Regrowth Of Scalp Hair Research Articles

Baricitinib Withdrawal and Retreatment in Patients With Severe Alopecia Areata

Baricitinib has demonstrated efficacy for treating severe alopecia areata in adults. There is currently limited information about the need for continuous therapy after achieving scalp hair regrowth. To report results from the randomized withdrawal period of the BRAVE-AA1 trial. BRAVE-AA1 was a randomized, placebo-controlled, phase 3 randomized clinical trial with a treatment withdrawal substudy that was conducted at 70 centers in 3 countries beginning in March 2019. It included 654 adults with severe alopecia areata (AA) (Severity of Alopecia Tool [SALT] score ≥50) who were randomized 3:2:2 to receive treatment with baricitinib, 4 mg; baricitinib, 2 mg; or placebo. Data were analyzed in August 2023. At week 52, 154 patients who were responders (SALT score ≤20) were rerandomized 3:1 to continue to take their current dose of baricitinib or transition to placebo (randomized withdrawal). Responders randomized to placebo who experienced a loss of treatment benefit (>20-point worsening in SALT score) at any time after week 52 were retreated with their original baricitinib dose. The proportion of patients who lost treatment benefit through week 152 and the proportion of patients who recaptured response after retreatment. The last observation carried forward was used to impute missing or censored data. Of 654 patients who received treatment, the mean (SD) age was 37.1 (13.0) years, and there were 383 women (58.6%). At week 52, 10 of 39 responders taking baricitinib, 2 mg, and 30 of 115 responders taking baricitinib, 4 mg, were rerandomized to placebo. At 4 and 8 weeks of treatment withdrawal, 0% and 10% to 11% of patients, respectively, lost treatment benefit regardless of dose. At week 152, 80% of patients had lost benefit compared with 7% for those who continued baricitinib therapy for both dose groups. Within the follow-up observation periods, 5 of 8 patients taking 2 mg (63%) and 21 of 24 patients taking 4 mg (87.5%) recaptured a SALT score of 20 or less response after retreatment. Severe AA is a chronic, relapsing condition, and this randomized clinical trial found that withdrawal of therapy for a patient population with severe AA who had achieved meaningful hair regrowth after 1 year of treatment with baricitinib resulted in loss of benefit for almost all patients, indicating that continued therapy is required to maintain hair regrowth. ClinicalTrials.gov Identifier: NCT03570749.

Improvement in Measures of Quality of Life and Symptoms of Anxiety and Depression in Patients with Severe Alopecia Areata Achieving Sustained Scalp Hair Regrowth with Baricitinib.

Alopecia areata (AA) is an autoimmune disease associated with high rates of emotional and psychosocial distress. The analysis reported here describes the evolution of measures assessing health-related quality of life (HRQoL) and symptoms of anxiety and depression up to week 104 in patients who achieved sustained scalp hair regrowth during treatment with baricitinib in the BRAVE-AA phase III trials. This post-hoc analysis included data from the double-blind, parallel-group, randomized, placebo-controlled phase III trials BRAVE-AA1 (ClinicalTrials.gov number: NCT03570749) and BRAVE-AA2 (ClinicalTrials.gov number: NCT03899259). Adults with severe AA (defined as a Severity of Alopecia Tool [SALT] score ≥ 50) randomized to baricitinib 4 mg or baricitinib 2 mg at baseline who achieved SALT score ≤ 20 by week 36 and maintained SALT score ≤ 20 through week 104 on the same dose of baricitinib were included in this analysis of integrated data. Scalp hair regrowth (SALT score) and improvements in Skindex-16 AA Scale and Hospital Anxiety and Depression Scale (HADS) domain scores were analyzed over the 104-week period using descriptive statistics. In total, 131 patients (88 on baricitinib 4 mg and 43 on baricitinib 2 mg) were included in this analysis. Across the two groups, the mean age (standard deviation) was 37.2 years (12.7), and 84 (64.1%) patients were female. The interquartile range) for time to achieve a SALT score ≤ 20 for patients treated with baricitinib 4 mg and baricitinib 2 mg was 13.1 and 19.6 weeks, respectively. By week 104, 91% (baricitinib 2 mg) and 96% (baricitinib 4 mg) of patients had achieved a SALT score ≤ 10 on baricitinib treatment. In both groups, progressive improvements in the Skindex-16 AA and HADS domain scores were observed up to week 104. This analysis of adults with severe AA treated with baricitinib revealed that achievement of sustained clinically meaningful scalp hair regrowth (SALT score ≤ 20) was associated with improvements in both measures of HRQoL and symptoms of anxiety and depression up to week 104.

