- Alopecia areata: Hair falls out typically in circular or oval patches. It affects the scalp, eyebrows, eyelashes and beard.
- Alopecia totalis: Patients lose all the hair on their scalps.
- Alopecia universalis: Hair loss involves the entire body.
After soccer practice three years ago, K. Reinhart, 16, noticed clumps of her hair falling out in the shower. Days passed, and she lost more hair. She tried using headbands and clever hair-styling techniques to disguise what she soon learned was at the root of her hair loss: alopecia areata, an autoimmune skin disorder that causes bald spots on the head, face and body. Within a year, all she had left were a few eyelashes.
Painful teasing by her classmates made the situation even worse. “Teenagers can be so mean, and they were ruthless towards me,” says Reinhart, who was home schooled after the taunting spread to social media sites. “I got called names such as ‘alien’ and ‘cancer child’ and ‘bald-headed freak’ that still haunt me today,” says the teen, who asked to have her first name and other details of her life withheld to protect her privacy.
Reinhart’s parents brought her to Yale Medicine to see Brett King, MD, who is at the forefront of helping patients with the disease regrow hair using a relatively new class of medicines that includes tofacitinib, a drug that’s approved by the Food and Drug Administration (FDA) for rheumatoid arthritis. Its active ingredient, a Janus kinase inhibitor (JAK inhibitor), keeps the immune system from attacking hair follicles so that the hair can grow.
Until this breakthrough research, there was not a reliable treatment for patients who have a severe form of the disease. Those missing just a few spots of hair on the scalp are usually treated effectively with cortisone shots from a dermatologist, but there was nothing effective for more widespread hair loss.
Alopecia areata leaves some people with circular or oval patches of hair missing from their scalps, eyebrows or other body sites. And in the most extreme cases, people lose all their hair. The disease affects people of all ages and ethnic backgrounds but often first crops up in childhood, like it did for Reinhart. An estimated 5 to 7 million Americans and over 100 million people worldwide have the disease.
Transforming lives of hair-loss patients
Alopecia areata is sometimes discounted as just a cosmetic concern, but it can be devastating emotionally and psychologically. People with it often suffer depression and anxiety.
“Some may argue it’s just hair,” Dr. King says. But hair frames the person you see in the mirror. It’s a sign of youth and vitality—of life. “Patients have told me that without hair, eyebrows and eyelashes, they feel like ghosts.”
After just 12 weeks or less of treatment with tofacitinib, hair growth can be seen, and in some cases the change is dramatic. Facial, scalp and body hair often respond differently to treatment.
Dr. King explains the medication does not work for people with male or female pattern baldness, called androgenetic alopecia. While the causes of that form of hair loss are not well understood, it is not an autoimmune disorder like alopecia areata.
The future of alopecia areata and related conditions
JAK inhibitors like tofacitinib are being explored for use in treating other dermatologic diseases as well. These drugs block the immune response that drives eczema (atopic dermatitis) and psoriasis, two chronic and frequently itchy skin disorders. And these drugs may help with vitiligo, a disease that causes pigment loss, leaving white spots on the skin.
It could, however, take a few years or more before JAK inhibitors are approved by the FDA for alopecia areata and other dermatologic conditions. Currently, treatment is not consistently covered by insurance for dermatologic conditions.
For Reinhart, treatment has helped her regrow not only her hair but also her confidence. “My life has done a 180 turnaround since treatment. It was truly a miracle,” says Reinhart , who wore a wig but no longer needs it. She continues to take the medication daily to avoid possible relapse.
“I am now fully recovered with full regrowth. I even have to get my eyebrows waxed,” she says. She is back at school and has been elected to student council this year. She goes to dances and has many friends, including a supportive boyfriend.
It’s stories like hers that inspire Dr. King's research. “For us, this is about giving people back normalcy and giving them the opportunity to achieve everything they have the potential to become,” says Dr. King.