Future management will increasingly depend on individualized risk stratification, long-term disease-specific safety data, and agent-specific rather than class-wide assessment.