Treatment preferences of adults and adolescents with alopecia areata: A discrete choice experiment.

PRODUCTS with janus kinase (JAK) inhibition have been shown to promote hair regrowth in patients with alopecia areata (AA). To guide drug-approval and treatment decisions, it is important to understand patients' willingness to accept the potential risks of JAK inhibition in exchange for potential benefits. We quantified the treatment preferences of adult (≥18 years) and adolescent patients (12-17 years) with AA in the US and Europe to determine the trade-offs they are willing to make between benefits and risks. Preferences for oral AA treatment attributes were elicited using a discrete choice experiment consisting of 12 tasks in which patients chose between two hypothetical treatment alternatives and no treatment. Benefits included the probability of 80%-100% scalp hair regrowth (Severity of Alopecia Tool score ≤ 20) and achieving moderate-to-normal eyebrow and eyelash hair. Treatment-related risks included 3-year probabilities of serious infection, cancer, and blood clots. Preference estimates were used to calculate the maximum level of each risk that patients were willing to accept for increases in treatment benefits. The most important attribute to both adults (n = 201) and adolescents (n = 120) was a 50% probability of achieving hair regrowth on most or all the scalp; however, adolescents placed greater relative importance on this attribute than did adults. Adults were averse to the risks of serious infection, cancer, and blood clots, whereas adolescents were averse to the risk of cancer. For a 20% increase in the probability of 80%-100% scalp hair regrowth, adults were willing to accept a mean (95% confidence interval) 3-year risk of serious infection, cancer, and blood clots of 7.4% (5.5-9.3), 2.5% (1.9-3.1), and 9.3% (6.4-12.2). Adolescents were willing to accept a 3-year risk of cancer of 3.3% (2.4-4.2). Patients with AA in the US and Europe are willing to accept substantial risks to obtain an effective treatment.

Clinical Benefits of Baricitinib Therapy According to Scalp Hair Regrowth in Patients with Severe Alopecia Areata.

The present analyses report integrated results from BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) on the clinical benefits of baricitinib treatment on the basis of the amount of scalp hair regrowth through 52weeks of treatment. This posthoc analysis was conducted with data from patients who were treated continuously for 52weeks with baricitinib 4mg or 2mg. Clinical outcomes were assessed using the Severity of Alopecia Tool (SALT) and Clinician-Reported Outcome (ClinRO) for Eyebrow (EB) and Eyelash (EL) hair. Secondary measures included the Hospital Anxiety and Depression Scale and Skindex-16 adapted for alopecia areata. At week52, patients were classified into three subgroups: SALT ≤ 20 response, intermediate response (achieved a 30% improvement from baseline (SALT30) without a SALT score ≤ 20), or nonresponse (never achieved SALT30). The criterion of SALT30 approximates a minimal clinical meaningful response to therapy. At week52, with baricitinib 4 mg treatment, the greatest (70%) improvement in EB and EL was observed in responders, but approximately 50% of patients with intermediate response and 20% of nonresponders experienced complete/nearly complete EB and EL regrowth. Improvement in emotional distress was directionally related to improvements in scalp hair regrowth, while impact on quality of life was proportionately greater for the responder subgroup. Clinically meaningful regrowth in eyebrow and eyelash hair can occur in the absence of complete scalp hair regrowth after treatment with baricitinib. Emotional distress and quality of life improvement is most associated with obtaining a clinical meaningful improvement in scalp hair. BRAVE-AA1, ClinicalTrials.gov number, NCT03570749, start date, 24September2018; BRAVE-AA2, ClinicalTrials.gov number, NCT03899259, start date, 8July2019.

