In what may well be a first observable case of its kind, a man whose hair loss was caused by the autoimmune disorder Alopecia Totalis appears to have been losing hair to Male Pattern Baldness at the same time.
The man, whose name is given as as just “Thomas” in a feature article by CNN, lost all of his hair at the age of 40 to what sounds like a classic case of Alopecia Totalis, an extreme form of Alopecia Areata which leads to total hair loss on the head.
Fast-forward seven years, and Thomas was one of 65 people with Alopecia Areata (AA) and its sister conditions to have taken part in a trial conducted at Stanford and Yale Universities which has gathered significant media interest.
In the trial, researchers gave the test subjects tofacitinib – a pill which goes under the brand name Xeljanz – which was originally developed to treat rheumatoid arthritis. Earlier research – as well as some chance discoveries – suggested that this drug may reverse hair loss on people with Alopecia Areata. Like AA, rheumatoid arthritis is an autoimmune disorder.
The Yale/Stanford trial was hailed as something of a success, with a third of the test subjects seeing regrowth of more than 50 per cent of their hair. Thomas was among this group – but what is remarkable is that his new regrowth was different to the hair he remembered. Specifically, he had a receding hairline and thinning on top, suggesting that Male Pattern Baldness had been causing miniaturisation of his hair follicles whilst he was also experiencing Alopecia Totalis. Continues below
Whilst Alopecia Areata presents as rounded bald patches anywhere on the scalp and Alopecia Totalis causes complete baldness, male hair loss causes thinning hair and affects only the top of the head and the hairline. It is also a gradual process whereas AA conditions tend to come on suddenly.
“The reason patients can regrow their hair in most cases of alopecia areata and all other forms such as alopecia universalis and totalis, is because this condition doesn’t usually destroy the follicles. It causes a disturbance in the hair cycle of the follicles that the immune system has mistakenly attacked,” explains Belgravia hair loss specialist Rali Bozhinova.
“Initially anagen follicles prematurely enter the resting ‘telogen’ phase – as in telogen effluvium, but in this case only in specific areas; then after re-entry to the anagen – active growth – phase, the growth cycle is being disturbed again, leading to premature re-entry to the telogen phase. So this quick cycle will repeat until the condition is treated. And because the hair doesn’t have time to grow in length, it results in exclamation mark hairs, which typical for AA.”
“However, as long as this doesn’t lead to permanent damage to the follicles, the follicles still exist and this means they can still be vulnerable to DHT. Those with MPB have a genetic predisposition to the condition, meaning that some of their hair follicles have DHT receptors – which are found in the dermal papilla cells – and therefore these follicles are more sensitive to DHT. As long as these follicles exist, they will be sensitive to DHT, no matter the disturbances in the hair growth cycle.”
In the CNN article, Dr George Cotsarelis, a dermatologist at the University of Pennsylvania, simplifies the difference between MPB and Alopecia Areata with an analogy. With Alopecia Areata, he says, “it’s like making a plant in my house think it’s springtime when it’s winter. You just throw a light up in the living room, and it warms things up.” By comparison, MPB is “like taking a brown plant that’s all but dead and bringing it back to life again.”
However there are existing, clinically-proven male hair loss treatments that do exactly that for people with MPB. Following a bespoke course from a specialist clinic can both stop hair thinning out and encourage regrowth. One of the components favoured here at Belgravia – high strength minoxidil – is also often used as a treatment for alopecia areata in its patchy form. This is why men – or women, as it is a unisex formulation – with both genetic hair loss and alopecia areata can be treated for both conditions simultaneously, as per the Success Story pictured below.
While Thomas’ regrowth story is certainly very encouraging, it should be noted that regulatory considerations may delay the release of a Xeljanz-based hair loss treatment for some years, if not permanently, as a number of side effects have been associated with the drug.
Likewise, the work of Dr Angela Christiano of New York’s Columbia University – also mentioned in the CNN article – may not find a larger audience for some time because of similar concerns.
Her recent trial on people with Alopecia Areata using a drug named ruxolitinib – which was developed to treat certain types of cancer – generated results that were arguably even more impressive than the Stanford/Yale study.
However, ruxolitinib, like Xeljanz, belongs to a group of drugs known as JAK inhibitors, which, while clearly effective at treating a number of ailments, are not without the risk of side effects. The side-effects of these drugs, while deemed acceptable when the drugs are used to combat serious ailments, face bigger hurdles when applied to what many consider to be “cosmetic” problems.
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.