What's New and Hot in Nail and Hair Treatments

Presenter Boni E. Elewski, MD, chair of the department of Dermatology and the James Elder professor of Graduate Medical Education at the University of Alabama at Birmingham, started her presentation on “What’s new and hot in nail and hair” by sharing a number of media reports noting the impressive results of low-dose minoxidil for hair loss. “Current therapeutic options for female pattern hair loss include topical minoxidil, oral minoxidil, spironolactone, finasteride, dutasteride, platelet rich plasma therapy, and hair laser therapy,” Elewski added. She shared study results of oral dutasteride in a large series of patients with frontal fibrosing alopecia, as well as positive results from 2 phase 3 trials of baricitinib for alopecia areata.

Elewski next discussed using the severity of alopecia tool (SALT) in evaluating a patient, a global severity score that captures percentage of hair loss. It is a weighted sum of the percentage of hair loss in the 4 quadrants of the scalp, ranging from 0 (no hair loss) to 100 (complete hair loss). Simply put, a SALT score of 0 would mean no hair loss; 50 would mean 50% hair loss, etc.

For severe hair loss, Elewski recommended some of these current options, such as baricitinib (for which she recommended monitoring before and after treatment, including screening for tuberculosis and hepatitis, and doing CBC and lipid panels). She also discussed treating patients with abnormal nails with itraconazole and efinaconazole, 2 effective antifungal medications (efinaconazole particularly for onychomycosis).

In discussing nail psoriasis, Elewski said, “Patients may have concomitant psoriatic arthritis, and medications that alleviate psoriatic arthritis generally improve psoriatic nails.” Additionally, several medications have shown effective against nail psoriasis, including adalimumab, secukinumab, and ixekizumab.

Elewski wrapped up this short session with some key points:
--oral minoxidil for alopecia should be dosed at between 0.25 and 2.5 mg daily
--for frontal fibrosing alopecia, dutasteride may be the best option
--baricitinib is approved for adults with severe alopecia areata
--for nail fungus, itraconazole and/or topical efinaconazole may be effective
--nail psoriasis can and should be treated, and now there are effective options.

Reference

Elewski BE. What’s new and hot in nails and hair. 2022 Fall Clinical Dermatology Conference. October 22, 2022. Las Vegas, Nevada.