Distribution of SALT scores by Therapeutic Tesponse in Patients with Severe Alopecia After 52 weeks of Baricitinib Therapy

Introduction: In pivotal BRAVE-AA1 and AA2 phase 3 clinical trials, the Janus kinase (JAK)1/JAK2 inhibitor baricitinib has demonstrated efficacy in achieving clinically meaningful regrowth of hair in patients with severe alopecia areata. While a significant proportion of patients achieve regrowth by weeks 36 and 52 on baricitinib versus placebo, other patients, particularly those with longer episode duration or with higher disease severity, require more time on therapy to see full treatment benefit. The treatment benefit and distribution of SALT scores at Week 52 across the spectrum of responders is reported here.
 Methods: Adults with Severity of Alopecia Tool (SALT) score ≥50 (≥50% scalp hair loss) were enrolled into BRAVE-AA1 and BRAVE-AA2. Patients were randomized 2:2:3 to receive once-daily placebo (N=345), baricitinib 2 mg (BARI-2MG) (N=340), or baricitinib 4 mg (BARI-4MG) (N=515). Patients randomized to baricitinib retained their treatment allocation through Week 52. Pooled outcomes were assessed by baricitinib group and in patients with SALT score ≤20 versus SALT score >20 at Week 52. Median and interquartile range (IQR) of SALT scores was assessed with last observation carried forward.
 Results: At baseline, the median SALT score across 1200 randomized patients was 96 (near-total hair loss), with 638 (53.2%) having SALT score 95-100. At Week 52, 24.1% of patients who received BARI-2MG and 41.6% of patients who received BARI-4MG had SALT score ≤20; median (IQR) absolute SALT scores in this group were 7 (1-12) with BARI-2MG treatment and 3 (0-11) with BARI-4MG treatment. 17.9% of patients who received BARI-2MG and 18.8% of patients who received BARI-4MG patients achieved SALT scores of 21-49 at Week 52; median (IQR) scores were 34 (27-41) following BARI-2MG treatment and 31 (26-42) following BARI-4MG treatment.
 Conclusions: While a significant proportion of patients achieved SALT ≤20, the findings of this analysis indicate that partial benefit across scalp hair regrowth is achieved even if patients do not meet clinical response criteria of SALT ≤20. There is a substantial proportion of patients who demonstrate movement towards improvement across the SALT score spectrum. In these patients, a longer treatment course may be necessary to achieve optimal treatment outcomes. 
 Funded by Eli Lilly and Company.

When to expect scalp hair regrowth during treatment of severe alopecia areata with baricitinib: insights from trajectories analyses of patients enrolled in two phase III trials.

Baricitinib is approved for the treatment of adults with severe alopecia areata (AA). In the absence of robust data on the patterns of regrowth during treatment of severe AA, there is a gap in the knowledge regarding treatment expectations. To examine whether different clinical response subgroups could be identified in baricitinib-treated patients with severe AA and factors that contribute to these subgroups. The BRAVE-AA1 and BRAVE-AA2 phase III trials enrolled patients with severe AA [Severity of Alopecia Tool (SALT) score ≥ 50 (≥ 50% scalp hair loss)]. Patients randomized to baricitinib 4 mg or 2 mg retained their treatment allocation for 52 weeks. Based on patterns identified through growth mixture modelling (GMM), patients were categorized into responder subgroups according to when they first achieved ≥ 30% improvement from baseline in SALT score (SALT30). For each responder subgroup, trajectories of response (i.e. achievement of a SALT score ≤ 20, SALT score ≤ 10 and ≥ 50% change from baseline in SALT score) and baseline disease characteristics are reported. Respectively, 515 and 340 patients were randomized to once-daily baricitinib 4 mg and 2 mg at baseline; 69% and 51%, respectively, achieved SALT30 at least once by week 52. Based on GMM findings, we identified three responder subgroups: early (SALT30 by week 12), gradual (SALT30 after week 12-week 36) and late (SALT30 after week 36-week 52). The proportions of early, gradual and late responders and nonresponders were, respectively, 33%, 28%, 8% and 31% among patients treated with baricitinib 4 mg, and 20%, 23%, 9% and 49%, respectively, among those treated with baricitinib 2 mg. Early responders had a shorter trajectory to maximal clinical outcomes (e.g. > 78% achieved a SALT score ≤ 20 by week 36) vs. gradual or late responders. Early responders were more frequent among patients with baseline severe AA (SALT score 50 to < 95) vs. very severe AA (SALT score 95-100). Overall, responders (early to late) were more frequent in patients with short (< 4 years) episodes of hair loss. These analyses identified early, gradual and late responder subgroups for scalp hair regrowth in baricitinib-treated patients with severe AA, and that these subgroups are influenced by baseline characteristics. Findings from these analyses will help to inform treatment expectations for scalp hair regrowth.

