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Source: Massachusetts General Hospital Summary: Physicians describe how their 13-year-old patient with alopecia totalis -- a total lack of scalp hair -- along with eczema, experienced significant hair regrowth while being treated with dupilumab.  Massachusetts General Hospital (MGH) physicians are reporting an unexpected side-effect from treatment with dupilumab, which is FDA approved for the treatment of moderate to severe eczema, also called atopic dermatitis. In their case report published in JAMA Dermatology, the physicians describe how their 13-year-old patient, who has alopecia totalis -- a total lack of scalp hair -- along with eczema, experienced significant hair regrowth while being treated with dupilumab, a drug marketed under the brand name Dupixent.
"We were quite surprised since this patient hadn't grown scalp hair since the age of 2, and other treatments that can help with hair loss did not in her case," says Maryanne Makredes Senna, MD, of the MGH Department of Dermatology, senior author of the JAMA Dermatology report. "As far as we know, this is the first report of hair regrowth with dupilumab in a patient with any degree of alopecia areata." In addition to longstanding alopecia, this patient had experienced extensive, treatment-resistant eczema since the age of 7 months. Treatment with prednisone and methotrexate, medications that can suppress the overactive immune system, led to limited improvement in the patient's eczema but no hair regrowth and was therefore discontinued. In July 2017 she began to be treated with weekly injections of dupilumab, which had recently received FDA approval. After six weeks of treatment, which led to significant improvement in eczema symptoms, she also noticed that fine light hairs called vellus hairs were appearing on her scalp. After seven months of dupilumab treatment, the patient had grown a significant amount of the pigmented hair that typically grows on the scalp. Because of a change in her insurance coverage, she had to discontinue dupilumab for a two-month period, during which she noticed shedding of the recently regrown hair. But after she could resume treatment in April 2018, the hair growth resumed and has continued. Senna explains that dupilumab's mechanism of targeting a key immune system pathway known to be overactive in eczema could explain its action against alopecia, since recent studies have suggested other elements of the same pathway may induce autoimmune hair loss. "Right now, it's hard to know whether dupilumab could induce hair growth in other alopecia patients, but I suspect it may be helpful in patients with extensive active eczema and active alopecia areata," she says. "We've submitted a proposal for a clinical trial using dupilumab in this patient population and hope to be able to investigate it further in the near future." Senna is the principal investigator of the Hair Academic Innovative Research (HAIR) clinical research unit at MGH and an instructor in Dermatology at Harvard Medical School.  If you're losing more strands than usual or you notice your hair's thinner than it used to be, here's what may be to blame.
Many people—and women especially—take great pride in their hair. It makes sense, as your crowning glory is just as front and center, just as visible to the rest of the world, as your face. Losing some hair every day is completely natural. It's a sign your body's growing new, healthy ones to replace the old. In fact, losing up to 100 hairs per day is normal. You can also kind of get an idea of what's normal for you by just paying attention to what you typically see in your brush or shower drain. "If all of a sudden you're noticing a lot more, or your ponytail is thinner or you're seeing more scalp," then you may be losing more hair than you should, Francesca Fusco, M.D., dermatologist at Wexler Dermatology in NYC and assistant clinical professor of dermatology at Mount Sinai, tells SELF. There are many different types of hair loss. Some, like genetic andogenetic alopecia (female pattern hair loss) are irreversible and out of your control—you get the hand you're dealt. But others, like the very common telogen effluvium, which is temporarily increased shedding caused by a wide variety of health and hormonal changes, can be fixed. With telogen effluvium hair loss, you need to think back to four or so months before to determine the culprit, Bethanee Schlosser, M.D., assistant professor of dermatology and director of the Women's Skin Health Program for Northwestern Medicine, tells SELF. "Shedding peaks about four months after the incident" that caused it, she explains. Other types of hair loss may happen progressively over some time and depending on whether they damage the hair follicle, can be either permanent or fleeting. If you've noticed your hair is falling out more than usual, looks thinner, or seems to be growing more slowly, here are some of the most likely things that could be causing it. 1. Childbirth During pregnancy, most women notice their hair going into rapid growth mode. "That’s when everything is in a grow, grow, grow phase, because there's surges of hormones [estrogen] that make hair grow," Fusco says. Since the hair growth stage lasts longer, normal shedding doesn't occur. Once estrogen levels go back to normal after delivery, hair resumes its normal growth cycles and starts to shed all that thick, luscious hair that accumulated over the last 10 months. Some women experience very mild shedding, but others experience intense shedding for a few months. 