Trending Clinical Topic: Alopecia

Ryan Syrek


April 08, 2022

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The conflict that occurred at this year's Academy Awards ceremony, along with new findings about treatment options and key associations, helped make alopecia this week's top trending clinical topic. At the Oscars, Chris Rock made a joke about Jada Pinkett Smith's hair, resulting in her husband, Will Smith, storming the stage and slapping Rock. Pinkett Smith has alopecia areata, an immune disorder that causes hair loss and can lead to depression. The incident occurred the same weekend as the American Academy of Dermatology 2022 Annual Meeting, during which key findings about alopecia were presented (see Infographic below).

Brett King, MD, PhD, an associate professor of dermatology at the Yale University School of Medicine presented the research, which was also published in the New England Journal of Medicine. King called the findings "hugely important," stating that "we are making a huge step forward toward the goal of FDA approval for a medication for alopecia areata."

All patients involved had severe alopecia areata, defined as a Severity of Alopecia Tool (SALT) score ≥ 50, meaning 50% or less scalp hair coverage. The score ranges from 0 (no hair loss) to 100 (complete hair loss). The primary endpoint was a SALT score ≤ 20 (80% scalp hair coverage). Researchers pooled data from two trials, BRAVE-AA1 and BRAVE-AA2, with a combined enrollment of 1200. At baseline, patients enrolled in the trial had a mean SALT score of 85.5. After 52 weeks, 39% of patients who received 4 mg of baricitinib had at least 80% scalp coverage. Of this group, nearly 3 out of 4 patients (74.1%) had at least 90% scalp coverage, or a SALT score ≤ 10.

None of the adverse events occurred in more than 10% of participants. The most common were headache, acne, and increases in muscle-related blood markers. In February 2022, the FDA granted priority review for baricitinib for the treatment of severe alopecia areata. "It's a fantastic achievement and a major step forward in alopecia areata, especially for patients with the most severe and refractory cases," said Arash Mostaghimi, MD, MPH, the director of inpatient dermatology at Brigham and Women's Hospital.

Another encouraging recent finding suggests that any link between alopecia areata and COVID-19 is likely weak at most. A systemic literature review published in JAAD International found that only nine of 402 articles screened from three databases met the study inclusion criteria. "This number alone highlights the very low number of published articles investigating this connection," said study author Rachel E. Christensen, a graduate student at Rutgers Robert Wood Johnson Medical School. Although COVID-19 has been linked to various dermatologic conditions, a 2021 South Korean study of 7958 case patients and 218,779 control patients found no connection between infection and alopecia, even after covariates such as age, gender, and income level were considered. Overall, the findings suggest that alopecia "could be a dermatological manifestation of COVID-19, with cases most often appearing 1-2 months following infection," according to the authors. "However, the heterogeneity of study designs and high proportion of case reports make it challenging to draw any conclusion."

Worldwide, the lifetime incidence of alopecia is approximately 2%. Approximately 700,000 people in the United States have the condition, according to a 2020 study. Of them, slightly more than half are women. The stigma associated with hair loss remains prevalent, which helps explain the emotional reaction by many to the Oscars incident and the importance of recent treatment findings. Pop culture and science combined to result in this week's top trending clinical topic.

Learn more about alopecia areata.


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