41915 Improvements in health-related quality of life and psychological symptoms in patients with severe alopecia areata achieving scalp hair regrowth: results from two randomized controlled trials

41915 Improvements in health-related quality of life and psychological symptoms in patients with severe alopecia areata achieving scalp hair regrowth: results from two randomized controlled trials

Scalp Hair Regrowth Is Associated With Improvements in Health-Related Quality of Life and Psychological Symptoms in Patients With Severe Alopecia Areata: Results From Two Randomized Controlled Trials

Scalp Hair Regrowth Is Associated With Improvements in Health-Related Quality of Life and Psychological Symptoms in Patients With Severe Alopecia Areata: Results From Two Randomized Controlled Trials

Trajectories For Scalp Hair Regrowth In Patients With Severe Alopecia Areata Treated With Baricitinib

Trajectories For Scalp Hair Regrowth In Patients With Severe Alopecia Areata Treated With Baricitinib

Comparative Efficacy and Adverse Clinical Events of Methotrexate versus Azathioprine with Steroid Mini Pulse Therapy in the Management of Moderate to Severe Alopecia Areata: A Tertiary Centre Based Interventional Study

Introduction: Alopecia areata is a T cell-mediated autoimmune disorder of hair follicles resulting in partial or total hair loss. Treatment of alopecia areata is difficult, and it has variable severity. Objectives: To compare the clinical efficacy and adverse clinical events of azathioprine versus methotrexate with steroid minipulse therapy in managing moderate to severe alopecia areata. Materials and Methods: Prospective non-blinded clinical trial conducted for 6 months in Department of Dermatology at Dhulikhel Hospital. Dermoscopic evidence of alopecia areata patients treated according to group assigned and effects and adverse event were noted. Results: There was a total of 36 patients enrolled. Twenty patients were in Group A (AZT+MPT) and 16 in group B (MTX+MPT). There was a significant improvement in SALT score at 6 months (Group A p-value: 0.03; group B p-value: 0.001). Treatment efficacy (percent scalp hair regrowth) in group A was 79.2%, and in group B was 89.01%. Conclusion: Both treatment regimens showed marked improvement with SALT score reduction; however, methotrexate with steroid minipulse therapy showed slightly higher treatment efficacy than azathioprine with steroid minipulse therapy.

Successful Treatment of Alopecia Totalis with Topical Calcipotriol: Serial Case Report and Review of the Literature

Background: Alopecia totalis (AT) often responds poorly to standard therapies. This disease is chronic and relapsing, no effective cure treatment has been established. Calcipotriol is a vitamin D analog and acts as a potent immunomodulatory agent can be used in the treatment of alopecia areata (AA) with promising results. The active form of vitamin D mediates its action by binding to specific vitamin D receptors (VDR) located in the nuclei of target cells. Expression of VDR in keratinocytes is necessary for maintenance of the normal hair cycle. Objective: Our study aims to show the effectiveness of topical calcipotriol in the treatment of Alopecia Totalis patient. Methods: Three patients diagnosed with AT, duration of disease 6 – 12 months, refractory to other treatments were selected and were started on topical calcipotriol and were followed up every 4 weeks for 12 weeks. The efficacy was measured by hair regrowth using photographic assessment, Severity of Alopecia Tool score (SALT), Hair Pull Test and physical examination. Patients will be followed up for 6 months after stopping treatment for assessing disease relapse. Results: The patients showed excellent response with complete regrowth of scalp hair after a single 12-week treatment course of topical calcipotriol and no hair loss relapse was observed over the next 6 months. Conclusion: In our patients, a novel treatment option topical calcipotriol was successfully used in the management of AT, in the absence of significant adverse side effects. We recommend that further controlled studies be required to establish safety, confirm efficacy, and disease remission protocol. To our knowledge, this is the first published case series of successful treatment for AT with single topical calcipotriol although the sample size was small.

