TouchDERMATOLOGY coverage from EADV 2025:
Alopecia areata (AA), an autoimmune disorder characterised by non-scarring hair loss, has seen major therapeutic advances in recent years, with Janus kinase (JAK) inhibitors such as baricitinib and ritlecitinib emerging as highly effective targeted treatments.
Alongside these advances, ultra-high frequency ultrasound has gained interest as a non-invasive imaging tool in AA. Beyond its role in visualising hair follicle and scalp structures, ultrasound has been explored in diagnosing AA and monitoring the evolution of condition across different stages. Importantly, it also holds potential for predicting and tracking treatment responses, opening the door to more personalised care approaches for patients receiving treatments such as JAK inhibitors.
In this interview, we were delighted to speak with Dr Flavia Manzo Margiotta (University of Pisa, Italy) at the EADV 2025 meeting to further explore this important topic and gain her expert insights following her oral presentation entitled ‘Alopecia Areata and Ultra-High Frequency Ultrasound: A Guide to Personalized Monitoring and Predicting Response to JAK Inhibitors‘.
Q. How does ultra-high frequency ultrasound improve the assessment of disease activity in patients with alopecia areata?
Monitoring disease activity in patients with AA is important because sometimes the clinical response and the efficacy of treatments cannot be seen immediately. Changes may be occurring from a pathophysiological point of view, and ultra-high frequency ultrasound can enhance our understanding, acting almost like a third eye of trichology, and allowing us to detect changes before clinical activity becomes visible.
Q. In your experience, what ultrasound biomarkers show the most promise in predicting response to JAK inhibitors?
The most promising biomarker of response is related to changes in the depth of the hair follicle. When the hair follicles reach the deepest part of the dermis, the reticular dermis, it indicates a transition from the telogen phase to the anagen phase. This serves as a marker that immune privilege has been restored, allowing us to identify that the patient is responding to treatment and that hair growth has resumed.
Q. How can personalized monitoring with ultra-high frequency ultrasound guide treatment decisions and optimize outcomes for patients?
In clinical practice, we usually wait a standard defined amount of time before telling a patient whether a drug is working or not. However, if we have a tool that allows us to see deeper, such as ultra-high frequency ultrasound, we can personalize that approach. For each patient, we can determine whether the usual timeframe is appropriate, whether more time is needed, or whether it would be better to adjust the treatment earlier. For example, by adding another drug to strengthen the therapy. This allows for a truly individualised approach, tailored to each patient’s response.
Q. What practical considerations should clinicians be aware of when integrating ultra-high frequency ultrasound into routine practice for alopecia areata?
First of all, dermatologists need proper training. Ultrasound is relatively easy to use once your eye becomes accustomed to interpreting the images, but I would strongly recommend undertaking thorough training before starting to use ultra-high frequency ultrasound in practice. There are many courses available, including those provided by the EADV, as well as workshops and hands-on sessions. After completing training, it is also helpful to work alongside colleagues who already have experience with the technique.
Q. How do you see the role of imaging evolving in the management of alopecia areata?
I think imaging will play an increasingly important role because it is non-invasive, quick, and well tolerated by patients. Many patients feel more confident knowing that their condition is being assessed not only by the clinician but also with the support of an objective imaging tool. If a department has the opportunity to invest in this technology, it can be a valuable addition to clinical practice and significantly support the management of alopecia areata.
Disclosures: Dr Flavia Manzo Margiotta has received honoraria from AbbVie, Almirall, Eli Lilly, Leo Pharma, Pfizer and Sanofi.
This content has been developed independently by Touch Medical Media for touchDERMATOLOGY. It is not affiliated with the European Academy of Dermatology and Venereology (EADV). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Cite: Benefits of ultra-high frequency ultrasound for personalised alopecia treatment. touchDERMATOLOGY. October 02, 2025
Editors: Gina Furnival & Victoria Jones
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