Ritlecitinib (Litfulo) achieved a SALT score of 20 or below in 23% of trial participants at 24 weeks, making it the second FDA-approved JAK inhibitor for alopecia areata and the first approved for adolescents as young as 12. Tracking your response to ritlecitinib with consistent documentation helps you and your physician evaluate whether this medication is working and supports insurance coverage decisions for a treatment that costs thousands of dollars annually.
This article is for informational purposes only and does not constitute medical advice.
How Ritlecitinib Works
Ritlecitinib is a selective JAK3 and TEC family kinase inhibitor. Unlike baricitinib (which targets JAK1/JAK2), ritlecitinib focuses on a different set of kinase pathways that play a role in the T-cell mediated autoimmune attack on hair follicles. By blocking JAK3 and TEC kinases, ritlecitinib reduces the activity of cytotoxic T cells that drive follicle destruction in alopecia areata.
FDA Approval and Key Trial Data
The FDA approved ritlecitinib in June 2023 for adults and adolescents aged 12 and older with severe alopecia areata. The ALLEGRO Phase 2b/3 trial provided the following key results:
| Metric | 50mg Dose at 24 Weeks |
|---|---|
| SALT 20 or below (80%+ coverage) | 23% of patients |
| SALT 50 or below (50%+ coverage) | Approximately 30 to 35% |
| Continued improvement at 48 weeks | Yes, additional responders over time |
| Approved age range | 12 years and older |
The approval for ages 12 and above is significant because alopecia areata frequently affects adolescents, and ritlecitinib offers a treatment option for this age group.
Building Your Ritlecitinib Tracking Protocol
Step 1: Establish Your Pre-Treatment Baseline
Before your first dose, create a comprehensive baseline record. This is the reference point against which all future measurements are compared.
Take photos from five standardized angles (overhead, front, back, left, right) under consistent lighting. Upload to myhairline.ai/analyze for zone-by-zone density measurements. Calculate or estimate your baseline SALT score. Record all current medications and previous treatment history.
Step 2: Set Your Monitoring Schedule
The clinical trial primary endpoint was measured at 24 weeks, so your tracking should cover at least this period with consistent data points:
| Period | Tracking Frequency | Focus |
|---|---|---|
| Weeks 0-12 | Every 4 weeks | Baseline confirmation, early signals |
| Weeks 12-24 | Every 4 weeks | Primary response window |
| Weeks 24-48 | Every 4-8 weeks | Extended response assessment |
| Beyond 48 weeks | Every 8-12 weeks | Maintenance monitoring |
Step 3: Record Data at Each Session
At every tracking session, capture:
- Five-angle photos under consistent lighting
- AI density measurements for frontal, vertex, parietal, and occipital zones
- SALT score estimate (overall percentage of scalp covered)
- Hair quality notes: Proportion of vellus vs. terminal growth
- Eyebrow and eyelash status if previously affected
- Side effect log for reporting to your physician
Expected Response Timeline
Weeks 0 to 12: Patience Required
Like other JAK inhibitors, ritlecitinib requires time to suppress the immune attack and allow follicles to re-enter the growth cycle. Visible changes in the first 12 weeks are uncommon but not impossible. Continue your tracking protocol consistently even if your photos look identical month to month. The data is still valuable for comparison.
Weeks 12 to 24: The Primary Response Window
This period corresponds to the clinical trial primary endpoint. Responders typically begin showing visible vellus regrowth during these weeks. Some patients notice regrowth appearing first on the sides and back of the scalp, then gradually extending to the top and front. AI density scans should begin reflecting measurable changes in responding zones.
Weeks 24 to 48: Continued Improvement
Trial data showed that response continued beyond 24 weeks, with additional patients reaching clinically meaningful improvement by week 48. If you are seeing a positive trend at 24 weeks but have not yet reached your goals, this continued improvement pattern provides reason to maintain treatment.
After 48 Weeks
Some patients continue to improve beyond one year. If your tracking data shows an ongoing upward density trend, continued treatment is supported. If improvement has plateaued well below your goals, discuss alternatives with your physician.
Converting AI Density Data to SALT Scores
Your dermatologist uses SALT scores, while AI density analysis provides hairs-per-square-centimeter measurements. Bridging these two metrics makes your tracking data more useful in clinical conversations. For a full guide on monitoring alopecia areata, see alopecia areata monitoring.
Approximate Conversion Method
The SALT score represents the percentage of scalp area without hair. To approximate it from density data:
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Determine your healthy baseline density. If you have photos or data from before hair loss, use that. Otherwise, typical healthy scalp density is approximately 100 to 150 hairs per square centimeter, varying by ethnicity and natural hair characteristics.
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Calculate your current density as a percentage of baseline. If your AI scan shows an average of 30 hairs per square centimeter and your estimated baseline is 120, your density is approximately 25% of normal.
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Your approximate SALT score is 100 minus that percentage. In the example above: 100 minus 25 equals approximately SALT 75.
This method provides an estimate only. Clinical SALT scoring accounts for the spatial distribution of hair loss across the entire scalp, which a simple average cannot fully capture. Always defer to your dermatologist for the official SALT score.
Ritlecitinib vs. Baricitinib: Tracking Differences
If you are deciding between these two FDA-approved options, or if you are switching from one to the other, note the following tracking considerations:
| Factor | Baricitinib (Olumiant) | Ritlecitinib (Litfulo) |
|---|---|---|
| Mechanism | JAK1/JAK2 inhibitor | JAK3/TEC family inhibitor |
| Approved ages | Adults only | 12 and older |
| Primary endpoint timing | 36 weeks | 24 weeks |
| Response rate (SALT 20 or below) | 35-40% at 36 weeks (4mg) | 23% at 24 weeks (50mg) |
| Response beyond primary endpoint | Yes | Yes |
If you are switching from baricitinib to ritlecitinib (or vice versa), reset your tracking baseline on the day you start the new medication. Your previous tracking data remains valuable for documenting treatment history, but the new medication needs its own response timeline. For detailed baricitinib tracking guidance, see baricitinib tracking protocol.
Insurance Documentation
Like baricitinib, ritlecitinib typically requires prior authorization. Your tracking data supports initial authorization by documenting disease severity (SALT score and photos), and supports re-authorization by demonstrating treatment response. Keep all tracking records organized by date in a dedicated folder.
Start Tracking Today
Whether you are considering ritlecitinib, just starting treatment, or weeks into your course, establishing objective density measurements provides the foundation for evaluating your response. Upload your current scalp photos to myhairline.ai/analyze and begin building the structured record that supports your treatment journey.
This article is for informational purposes only and does not constitute medical advice. Ritlecitinib requires prescribing and monitoring by a qualified physician. Always consult your dermatologist before starting or changing any treatment.