What changed in 2023 for GPs, dermatologists and aesthetic doctors and nurses: ritlecitinib approved in the US, Europe and the UK, negative funding decisions on baricitinib, new JAK inhibitor safety measures, and research on oral minoxidil.
From the editors
This edition looks back at 2023 from the consulting room. It is part of Four years in review, a retrospective series published in 2026. Trichozette did not exist in 2023; this is a look back, written with the sources in front of us.
For clinicians who treat hair loss, 2023 was dominated by alopecia areata. Ritlecitinib was approved by the FDA in June, by the European Commission in September and by the MHRA in the autumn. In the same months, the Scottish Medicines Consortium and NICE declined to recommend baricitinib for severe alopecia areata on cost-effectiveness grounds. In April the MHRA had published new measures to reduce serious risks with several JAK inhibitors, and in October the FDA accepted an application for a third medicine in the class, deuruxolitinib.
For aesthetic doctors and nurses, the England consultation on licensing non-surgical cosmetic procedures raised questions about who would be allowed to perform what, including platelet-rich plasma therapy and hair restoration surgery.
This edition sets out those events, then turns to practice: the conversation about JAK inhibitors, the evidence on oral minoxidil as it stood in 2023, and working well with trichologists and cosmetic colleagues. We do not give doses. Prescribing decisions belong to the clinician, using current guidance and the product information.
The Trichollective editorial team
Alopecia areata
In 2023 ritlecitinib reached the UK while funding bodies turned down baricitinib. How the year reshaped the conversation about severe alopecia areata.
Photograph Vince Mariel Conlu / Unsplash
Words by the Trichollective editorial team
Alopecia areata had long been a frustrating condition to treat. Before the JAK inhibitors, options for severe disease were limited and evidence was often weak. 2023 changed the landscape, although not in a straight line.
On 23 June 2023 the FDA approved ritlecitinib, an oral inhibitor of JAK3 and the TEC kinase family, for severe alopecia areata in people aged 12 and over. It was the first treatment approved in the US for adolescents with the condition. The European Commission granted marketing authorisation in September, following a positive opinion from the EMA's medicines committee in July, and the MHRA authorised it for the UK, as reported in early November.
The approvals rested on the ALLEGRO-2b/3 trial, published in The Lancet, which enrolled 718 people aged 12 and over with at least 50% scalp hair loss. At 24 weeks, 23% of those on the licensed regimen had 20% or less of their scalp without hair, compared with 1.6% on placebo.
Baricitinib was already licensed for severe alopecia areata in adults, but in 2023 it did not win routine NHS funding. The Scottish Medicines Consortium did not accept it in August because of uncertainty about cost-effectiveness. NICE did not recommend it in October in technology appraisal TA926. NICE noted that the trials showed improved regrowth at 36 weeks compared with placebo, but not a meaningful improvement in most quality-of-life measures, and that cost-effectiveness estimates were uncertain and above what it normally considers acceptable.
“Patients read about approvals. They do not always read about appraisals.
In practice, patients read about approvals. They do not always read about appraisals. A clear explanation of what is licensed, what is funded and why helps manage expectations, and patients with severe alopecia areata benefit from dermatology review and from psychological support, whatever their treatment.
Test yourself
Why did NICE not recommend baricitinib for severe alopecia areata in October 2023?
Sources
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Next · 2026 · Year in review
2026 in review
What changed, and what it asks of us.