Effectiveness and Predictive Factors of Response to Tofacitinib Therapy in 125 Patients with Alopecia Areata: A Single-centre Real-world Retrospective Study

Alopecia areata is an autoimmune disorder that greatly impacts patients' quality of life, and its management remains challenging. Tofacitinib is the first Janus kinase inhibitor to be approved for clinical use and is the most extensively studied. Several studies have demonstrated the clinical effectiveness of oral tofacitinib in treating patients with alopecia areata. However, despite being widely used in clinical practice, no prospective randomized controlled trials have been implemented and its indication criteria have not been thoroughly established. Moreover, little is known about the factors associated with response to therapy under real-world conditions. The aims of this retrospective cohort study of patients with alopecia areata treated with tofacitinib for 3 months were to assess the effectiveness of tofacitinib and to identify predictive factors of response to it. Primary outcome was the change in disease severity, as evaluated by Severity of Alopecia Tool (SALT) grade. A total of 125 patients with alopecia areata were included, the incidence of effectiveness was 83.2%, and 16.0% of patients achieved a result of complete remission. Total duration of alopecia areata and previous hair regrowth were independent predictors of response. Combined therapy was associated with relapse after discontinuation. No severe adverse event was observed. This study suggests that tofacitinib provides an effective treatment option for patients with alopecia areata, and that earlier intervention in the treatment of severe alopecia areata with tofacitinib may lead to better outcomes.

LITFULOTM (Ritlecitinib) Capsules: A Janus Kinase 3 Inhibitor for the Treatment of Severe Alopecia Areata

LITFULOTM (ritlecitinib) capsules were recently approved for the treatment of severe alopecia areata in adolescents and adults, aged ≥12 years. Ritlecitinib is the active ingredient and a dual inhibitor of Janus kinase 3 and the tyrosine kinase expressed in hepatocellular carcinoma kinase family. It prevents immune attack on the hair follicles that leads to hair loss. In a phase 2b-3 dose-dependant study, five doses of oral ritlecitinib and placebo administered once daily (QD) were investigated. Ritlecitinib demonstrated efficacy in achieving the primary outcome, Severity of Alopecia Tool (SALT) score of ≤20, at week 24 (31% [38/124] 200-mg ritlecitinib QD for 4 weeks, then 50 mg QD for 20 weeks; 22% [27/121] 200-mg ritlecitinib QD for 4 weeks, then 30 mg QD for 20 weeks; 23% [29/124] 50-mg ritlecitinib QD; 14% [17/119] 30-mg ritlecitinib QD; 2% [1/59] 10-mg ritlecitinib QD; and 2% [2/130] placebo). Mild to moderate common adverse effects were observed, which included headache, nasopharyngitis, and upper respiratory tract infection. The recommended regimen of ritlecitinib capsules is 50 mg QD with without food and swallowed whole.

Culprits of Medication-Induced Telogen Effluvium, Part 1

Telogen effluvium (TE) is a common clinical consequence of medication-related alopecia. The inciting cause of TE may be difficult to identify due to delays in clinically apparent hair loss. Because medication-induced TE is a nonscarring alopecia that typically is reversible, appropriate management requires identification of the underlying triggering medication and cessation of it, if possible. In part 1 of this series, we review the existing literature on medication-induced TE with a focus on systemic retinoids, antifungal agents, and psychotropic medications.

Drug Survival and Long-term Outcome of Tofacitinib in Patients with Alopecia Areata: A Retrospective Study

