Natasha Mesinkovska, MD, PhD, is a dermatologist and researcher at the University of California, Irvine School of Medicine Department of Dermatology.

Natasha Mesinkovska, MD, PhD

What Upadacitinib Could Mean for Younger Patients With Severe Alopecia Areata

 reviews AbbVie’s supplemental new drug application for upadacitinib (Rinvoq) in 

, Natasha Mesinkovska, MD, PhD, highlighted the potential impact that an additional approved therapy could have on younger patients, long-term disease management, and broader recognition of alopecia areata as a chronic autoimmune condition.

team, Mesinkovska emphasized the unique burden alopecia areata can place on adolescents and their families. She noted that while some young patients may appear outwardly resilient, the psychosocial impact of hair loss during adolescence is often substantial. Based on her experience treating patients and participating in clinical trials, she suggested that successful treatment can have meaningful effects beyond hair regrowth alone, improving confidence and quality of life during a particularly vulnerable stage of development.

The inclusion of adolescents aged 12 years and older in the UP-AA phase 3 program was therefore a notable aspect of the submission, particularly given the limited number of approved treatment options currently available for younger patients with severe disease.

Mesinkovska also addressed the significance of complete scalp hair regrowth, one of the secondary endpoints achieved in the clinical program. She noted that expectations for treatment success in alopecia areata have evolved considerably in recent years. Historically, clinical trial responders were defined as patients achieving at least 80% scalp hair coverage, a benchmark that was itself considered highly meaningful. However, newer therapies are now raising expectations by demonstrating the possibility of near-complete or complete regrowth in some patients.

According to Mesinkovska, these outcomes help establish a higher standard for future therapies and reflect growing ambitions among both clinicians and patients seeking optimal disease control.

Despite recent advances, she noted that several important unmet needs remain. The underlying cause of alopecia areata is still not fully understood, limiting the ability to predict who will develop the disease or how it might be prevented. Additionally, disease flares can still occur even among patients receiving treatment, highlighting the need for therapies that provide durable long-term control.

Mesinkovska also pointed to the ongoing need for treatment strategies patients and clinicians can feel comfortable using over extended periods. While safety data for JAK inhibitors in alopecia areata have thus far been reassuring, she noted that the field continues to seek approaches that minimize treatment burden while maintaining efficacy.

Looking ahead, Mesinkovska noted a potential approval of upadacitinib could further reinforce understanding of alopecia areata as a chronic autoimmune disease rather than a purely cosmetic condition. Given the drug’s established use across multiple inflammatory diseases, she highlighted its potential expansion into alopecia areata may help underscore the immunologic nature of the disorder and its broader impact on patient health.

Disclosures: Mesinkovska has served on advisory boards for Arena Pharmaceuticals, Concert Pharmaceuticals, La Roche-Posay Laboratorie Pharmaceutique, Lilly ICOS LLC, Nutrafol, and Pfizer Inc.; as a speaker for Eli Lilly; and as an investigator for AbbVie, Arcutis, Inc., Arena Pharmaceuticals, Kyowa Hakko Kirin Pharma, Inc., Lilly ICOS LLC, Merz Aesthetics, and Pfizer Inc. She received honoraria for advisory board and speaking activities, research funding from Merz Aesthetics and Pfizer Inc., and no compensation for investigator roles with AbbVie, Arcutis, Arena Pharmaceuticals, Kyowa Hakko Kirin Pharma, and Lilly ICOS LLC.

AbbVie. AbbVie submits application to FDA for upadacitinib (Rinvoq) for adults and adolescents with severe alopecia areata. Published April 28, 2026. Accessed June 9, 2026. 

https://www.prnewswire.com/news-releases/abbvie-submits-application-to-fda-for-upadacitinib-rinvoq-for-adults-and-adolescents-with-severe-alopecia-areata-302754816.html

Smith T. Upadacitinib sNDA Submitted to FDA for Severe Alopecia Areata. HCPLive. April 28, 2026. Accessed June 9, 2026. 

https://www.hcplive.com/view/upadacitinib-snda-submitted-to-fda-for-severe-alopecia-areata

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Natasha Mesinkovska, MD, PhD, speaks on the potential impact that an additional approved therapy like upadacitinib could have on younger patients with alopecia areata.

