JAKi and the brave new world of hair loss  

2 minute read

Rheumatologists are having hairy conversations with dermatologists about immunosuppressants.

Patients with covid-related hair loss are benefiting from rheumatologists and dermatologists working together on its treatment, says Irish dermatologist Dr Dmitri Wall. 

In June last year, the JAK inhibitor baricitinib won US FDA approval for patients with severe alopecia areata and is now being used for hair loss more broadly. 

In this podcast episode, Dr Wall talks about the discussions he’s been having with rheumatologists when treating patients with severe hair loss associated with long covid.  

“I have a number of patients back in Ireland who are seeing me and they’re also seeing a rheumatologist. There’s back and forth communication between me and the rheumatologists saying ‘Look, maybe we can alter the dose in this way to best cover both’,” he said. 

Dr Wall said that for patients who have a more rapid trajectory and more extensive disease, one of the big, current discussions is the use of JAK inhibitors. 

“It’s making a huge difference to patients with more severe or more progressive alopecia areata,” he said 

Dr Wall also talks about his recently published paper which includes a case report on a patient with Crohn’s disease and severe hair loss. Dr Wall encouraged the patient to speak with his gastroenterologist about looking for clinical trials where both conditions could possibly be treated.  

“I didn’t hear anything for a year but then I got an email that said, ‘I just want to thank you. I got on that clinical trial and all my hair grew back’. As it turned out, he was treated with filgotinib, which has never been described in the area of alopecia areata before,” Dr Wall said. 

Dr Wall provides some research insights from the UK–Irish Atopic eczema Systemic Therapy Registry (A-STAR) and reveals what showed up as a result of covid. 

“We had this really strange but interesting collection of data suggesting that while some of the immunosuppressants could be beneficial with covid, some of them may actually be more damaging. And that’s what the registry started to define as giving people a degree of awareness of the circumstances, the patients where they should or shouldn’t be prescribed,” he said. 

Br J Dermatol 2022, November 25

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