Several non-randomized clinical trials and retrospective studies have demonstrated encouraging efficacy and well-tolerated safety of tofacitinib in the treatment of alopecia areata. However, there are scarce data on a large cohort of patients with alopecia areata in long-term real-world practice. This single-centre, retrospective, observational cohort study included 126 patients with alopecia areata treated with tofacitinib between February 2021 and December 2022. The aims of this study are to evaluate drug survival, effectiveness and safety of tofacitinib for treatment of alopecia areata, and to identify potential factors influencing long-term outcomes. Median duration of treatment was 23.00 (interquartile range (IQR) 15.00, 47.25) weeks. Median all-cause survival time of 126 patients treated with tofacitinib was 44 weeks (95% confidence interval (95% CI) 36.3, 51.7), and the all-cause drug retention rate at 12 weeks, 24 weeks and 48 weeks were 90.0%, 66.4% and 42.3%, respectively. The most common reason for discontinuation was complete remission/satisfaction. A total of 80 patients treated with tofacitinib for over 6 months were included in the efficacy analysis, the overall complete response rate at 24 weeks was 33.8% (27/80). No life-threatening serious adverse events occurred. Sex is an independent risk factor in predicting patient outcomes. This real-world study confirmed the high effectiveness and acceptable safety profile of tofacitinib in alopecia areata, with a satisfactory drug survival rate, and provides supporting data for the clinical application of tofacitinib in Chinese patients with alopecia areata.

Major improvement of very severe alopecia areata in patients treated with the combination of baricitinib and low doses of corticosteroids: an eight-case series

Alopecia areata (AA), especially very severe types, causes patients severe psychological and social distress. Although baricitinib alone has been shown to be effective in conferring complete hair regrowth (HR) in severe AA [Severity of Alopecia Tool (SALT) score 50-94], it gave poor therapeutic results in very severe AA (SALT score ≥ 95). Methotrexate alone is similarly ineffective, but in a recent study of patients with areata totalis or universalis, low-dose prednisone with methotrexate gave a 20% rate of HR, and was effective and well tolerated. In our study of baricitinib 4 mg + prednisone 20 mg per day tapered over 3 months to treat eight women with very severe AA, seven of eight achieved complete HR (SALT score 0) and one had partial HR (SALT score 30).

A Retrospective Review of Anthralin in Petrolatum in the Treatment of Alopecia Areata in the Pediatric Population

BACKGROUND/OBJECTIVES

Alopecia areata (AA) is a T-cell driven autoimmune disease, which results in hair loss. This study aims to determine the efficacy, tolerability and safety of different concentrations of anthralin in the treatment of pediatric AA.

METHODS

A retrospective cohort study of patients < 18 yo diagnosed with AA treated with anthralin at SickKids Hospital, Toronto dermatology outpatient clinic in 2016 - 2018. Anthralin used at 0.1%, 0.2%, 0.5% and 1% in petrolatum at short contact, at increments of 15 minutes every week until a 1 hr maximum contact achieved. No other treatment was used in conjunction. Severity of Alopecia Tool (SALT) scores (SS) were determined using photographs and descriptions to assess severity of alopecia at baseline and post anthralin treatment.

RESULTS

A total of 11 charts were reviewed in this retrospective cohort. Hair loss pattern; 3 patients with patchy, 6 had mixed (patchy and ophiasis), and 2 were totalis. All except for 1 patient had failed traditional treatments. One patient had complete hair regrowth, 3 showed more than 85% hair re-growth and 7 patients showed more than 75% hair regrowth, the average time for this to occur was 6.5 months. None of the patients experience serious side effects.

CONCLUSIONS

Our study demonstrated the efficacy and tolerability of topical anthralin 0.1% to 1% in pediatric alopecia areata. In our study, anthralin 0.2% appears to offer the best performance and tolerability profile among the different concentrations used, with treatment course of at least 6 months in order to achieve more than 75% hair regrowth.

New-onset alopecia areata during inclisiran therapy

This article has been retracted. Please see: https://doi.org/10.1093/ced/llad447

Dupilumab Induced Hair Regrowth in Alopecia Totalis

Alopecia Areata (AA) is an autoimmune process that results in varying degrees of hair loss. Currently, there is no single treatment that has proven to be efficacious in a large cohort of patients. Dupilumab, a human monoclonal antibody recently approved for the treatment of atopic dermatitis, may be a potential treatment option for patients with treatment resistant AA. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.6254 Citation: Bur D, Kim K, Rogge M. Dupilumab induced hair regrowth in alopecia totalis. J Drugs Dermatol. 2023;22(4):410-412. doi:10.36849/JDD.6254.

[Alopecia areata universalis under treatment with sitagliptin : Possible immunological effect of dipeptidyl peptidase-4 inhibitors?]

