 By Cara Murez HealthDay Reporter THURSDAY, Aug. 17, 2023 (HealthDay News) -- A new type of medication, JAK inhibitors, can effectively treat moderate to severe alopecia areata, a hair loss condition that has been historically hard to treat. A study of its effectiveness, by Dr. Brett King and Dr. Brittany Craiglow of Yale University, was published in August in a supplement to the Journal of the American Academy of Dermatology. “Because alopecia areata is an inflammatory condition, a JAK inhibitor will essentially reduce the inflammation that is fueling the disease and bring your immune system back into balance,” said dermatologist Dr. Sandra Johnson. She is an adjunct professor at the University of Arkansas for Medical Sciences, in Little Rock, who was not involved with the study. “The development of JAK inhibitors has given us another treatment to improve the lives of patients with alopecia areata,” Johnson said in a news release from the American Academy of Dermatology.
The condition is more common in kids but can happen at any age. It involves sudden hair loss with affected patches that grow larger. In some cases, it spreads to the entire head or body. It is also more common in those who have a close blood relative with the disease and in people who have been treated for cancer with a drug called nivolumab (Opdivo). Medical conditions such as asthma, hay fever, eczema, thyroid disease, vitiligo and Down syndrome also increase alopecia areata risk. Courtney Martens, a mother of two from Edmond, Okla., participated in a clinical trial at Johnson's practice in Fort Smith, Ark. Martens began living with alopecia areata at 38, when she first noticed a bald patch about the size of a silver dollar on her scalp. Eventually, Martens lost all hair on her scalp, eyebrows and eyelashes. She was diagnosed with alopecia areata in 2017. Her immune system was causing her body to attack its own hair follicles. “It’s pretty traumatizing,” Martens said in the news release. “Most people think it’s just hair, but it was exhausting because it became what everybody talked about. It was like I lost my identity because I was always the girl with pretty hair growing up.” After she received treatment with a JAK inhibitor at Johnson's practice, Martens was able to completely regrow her hair. She said that she feels blessed that the treatment worked for her. The new study credits JAK inhibitors with ushering in a new era, making treatment of moderate-to-severe alopecia areata possible. The authors noted that two drugs — baricitinib and ritlecitinib — are approved, and a third, deuruxolitinib, is moving toward approval. Clinical trials are also ongoing. Diagnosis of alopecia areata involves an examination of the area of hair loss as well as a person’s nails. Blood tests may be needed to rule out other diseases caused by the immune system. Besides JAK inhibitors, contact immunotherapy can be used to change a person’s immune system so that it stops attacking their hair follicles. Other treatments options include a disease-modifying antirheumatic medication called methotrexate and anti-inflammatory corticosteroids. “We now have more treatment options than ever before for alopecia areata patients, and they are providing results for people for whom previous treatments were not effective,” Johnson said. “It’s important to know that no one treatment works for everyone. Your board-certified dermatologist can recommend the treatment options that work best for you.” More information The U.S. National Institutes of Health has more on alopecia areata. SOURCE: American Academy of Dermatology, news release, Aug. 15, 2023 Copyright © 2023 HealthDay. All rights reserved.  Hair loss is a common condition known as alopecia in the medical field.