2. Changes in birth control Going off the Pill or changing to a different type of hormonal contraception can also cause hormone-induced shedding. "Whether you're just starting it, discontinuing it, or changing brands, your body can react by causing the hair to go into an increased shedding mode," says Fusco. 3. Protein deficiency Eating protein is essential for our bodies to make new hair cells. If you're not eating enough, your body won't have enough new hairs to replace the old ones when they shed. 4. Certain medications "Medications can cause chronic shedding," Schlosser says. The most notorious for doing so are blood pressure medications, but some antidepressants and HIV medications may do it as well. Always talk with your prescribing doctor if you notice you're losing hair a few months after starting new meds. 5. Dandruff or scalp psoriasis When the skin on the scalp is inflamed and itchy, and you frequently scratch the hell out of it, your hair may start to shed more than usual. Dandruff is the most easily treated cause of hair loss, Fusco says, because you can treat it with a zinc pyrithione shampoo (she recommends Clear Complete Scalp Care Anti-Dandruff System). "Consistency is the trick," so it's important to find a shampoo and conditioner you like, she says. Similarly, seeing a dermatologist to treat your psoriasis and restore your scalp's health will get your hair growing back normally. 6. Going through intense emotional or physical stress When you're experiencing something stressful or traumatic—not your average day-to-day stress, but something big and life-altering like a divorce, a death in the family, a significant job change, or a big move—you may experience a temporary halt in hair growth as your body puts its resources toward getting you through said big event. "Hairs don’t all grow at the same rate," Schlosser explains. "Some are growing some are resting and some are actively being shed. When you have these conditions, your body halts hair growth, and then things get restarted and all these hairs that have been halted start to get pushed out at the same time." The same thing can happen with physical stress and trauma, like having a big operation, being hospitalized, or even losing a significant amount of weight very quickly. 7. Autoimmune diseases "An autoimmune condition makes the body recognize its own hair follicles as foreign and it attacks them and makes the hair fall out," Fusco explains. This could be alopecia areata—an autoimmune hair loss condition— or something like lupus, rheumatoid arthritis, thyroid disease, and certain types of anemia (like sickle-cell anemia, not the more common iron-deficiency anemia). Schlosser notes that lupus can cause some scarring of the hair follicle, resulting in permanent hair loss. 8. Wearing too-tight hairstyles too often This can cause traction alopecia, Schlosser says. "Classically, this happens when people wear tight braids chronically, but i’ve seen it with tight ponytails, too," she explains. It can cause progressive thinning of the hairline, and if you do it for long enough, the hair loss may actually become permanent. It's considered a scarring process, which can damage the hair follicle beyond repair. Schlosser advises never wearing one hairstyle for too long, and trying not to pull too tightly if you can help it. 9. Heat-styling your hair on the reg Fusco says that women will come to her explaining they have hair loss, when really they have something called trichorrhexis nodosa. This is a condition where damaged, weak points in the hair shaft cause hair to break off easily. The cause? Thermal damage to the hair from things like using hot tools and over-bleaching. "Hair loss is not necessarily from the root but it's from somewhere along the shaft," she explains. 10. Over-processing your hair Getting frequent perms, chemical straightening or relaxing procedures—basically anything that uses harsh chemicals on your scalp and hair—can damage the hair follicle and cause permanent hair loss. "After repeated insults, the hair follicles just won't grow back," Schlosser says. This can cause hair to appear thinner, and may be especially noticeable on the scalp. Remember, many hair loss conditions are treatable. Most cases of increased shedding will gradually resolve on their own without treatment, Schlosser says. But if your hair doesn't return to its normal fullness after six to nine months, see a doctor for an evaluation to find out if something else is going on. "If you ever have any symptoms like itching, pain, burning, flaking, redness, or notice you can't see as many hair follicles anymore, you should seek help sooner." See your primary care provider or go directly to a dermatologist who specializes in treating hair loss. They can determine what type it is and what the right treatment approach is for you.