Ein 64-jähriger Patient entwickelte 1 Monat nach Therapieeinleitung mit Sitagliptin, einem Dipeptidylpeptidase-4(DPP‑4)-Inhibitor, und Metformin eine Alopecia universalis. Die Therapie des Diabetes wurde auf das Sitagliptin eines anderen Herstellers und Dapagliflozin umgestellt. Auf unser Anraten wurde Sitagliptin abgesetzt und eine Monotherapie mit Dapagliflozin fortgeführt. Nach 6 Wochen war eine erneute Therapie mit Sitagliptin bei unzureichend eingestelltem Diabetes notwendig. Die Alopezie persistierte. Aufgrund des immunologischen Interaktionspotenzials vermuten wir eine Assoziation zwischen DPP-4-Inhibition und der Alopezie. Der kurze therapiefreie Zeitraum scheint zu gering, um ein erneutes Haarwachstum zu beobachten. DPP‑4 kann sowohl eine Inhibition als auch Aktivierung des Immunsystems bewirken.

Albendazole-induced anagen effluvium: a brief literature review and our own experience

Albendazole is a drug commonly used for treating many parasitoses. The primary mechanism of action is inhibition of microtubule polymerization binding to β-tubulin, similar to colchicine as a microtubule formation inhibitor. It is reasonable that these two antimitotic drugs can cause side effects such as alopecia and cytopenia by a similar mechanism. In the literature, only one albendazole-induced anagen effluvium has been reported. This article presents two cases of anagen effluvium that developed 2 weeks after oral albendazole administration, summarizes all cases reported to date, and offers recommendations for a diagnostic approach.

Reversible Alopecia Secondary to OROS Methylphenidate

INTRODUCTION

Attention deficit hyperactivity disorder has a prevalence of 1-4% of the Spanish school population. Its treatment consists of giving amphetamine derivatives and, recently, non-stimulant drugs, without finding any differences in efficacy in the studies performed.

CLINICAL CASE

A 7-year-old girl was referred from neurology due to learning delay and behaviour disorders. Diagnosed as likely ADHD, treatment was started with immediate release methylphenidate, and later with an osmotic release oral system (OROS) methylphenidate. When alopecia areata appeared, this treatment was withdrawn. After the re-introduction of modified release methylphenidate 30:70, symptom control was achieved without the appearance of alopecia.

DISCUSSION

There is a published history of two cases of alopecia areata with OROS methylphenidate that resolved after increasing the dose of the drug without clearly knowing the reason for this event. There is no consensus on the priority use of the immediate release formula or the OROS methylphenidate.

Remote-onset alopecia areata attributed to ipilimumab

Ipilimumab is a fully humanized monoclonal antibody against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and one of a growing class of immunomodulatory therapies for melanoma. The most common toxicities are immune-related adverse effects (irAEs), which manifest most frequently in the skin as rash and pruritus. We report a case of alopecia areata (AA) attributed to ipilimumab that presented 1.5 years after treatment. Because CTLA-4 dysregulation has been increasingly linked to AA, the incidence of this irAE may increase following US Food and Drug Administration approval of a higher dose of ipilimumab for adjuvant treatment of stage III melanoma.

The influence of methotrexate on hair loss while using immunomodulatory doses

Hair loss is a significant and constantly growing social problem among both women and men. Many drugs through their toxic effects on the cells of the hair follicle matrix have an influence on mitotic divisions and the hair growth cycle, leading to anagen or telogen effluvium. Currently, there are more and more publications and clinical studies evaluating the possibility of using methotrexate in the treatment of various types of non-scarring and scarring alopecia, but there is no study of the effect relating to the hair loss with low doses of the drug in other therapeutic indications.

AIM

The aim of the study was to evaluate if methotrexate used in immunomodulatory doses could cause increased hair loss.

MATERIALS AND METHODS

Data from a survey was analyzed in 68 patients treated with methotrexate at the Department of Dermatology of the Jagiellonian University in Cracow in the years 2015-2018.

RESULTS

Increased hair loss after the beginning of methotrexate administration occurred in 29,4% of the subjects, the majority (60%) were women. More frequent occurrence of general symptoms was perceived among the patients who reported alopecia.