SAT-223 Insights into Ovarian Hyperandrogenism: Lessons from Two Unusual Cases

Introduction: The majority of cases with postmenopausal hyperandrogenism have a benign etiology such as ovarian hyperthecosis, hilus cell hyperplasia, ovarian or adrenal tumors. Determining adrenal versus ovarian OR tumorous versus nontumorous causes of hyperandrogenism can be tricky. Here we report two very different cases associated with ovarian hyperthecosis. Case 1: The 73 year old obese female with a history of prediabetes, hysterectomy and breast cancer presented with severe hirsutism and virilization over 5 years. Testosterone levels per LC/MS were between 200-350 ng/dL and rose further during a 2d LDDST (Low Dose Dexamethasone Suppression Test), while cortisol and DHEA-S suppressed appropriately. Imaging was negative for an adrenal or ovarian mass. Based on the biochemical data, we suspected a tumorous ovarian source of androgen excess despite negative imaging findings. The patient underwent salpingo-oophorectomy which revealed small bilateral steroid cell tumors (0.7-0.9 cm) in the setting of bilateral focal hyperthecosis and hilus cell hyperplasia. Postoperative testosterone levels fell to 14 ng/dL. Case 2: The 53 year old obese female with a history of diabetes and PCOS presented with progressive male pattern hair loss, acne and acanthosis nigricans over 3-5 years. Her testosterone levels per LC/MS were between 100-150 ng/dL. During LDDST, cortisol and DHEA-S suppressed appropriately, testosterone increased further. Imaging was again negative for an adrenal or ovarian mass. Following this workup, the patient was treated with a GnRH analogue which resulted in complete testosterone suppression, regression of acanthosis nigricans and scalp hair regrowth. She later underwent salpingo-oophorectomy which showed only a few scattered, minute clusters of luteinizing theca cells in both ovaries, no tumor was identified. Lessons: These cases illustrate that imaging often fails to detect small ovarian tumors, stressing the need for additional diagnostic markers such as LDDST. Based on their case series, Kaltsas et al. suggested that lack of testosterone suppression during LDDST ruled out a nontumorous androgen source (1). However, this was not true for case 2 presented here: Testosterone remained non-suppressed during LDDST, yet she did not have an androgen-producing tumor, but mild hyperthecosis. Notably, her testosterone levels were <150 ng/dL. In summary, we propose that testosterone levels >150 ng/dL PLUS absent testosterone suppression during LDDST might be suggestive of androgen-producing tumors. Furthermore, therapy with GnRH can be an alternative to surgery in cases with ovarian hyperandrogenism.

A multicenter survey of temporal changes in chemotherapy-induced hair loss in breast cancer patients.

PurposeMany breast cancer patients suffer from chemotherapy-induced hair loss. Accurate information about temporal changes in chemotherapy-induced hair loss is important for supporting patients scheduled to receive chemotherapy, because it helps them to prepare. However, accurate information, on issues such as the frequency of hair loss after chemotherapy, when regrowth starts, the condition of regrown hair, and the frequency of incomplete hair regrowth, is lacking. This study aimed to clarify the long-term temporal changes in chemotherapy-induced hair loss using patient-reported outcomes for chemotherapy-induced hair loss.MethodsWe conducted a multicenter, cross-sectional questionnaire survey. Disease-free patients who had completed adjuvant chemotherapy consisting of anthracycline and/or taxanes for breast cancer within the prior 5 years were enrolled from 47 hospitals and clinics in Japan. Descriptive statistics were obtained in this study. The study is reported according to the STROBE criteria.ResultsThe response rate was 81.5% (1511/1853), yielding 1478 questionnaires. Hair loss occurred in 99.9% of patients. The mean time from chemotherapy until hair loss was 18.0 days. Regrowth of scalp hair occurred in 98% of patients. The mean time from the completion of chemotherapy to the beginning of regrowth was 3.3 months. Two years after chemotherapy completion, the scalp-hair recovery rate was <30% in approximately 4% of patients, and this rate showed no improvement 5 years after chemotherapy. Eighty-four percent of the patients initially used wigs, decreasing to 47% by 1 year after chemotherapy and 15.2% after 2 years. The mean period of wig use was 12.5 months. However, a few patients were still using wigs 5 years after completing chemotherapy.ConclusionsOur survey focused on chemotherapy-induced hair loss in breast cancer patients. We believe these results to be useful for patients scheduled to receive chemotherapy.

Weekly Azathioprine Pulse versus Betamethasone Oral Mini-Pulse in the Treatment of Moderate-to-Severe Alopecia Areata.

