Depression May Be a Driver of Alopecia Areata

MedicalResearch.com Interview with:

Isabelle Vallerand, PhD Epidemiologist, MD Student Department of Community Health Sciences Cumming School of Medicine University of Calgary

Dr. Vallerand

Isabelle Vallerand, PhD
Epidemiologist, MD Student
Department of Community Health Sciences
Cumming School of Medicine
University of Calgary

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that patients with alopecia areata, a form of autoimmune hair loss, are at a higher risk of suffering from depression than the general population. But in practice, we often hear patients tell us that they believe their hair loss developed as a result of stress or problems with mental health – certainly the phrase “so stressed your hair is falling out” is something most people have heard of. Despite this, there has actually been very little research investigating the role that mental health may have on development of alopecia areata.

Interestingly, depression has recently been associated with increased systemic inflammatory markers, so there is biologic plausibility that depression could increase the risk of alopecia areata. Our group was interested in addressing this question, and used a large population-level health records database with up to 26 years of follow-up to study it. We ultimately found that not only does depression increase one’s risk of alopecia areata, but that it increases their risk by nearly 90% compared to people who have never had depression. We also found that using antidepressants can significantly decrease the risk of developing alopecia areata in patients with depression. So there appears to be an important link between mental health and development of hair loss from alopecia areata.

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Immunotherapy Tofacitinib Can Halt Alopecia Areata

MedicalResearch.com Interview with:
Dr. Morton Scheinberg, MD, PhD
From Hospital Israelita Albert Einstein and Hospital AACD,
São Paulo, and
Clinica Dermatosineida, Maringa, Parana, Brazil.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: That universal hair loss associated with a localized autoimmune reaction on the cells involved with the hair follicles can be halted with tofacitinib.

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JAK Inhibitor Tofacitinib Regrows Hair In Patients With Severe Alopecia Areata

MedicalResearch.com Interview with:

Brett A. King, MD, PhD Assistant Professoro Department of Dermatology School of Medicine Yale University New Haven, CT 06520

Dr. Brett King

Brett A. King, MD, PhD
Assistant Professor Department of Dermatology
School of Medicine
Yale University
New Haven, CT 06520

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent advances in the understanding of the pathogenesis of alopecia areata (AA) have yielded Janus kinase (JAK) inhibitors as a promising therapy. Short-term treatment with the JAK inhibitor, tofacitinib, has shown efficacy for severe AA, alopecia totalis (AT), and alopecia universalis (AU), but long-term data are lacking.

In this retrospective series of patients aged 18 years or older treated with tofacitinib, of 65 potential responders to therapy, defined as those with AT or AU with duration of current episode of disease of 10 years or less or AA, 77% achieved at least some hair regrowth, with 58% of patients achieving greater than 50% change in SALT score and 20% of patients achieving complete scalp hair regrowth over 4 to 18 months of treatment. Tofacitinib was well tolerated, and there were no serious adverse events.

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Alopecia Areata: Humira May Improve, or Worsen, Hair Loss

Marie C. Leger, MD, PhD Ronald O. Perelman Department of Dermatology New York University School of Medicine, New YorkMedicalResearch.com Interview with
Marie C. Leger, MD, PhD
Ronald O. Perelman Department of Dermatology
New York University School of Medicine, New York

Medical Research: What are the main findings of the study?What was most surprising about the results?



Dr. Leger: Alopecia areata is a T-cell mediated autoimmune disease. As such, there was initially hope that inhibiting the helper T cell cytokine TNF-α could effectively treat this condition. This has not been shown to be the case—in fact, one open-label study of etanercept in 17 patients with moderate to severe alopecia showed no hair regrowth and even worsening of alopecia in several subjects. There have been many other case reports in the dermatologic literature of TNF-α inhibitors causing alopecia areata. In contrast, our case report presents a patient who very clearly grew hair on adalimumab—its strength lies in the fact that her hair loss and regrowth were replicated on withdrawal and rechallenge with the medication.

Our patient’s paradoxical response to adalimumab complements other literature suggesting that there are genetic variations in the way a patient’s immune system responds to TNF-α inhibitors. In different individuals, these medications can either treat or cause conditions such as psoriasis or lupus. It seems that this is also the case with alopecia areata.
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Study Examines Risk of Alopecia Areata and Vitiligo in Stem Cell Recipients

MedicalResearch.com Interview with:
Rena Zuo, BA
MD Candidate at Duke University School of Medicine and

Edward W. Cowen, MD, MHSc
Senior Clinician
Head, Dermatology Consultation Service
Dermatology Branch
Center for Cancer Research National Cancer Institute
National Institutes of Health

MedicalResearch: What are the main findings of the study?


Answer: Chronic graft-vs-host disease (cGVHD) is a debilitating multisystem disease that occurs in patients receiving allogeneic hematopoietic stem cell transplantations as treatment for hematologic disorders. Although the diverse clinical presentations of cGVHD frequently mimic other autoimmune diseases such as Sjögren syndrome and systemic sclerosis, and low-titer antibodies are commonly found in patients with cGVHD, the exact pathogenesis and role of autoimmunity in cGVHD are incompletely understood.

Our study is the first to characterize and identify risk factors associated with the development of two uncommon autoimmune phenomena, specifically alopecia areata and vitiligo, in the setting of cGVHD. Laboratory markers, including 11 antibodies, transplant-related factors, and other cGVHD systemic manifestations were analyzed.

Several particularly interesting results were found:

  1. Among 282 patients with cGVHD, 15 demonstrated vitiligo (14 of 282; 4.9%) and/or alopecia areata (2 of 282; 0.7%).
  2. Female donor and female donor to male recipient sex mismatch, in particular, are significantly associated with the development of vitiligo and/or alopecia areata.
  3. Positive anti-cardiolipin (ACA) IgG was also significantly associated with development of vitiligo and/or alopecia areata.

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