CONCLUSIONS

Studied group of patients was relatively small, however, it seems that drug hair loss during methotrexate treatment occurs relatively often.

PD-1 inhibitor induced alopecia areata

Immune checkpoint modulators are becoming more prevalent in clinical use for the treatment of metastatic melanoma and other malignancies. These drugs, including programmed death 1 (PD-1) inhibitors, have a high incidence of immune adverse events, including cutaneous manifestations. Alopecia is a known side effect with these drugs, but previous reports describe chemotherapy-induced alopecia. We report a case of alopecia areata in a patient on monotherapy with pembrolizumab (PD-1 inhibitor). It is important for the dermatologist to recognize and appropriately treat to decrease morbidity for these patients.

Adalimumab-induced psoriatic alopecia/alopecia areata-like reaction in a patient with Crohn's disease

Anti-tumor necrosis factor (anti-TNF) agents have been successfully used to treat both chronic idiopathic inflammatory bowel disease and other immune-mediated chronic diseases, but they can also induce a wide array of cutaneous reactions, including new-onset psoriasis and alopecia. We report a case of alopecia associated with psoriasiform skin lesions in a patient on adalimumab treatment for Crohn's disease.

Cetuximab-induced crusted pustular eruption with patchy alopecia

A 52-year-old man with recurrent metastatic rectal carcinoma being treated with cetuximab presented to the emergency department with a diffuse papulopustular eruption on the face, scalp, chest, and groin, accompanied by patchy alopecia of the scalp and facial hair.

Alopecia areata universalis complicating daclizumab therapy for uveitis

Alopecia areata (AA) is a complication of biologic therapy with several anti-tumor necrosis factor (TNF) inhibitors and efalizumab for the treatment of various autoimmune diseases. We report the case of a 51-year-old woman who developed AA universalis while undergoing treatment with daclizumab, an immunosuppressive biologic therapy, administered for treatment of inflammatory ocular disease. Although immunomodulatory agents that function by interfering with T helper cell stimulation are expected to impede autoimmune-related processes, we believe that daclizumab may be causally related to the development of AA.

Concomitant alopecia areata and hypertrichosis after infliximab therapy: rara avis

We present a 37 year-old man with HLA-B27 positive ankylosing spondylitis for the last 3 years. Interestingly, he developed both alopecia areata and hypertrichosis simultaneously following infliximab treatment. Reporting this interesting patient of ours -to our best notice for the first time in the literature- we call attention of clinicians to the contradistinctive effects of anti-TNF-α agents on hair growth cycle.

Alopecia areata universalis during off-label treatment with Infliximab in a patient with Behçet disease

Infliximab, a chimeric monoclonal anti-TNF-alfa agent used to treat autoimmune diseases, has shown a paradoxical side effect in the development of autoimmunity. We describe a case of alopecia areata universalis associated with infliximab treatment in a patient with Behçet disease. This case suggests a complex and contradictory role of TNF-α in the pathogenesis of alopecia areata.

Reversible alopecia universalis secondary to PEG-interferon alpha-2b and ribavirin combination therapy in a patient with chronic hepatitis C virus infection

Combined treatment with pegylated interferon (PEG-IFN) and ribavirin is currently recommended for the treatment of chronic hepatitis C virus (HCV) infection. Many side effects including hair disorders have, however, been reported related to this treatment. Alopecia universalis is a severe form of hair disorder. Three cases of alopecia universalis during PEG-IFN and ribavirin combination therapy have been reported in the literature. Herein is reported a case of reversible alopecia universalis, with complete hair loss extending to the whole body, secondary to PEG-IFN alpha-2b and ribavirin combination therapy for chronic HCV infection. Hair regrowth began within 3 months of the completion of combined therapy. In case the liver disease is advanced, and virologic response occurs, treatment can still be completed, as it appears that these side effects are reversible.

