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New Treatment for Hair Loss From Alopecia Areata

FDA-approved drug could be the answer for patients with severe cases

man getting his scalp checked
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Millions of people in the U.S. struggle with alopecia areata, an autoimmune disease that commonly results in patches of hair loss. But now they have cause for optimism.

The U.S. Food and Drug Administration (FDA) recently approved Olumiant (baricitinib), the first systemic drug to treat adults with severe alopecia areata. Olumiant works by blocking the activity of enzymes that contribute to inflammation and has proved to be effective in hair regrowth in clinical trials. This medical breakthrough is a beacon of hope for patients who’ve grown frustrated with a lack of answers.  

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“This is a wonderful new treatment option for people with more diffuse cases of alopecia areata who are otherwise healthy and are not on any other immunosuppressant medication,” says board-certified dermatologist and hair transplant surgeon Felicia Ekpo, D.O. “Baseline and regular lab monitoring by a physician comfortable [with] prescribing this medication is very important … due to the potential side effects.”

This milestone comes months after the Oscars incident that put Jada Pinkett Smith’s struggle with alopecia center stage. The actress has been candid about her hair loss in recent years, and her transparency is raising much-needed awareness about alopecia areata, which affects more than 300,000 people in the U.S. each year.

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While there’s currently no cure for the condition, strides are being made toward improving patients’ lives. What’s more, the earlier it’s treated, the better the outcome. Here’s what you need to know.

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What is alopecia areata?

First things first: Alopecia is simply an umbrella term for a wide range of hair-loss conditions — from male- or female-pattern baldness to chemotherapy-induced hair loss. One of the most common of these conditions is alopecia areata, which occurs when the immune system attacks the hair follicles. “For some reason, the body says, Hey, you’re not a part of here, and the hair follicles get attacked by inflammatory cells called lymphocytes,” Ekpo explains. “This is done as a protective mechanism because the body is seeing the hair follicles as something foreign.”

Since alopecia areata is considered non-scarring (meaning the hair follicles are not permanently damaged), regrowth is possible. “I tell my patients, ‘As soon as you start to see more hair than usual falling out, come in,’ ” says Ekpo, who warns that alopecia areata can become resistant to treatment if ignored.

The signs

The onset of alopecia areata is typically very sudden, and it can spread rapidly, according to certified trichologist Penny James. The most common sign is the appearance of small round-shaped bald patches on the scalp, but hair loss can occur on other parts of the body, too. Additionally, white hairs may appear in the bald areas of the scalp, as well as small pieces of broken hair that are tapered toward the scalp, called exclamation point hairs. Sufferers may even see changes in their nails, including pitting, white spots and ridges.

For some people, intervention may not be necessary, as the hair often grows back on its own within a few months. For others, episodes of hair loss will come and go throughout life, making the condition especially frustrating. In some cases, localized alopecia areata can progress to alopecia totalis (hair loss throughout the scalp) or alopecia universalis (complete hair loss throughout the body).

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Who’s at risk?

Alopecia areata can affect anyone, anytime. But a small study published in the Annals of Dermatology suggests that when it occurs later in life, it is milder.

Though the exact cause of the disease is unknown, it’s thought to be genetic. Having a family history of other autoimmune diseases, and having an underlying autoimmune disease yourself, can increase your susceptibility to alopecia areata, Ekpo says. For this reason, it’s crucial to ask your doctor for blood tests to rule out other autoimmune conditions, such as thyroid disease, lupus and vitiligo.

Other possibilities? “Viral infections, stressful events in life or exposure to any substance that can become an antigen to the body are a few factors to consider,” James says. “About 3 percent of people with alopecia areata have celiac disease, and about 40 percent of patients suffer from atopic diseases, [such as] allergies and asthma.” 

Treatment  

Keep in mind that the type of treatment needed depends on the severity of the disease, so it’s wise to work with a dermatologist to determine the best plan. “One thing may not work for everyone,” Ekpo says. “With my patients, everything is an individualized treatment approach.” And though treatment may encourage hair growth, it’s possible that hair may fall out again once therapy ends.

Besides Olumiant, patients with severe disease may benefit from topical immunotherapy (aka contact immunotherapy), which involves applying sensitizing chemicals to the bald areas of the scalp to trigger an allergic reaction. The end goal is to alter the immune response.

Additionally, corticosteroids are commonly used to calm inflammation and promote hair growth. For mild cases of alopecia areata, topical minoxidil combined with topical corticosteroids may be effective. As James explains it, minoxidil pushes the hair into the active phase, stimulating growth. Also, many trichologists recommend taking L-tyrosine, an amino acid that “reduces inflammation around the hair follicle and can be of benefit to alopecia areata, unless the person needs more aggressive interventions,” James says. 

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