{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:01:55Z","timestamp":1791838915495,"version":"4.3.4"},"reference-count":22,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Alopecia areata is an autoimmune disorder characterized by nonscarring hair loss and systemic immune dysregulation. Hematological indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), mean platelet volume (MPV), systemic immune-inflammation index (SII), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) have been associated with inflammatory activity in dermatologic diseases. This study aimed to compare systemic inflammatory markers among patients with severe and mild alopecia areata and healthy controls, and to explore longitudinal changes in these markers in patients with severe disease who achieved clinical improvement following Janus kinase (JAK) inhibitor therapy. Methods: This retrospective cohort study included 129 participants: 43 patients with severe alopecia areata (SALT \u2265 50) treated with JAK inhibitors who achieved documented clinical improvement, 43 patients with mild disease (SALT \u2264 20), and 43 age- and sex-matched healthy controls. Hematological inflammatory markers, including red cell distribution width (RDW), MPV, MLR, NLR, PLR, SII, ESR, and CRP, were compared across groups. In patients with severe disease, longitudinal changes were assessed at baseline, three months after treatment initiation, and at the time of documented clinical improvement. Results: MLR, NLR, PLR, SII, and ESR levels were significantly higher in the severe group compared with mild cases and controls, while RDW, MPV, and CRP showed no significant differences. Among patients with severe alopecia areata who achieved clinical improvement following JAK inhibitor therapy, NLR and SII decreased significantly over time. MLR, PLR, and CRP also showed reductions during follow-up, while ESR and RDW remained unchanged. Conclusions: Systemic inflammatory markers are elevated in severe alopecia areata compared with mild disease and healthy controls. In patients who achieved clinical improvement with JAK inhibitor therapy, several inflammatory indices demonstrated longitudinal changes. These findings are exploratory and suggest an association between systemic inflammation, disease severity, and clinical improvement rather than definitive predictive biomarkers.<\/jats:p>","DOI":"10.3390\/jcm15010396","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T15:28:57Z","timestamp":1767626937000},"page":"396","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Systemic Inflammation Marker Alterations in Severe Alopecia Areata Patients Treated with Janus Kinase Inhibitors"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7129-4339","authenticated-orcid":false,"given":"Gokhan","family":"Sahin","sequence":"first","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55139, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma","family":"Aydin","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55139, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"Pancar Yuksel","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55139, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaad.2017.04.1141","article-title":"Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis","volume":"78","author":"Strazzulla","year":"2018","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1111\/bjd.16808","article-title":"Alopecia areata: A review of disease pathogenesis","volume":"179","author":"Rajabi","year":"2018","journal-title":"Br. J. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jaad.2016.09.007","article-title":"Tofacitinib for the treatment of severe alopecia areata and variants: A study of 90 patients","volume":"76","author":"Liu","year":"2017","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1056\/NEJM199902113400607","article-title":"Acute-phase proteins and other systemic responses to inflammation","volume":"340","author":"Gabay","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"86","DOI":"10.3109\/10408363.2014.992064","article-title":"Red blood cell distribution width: A simple parameter with multiple clinical applications","volume":"52","author":"Salvagno","year":"2015","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"9213074","DOI":"10.1155\/2019\/9213074","article-title":"Mean platelet volume (MPV): New perspectives for an old marker in the course and prognosis of inflammatory conditions","volume":"2019","author":"Korniluk","year":"2019","journal-title":"Mediat. Inflamm."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ke, J., Qiu, F., Fan, W., and Wei, S. (2023). Associations of complete blood cell count-derived inflammatory biomarkers with asthma and mortality in adults: A population-based study. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1205687"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1111\/1346-8138.13061","article-title":"Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis","volume":"43","author":"Kim","year":"2016","journal-title":"J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"154","DOI":"10.4274\/haseki.galenos.2023.9050","article-title":"Effect of biological therapy on systemic inflammatory markers among patients with chronic plaque psoriasis","volume":"61","author":"Kulakli","year":"2023","journal-title":"Med. Bull. Haseki"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1111\/ijd.16744","article-title":"The role of new inflammatory markers in determining disease activation and severity in patients with hidradenitis suppurativa","volume":"62","author":"Solak","year":"2023","journal-title":"Int. J. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Liakou, A.I., Rotsiamis, N., Tsantes, A.G., Routsi, E., Rompoti, N., Ioannou, P., Mpakosi, A., Tsamtsouri, L., Agiasofitou, E., and Kotsafti, O. (2024). Association between Inflammatory Markers and Psychometric Scores in Patients with Hidradenitis Suppurativa. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195795"},{"key":"ref_12","first-page":"e56034","article-title":"An Evaluation of the Hematological Markers of Systemic Inflammation and Oxidative Stress in Vitiligo: A Case-Control Study","volume":"16","author":"Temel","year":"2024","journal-title":"Cureus"},{"key":"ref_13","first-page":"9516","article-title":"Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory markers in psoriasis: A case-control study","volume":"15","author":"Nguyen","year":"2022","journal-title":"Dermatol. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Katoulis, A.C., Pappa, G., Sgouros, D., Markou, E., Kanelleas, A., Bozi, E., Ioannides, D., and Rudnicka, L. (2025). A Three-Step Diagnostic Algorithm for Alopecia: Pattern Analysis in Trichoscopy. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041195"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/jdv.19768","article-title":"European expert consensus statement on the systemic treatment of alopecia areata","volume":"38","author":"Rudnicka","year":"2024","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jdermsci.2023.09.008","article-title":"Alopecia areata: What\u2019s new in the epidemiology, comorbidities, and pathogenesis?","volume":"112","author":"Dainichi","year":"2023","journal-title":"J. Dermatol. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4048","DOI":"10.1111\/jocd.14048","article-title":"Investigation of the relationship between alopecia areata and inflammatory blood parameters","volume":"20","author":"Dere","year":"2021","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1111\/jocd.13131","article-title":"Evaluation of complete blood cell and inflammatory parameters in patients with alopecia areata: Their association with disease severity","volume":"19","year":"2020","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_19","first-page":"e2023118","article-title":"The use of new hematological markers in the diagnosis of alopecia areata","volume":"13","author":"Acar","year":"2023","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e2024193","DOI":"10.5826\/dpc.1403a193","article-title":"Evaluation of serum inflammatory markers and their relationship to treatment response in alopecia areata patients","volume":"14","author":"Komurcugil","year":"2024","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"adv40971","DOI":"10.2340\/actadv.v104.40971","article-title":"Complete blood collection-based systemic inflammation biomarkers as a severity biomarker in alopecia areata: A cross-sectional study","volume":"104","author":"Deng","year":"2024","journal-title":"Acta Derm. Venereol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1007\/s11845-025-03969-6","article-title":"The effect of IL-17 and IL-23 inhibitors on hematological inflammatory parameters in patients with psoriasis vulgaris","volume":"194","year":"2025","journal-title":"Ir. J. Med. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/396\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T15:47:23Z","timestamp":1767628043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010396"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010396","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]}}}