It has many known causes, including (1Trusted Source, 2Trusted Source):
Micronutrient deficiencies Hair is made up of two main structures — the hair shaft, which is what you see, and the hair follicle, which is hidden underneath the skin. Hair grows from the hair follicle (4Trusted Source). Hair typically grows at a rate of 0.35 mm per day. The scalp sheds about 100 hairs per day, which can increase with hair care practices like washing and brushing (5Trusted Source). Hair follicles are highly active and sensitive. In fact, hair follicle cells are among the most rapidly dividing cells in your body, so it’s no surprise that nutrient deficiencies can negatively affect hair growth (3Trusted Source). Iron Iron deficiency is the most common nutrient deficiency in the world and can cause hair loss (3Trusted Source). This condition is related to a type of hair loss known as telogen effluvium (TE), a type of hair loss characterized by a disruption in the normal hair growth cycle. This leads to excessive hair shedding and hair loss (5Trusted Source). Researchers are still studying how iron deficiency causes hair loss, but it appears to disrupt hair growth by diverting iron stores in the hair follicle to other areas of the body (6Trusted Source). Some studies have shown that people with hair loss tend to have lower iron levels in their blood and hair compared with people who don’t have hair loss (7Trusted Source, 8Trusted Source). Vitamin D Vitamin D plays an important role in hair growth and the health of your hair follicles (6Trusted Source). Research has shown that vitamin D levels are lower in people with hair loss conditions, including female pattern hair loss and an autoimmune skin disease called alopecia areata (9Trusted Source, 10Trusted Source, 11Trusted Source, 12Trusted Source). Research has shown that taking vitamin D supplements promoted hair regrowth in some people with hair loss related to vitamin D deficiency (13Trusted Source). A 2020 study that included 109 people found that those with hair loss had significantly lower blood levels of vitamin D than people without hair loss. In fact, nearly 80% of the people with hair loss had low vitamin D levels (14Trusted Source). Iron deficiency was common among those with hair loss as well (14Trusted Source). These findings led the researchers to recommend that all people with diffuse hair loss be tested for low vitamin D and iron levels (14Trusted Source). Zinc Zinc is a mineral that plays important roles in immune function, protein synthesis, cellular division, and more. It’s necessary for hair follicle function and helps protect against hair follicle shrinkage and slowed growth. It also helps promote hair follicle recovery (15Trusted Source). Zinc deficiency can cause hair loss, and studies show that people with certain hair loss conditions tend to have lower zinc levels than people without hair loss. Those conditions include (6Trusted Source, 15Trusted Source):
In addition to the vitamins and minerals listed above, research has found that deficiencies in the following nutrients are associated with hair loss (6Trusted Source, 16Trusted Source, 17Trusted Source, 18Trusted Source):
If you think that you may be experiencing hair loss due to a nutrient deficiency, talk with a healthcare professional. They may suggest you get a blood test to assess your micronutrient levels and rule out deficiencies. SUMMARY A deficiency in one or more micronutrients may lead to hair loss. If you’re experiencing hair loss, you may want to be tested for deficiencies in iron, vitamin D, zinc, B vitamins, and copper. Calorie and protein restriction The cells that make up the hair bulb, which is the part of the hair follicle that produces hair, have a high turnover rate, meaning new cells grow and replace old cells at a rapid rate (4Trusted Source). For this reason, the hair is very sensitive to deficiencies in protein and calories, both of which your follicles need in constant supply to grow and function properly (6Trusted Source). Calorie restriction affects the energy supply to the hair follicle, which can lead to hair loss. Studies have shown that very low calorie diets can result in hair loss in some people (19Trusted Source, 20Trusted Source, 21Trusted Source). Protein restriction can happen in some very low calorie diets and lead to hair thinning and hair loss. Your hair needs amino acids, the building blocks of protein, to grow properly, so a diet without enough protein may lead to hair growth abnormalities, such as hair loss and thin, brittle hair (22Trusted Source, 23Trusted Source, 24Trusted Source). A very low calorie intake and protein restriction can negatively affect health in many other ways, too. That’s why it’s essential to fuel your body with enough calories and include protein-rich foods in your diet to ensure your body is getting the nutrients it needs (25Trusted Source). SUMMARY Not eating enough calories and protein, such as in very low calorie diets, may lead to hair loss. Weight loss When people lose a significant amount of weight, they may experience hair loss. However, people tend to experience this in extreme situations, such as after