Management options for moderate‐to‐severe alopecia areata (AA) are limited owing to a lack of safe and effective treatments suitable for long‐term use. However, newer agents have the potential to induce and maintain hair regrowth in patients with a better side‐effects profile compared to systemic steroids or conventional systemic agents. In this article, we conducted a systematic review of newer agents, including Janus kinase (JAK) inhibitors, biologics and phosphodiesterase‐4 (PDE‐4) inhibitors, for the treatment of AA in adult patients evaluated in randomized controlled trials (RCTs) using the Severity of Alopecia Tool score. A literature search was performed on PubMed and ClinicalTrials.gov, which identified 106 items with 12 RCTs eligible for review. Information regarding the treatment regimen, duration, endpoints, efficacy and adverse events were extracted; product monograph information was also summarized for approved agents with or without indications for AA. Overall, current data suggest the oral JAK inhibitors (baricitinib, ritlecitinib, deuruxolitinib, brepocitinib) as a promising new class of agents that can induce significant hair regrowth, with mild to moderate adverse effects. Baricitinib recently received US FDA approval for the treatment of severe AA, while ritlecitinib and deuruxolitinib have received the breakthrough therapy designation for AA. In contrast, PDE‐4 inhibitors (apremilast) and the biologics (dupilumab, secukinumab and aldesleukin) appear to have limited efficacy thus far. Results from ongoing and future long‐term studies could shed light on the utility of the newer agents in altering the progression of AA.

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Onychomycosis is caused by dermatophytes, non‐dermatophytes and yeasts. It has a global prevalence of 5.5%, requires long treatment periods, and has high relapse rates following therapy. Oral antifungals are generally the most common treatment. While effective, they have limitations such as drug–drug interactions, hepatotoxicity and adverse side effects; thus, they cannot be used in several populations. Topical antifungals do not have the safety limitations but are typically not as effective. The primary challenge of topical treatment is the permeation of drug molecules across the nail plate barrier, which is a highly cross‐linked keratin network. The use of drugs and formulations with favourable characteristics such as small size, absence of lipophilicity, hydrophilic nature, hydrating properties and appropriate pH can greatly improve permeation. Here, we review physical, nanoparticle‐based, formulation‐based, mechanical and chemical drug delivery strategies to improve the permeation of drugs across the nail plate.

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Hair loss, caused by multi-faceted conditions such as alopecia areata (AA) and pattern hair loss (PHL, or androgenetic alopecia), has an estimated global prevalence of up to 2% for AA and up to 80% in men and 42% in women for PHL. 1,2 These conditions often cause significant emotional distress and psychological burden to patients, leading to increased demand for effective treatments. This has created a multibillion-dollar industry with over 2.2 million hair restoration procedures performed worldwide in 2019 according to the International Society of Hair Restoration Surgery. 3 The ever-increasing presence of social media in healthcare has not only improved patients' understanding of their conditions, but also shifted the traditional patient-doctor relationship towards more patient autonomy; patients with better access to pertinent medical information