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Alopecia Areata — SCE Dermatology MCQ

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HardHair DisordersAlopecia AreataSCE Dermatology

A 15-year-old has severe alopecia areata with a SALT score of 72 and substantial psychosocial impairment. Topical treatment has failed and systemic therapy is being discussed in an NHS specialist service. Which oral targeted treatment has a positive NICE recommendation for this age group?

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Correct answer: A — Ritlecitinib, an oral JAK3 and TEC-family kinase inhibitor

Explanation lettering: C = shown as A · E = shown as C · A = shown as E

C is correct. NICE TA958 recommends ritlecitinib within its marketing authorisation for severe alopecia areata in people aged 12 years and over, subject to the commercial arrangement. It is therefore the relevant positively appraised oral targeted option for this 15-year-old. Baricitinib is licensed for severe alopecia areata in adults but NICE TA926 did not recommend it for routine NHS use, and it does not cover this adolescent indication. Finasteride treats androgen-dependent hair loss, terbinafine treats dermatophyte infection, and minoxidil is a hair-growth promoter rather than the NICE-appraised systemic immunomodulator described. Baseline infection, vaccination and safety assessment remains necessary.

Reference: NICE TA958 ritlecitinib recommendations: https://www.nice.org.uk/guidance/ta958/chapter/1-Recommendations