bariatric surgery, or after following an extreme diet that didn’t provide adequate calories or nutrients (26Trusted Source). You might think that nutrient deficiency may cause hair loss after bariatric surgery, and this is true. However, interestingly, in some people the causes may actually be the stress of the surgery and the rapid weight loss that follows it. Research suggests that acute hair loss that occurs within 3 months after bariatric surgery is associated with the surgery itself (26Trusted Source). Yet, hair loss that occurs 6 months after surgery and beyond may be caused by nutrient deficiencies that develop as a result of surgery-related malabsorption (26Trusted Source). That’s why it’s important for people who have undergone bariatric surgery to take micronutrient supplements. These help prevent hair loss related to the surgery, as well as other serious complications (27Trusted Source, 28Trusted Source). Research has shown that the rapid weight loss often experienced among people following very low calorie, restrictive diets may also lead to hair loss (29Trusted Source, 30Trusted Source, 31Trusted Source, 32Trusted Source). SUMMARY If you lose weight very fast, including from crash dieting or after bariatric surgery, you may also experience hair loss. Supplement use Consuming some nutrients in supplement form may help your hair stay healthy and grow at an optimal rate. However, taking other kinds of supplements can have the opposite effect. In fact, some supplements are associated with hair loss. If you don’t have a nutrient deficiency, taking high doses of certain nutritional supplements can harm your hair. These supplements include (3Trusted Source):
When there’s too much vitamin A for the liver to handle, the extra vitamin A goes into circulation, leading to high levels in the blood. Because maintaining optimal blood levels of vitamin A is essential for hair follicle function, excessive amounts of this nutrient in the body can cause hair loss. Having too much vitamin A in your system is also called hypervitaminosis A (33Trusted Source). Excessive nutrient intake from food may lead to hair loss as well. One case report found that a woman who consumed 10–15 paradise nuts, which are very high in selenium, per day for 20 days developed severe health issues and lost all the hair on her head. Healthcare professionals found that her blood levels of selenium were nearly five times higher than the normal range. Doctors reasoned that this was the cause of her hair loss (34Trusted Source). What’s concerning is that many supplements that claim to boost hair growth contain high amounts of nutrients that may lead to hair loss if you consume too much of them. Other dietary supplements, including herbal supplements, may likewise lead to hair loss, especially at high dosages. That’s why it’s essential to speak with a trusted healthcare professional before you start taking supplements (35Trusted Source, 36Trusted Source). SUMMARY If you don’t have a vitamin deficiency, taking high dosages of certain nutrients, such as vitamin A, vitamin E, and selenium, may trigger hair loss. Other factors that may lead to hair loss Other factors may also be associated with an increased risk of hair loss, according to research. These include:
A 2013 study including 92 male identical twins found that smoking, consuming more than four alcoholic drinks per week, increased caffeine consumption, and increased stress duration were linked to hair loss. Interestingly, the study found that complete abstinence from alcohol and increased exercise duration were also associated with hair loss (37Trusted Source). Smoking has likewise been linked to the autoimmune condition alopecia areata, which causes hair loss (38Trusted Source). Research has also shown that poor sleep quality is a risk factor for alopecia areata (39Trusted Source). A 2020 study that included 1,825 women found that alcohol consumption and poor sleep were associated with more severe female pattern hair loss (40Trusted Source). On the other hand, avoiding alcohol and getting sufficient sleep were associated with less severe female pattern hair loss (40Trusted Source). If you want to limit the other factors that may cause hair loss, consider avoiding smoking, limiting your alcohol intake, getting optimal sleep, and managing your stress levels. In combination with a nutritious diet, these actions may help keep your hair healthy and reduce your risk of hair loss. SUMMARY Smoking, drinking, stress, and lack of sleep may increase your risk of hair loss. The bottom line Many factors can affect hair loss, including medical conditions, hormonal dysregulation, and infection. Other factors that can lead to hair loss include micronutrient deficiencies, not consuming enough calories or protein, and taking high doses of certain dietary supplements. If you’re experiencing significant hair loss, it’s important to visit a healthcare professional to find the cause or causes of your hair loss so that you can get the treatment you need. Source: Healthline.com 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. |
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