Imagine within just weeks losing every bit of hair... all over. It's unpredictable and it happens. Alopecia areata is an autoimmune skin disease that can have a devastating affect on self-image, especially women's. Bald Girls Do Lunch is the only nonprofit created specifically to help women cope, gain confidence and feel a sense of community.Learn more...
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Clinical Review: Management of Alopecia Areata.
Published July 31, 2010
M J Harries, J Sun, R Paus, and L E King, Jr
Management of alopecia areata
BMJ 2010; 341: c3671
A comprehensive review of the treatments currently in use for treating alopecia areata, totalis and universalis.; referenced and offering statistical data on the efficacy of various approaches. Ask your doctor or medical librarian for a copy of this article. Discuss the findings with your dermatologist and decide together which if any of the treatments you might consider in an attempt for regrowth. Of particular interest are the relapse rates and the results of therapies used both alone and in combination with each other.
This article reminds that the biological agents (alefacept, efalizumab and etanercept) are not effective for alopecia areata patients. Those are the randomised controlled drug trials promoted as beacons of hope for patients with much fanfare over the past decade. BGDL advises a temperate wait and see approach to any clinical trial; not just for alopecias but for any disease. The results are not in until they’re in.
It’s simple. Because in a news cycle like we’re in right now with a recently published genetics study about the identification of genes for hair loss, women feel worse than ever. Yes, worse than ever. Consider this:
#1) Researchers have been identifying genes for all kinds of diseases in labs around the world for a very long time and with ever more exacting tools.
#2) The identification of genes, while noble and hard work, is light-years away from anything to do with finding treatments and cures. Look at the history.
#3) Not one iota of this work, as earnest as it is, helps a woman living with alopecia areatatoday.
#4) The oft heard expectation that if THEY will find a cure, if THEY would be more interested in hair loss as a problem, then I will feel better. This belief is long held for many and a giant step in the wrong direction. Actually, not a step at all. It cements women into immobility, wallowing in self pity, unable to take charge of their lives.
#5) Because in comments pouring out below the hair loss gene blogs, women still lament their sadness for feeling ” freakish”, “abnormal”,”strange” and worse. They want someone to fix them. It doesn’t work that way.
#6) Because we know how to push that self-talk not just to the back burner. We know how to get it off your stove.
While the NAAR page on the MD Anderson website states “Nearly 2% of people in the United States, many of them children, suffer from alopecia areata, a skin disorder that causes hair to fall out in patches….” this very recent update (February 2010, Journal of the American Academy of Dermatology) makes it clear that the prevalence of the condition is 0.1% 0.2% in the United States.
It would be more accurate for the MD Anderson site to say that the lifetime risk is 2%.
You may have heard of a photochemical treatment for AA using systemic or topical Psoralen combined with Ultra-Violet A light therapy (PUVA). The February, 2010 issue of the JAAD reviews current treatments and states why this treatment is no longer commonly used:
“Systemic and topical psoralen plus ultraviolet A light phototherapy have been used with limited success. Long-term safety, side effects, and a high relapse rate have curtailed the use of psoralen plus ultraviolet A light phototherapy”
….”Two large retrospective studies showed that the response rate is no better than the spontaneous remission rate. Because of the high relapse rates, lack of randomized controlled trials, and the increased risk of skin malignancies with PUVA, this line of therapy has become a less favored treatment option.”
Presented below is the concluding paragraph and final sentence in the February, 2010 JAAD (Journal of the American Academy of Dermatology) feature article “Alopecia Areata Update: Part II Treatment”. (Italics and bolding added)
“There has been little progress in the treatment of AA in the past decade, and ILCSs are still the preferred method of treatment for most patients. Newer topical and systemic agents (eg. biologics) have been tried, but the outcomes have been unattractive. We are still in need of developing treatment options for refractory cases and for specific hair-bearing sites ( ie eyelashes) where treatment choices are almost nonexistent. Because of higher psychiatric morbidity in patients with AA, psychosocial support is a valuable tool in any management plan.
We never ask you to send money for research and leave you stranded with no follow up. In fact, we don’t ever ask you to send your money to research at all.
What do we do? Bald Girls Do Lunch is the leader in providing primary sources and tools so you really know what dermatological science is learning about AA,where it’s headed, and where it has totally dead ended.
A terrific new knowledge tool:
February, 2010, Journal of the American Academy of Dermatology ( Vol 62, Issue 2, Pages 191-202)
Alopecia Areata Update: Part II: Treatment.
In 2008 the news releases were afire including coverage on the network morning talk shows that a baldness cure was “right around the corner” courtesy of the start-up Follica using a novel scientific discovery by Dr. George Cotsarelis at UPenn. Standing by our advice then, we still say “Don’t hold your breath.”
A brief summary of alopecia areata cause and treatments. I like the photos.
One photo depicts how bare an area of the scalp can become…the characteristically totally smooth patch of hairless terrain. The other shows the appearance of finger nail pitting or the ’sandpaper’ appearance a common condition in many alopecia areata patients.
It’s a small scientific study( 42 patients) putting Bexarotene gel 1% on half the head of alopecia areata patients. The gel can be irritating and cannot be used if pregnant or getting pregnant.
Some people had some regrowth. Based on this study, the authors think their hypothesis has merit for further study possibly including a placebo.
