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Alopecia areata is caused by complex factors, including oxidative stress. This review provides details about how oxidative stress impacts AA, and how this information can be used to better treat the disease.

The pathogenesis of alopecia areata (AA) is not currently understood in detail, although it is known that the collapse of the hair-follicle-immune-privileged (HFIP) site bears a major responsibility in causing AA hair loss symptoms. Many other skin diseases can be caused by or worsened due to oxidative stress, but it is unclear what role, if any, oxidative stress plays in the onset of AA. Oxidative stress can cause the onset of skin diseases in various ways, including by inducing major histocompatibility complex (MHC) class I chain-related A (MICA) expression in keratinocytes. This activates the natural killer cell-expressed NKG2D receptor, which can lead to a destabilized HFIP site and, from there, to AA. This article, published in the journal Antioxidants, provides a detailed review of research into oxidative stress and its relationship to AA, including a discussion of treatments that target oxidative stress.

Oxidative Stress and the Immune Response in Patients With AA

The study involved a review of past literature and research into AA and oxidative stress. Oxidative stress is known to contribute to the pathogenesis of other autoimmune diseases that target the skin, including psoriasis, by causing inflammation and cell apoptosis. Recent research has shown an association between AA and psoriasis, as both diseases are T cell-mediated. Another mechanism that can be involved in the pathogenesis of AA is autophagy. Autophagy enables the destruction of organelles and macromolecules, and can be caused by many factors, including oxidative stress and inflammation. 

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Oxidative stress biomarkers could be a useful way to determine the role it is playing in a given case of AA as well as guide correct therapeutic options for a patient. The authors consider the best oxidative stress biomarkers for AA to be malondialdehyde (MDA), advanced glycation end-products, and ischemic-modified albumin. MDA was found to be an indicator of lipid peroxidation, and it can be quantified with common instruments. In AA, it seems to be an indicator of disease severity. 

Using Oxidative Stress to Understand Medical Treatments for AA

These oxidative stress-related metrics can be useful targets for treatment using molecules that influence the redox balance. JAK inhibitors are one treatment approach that achieves good results for psoriasis and may be a useful treatment for AA as well. Tofacitinib and ruxolitinib were found to effectively treat AA symptoms, but are associated with significant side effects over time.

Although definitive conclusions have not been reached, oxidative stress seems to play a role in the pathogenesis of AA. Further research with larger groups is needed to determine the exact mechanisms involved. The use of oxidative stress biomarkers can be a useful guide for future research and can also help clarify treatment details for patients with AA.


Peterle, L., Sanfilippo, S., Borgia, F., Cicero, N., & Gangemi, S. (2023). Alopecia Areata: A Review of the Role of Oxidative Stress, Possible Biomarkers, and Potential Novel Therapeutic Approaches. Antioxidants (Basel), 12(1). https://doi.org/10.3390/antiox12010135