What’s new in hair — September 2016 | Dr. Yuval Ramot

Hair removal-related injuries in the United States, 1991-2014

J Cosmet Dermatol. 2016 Sep 5. doi: 10.1111/jocd.12283. [Epub ahead of print]

Body depilation practices are becoming increasingly popular. Nevertheless, information on side effects because of these procedures is still lacking. In this paper, Swain et al. used data from the National Electronic Injury Surveillance System (NEISS) from 1991 to 2014 to evaluate the extent and characteristics of hair removal-associated injuries in the United States. They found that, overall, hair removal-associated injuries increased nearly nine fold between 1991 and 2013. The highest incidence rate was recorded in 2013 (9/100,000). While from 1991 to 2010 those aged 65+ had the highest incidence rate, starting from 2011, people aged 19–34 had the highest rate, and therefore the authors advice that caution should be taken when undergoing depilatory practices particularly for this age group.


Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata

JCI Insight. 2016;1(15):e89776. doi:10.1172/jci.insight.89776

Recently, several cases of alopecia areata (AA), treated successfully with JAK inhibitors, have been published. Crispin et al. conducted a 2-center, open-label trial to assess the safety and efficacy of tofacitinib, a pan-JAK inhibitor, in patients with severe AA, alopecia totalis (AT) or alopecia universalis (AU). 66 patients were treated, and followed for three months. Almost two thirds of the patients responded to treatment, and a third of the patients achieved an improvement in SALT score of 50% or greater, with AT and AU patients being less responsive than AA patients. Adverse events were restricted to grade I and II infections. Unfortunately, all the patients started losing their hair two months after stopping the medication. It should be noted that patients were treated with a dose of 5 mg twice daily, which might be a sub-optimal dose for AA, as has also been found for psoriasis. Therefore, larger controlled studies, using higher doses of tofactinib, are warranted.


Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata

JCI Insight. 2016;1(15):e89790. doi:10.1172/jci.insight.89790

While tofacitinib showed only moderate effectiveness in the treatment of alopecia areata (AA), Mackay-Wiggen et al. reported better outcomes with ruxolitinib, a JAK1/2 inhibitor that is FDA-approved for the treatment of myeloproliferative disorders. Twelve moderate-severe AA patients were treated with oral ruxolitinib, and followed for 3-6 months. Significant response to treatment was observed in 75% of the patients, with 92% reduction in hair loss. When followed for 12 weeks after stopping treatment, 3 patients reported significant hair shedding, while the other 6 reported shedding, but without significant hair loss. Together with the report on the efficacy of tofacitinib for treating AA, this report shows that the inhibition of the JAK pathway holds promise as a treatment for moderate-severe AA, and further strengthens the need for conducting controlled clinical trials for these medications.


Mutational analysis of 29 patients with autosomal recessive woolly hair and hypotrichosis: LIPH mutations are extremely predominant in autosomal recessive woolly hair and hypotrichosis in Japan

Br J Dermatol. 2016 Sep 19. doi: 10.1111/bjd.15070. [Epub ahead of print]

Autosomal recessive woolly hair (ARWH) is a rare condition, caused by mutations in LIPH, LPAR6 or KRT25. In this paper, Takeichi et al. screened 29 patients with ARWH from 29 different families for mutations in LIPH. They found mutations in this gene in 27 out of the 29 patients analysed, with predominance of the c.736T>A mutation. Therefore, they suggest that genetic diagnosis of ARWH in Japan should focus on exon 6. The underlying cause for ARWH in the two cases without known mutations in LIPH has not been identified in the current study.


Alopecia areata totalis and universalis: multicenter review of 132 patients in Spain

J Eur Acad Dermatol Venereol. 2016 Sep 8. doi: 10.1111/jdv.13959. [Epub ahead of print]

Alopecia totalis (AT) and alopecia universalis (AU) are the two subtypes of aloepecia areata (AA) with the worst prognosis. Five percent of the patients with AA will progress to suffer from these conditions, which bear substantial effects on the quality of life of the patients. Vano-Galvan et al. performed a retrospective multicenter study on a large number of AT and AU patients, in order to describe the clinical and epidemiological characteristics of these patients, and to elucidate the therapeutic response and prognostic features in this population. They show that the most prevalent initial presentation was multifocal AA, that rather quickly developed into AT or AU, usually in less than a year. They could also show that, as was reported before, treatment of these conditions is especially disappointing, and although some response is usually seen in the beginning of therapy, the therapeutic benefits do not last for long. There was no difference in the effectiveness of the different treatments. Poor prognostic factors in this cohort included AU and a positive family history.


Estimated serum vitamin D status, vitamin D intake, and risk of incident alopecia areata among US women

Arch Dermatol Res. 2016 Sep 23. [Epub ahead of print]

Vitamin D deficiency has been linked to a large number of disorders, among them alopecia areata (AA). Nevertheless, this connection is still not well-established, and was not prospectively examined in incident AA. In this study, Thompson et al. used the Nurses’ Health Study (NHS) to prospectively examine the connection between vitamin D levels and self-reported incident AA. They found no statistically significant association between predicted vitamin D levels and vitamin D intake and the risk of AA development. Therefore, this study does not support previous reports, which suggested that vitamin D has a role in preventing AA.

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