Topical tacrolimus (Protopic) has FDA approval and is commonly used for dermatitis and psoriasis. It’s action on T-cells (types of white blood cells known as lymphocytes) made it a natural for trials on alopecia areata patients, AA also being a T-cell mediated condition. Dr. Kevin McElwee summarizes the results on an AA study and describes where research might next look to further test its effectiveness. Read more…..
User friendly, 22 pages and free (your tax dollars at work). Order the newly revised Questions & Answers About Alopecia Areata from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH).
In December, this blog said “Lumigan a Hot Topic….” following the FDA approval for this glaucoma medication to be used in cosmetic use for growing longer, fuller lashes. I have seen it work for alopecians who have some lashes, albeit very thin and short.
Have I used it? No. I have blue eyes and I like them a lot. One of the side effects of Lumigan (bimatoprost ophthalmic solution) is permanently turning blue eyes to brown along with the risk of skin hyper-pigmentation at the application site which may be reversible. Great care must be taken in maintaining sterility of the applicator to avoid contamination and infections. Safe and effective pediatric use has not been established.
The active ingredient is bimatoprost ophthalmic solution 0.03%. Prescribed as a glaucoma med it’s known as Lumigan. Recently approved by the FDA for lash enhancement, the product is called Latisse.
From the University of British Columbia, noted dermatologist and hair researcher Dr Jerry Shapiro has proposed a clinical trial using intradermal injections of Botox (Botulinum toxin A) to stimulate hair growth in patients with alopecia areata. The proposed interventional study is designed as randomized and double blind ( subject and investigator) using a placebo control.
The hypothesis: that intralesional injections of Botulinum Toxin A can be used as a treatment for AA. Potential points of action of this treatment include changes in neurotransmitters, which either directly or via neuroimmunologic mechanisms influence cytokines (proteins that serve as messengers between cells) that are responsible for the hair growth arrest in alopecia areata.
The future dims further for treatments - another reason why BGDL is passionately helping women live beautifully and successfully today.
Dermatology Times reports on the study by Dr. Bruce Strober of the New York University Medical Center’s Department of Dermatology who conducted a randomized, double-blind, placebo-controlled 12-week trial with alefacept (Amevive) in patients with chronic severe alopecia areata.
“According to Dr. Strober, trial results were resoundingly unsuccessful. There was no difference between the treated group and the placebo group, and there was a very low level response in both groups.” Click here to read more.
From the Cochrane Skin Group, University of Nottingham ( UK)
Authors: Delamere FM,Sladden MM, Dobbins HM, Leonardi-Bee J.
“Authors’ Conclusions: Few treatments for alopecia areata have been well evaluated in randomised trials. We found no RCTs on the use of diphencyprone, dinitrochlorobenzene, intralesional corticosteroids or dithranol although they are commonly used for the treatment of alopecia areata.
Similarly, although topical steroids and minoxidil are widely prescribed and appear to be safe, there is no convincing evidence that they are beneficial in the long-term. Most trials have been reported poorly and are so small that any important clinical benefits are inconclusive. There is a desperate need for large well conducted studies that evaluate long-term effects of therapies on quality of life.”
Abstract of conclusions from “Interventions for alopecia areata”, Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004413
The clinical trial using alefacept for alopecia areata is completed and the results have been summarized in Skin & Allergy News: September 2008 ( vol 39, issue 9, page 2). Principal research collaborator is Maria K. Hordinsky, MD.
The purpose of this study was to examine prospectively the safety and efficacy of alefacept in the treatment of subjects with severe alopecia areata of the scalp. Common features between psoriasis and alopecia areata, including immunologic and therapeutic aspects, suggested that alefacept, which has been shown to be a safe and statistically significant beneficial therapeutic modality for the treatment of psoriasis, may have therapeutic value in alopecia areata.
Results abstract:— Alefacept fared no better than placebo in treating chronic, severe alopecia areata in a 12-week double-blind, randomized study of 45 adults. Patients with at least a 6-month history of alopecia areata with 50%–95% scalp involvement were randomized to receive a single weekly intramuscular injection of either placebo or 15 mg of alefacept (Amevive) for 12 weeks, followed by a 12-week observation period.
It was announced in a press release by Allergan Inc. on 12/3/08 that the drug Lumigan, currently approved to treat glaucoma, is close to FDA approval for cosmetic use as an eyelash growth enhancer for upper lashes - but don’t get excited if you have extensive loss due to AA. It had been discovered in clinical studies that a side effect in glaucoma patients was the growth of longer, darker and fuller lashes. The FDA posted a review of the drug on its Web site Wednesday ahead of a Friday review by an outside panel of medical experts. The advisory panel is being asked to vote on whether it thinks Latisse ( the proposed brand name) should be approved. The FDA usually follows its panels’ advice. If approved, the product would be the first FDA-approved product sold for eyelash enhancement.
Two pilot studies were done with alopecia areata volunteers at the University of California San Francisco using Lumigan or Xalatan on patients with greater than 50 percent eyelash loss and concluded that it was not effective. No study has yet been done on AA patients with less than 50 percent loss. These pilot studies were a joint effort of the UCSF departments of dermatology and opthalmology with principal investigators Drs. Price and Stamper.
And as with all drugs, there will be risks and the potential for serious side effects in some people.
