We bring updates on research studies which have been published in the last few months, including on a new potential treatment for Male Pattern Hair Loss, the relationship between stress and alopecia areata, a consensus study on treatment of Frontal Fibrosing Alopecia, a podcast series talking about romantic relationships and visible differences, and finally, JAK inhibitors for alopecia areata. 

Potential new treatment for Male Pattern Hair Loss (MPHL)

Pharmaceutical company Cosmo have announced the results of their phase III clinical trials on topical clascoterone for Male Pattern Hair Loss (MHPL), also known as androgenetic alopecia. In a press release, the company say that improvements in hair growth were seen in men with mild-moderate MPHL after 6 months of treatment. Cosmo suggest they will now move forward with applying for regulatory approval in the US and Europe. We will await the publication of results in a scientific journal and continue to monitor this potential new medicine. Please note that the research did not include women with Female Pattern Hair Loss (FPHL). This medicine is unlikely to become a new treatment option for women as it targets androgen hormones, which are not thought to be the driving factor behind FPHL in most cases.

New study links stress to alopecia areata (AA)

People with alopecia areata often suspect that stress may have triggered their condition, however a direct link between stress and AA has not been proven. A new study from Harvard University has now found a mechanism directly linking stress to hair loss in mice. During acute stress, sympathetic nerves release norepinephrine around the hair follicle, which results in the death of ‘hair follicle transit amplifying cells’ (HF-TACs). These cells drive hair growth and produce the hair that comes out of the skin. However, hair growth is intensive and so switching this off during periods of high stress may be a strategic way of preserving energy and resources.

But, the researchers saw this resulted in further action by the immune system. When the HF-TACs die off, the debris left behind triggers local immune cells called macrophages and dendritic cells. These call into action T cells from elsewhere in the body, to launch attacks on the hair follicle. The T cells learn to attack a specific target in the hair follicle, which they mistakenly see as a threat. As a result, they continue to attack, even months and years after the stressful event. It should be noted this study was done on mice, so it remains to be seen if the mechanism is the same in humans.

International experts publish statement on treatment of Frontal Fibrosing Alopecia (FFA)

No clear guidelines currently exist for the treatment of FFA. For this study, 69 experts from around the world answered 365 questions to reach consensus on the best way to manage FFA. Consensus was reached on 202 questions, including on best treatments to use and how to use them, and monitoring of disease activity. The statement recommends early and aggressive treatment, generally with more than one type of treatment, to prevent progression and permanent hair loss. It also says that patients should be advised to keep using sunscreen, and not to selectively avoid chemical or physical sunscreens. While no clear consensus was reached on whether sunscreen use on the forehead and eyebrow region should be avoided, around 60% of experts thought it would be beneficial. Alternative methods of sun protection, such as hats, should be used, to protect against the risk of skin cancer. The statement also highlights that more effective treatments are needed for FFA.

Podcast series on romantic relationships for people with a visible difference

Loving ACTion is a series of 7 podcast episodes aimed at adults with visible differences who have concerns relating to intimacy and romantic relationships. They include researchers from the Centre for Appearance Research (CAR), and individuals, who talk about lived experiences of visible difference (including alopecia), intimacy and romantic relationships. An evaluation with people who listened to the podcasts found they experienced significant improvements in body esteem, self-compassion and psychological flexibility, as well as significant reductions in appearance-focused distress, fear of negative appearance evaluation and internal shame. A summary of the evaluation can be found here. To access the podcasts, please visit the Visible Difference Support Hub.

JAK inhibitors for alopecia areata (AA)

Several recent publications give new insights into the use of JAK inhibitors for AA. Deuruxolitinib is one JAK inhibitor medicine, developed by Sun Pharma, that will soon be evaluated by NICE for use on the NHS. Alopecia UK has been invited to take part in this appraisal. In November 2024, the results of the first phase III clinical trial (THRIVE-AA1) were published, which showed that with twice-daily 8mg, 29.6% of people reached SALT20 (meaning more than 80% scalp hair coverage). Now, publication of the results from the second parallel trial (THRIVE-AA2) show that 33.0% of people reached SALT20 on the 8mg dose after 24 weeks. In both trials, the treatment was well tolerated by patients and side effects were mostly mild or moderate in severity. 

A letter by leading US dermatologists describes the importance of having multiple JAK inhibitors medicines available to choose from. Clinical trials with various JAK inhibitors have shown similar percentages of people respond successfully to treatment. This suggests that one may not necessarily be better than the others for treating severe AA. But, when people do not respond to one JAK inhibitor, some patients are able to regrow hair after they switch to another JAK. So, it will be important to have more options available.