Arthritis drug may help with hair loss condition alopecia

For people who suffer from a condition that causes disfiguring hair loss, a drug used for rheumatoid arthritis might regrow their hair, a new, small study suggests. Alopecia areata is an autoimmune disease that causes patchy or complete hair loss, including on the head, body, eyebrows and eyelashes. Researchers found that more than 50 percent of 66 patients treated with the drug Xeljanz (tofacitinib citrate) saw hair regrowth in three months.

“There is hope now that we will have more to tell patients than get counseling and a wig,” said lead researcher Dr. Brett King, an assistant professor of dermatology at the Yale School of Medicine, in New Haven, Conn. Xeljanz appears to work by stopping the immune system’s attack on hair follicles, King said. In addition, the researchers have identified genes that might predict a patient’s response to treatment, he said. King said it is doubtful that Xeljanz will work for the most common types of hair loss (such as male pattern baldness), which are not the result of an autoimmune disease.

Whether the hair regrowth will last or how long someone would have to take the medication isn’t known, King noted. “It may be that if we can treat people for long enough the condition might go into remission, but we don’t know the answer to that,” he said. For the study, King and colleagues treated the patients with 5 milligrams of Xeljanz twice a day for three months. Over that period, more than 50 percent of the patients saw some hair regrowth and one-third recovered more than half of the lost hair on their head, King said. Side effects​ were mild, he added. King hopes that a big drug company will look at these results and sponsor larger trials to seek FDA approval for using Xeljanz as a standard treatment for the 4 million to 11 million Americans with alopecia areata.

Treatment with Xeljanz​ is expensive, costing as much as $40,000 a year. Because the drug is not approved for the treatment of alopecia areata, it may not be covered by insurance for that use, King said. Doctors, however, may be able to convince insurers to cover the cost, he added. The study was published Sept. 22 in the journal JCI Insight. Two dermatologists not involved with the study said the findings hold promise. “The results from this trial are very exciting,” said Dr. Katy Burris, an assistant professor of dermatology at Northwell Health in Manhasset, N.Y. “Alopecia areata is a frustrating condition for patients as well as physicians, and current treatment options have mixed results,” Burris said. Treatments included general immunosuppressants such as cortisone injected directly into the areas of hair loss, like the scalp or brows.

More-involved treatments include oral medications or skin creams to try to suppress the immune response or to stimulate the immune system to overcome the hair loss, said Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City. “Alopecia areata can strike at any age and can be devastating to the person suffering [from the disease],” Day said. “The great news is that Xeljanz has worked even in patients who had five or more years of hair loss. The hair begins to grow within a month, and the regrowth is significant, with the hair often regrowing at or near normal thickness and volume,” she said. More research needs to be done to see how safe the treatment is, especially in children, Burris said. “However, these results keep us hopeful that a new, safe, effective treatment may be on the horizon shortly.”

Can How You Wear Your Hair Cause Hair Loss?

No one wants to lose their hair and fortunately, for many women, balding is entirely preventable. While 95 percent of hair loss in men is caused by male pattern baldness, which is largely hereditary, women lose hair for a wider variety of reasons, such as stress, childbirth, or taking certain birth control pills. Other types of female balding may be easier to control than previously thought, at least according to a recent study by Johns Hopkins researchers.

The new report published in the Journal of the American Academy of Dermatology found that certain hairstyles increase a woman's risk of baldness and avoiding them can keep locks full and flowing.

"Hair is a cornerstone of self-esteem and identity for many people, but ironically, some hairstyles meant to improve our self-confidence actually lead to hair and scalp damage," said Crystal Aguh, study author and assistant professor of dermatology at the Johns Hopkins University School of Medicine. What hairstyles are linked to baldness?

Not all hairstyles are created equal. 

According to researchers, styles that may lead to balding include braids, dreadlocks, weaves, tight ponytails, and extensions. They put more tension on the wearer's hair follicles, especially when the hair is tightly styled.

The exact mechanics of traction alopecia, which is what scientists call hair loss caused by tension to the hair root, is pretty simple. When hair is pulled back and stretched — like when a person styles their hair in a tight bun or braid — stress is carried down the hair shaft to the follicle. Put enough tension on the root for long enough and hair loss may start.

The risk of balding from traction alopecia can be enhanced by other styling decisions, too. Chemical straightening, coloring, frequent wig wearing, and other process that make your hair brittle can also put added strain on your hair and scalp, increasing the chances that a tight hairstyle will cause your hair to fall out according to the study.

So braids aren't okay?

It's not that simple, say researchers.

Tight hairstyles are usually fine, according to the study, but wearers need to be conscious of how frequently they wear their hair in these styles. Researchers advise that braids should be loosened every two to three months to give hair follicles a break, and styles that involve high levels of tension should be removed every six to eight weeks — like weaves and extensions. Black women were most likely to suffer from traction alopecia because such high-tension hairstyles are more commonly worn, with around one-third of Black women suffering some kind of hairstyle related hair loss.

Even if traction alopecia sets in, all isn't lost. Not only is this kind of hair loss entirely preventable, since it's caused by hairstyling decisions, but it's also often reversible — if patients seek early treatment from medical professionals.

"We have to do better as care providers to offer our patients proper guidance to keep them healthy from head to toe," Aguh said about the findings. "[S]imply telling patients to abandon [certain hairstyles] won't work for everyone. Instead, physicians can educate themselves to speak with patients about making the best hairstyling choices to minimize preventable hair loss."