Background:Corticosteroids are the most common agents used in the treatment of alopecia areata (AA), however, their long-term use is associated with severe side effects. Therefore, other immunosuppressive agents have been tried and azathioprine appears to be an effective and promising alternative.Objective:The main objective of this study was to compare the efficacy of 300 mg once weekly azathioprine pulse (WAP) and 5 mg betamethasone on 2 consecutive days every week in the management of AA.Materials and Methods:In this open-label, randomized comparative study, 50 patients of AA with >10% scalp area involvement were treated with either 300 mg WAP or 5 mg betamethasone on 2 consecutive days every week for 4 months or till complete scalp hair regrowth and followed up for next 5 months. Primary efficacy parameters were average percentage scalp hair regrowth and change in average Severity of Alopecia Tool (SALT) score at 4 months.Results:Twenty patients in WAP group and 21 patients in betamethasone group completed the study. The median percent scalp hair regrowth and the median change in SALT score was 44.52 and 9.5 in WAP group compared to 71.43 and 14 in betamethasone group at 4-month, respectively, which were statistically similar in two groups, however, side effects were significantly higher in betamethasone group. On further follow-up at 9 months, 10 (50%) patients in WAP group and 13 (62%) patients in betamethasone group achieved complete hair regrowth. Lack of control group was a limitation of our study.Conclusion:WAP and betamethasone therapy, both appear to be effective in the treatment of AA. However, betamethasone caused several side effects; therefore, WAP can be used as a better alternative to corticosteroids in AA.

Alopecia Areata and Severe Psoriasis Successfully Treated with Apremilast

This case report shows the effectiveness of Apremilast in refractory ophiasis AA with a rapid and highly scalp-hair regrowth with a cosmetically important response.

Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata.

Alopecia areata (AA) is an autoimmune disease characterized by hair loss mediated by CD8+ T cells. There are no reliably effective therapies for AA. Based on recent developments in the understanding of the pathomechanism of AA, JAK inhibitors appear to be a therapeutic option; however, their efficacy for the treatment of AA has not been systematically examined. This was a 2-center, open-label, single-arm trial using the pan-JAK inhibitor, tofacitinib citrate, for AA with >50% scalp hair loss, alopecia totalis (AT), and alopecia universalis (AU). Tofacitinib (5 mg) was given twice daily for 3 months. Endpoints included regrowth of scalp hair, as assessed by the severity of alopecia tool (SALT), duration of hair growth after completion of therapy, and disease transcriptome. Of 66 subjects treated, 32% experienced 50% or greater improvement in SALT score. AA and ophiasis subtypes were more responsive than AT and AU subtypes. Shorter duration of disease and histological peribulbar inflammation on pretreatment scalp biopsies were associated with improvement in SALT score. Drug cessation resulted in disease relapse in 8.5 weeks. Adverse events were limited to grade I and II infections. An AA responsiveness to JAK/STAT inhibitors score was developed to segregate responders and nonresponders, and the previously developed AA disease activity index score tracked response to treatment. At the dose and duration studied, tofacitinib is a safe and effective treatment for severe AA, though it does not result in a durable response. Transcriptome changes reveal unexpected molecular complexity within the disease. ClinicalTrials.gov NCT02197455 and NCT02312882. This work was supported by the US Department of Veterans Affairs Office of Research and Development, National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health grant R01 AR47223 and U01 AR67173, the National Psoriasis Foundation, the Swedish Society of Medicine, the Fernström Foundation, the Locks of Love Foundation, the National Alopecia Areata Foundation, and the Ranjini and Ajay Poddar Resource Fund for Dermatologic Diseases Research.

Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata.

