Alopecia, the new drugs that save hair (but not in all cases) – breaking latest news

We will hear often, in the coming months, about drugs that make hair grow back because there are several new things to come. This is good news for patients suffering from alopecia areata, which however does not concern the majority of people who would like to counteract the hair loss, once flowing, and who suffer instead from androgenetic alopecia. That is the classic irreversible baldness, more typical of men.

The difference between alopecia areata and “classic baldness”

To avoid confusion and false hopes, it is good to clarify immediately: alopecia areata is often “temporary” and in mild forms, hair regrowth can occur without any treatment, usually within a year. “It’s a autoimmune disease whereby our immune defenses make a mistake and damage hair follicles as if they were foreign,” he explains Bianca Maria Piraccinidirector of the Dermatology and Venereology Unit of the University of Bologna —. Hair falls out sharply forming one or more round patches that can widen and merge until all hair is lost (total alopecia areata) and body hair (universal alopecia areata)».

It’s something else instead androgenetic alopeciawhich occurs when the follicles shrink and the hair becomes thinner, especially on the forehead and temples. It is more typically male, but “in a mild form this often happens also in women with advancing age, especially after menopause – continues the expert -. To cure it today various medicines (such as minoxidil or finasteride) can be used which, if caught early, they can slow down hair loss and regrow hair».

The different and multiple causes

Having different causes, the two pathologies require therapies that act on different mechanisms and the innovations that have reached the experimental stages, approved by the European and American regulatory bodies, concern exclusively alopecia areata. “Here because first of all you need to have a definite diagnosiswhich the dermatologist reaches with a careful visit and using the dermatoscope, an instrument that allows you to observe the scalp and hair with magnifications up to 400 times — continues Katy Perry, director of Dermatology at the Gemelli Polyclinic in Rome —. The causes of a slight, widespread and above all temporary hair loss can be many: drug intake, thyroid disorders (hypothyroidism or hyperthyroidism), anemia (lack of iron), rapid weight loss, acute infections, for example. These are factors that cause the so-called telogen effluvium, which is reversible when the triggering cause is removed. It is therefore neither androgenetic alopecia nor areata alopecia ».

The therapies

The more extensive alopecia areata is, the more difficult it responds to therapy. Although there are different therapies that can be prescribed by the specialist (corticosteroids, anthralin, topical immunotherapy) and which must be followed for about 12 months before seeing a result, definitive healing is never achieved. “This disease can recur over time – says Piraccini -. Current treatments have as a goal block the attack of the immune system and stimulate hair regrowth, a strategy that works especially for people with milder forms (i.e. about less than 50% hair loss). But with the arrival of a new class of medicines, Janus kinase inhibitors (or JAK inhibitors)Let’s hope we can do better.” Recently the publication of two important studies in the scientific journal New England Journal of Medicine led to the approval by the European Medicines Agency (EMA) of baricitinibthe first of this “family” of medicines (others in the category are in the final stages of experimentation): 40% of the 1,200 adult patients with severe alopecia areata treated at 36 weeks achieved 80% scalp coverage and 75% made it up to 90%.

Patients awaiting recognition (and exemptions)

Alopecia areata can affect patients of any race, ethnicity and age. As also demonstrated by the shaved head of the actress Jada Pinkett Smith, who ended up in the spotlight during the 2022 Oscar awards ceremony due to the clash between her husband Will Smith and the comedian Chris Rock host of the event. Or, more recently, the case of former French premier Edouard Philippe, possible next candidate for the Elysée after Macron. “This pathology has a significant emotional, psychic and social impact on those who suffer from it – he concludes Claudia Cassiapresident of the Alopecia & Friends Association —: many patients experience anxiety and depression due to the loss of hair, eyebrows, eyelashes and hair, which results in a strong conditioning in their private, social and professional life. And scholastic, because unfortunately it does not spare children and adolescents. For years, with the support of the Italian Society of Dermatology (SIDeMaST), we have been asking for the recognition of alopecia areata as an autoimmune, chronic and relapsing disease. A crucial step to give dignity to a disease that, at the moment, does not exist for the National Health Service”. And to be able to have an exemption codeso that patients are not forced to pay out of their own pockets for aids such as wigs, which for now in Italy are reimbursed only in Emilia Romagna.