Alopecia: New hope for the hopeless

There’s good news for those who suffer from the most extreme forms of alopecia areata-and for the doctors seeking to help them.

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During their presentation “New Drugs and New Concepts” at MauiDerm 2015, Neal Bhatia, M.D., and Ted Rosen, M.D., highlighted tofacitinab (Xeljanz, Pfizer), approved by the Food and Drug Administration for treating psoriasis and psioriatic arthritis but found to be a potential breakthrough treatment for alopecia. Noting that alopecia totalis is “basically hopeless,” Dr. Rosen mentioned a case report involving a plaque psoriasis patient who grew a full head of hair while being treated with tofacitinab citrate. 

That case was reported by two Yale researchers in a paper that appeared in the June 2014 issue of the Journal of Investigative Dermatology. The 25-year-old patient, diagnosed with plaque psoriasis and alopecia universalis, was referred to Yale for treatment of the psoriasis. Brett A. King, M.D., assistant professor of dermatology and co-author of the paper, decided to treat the patient with daily 10 milligram dosages of tofacitinab. After two months, the patient’s psoriasis had improved-and for the first time in seven years, he’d grown scalp and facial hair. After three more months at 15 mg daily, the patient had a full head of hair, eyelashes and eyebrow.

According to Dr. Bhatia, a San Diego dermatologist, two studies are currently under way-one at Yale (led by Dr. King), the other in Europe-to investigate the efficacy of tofacitinab for treating alopecia areata, alopecia totalis and alopecia universalis. The Yale study, Dr. Bhatia tellsDermatology Times, is evaluating performance of 5 mg twice-daily tofacitinab dosages for three months. The estimated final completion date for the study is July 15.

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“There’s a lot of interest in where this could lead,” he says. “The 5 mg dose is very safe, and while a 10 mg dose is very effective, it brings with it the possibility of more elevation of liver enzymes and effect on blood counts-monitoring is definitely necessary. For the longer duration treatments-alopecia totalis and universalis-you need the smaller dosage.”

Dr. Bhatia is enthusiastic about tofacitinab’s potential for being the long-awaited solution to the alopecia problem. 

“This is a breakthrough for people who had no other option, for whom nothing worked before,” he says. “This is one of those molecules that have a step-down-maybe one day we’ll be talking about going from orals to topical.”

Both Dr. Bhatia and Dr. Rosen are optimistic about fexofenadine, an antihistamine primarily used for treating allergies. In another presentation at MauiDerm, Dr. Rosen noted that fexofenadine has been widely used in Japan as both an adjunctive treatment and primary monotherapy for alopecia areata.

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