Alopecia areata is a common chronic hair disease, characterized by sudden and repeated attacks, the cause of which is not yet fully understood. It is currently believed that it may be related to factors such as autoimmunity, genetics, neuropsychiatric factors, and endocrine disorders. Neuropsychiatric factors are considered to be important predisposing factors for alopecia areata. The disease brings greater psychological burden and mental stress to patients. Related research shows that negative emotions may aggravate the condition, so patients with alopecia areata need the care of doctors, families, and society to make “plaque” refute “new hope” in the years.
In the live broadcast event of “Jieyihui” on May 23, four experts in the field of skin treatment were invited to introduce topics such as alopecia areata knowledge, daily management points, caring for patients with alopecia areata, mental health, and research progress on new drugs for alopecia areata. Provide opportunities for direct communication with doctors for patients and their families to help patients understand the current treatment status of alopecia areata.
Doctor, I am 25 years old. Hair loss often occurs when I wash my hair. Every time I wash my hair, there will be a lot of hair fall. Are you worried that I am alopecia areata?
Dr. Yang Qinping answered:
Alopecia areata is a common disease in dermatology, and it occurs in all ages of different races worldwide. According to statistics from global dermatology clinics, 85.5% of patients will develop alopecia areata disease before the age of 40, which is a high incidence period in the middle and young age. Alopecia areata is a disease of organ-specific immunity induced by environmental factors in a genetic background. About 1/3 of patients with alopecia areata have a positive family history. Neurotrauma, mental abnormalities, allergies, infections and endocrine disorders are all environmental factors that induce alopecia areata. At present, the clinical manifestations of alopecia areata are mainly divided into patch type (single or multiple), total alopecia (AT), general alopecia (AU) and other rare types. It should be noted that trichotillomania, pseudoalopecia areata, syphilitic alopecia, triangular alopecia, androgenic alopecia, etc. are different from clinically determined alopecia areata and need to be distinguished. In the diagnosis of alopecia areata, hair pull tests, dermoscopy, pathological examination of skin lesions and laboratory tests are all helpful for clinical diagnosis. If it is not possible to determine whether the hair loss is alopecia areata, it is recommended to go to the hospital to cooperate with the doctor for a detailed examination.
Doctor, I have been diagnosed with alopecia areata for half a year, and the effect is not obvious after treatment. Is the hair secret recipe I found on the Internet (rubbing hair with ginger and beer) effective?
Dr. Fan Weixin replied:
The treatment of alopecia areata is to control the progression of the disease, promote hair regeneration, prevent or reduce recurrence, and improve the patient’s quality of life. The treatment of alopecia areata must not be accepted as a folk remedy, but must be coordinated with the doctor’s recommendations and programs to “medicate the symptoms”. The treatment of alopecia areata at different stages and with different symptoms is different. It can be roughly divided into: ①General treatment: actively treat the primary disease, remove the inducing factors, and maintain a happy mood. ②Local treatment: topical glucocorticoid, intradermal injection of glucocorticoid, local immunotherapy, topical minoxidil. ③ Systemic treatment: glucocorticoids, immunosuppressive agents. ④Other treatments: new medicines and new medicines, traditional Chinese medicine treatment based on syndrome differentiation, and patients’ self-healing. For patients who have not worked after treatment, it is recommended to consider clinical trials to bring new hope to the treatment of alopecia areata.
Doctor, my alopecia areata is getting worse now. I don’t dare to meet people without wigs now, and I don’t dare to see my favorite girl. I often suffer from insomnia at night… what should I do?
Dr. Gao Yunlu replied:
Alopecia areata is considered to be a typical psychosomatic disease mainly because patients often have greater psychological pressure. The occurrence of some stress events in life will lead to the continuous activation of the hypothalamic-pituitary-adrenal axis, and the levels of CRH, ACTH, and CORT will continue to rise and act on the corresponding receptors in the skin, thereby causing local inflammatory reactions, leading to alopecia areata. The appearance of alopecia areata will leave the patient anxious and depressed for a long time. And mental symptoms such as anxiety and depression will further induce alopecia areata and enter a vicious circle. I suggest strengthening psychological intervention, comprehensively referring to various psychological intervention methods, and formulating strategies suitable for patients.
Doctor, I have been treating alopecia areata for 4 years. Many drugs and methods have been used, but none have had much effect. what should I do?
Dr. Zhang Xingqi replied:
For patients with alopecia areata where conventional treatments are ineffective, I suggest considering JAK inhibitors to participate in alopecia areata clinical research. JAK inhibitors include tofacitib, lucotinib, and barretinib. The efficacy of JAK inhibitors in patients with alopecia areata has gradually been recognized. Several clinical research projects of JAK inhibitors are currently underway. According to the analysis, tofacitib is effective in 72.4% of patients with alopecia areata. Among them, 45.7% of the patients had good effect after use. Child patients have similar effects to adult patients in terms of treatment response, disease recurrence, and improvement of SALT. A number of studies have shown that JAK inhibitors are a safe and effective method for the treatment of severe alopecia areata, total alopecia and general alopecia. In the past 3 years, about half of the patients treated with oral JAK inhibitors had moderate or severe alopecia areata with almost complete hair growth after treatment, and the effect was more obvious.
There are currently 3 JAK inhibitors approved worldwide. As a novel mechanism of oral small molecule targeted drugs, JAK inhibitors are cheap and only need to be taken orally, which can significantly improve the therapeutic effect, and its safety has been approved by the FDA. With the joint promotion of domestic companies in the development of JAK inhibitor generic drugs and innovative drugs, a new generation of JAK inhibitors is being accelerated. They have better targeting and safety, and may have better efficacy. They have entered the phase III clinical stage and deserve everyone’s attention.
There are currently two phase III clinical trials of JAK inhibitors for adult patients with severe and extremely severe alopecia areata, and patients are now being recruited. Are you still worried about the ineffective treatment?
Patients with alopecia areata, please scan the QR code below to sign up for the clinical trial and bring new hope to yourself and your loved ones!