Influence of FHIT on benzo[a]pyrene-induced tumors and alopecia in mice: chemoprevention by budesonide and N-acetylcysteine

The FHIT gene has many hallmarks of a tumor-suppressor gene and is involved in a large variety of cancers. We treated A/J mice and (C57BL/6J x 129/SvJ)F1 (B6/129 F1) mice, either wild-type or FHIT+/-, with multiple doses of benzo[a]pyrene (B[a]P) by gavage. B[a]P caused a time-related increase of micronuclei in peripheral blood erythrocytes. Both A/J and B6/129 F1 mice, irrespective of their FHIT status, were sensitive to induction of forestomach tumors, whereas B[a]P induced glandular stomach hyperplasia and a high multiplicity of lung tumors in A/J mice only. Preneoplastic lesions of the uterus were more frequent in FHIT+/- mice. B6/129 F1 mice underwent spontaneous alopecia areata and hair bulb cell apoptosis, which were greatly accelerated either by FHIT heterozygosity or by B[a]P treatment, thus suggesting that FHIT plays a role in the pathogenesis of alopecia areata. The oral administration of either budesonide or N-acetyl-L-cysteine (NAC) inhibited the occurrence of this inflammatory skin disease. In addition, these agents prevented B[a]P-induced glandular stomach hyperplasia and decreased the size of both forestomach tumors and lung tumors in A/J mice. Budesonide also attenuated lung tumor multiplicity. In B6/129 F1 mice, NAC significantly decreased the proliferating cell nuclear antigen in lung tumors. Both budesonide and NAC inhibited B[a]P-induced forestomach tumors and preneoplastic lesions of the respiratory tract in B6/129 F1 mice. In conclusion, heterozygosity for FHIT affects susceptibility of mice to spontaneous alopecia areata and B[a]P-induced preneoplastic lesions of the uterus and does not alter responsiveness to budesonide and NAC.

Recurring chemotherapy-associated alopecia areata: case report and literature review

A 52-year-old woman with stage IIIC ovarian cancer and stage IA uterine cancer experienced recurring alopecia areata of her eyebrows, eyelashes, arms, legs, and pubic area beginning 5 months after completing chemotherapy with paclitaxel and carboplatin. The condition recurred in a cyclic fashion over the ensuing months. Alopecia is a well-recognized adverse event associated with chemotherapy; however, to our knowledge, this cyclic pattern of alopecia has not been reported in a patient with cancer. Our report of a cancer survivor who experienced cyclic alopecia areata indicates that this condition may be related to autoimmune changes instigated by chemotherapy. Oncology health care practitioners should evaluate unusual clinical cases of alopecia for underlying pathology.

[Pyrethroid exposure following indoor treatments with a dog flea powder]

Pyrethroid exposure following indoor treatments with a dog flea powder.

HISTORY

A 42 year old woman reported hair loss, gastrointestinal and non-specific symptoms. The patient has lived in a council flat and kept a dog who had been regularly treated with pyrethroid containing flea powder.

INVESTIGATIONS

The biological monitoring of pyrethroid meta-bolites in urine was performed using gas chromatography-mass spectrometry. The values at admission and follow-up after 4 weeks were highly elevated. Inspection of the flat revealed a humid and cramped dwelling.

TREATMENT

We recommended redevelopment and cleaning of the dwelling and the avoidance of ectoparasiticide use.

CONCLUSION

To our knowledge this is the first documented case of high indoor pyrethroid exposure following the use of ectoparasiticides with domestic animals. Pyrethroids can cause neurotoxic symptoms and skin irritation. There are few data concerning chronic effects. The causal connection between pyrethroid exposure and symptoms remains unclear and poses a great problem in environmental medicine.

Heavy metal poisoning in glass worker characterised by severe

The paper presents the clinical description of the masticatory organ and biochemical assessment of dental tissue in a patient employed in a glassworks for 20 years. During 12 years the patient has suffered baldness ("Alopecia areata") and atypical extensive and non-healing cutaneous lesions. Dental examination revealed changes typical of chronic poisoning by cadmium and bismuth compounds.

Alopecia associated with zidovudine therapy

Alopecia has been described in patients infected with the human immunodeficiency virus (HIV). Zidovudine reportedly influences hair growth in these patients, causing regrowth or thickening. A 33-year-old HIV-infected man developed alopecia areata after beginning zidovudine therapy. The alopecia reversed after the drug was discontinued.