Alopecia areata, Jada Pinkett Smith’s hair-loss condition, now treatable by arthritis and Covid-19 drug, heralding ‘a new era’ for sufferers
- Hair loss from alopecia has few physically harmful effects, but can cause anxiety and depression. A new drug to treat it could be a game-changer, expert says
- The drug, used to treat rheumatoid arthritis and Covid-19 cases, was recently approved by the US Federal Drug Administration for use in treating alopecia areata
It affects nearly 2 per cent of people – irrespective of age, gender or heritage – at some point during their life. It is the second most common form of hair loss after androgenetic (also known as androgenic) alopecia, or male pattern baldness.
The root causes of alopecia
Androgenetic alopecia is caused by the increased sensitivity of hair follicles to a hormone, dihydrotestosterone; alopecia areata is caused by an autoimmune disease that affects hair follicles.
It can cause hair loss in three ways:
in patches – alopecia areata, the most common type;
alopecia totalis, when all the hair is lost from the scalp; and
alopecia universalis, which results in complete loss of hair from the scalp, face and body.
A typical scalp has from 100,000 to 150,000 hairs, says Veena Dansinghani, an alopecia and hair loss specialist, and director of the Naveda Wellness Centre in Hong Kong, who has suffered with hair loss herself.
Hair growth cycles through three phases:
the anagen phase (growing), which can last from two to eight years and generally accounts for about 85 per cent to 90 per cent of the hair on our head;
the catagen phase (transition), during which hair follicles shrink, usually over two to three weeks; and
the telogen phase (resting), which lasts two to four months, at the end of which hair falls out.
Most people lose about 50 to 100 hairs a day. That’s normal. When shedding outpaces growth, alopecia happens. And it’s not just the hair on your head; it can affect anywhere on your body: limbs, eyelashes, brows, nasal hair.
Pinkett Smith’s gender wasn’t unusual either – more than 50 per cent of women will experience some hair loss during their lives.
Other hair-loss triggers
Hair shedding can also be triggered by unusual stress, says Dansinghani. “I call it the three Bs: bereavement, bankruptcy, or a break-up.”
In this case, it’s identified as telogen effluvium – temporary hair loss that happens after stress, a shock, or trauma.
“Compulsive hair pulling or tight ponytails can cause it, too, as can autoimmune illness,” she says.
In alopecia areata, the body produces an excessive amount of cytokines – small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells – that can upset the immune system, which in turn attacks the follicles.
New drug gets FDA approval
The good news is that in June 2022, the US Food and Drug Administration (FDA) approved a drug for use against the condition. Baricitinib, under the brand name Olumiant, is an oral treatment that works by interrupting cytokine cell signalling and blocking the immune system from attacking hair follicles, creating an opportunity for the body to start growing hair again.
It was first approved in 2018 to treat specific rheumatoid arthritis cases. It was also approved for the treatment of Covid-19 in adults.
Sometimes alopecia corrects itself naturally but that, says Dansinghani, depends on whether it’s a temporary situation or a transient one. With postnatal hair loss, or hair loss after surgery, a crash diet or even a change in diet, the hair returns as the body recovers.
“Hair is very sensitive to body imbalances due to its fast rate of growth, so hair loss can follow the slightest body imbalance,” she says.
Hair loss affects mental health
Losing your hair, a spokesperson for the US National Alopecia Areata Foundation (NAAF) in California says, “can have a tremendous impact”.
“Just imagine waking up one morning and finding all your hair on your pillow. It can happen very suddenly and the shock can be devastating to some patients. There are multiple studies which prove the psychosocial burden of this disease; this is not just a cosmetic condition”.
Dansinghani agrees. “Alopecia has few physically harmful effects” (though losing nasal hair, for example, can lead to infections of the sinus, for example) but can lead to significant psychological consequences, “including high levels of anxiety and depression”.
She sees an important link between hair and identity, especially for women. About 40 per cent of women with alopecia have had marital problems as a consequence, and about 63 per cent claim to have had career-related problems.
“Consider how much time and effort and money we put into maintaining a glossy crowning glory, and it stands to reason that losing it will affect us,” she says.
Why the new drug matters
Amina, one of Dansinghani’s clients, remembers the day she began to lose her hair.
“I was combing it and suddenly saw a big bald spot. I couldn’t believe it. When you first see it, it is very scary and overwhelming.
“I messaged several doctors right away because I knew something needed to be done. Hair is one of the most important features of our body – especially for women. I knew I had to fix it right away, before it got worse.”
“There are so many toxic chemicals in the products we use today; we need to be careful and conscious of what we are consuming internally and externally,” she says.
Nicole Friedland, president of the NAAF, heralds the newly approved drug Olumiant as “the dawn of a new era”.
“For the first time, alopecia areata patients have the option of an approved treatment that has undergone rigorous testing in clinical trials. We anticipate more treatments to come, bringing additional choices to our community,” she says.
Dansinghani is more cautious, saying we won’t know the real impact of this drug for at least a year after alopecia patients have had access to it. In the first trials, it took 36 weeks for patients to achieve adequate scalp coverage, that is 80 per cent hair regrowth.
Based on these results, she adds, the treatment looks promising and could be a real game-changer for most alopecia sufferers.