An excellent article in The Pharmaceutical Journal heralds the dawn of new era in the treatment of Alopecia Areata, the much-misunderstood autoimmune disorder that leads to sudden, patchy hair loss.
The article, entitled ‘A Ray of Hope for Alopecia Areata Patients’, takes a long hard look at the work of some of the best-known names in hair loss research, whose recent progress paints a promising picture in terms of future treatments. While Alopecia Areata can currently be treated in its mild to moderate state, success isn’t always guaranteed and there are no reliable treatments for its more severe cousins, Alopecia Totalis and Alopecia Universalis.
One of the most interesting comments in the article comes from an immunologist whose geneticist colleagues had asked him for his opinion on what Alopecia Areata really was. After analysing what they had showed him, “This is just diabetes of the hair follicle,” he said.
Immune privilege affected
The writer of the Pharmaceutical Journal story does a good job of explaining how scientists generally view Alopecia Areata. He says that the “immune privilege” – i.e., exemption from the effects of the immune system – that hair follicles normally enjoy have effectively been switched off in cases of Alopecia Areata. Worse, the follicles send out danger signals which makes the immune system set out to destroy them. During this time the hair growth cycle is paused in the telogen phase.
Ralf Paus, a dermatology researcher at both Manchester and Münster Universities, explains in the article that most treatments don’t work because they fail to address this anomaly: they don’t fix the hair follicle’s immune privilege.
Readers of the Belgravia blog will be familiar with the work of Dr Angela Christiano, pictured, a geneticist from Columbia University in New York, who has herself experienced AA and who has enjoyed spectacular results during clinical trials by treating people with AA with drugs containing JAK inhibitors. The article explains how the “diabetes” comment from her immunologist colleague had been instrumental in opening up a new line of thinking.
“For years,” Dr Christiano is quoted as saying, “people assumed Alopecia was a relative of psoriasis. Most trials just tested existing psoriasis drugs and we we wondered why they didn’t work. We never thought about diabetes or coeliac or rheumatoid arthritis, but that’s the group of autoimmune diseases we clearly align with.”
The studies of Dr Christiano’s team led them to a gene known as ULBP: this gene is unique to Alopecia and, explains the writer in the Pharmaceutical Journal, it “codes for a danger signal expressed by hair follicles in Alopecia.”
This discovery in turn led to Christiano’s team testing JAK inhibitors as a possible treatment. To explain why, it is necessary to quote the article in full: “When the ULBP-encoded surface protein binds to a killer receptor on the T cell it engages an intracellular cascade that destroys the hair follicle dermal sheath cells and forces hair growth out of its cycle. Several of these intracellular pathways go through tyrosine kinases called janus kinases (JAKs), particularly JAKs 1-3. By inhibiting JAKs 1 and 2, as Christiano and colleagues did with the myelofibrosis drugs ruxolitinib, you negate the effect of the danger signal and stop the disease in its tracks.”
Results were little short of spectacular, although the fanfare quickly died down when the Columbia team realised that the hair growth brought on by two JAK inhibitor drugs – ruxolitinib and also tofacitinib – didn’t appear to be permanent. As a result clinical trials are ongoing and are investigating different possible applications of these drugs, including topical formulations such as a ruxolitinib cream.
Not a million miles away in terms of approach is the work of the University Hospital of Nice in France – their testing of low-dose IL-2 (interleukin 2) on people with the more severe forms of Alopecia Areata was also mentioned in the article. Their results in a small-scale test were less dramatic, but still very promising and the hair growth they saw appears to be long-lasting.
Might the future of Alopecia Areata treatment, then, be a unique new product which takes the best parts of both JAK inhibitor drugs and the IL-2 protein to turn the immune privilege of hair follicles back on?
Lack of interest from pharmaceutical companies
While the article certainly does hint at a rosier future for people with Alopecia Areata, it also points out that there seems to be a distinct lack of interest in development among the major pharmaceutical companies. It also cautions that new treatments can take many years to perfect, license and get to market.
There is also the issue that at present, JAK inhibitor drugs list increased risk of certain cancers as a very unfortunate side effect.
For adults with Alopecia Areata, there is hope for regrowing their patchy hair loss, in the form of professional hair loss treatment. At Belgravia we have seen many successes from using personalised treatment plans formed around topical applications of high strength minoxidil from a wide range of formulations available at our in-clinic pharmacies. This effective approach has helped many clients to regrow their hair, a few examples of which can be seen in our Alopecia Areata Treatment Success Stories gallery.
Sadly, this treatment will not work on the more severe Totalis or Universalis, or on other autoimmune hair loss conditions, such as Alopecia Barbae which affects men’s facial hair. Anyone with a diagnosis of complete hair loss from their entire head, from head to toe, or patchy facial hair loss, should consult their doctor for further advice.
The Belgravia Centre
The Belgravia Centre is the leader in hair loss treatment in the UK, with two clinics based in Central London. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the UK or the rest of the world. View our Hair Loss Success Stories, which are the largest collection of such success stories in the world and demonstrate the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time for our hair loss helpline or to arrange a free consultation.