How Upadacitinib Could Expand Options for Severe Alopecia Areata, With Natasha Mesinkovska, MD, PhD

 submission for upadacitinib (Rinvoq) in severe alopecia areata represents another important step forward for a patient community that had few effective treatment options until just a few years ago, according to Natasha Mesinkovska, MD, PhD, a dermatologist and affiliated expert with the National Alopecia Areata Foundation.

, Mesinkovska emphasized the rapid evolution of the alopecia areata treatment landscape since the first FDA approval of a JAK inhibitor for the condition in 2022. She described the progress as the culmination of decades of work by researchers, clinicians, and patient advocates.

“Hair is having its moment,” Mesinkovska said, noting that individuals with alopecia areata historically had limited therapeutic options and often faced the choice of concealing their hair loss or embracing it publicly without effective treatment available.

She highlighted the importance of expanding the number of approved therapies within the JAK inhibitor class, particularly because alopecia areata commonly affects younger individuals. If approved, upadacitinib would provide another treatment option for both adolescents and adults aged 12 years and older, a population with significant unmet needs.

Discussing the phase 3 UP-AA data that supported the submission, Mesinkovska stressed that additional therapies are valuable because patients do not respond uniformly to treatment. She compared the expanding therapeutic armamentarium to having multiple keys available for different locks.

Mesinkovska also noted the study findings reinforce a pattern already observed with JAK inhibitors, namely that higher doses may produce more robust efficacy but can also be associated with a greater likelihood of adverse events. As a result, clinicians must continue balancing efficacy and safety considerations when selecting therapies.

Reflecting on the treatment landscape since the approval of baricitinib, Mesinkovska acknowledged that adoption of newer therapies has been somewhat slower than many specialists initially anticipated. She attributed this to caution among both physicians and patients. Clinicians have sought additional real-world experience with the medications, while some patients with longstanding disease remain hesitant after experiencing previous treatment disappointments.

Nevertheless, she believes confidence in these therapies continues to grow as more patients receive treatment and gain experience with newer options.

Mesinkovska also pointed to what she perceives as an increase in alopecia areata cases following the COVID-19 pandemic, whether due to greater recognition of the disease or potential autoimmune triggers. As awareness and demand for treatment increase, she said additional approved therapies could further strengthen the field and provide patients with greater confidence that meaningful treatment options are available.

This interview on a possible upcoming therapeutic option for severe alopecia areata highlights information regarding upadacitinib (Rinvoq) and its potential.

Networking, Niches, and Why Authenticity Is Your Biggest Career Asset in Dermatology

, the conversation opened with both physicians sharing the speakers they most admire and actively try to emulate. Host Mona Shahriari, MD, named Linda Stein Gold as a formative influence, praising her ability to translate complex material through analogy and metaphor in a way that made audiences not just understand a topic, but feel it emotionally.

Guest Natasha Mesinkovska, MD, PhD, pointed to Ted Rosen as her model, drawn to his stripped-down presentation style, big letters, two words on a slide, a photograph, humor and a relaxed presence that made him feel like someone you just happened to know. She also credited Dirk Elston with teaching her the value of the pause, an acknowledgment that she naturally tends to run through material quickly. The throughline for Mesinkovska was clear: the speakers she gravitates toward are those who lead with images and simplicity, and that is the presenter she is working to become.

From there, Shahriari raised a more pointed question: whether women are judged differently on stage. Mesinkovska answered directly and without hesitation. She acknowledged that audiences scrutinize what women wear, down to their jewelry and shoes, in ways that simply do not apply to their male counterparts.

Rather than treating that reality as a liability, she reframed it as an opportunity. Women on stage, she argued, hold a particular kind of power and should lean into whatever makes them feel confident and authentic, whether that means a red dress, heels, or a sweatshirt. The message was simple: own it. Shahriari echoed the sentiment, noting that her own heels are a source of personal confidence she has never felt the need to apologize for.

