New Hope For Alopecia Patients
My name is Tova Younger and I am a Physician Assistant student at SUNY Downstate Medical Center. I am thrilled to be spending my Dermatology rotation at Marmur Medical, where a broad range of dermatologic conditions are treated. Today, I’d like to discuss hair. We have all heard of the phrase “Having a great hair day”, which means feeling great about the way we look and having the confidence to tackle anything that comes our way. But some of us don’t get to enjoy great hair days. Fifty six million Americans suffer from hair loss, also known as alopecia.
Alopecia can be devastating to one’s sense of self esteem. It is especially difficult for young adults to deal with. I personally observed a friend struggle with alopecia throughout high school. She spent vast amounts of time strategically placing her hair in ways that might mask her hair loss and spent the rest of the time worrying her hair loss was visible despite her best efforts to hide it. The experience was emotionally draining for her and denied her the confidence she needed to be successful in other areas of her life. She frequently turned down opportunities to engage in social activities or extracurricular excursions. Her concerns about her hair loss, far from being merely a cosmetic concern, really impacted every aspect of her high school experience and made her world, a much smaller place.
Alopecia is a broad term that refers to various types of hair loss. There are two categories of alopecia; scarring and non-scarring. Scarring alopecia causes the hair follicle structure to be replaced by fibrous tissue which causes scarring, erythema, hypopigmentation and atrophy of the scalp. Scarring alopecia can be caused by discoid lupus, lichen planopilaris, follicular degeneration syndrome, T-cell lymphoma, folliculitis decalvans and pseudofolliculitis barbae. Non-scarring alopecia is hair loss without scarring or fibrosis. Non-scarring alopecia can be caused by traction (pulling your ponytail too tight!), an autoimmune disease, pregnancy, chemo/radiation therapy, hormones, emotional stress and physical stress which is associated with telogen effluvium. A subtype of non-scarring alopecia is alopecia areata which is caused by an autoimmune disease and is defined as loss of hair in round or oval patches with no associated inflammation of the skin. Alopecia areata totalis is the complete loss of hair on the scalp. Alopecia areata universalis is the complete loss of both scalp hair and hair on the rest of the body.
Fortunately, there are treatments for alopecia which can reverse the effects of the disease in many cases. Treatments include steroids, topical Minoxidil (Rogaine), cyclosporine and antibiotics. Finasteride can be used by men for androgenic alopecia. Many people opt for hair transplantation.
Most recently a new drug was found to be effective in the treatment of alopecia unversalis, it’s off label, experimental and exciting but has side effects. The drug, Tafacinitib (Xeljanz) works by inhibiting the intracellular JAK2 pathway, responsible for the overproduction of pro-inflammatory cytokines, in other words it reduces inflammation associated with alopecia. It was initially approved by the FDA to treat rheumatoid arthritis, an autoimmune disease. Dr. Brett King at the Yale University School of Medicine used the drug to treat a 25 year old male who presented with plaque psoriasis and alopecia universalis. After an 8 month course of Xeljanz the patient had completely regrown his scalp hair as well as hair on the rest of his body. While this is a very encouraging preliminary result, Xeljanz is known to have potentially serious side effects such as increased risk of infection, elevation of cholesterol levels and increased risk of cancer which is why before one starts Xeljanz a whole panel of blood tests have to be ordered. More studies are needed and physicians and patients who are considering use of the drug need to take into account the potential long and short term risks.
Xeljanz has been used for alopecia areata, a less severe form of alopecia universalis. The mechanism is the same and no strong studies have been done so its success is really on a case by case basis. During my first week at Marmur Medical we saw several young men and women who suffered from alopecia areata and who will likely start Xeljanz. With Dr. King’s help, we hope to help these patients safely regain their hair and their confidence.