Pluripotent stem cells We previously reported on the RepliCel method, which draws on the findings of Japanese scientist, Shinya Yamanaka, who won the 2012 Nobel Prize for Physiology or Medicine after discovering that mature cells can be converted into stem cells. Whilst this ground-breaking cell regeneration development is being used to create ‘cell pharmaceuticals’ – which can help repair nerve damage – using the information to treat thinning hair is reportedly seen as the real ‘cash cow’ of regenerative medicine. His pluripotent stem cell findings were recently furthered in specific relation to genetic hair loss by a team at the Sanford-Burnham Medical Research Institute in California. They found that human stem cells could be converted to dermal papilla cells, using the pluripotent stem cells. As dermal papilla cells are an integral part of the hair follicle formation and hair growth cycle processes, the study concluded that, following successfully regrowing hair in mice during trials, their method for inducing hair growth could also work on humans. About the RepliCel process
In order to fully understand how the concept behind Shiseido and RepliCel’s method for restoring hair would work, it is necessary to first know what causes androgenetic alopecia. Testosterone byproduct, DHT is found in the bloodstream of both men and women. In those with a genetic predisposition to hereditary hair loss, DHT attacks hair located around the top of the scalp by binding itself to the hair follicles. This on-going DHT onslaught gradually weakens the targeted follicles – a process technically known as ‘miniaturisation’. This causes the hair to thin and can potentially even lead to baldness which is where the hair follicle dies completely. Shiseido and RepliCel’s technique revolves around re-activating the existing hair follicles. In order to do this, hairs are extracted from the scalp at root level – making it less invasive than a hair transplant – and specific cell populations are isolated from the person’s own healthy hair follicles. These cells are then replicated into the millions and injected back into affected areas of the scalp. What is not immediately clear is how this procedure could be sold to the public; we assume it is likely to be delivered in the same format as some of Shiseido’s beauty treatments, so could perhaps take place in spa-type environments, as well as at dermatology and hair loss clinics. Though it is unlikely to be suitable for home-use, we did find information from RepliCel which notes they are ‘also developing a propriety injection device optimised for the administration of its products and licensable for use with other dermatology applications’. We will report any new updates on these delivery systems, as soon as information becomes available. Timeline for launch According to a press release issued by RepliCel, Shiseido has an exclusive license for the hair loss productknown as ‘RCH-01’ in certain Asian countries including Japan, China and South Korea. There is no mention yet as to when it will launch – although they expect it to be in 2018 – and whether it will be made available outside of these territories, through Shiseido or any other brand. The product is currently undergoing ‘multiple clinical trials’ which will continue throughout 2015. Additionally, Shiseido is carrying out its own clinical trial ‘of RCH-01 and the device’ which has no date attached but is said to be scheduled to happen ‘in late prototype development’. Where genetic hair loss is concerned, three years can be a long time. If you are concerned that you are losing more hair than usual and would like to investigate ways to prevent further shedding and regrow your hair, visit a hair loss specialist sooner rather than later. They can provide you with a diagnosis of your condition then tailor a personalised hair loss treatment plan featuring clinically-proven components which, if followed as directed, should start to produce visible regrowth results within the first three to six months. |
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May 2024
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