BACKGROUND. Alopecia areata (AA) is a common autoimmune disease with a lifetime risk of 1.7%; there are no FDA-approved treatments for AA. We previously identified a dominant IFN-γ transcriptional signature in cytotoxic T lymphocytes (CTLs) in human and mouse AA skin and showed that treatment with JAK inhibitors induced durable hair regrowth in mice by targeting this pathway. Here, we investigated the use of the oral JAK1/2 inhibitor ruxolitinib in the treatment of patients with moderate-to-severe AA. METHODS. We initiated an open-label clinical trial of 12 patients with moderate-to-severe AA, using oral ruxolitinib, 20 mg twice per day, for 3-6 months of treatment followed by 3 months follow-up off drug. The primary endpoint was the proportion of subjects with 50% or greater hair regrowth from baseline to end of treatment. RESULTS. Nine of twelve patients (75%) demonstrated a remarkable response to treatment, with average hair regrowth of 92% at the end of treatment. Safety parameters remained largely within normal limits, and no serious adverse effects were reported. Gene expression profiling revealed treatment-related downregulation of inflammatory markers, including signatures for CTLs and IFN response genes and upregulation of hair-specific markers. CONCLUSION. In this pilot study, 9 of 12 patients (75%) treated with ruxolitinib showed significant scalp hair regrowth and improvement of AA. Larger randomized controlled trials are needed to further assess the safety and efficacy of ruxolitinib in the treatment of AA. TRIAL REGISTRATION. Clinicaltrials.gov NCT01950780. FUNDING. Locks of Love Foundation, the Alopecia Areata Initiative, NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and the Irving Institute for Clinical and Translational Research/Columbia University Medical Center Clinical and Translational Science Award (CUMC CTSA).

Scalp Hair Regrowth in Hormone-Treated Transgender Woman.

Evidence of androgenetic alopecia, or male pattern baldness, can be distressing for transgender women. Here we present the case of a transgender woman with scalp hair regrowth after ∼6 months on oral estradiol and spironolactone therapy achieving testosterone levels within normal female range.

Pemphigus vulgaris with loss of hair on the scalp

Pemphigus vulgaris is an autoimmune disease, which leads to flaccid bullae and erosions. Although the scalp is commonly involved, hair loss is rarely seen. We herein report a case of 32-year-old female patient with a 2-year history of pemphigus vulgaris, involving the skin and mucosa. Although clinical improvement was achieved with oral corticosteroids and mycophenolate mofetil, the patient developed tender plaques on her scalp, accompanied by hair loss. Histopathology and direct immunofluorescence were consistent with pemphigus vulgaris. Skin swab cultured Staphylococcus aureus. Treatment with oral and topical corticosteroids combined with mycophenolate mofetil resulted in clinical remission, with regrowth of scalp hair. Alopecia is an unusual clinical manifestation of pemphigus vulgaris. Our case supports the hypothesis that hair loss is induced by antibody-mediated outer root sheath keratinocyte acantholysis, in combination with skin infection, that together lead to the observed hair loss.

Formulation and assessment of the efficacy of a herbal shampoo containing lavender oil

Today considerable consumer interest has risen towards the use of herbal hygienic and cosmetic products. Lavender oil is a well-known essence with uses in the treatment of alopecia, dandruff and scalp hair re-growth, as well as possessing antimicrobial, antiviral and antifungal effects. Hence, this study was undertaken to formulate and assess the efficacy of a new clear liquid hair shampoo containing this essence. Initially, various concentrations of anionic, nonionic and amphoteric surfactants were examined to obtain a suitable and effective cleansing detergent base. Next, the necessary additives were incorporated into the detergent base to obtain the most desirable clear shampoo formulation. Finally, 0.5% lavender essence was included within the shampoo base and then the product underwent various physico-chemical tests as well as assessment of the efficacy and acceptability in twenty volunteers. Following extensive formulation, eventually a clear liquid shampoo containing triethanolaminelauryl sulfate and sodium laurylether sulfate (anionic detergents), coconut diethanolamide (foam builder, stabilizer and hair softener), poloxamer 407 and alkyldimethylaminobetaine (nonionic and amphoteric co-detergents for reducing eye and skin irritation), sodium chloride (viscosity adjusting agent), methyl and propyl paraben (preservatives), BHA (antioxidant), glycerin (conditioner), EDTA (sequestrant) and lavender oil was prepared. This formulation had a clear appearance, pleasant odor, good spreadability, substantivity and skin feel, and a pH of 7.05±0.07. It produced copious amounts of a rich, stable, and durable foam, with desirable washability following use. This shampoo formulation supported no microbial or fungal growth, and remained stable under thermal, mechanical and accelerated stability tests (at 40°C for 6 months). Finally, the efficacy (especially against dandruff), applicability and acceptability of this shampoo was justified and approved by twenty volunteers. The formulated lavender oil containing clear liquid shampoo appears to be a pleasant, acceptable and effective herbal product, particularly suitable against dandruff as well as hair and scalp hygiene.