Updates on a New Alopecia Treatment

The 2022 Oscars are known for the slap heard around the word. The cause was a joke about alopecia. The response was an indication that dealing with alopecia areata is not a laughing matter, but a newly approved medication may help.

woman with alopecia

© Diana Andrunyk | Getty Images

According to the National Institutes of Health (NIH), alopecia areata is a disease of the immune system that attacks your hair follicles. Your immune system is your defense against foreign invaders like viruses or bacteria, but sometimes the immune system mistakes normal body tissues as foreign and attacks them. This is called an autoimmune disease.

The word alopecia means bald, and areata means patches. Alopecia areata – usually referred to as just alopecia – affects about 7 million Americans. You have about a two percent risk of having this condition during your lifetime. Alopecia is an unpredictable disease. It can cause patches of hair to fall out or all the hair on your body. It can go away forever, come back, or never leave. There is no cure but a few months after “the slap,” the FDA approved the first oral drug for alopecia, called Olumiant (baricitinib).

Symptoms of Alopecia

Alopecia affects men and women equally and it usually starts suddenly before age 30. There are three types based on the symptoms. The most common type is patchy areata. This type causes hair to fall out in coin-size patches, usually from the scalp but it can also affect other areas of the body. Alopecia totalis causes all or almost total loss of scalp hair, and alopecia universalis causes all or almost total loss of body hair.

Types of Alopecia Level of Hair Loss Where It Affects
Alopecia areata Patchy baldness Anywhere on the body (scalp, chin, eyebrows, eyelashes, inside nose or ears)
Alopecia totalis Complete baldness Scalp
Alopecia universalis Complete baldness Entire body

About 10 to 20 percent of people will also have nail changes that can include a red color, pits, and ridges. Other than that, there are no other signs or symptoms and people with alopecia are usually in good health overall.

Alopecia is not contagious. You may be at higher risk if you have a family history of alopecia, which is the case for about 10 to 20 percent of people with the disease. You may also be at higher risk if you have allergies or another type of auto-immune disease like psoriasis, thyroid disease, or vitiligo (a skin disease that causes loss of skin color). In some cases, an attack of alopecia may be triggered by stress or by cold weather.

Alopecia Treatment and Prognosis

One good thing about alopecia is that although it attacks hair follicles, it rarely destroys them, so regrowth of hair is possible. In fact, most people with alopecia will have hair regrowth within one year. In most cases, no treatment is recommended for the first year. After that, there are many options but no treatment guidelines that fit everyone. Treatments may include steroid creams and injections. Some drugs that are approved for other conditions like arthritis, male pattern baldness, and glaucoma may help. Other options for long-term alopecia are wearing a wig, shaving the head, and wearing false eyelashes.

Olumiant is the first FDA-approved drug for alopecia in about 30 years. According to Alopecia UK, this new drug may work better than other available treatments. Olumiant is the first systemic treatment approved for alopecia, meaning it is an oral drug that gets absorbed into your blood and travels to all parts of the body. This drug is in a class of drugs called Janus Kinase (JAK) enzyme inhibitors. These drugs block enzymes that your body uses to mount an immune reaction.

Although this is the first JAK inhibitor approved for alopecia, it has previously been approved for rheumatoid arthritis in 2018. It is only approved for adults with severe alopecia. FDA approval was based on two clinical studies that compared this drug to a placebo in adult patients with alopecia and at least 50 percent hair loss (severe alopecia).

Although the drug handily outperformed the placebo. It did not work for everyone, and the effects stopped when the drug stopped. JAK inhibitors carry a warning for serious infections, cancers, blood clots, and heart attacks, so they must be used with caution. There are also other JAK inhibitors being tested for alopecia, so the future does look brighter for those with alopecia.

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Chris Iliades, MD

Dr. Chris Iliades is board-certified in Ear, Nose and Throat and Head and Neck Surgery from the American Board of Otolaryngology and Head and Neck Surgery. He holds a medical … Read More

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