The discussion then turned to authenticity and the pressures of personal branding in an era of social media and influencer culture. Mesinkovska was candid about the professional trade-offs that come with her commitment to honesty, acknowledging that her directness is not always considered industry-friendly. She has made peace with that, viewing the credibility she has built through institutional rigor and independent research as its own form of currency. She also admitted she is not well-suited to social media, finding the environment too harsh for someone who describes herself as sensitive.

Closing out the episode, Mesinkovska offered practical advice for women hoping to build a national presence. Her playbook started with human connection: find the people you admire and simply introduce yourself. From there, she stressed the importance of identifying genuine areas of interest rather than chasing prestige, finding a niche that excites you personally, and growing within it through research, collaboration, and willingness to change direction when your passions evolve. Her parting thought was characteristically direct: carve your own path, then carve a whole lot more of them.

Editor’s note: This episode was produced with the help of AI tools.

This discussion reflects on great speakers, the unique pressures women face on the podium, and what it takes to build a national platform in academic medicine.

Resilience, Rejection, and Recognition in Academic Dermatology

, dermatologist Natasha Mesinkovska, MD, PhD, reflects on career development, mentorship, and communication style, offering several practical insights relevant to clinicians navigating academic medicine.

Mesinkovska emphasizes the importance of proactively seeking opportunities early in one’s career. She describes a willingness to “ask for anything,” even offering to perform logistical tasks simply to gain exposure to academic meetings and professional environments. This mindset, prioritizing access and experience over prestige or compensation, ultimately facilitated speaking opportunities and career advancement. Her experience underscores a key principle: visibility and initiative often precede recognition. For clinicians, particularly early-career physicians and trainees, explicitly expressing interest in roles or opportunities may significantly increase the likelihood of inclusion.

Importantly, Mesinkovska acknowledges that self-advocacy does not always come naturally. She notes a personal discomfort with advocating for herself, contrasting this with her strong advocacy for mentees. This dichotomy highlights a common challenge among clinicians, especially women, who may hesitate to promote their own accomplishments or request opportunities. Nevertheless, she identifies “asking” as a foundational rule in mentorship, emphasizing that rejection is both common and necessary. She contextualizes success as a numbers game, numerous rejections accompany each acceptance, whether for publications, presentations, or awards. This normalization of rejection reframes it as an expected component of academic progression rather than a deterrent.

Mentorship emerges as another central theme. Mesinkovska describes a deliberate effort to “pay forward” the opportunities she received by supporting junior colleagues. She actively promotes mentees’ achievements and views their success as a shared accomplishment. This approach aligns with best practices in academic medicine, where sponsorship, actively advocating for trainees and junior faculty, can be as impactful as traditional mentorship. Her comments also suggest that fostering a supportive team culture requires intentional recognition of contributions, even for high-performing individuals who may otherwise go unnoticed.

The discussion also explores Mesinkovska’s approach to medical education and lecturing. She attributes her distinctive presentation style to a strong foundation in basic science (as a PhD-trained physician) combined with an emphasis on simplification and audience engagement. Her ability to translate complex scientific concepts into accessible, memorable content reflects experience in patient-facing scientific communication. She notes that preparing a single lecture may require 20–30 hours, highlighting the substantial effort behind effective teaching. This serves as a reminder that high-quality educational delivery is a skill requiring both time investment and deliberate practice.

Finally, Mesinkovska touches on the importance of valuing intellectual property in academic work. Initially sharing her materials freely, she later recognized the need to protect the significant effort involved in content creation. This perspective may resonate with clinicians increasingly contributing to educational and digital platforms.

Overall, the segment reinforces several actionable themes for clinicians: proactively seek opportunities, normalize rejection, invest in mentorship and sponsorship, prioritize clarity in communication, and recognize the value of one’s academic contributions.

This segment of the latest episode of The Medical Sisterhood highlights insights into the career of Natasha Mesinkovska, MD, PhD.

Natasha Mesinkovska, MD, PhD

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