Women with symptoms of alopecia areata, an autoimmune disease affecting hair follicles, can face bald patches, total baldness and even loss of body hair. But genetic research is creating new ways to fight this hair loss condition. In an exclusive interview, two doctors on the cutting edge of research discuss the future of alopecia areata treatment...
Thinning hair is common as you get older, even for women.
But if you suffer from symptoms of alopecia areata, hair loss can happen at any age – and the results can be emotionally devastating.
“When first diagnosed, everyone goes through shock and almost a grieving period – because it can continue, get worse, all the hair might come out or it can get better,” says Angela Christiano, Ph.D., professor of dermatology and genetics and a vice chair of the dermatology department at Columbia University.
She suffers from the autoimmune disease, which affects more than 4.7 million people in the U.S., according to the National Alopecia Areata Foundation (NAAF).
It can cause small patches of hair loss or complete baldness, including nose and ear hair, eyelashes and eyebrows.
Christiano was diagnosed with symptoms of alopecia in 1996.
At the time, her dermatologist told her doctors he had no idea what caused it or how far it would progress – and there were few options for alopecia areata treatment.
To a scientist, that was “like waving a red cloth in front of a bull,” she says.
Now, after years of study, genetic researchers, including Christiano, have identified pathways for potential new medications and a new use for drugs already on the market.
At NAAF’s recent annual conference in Los Angeles, we spoke exclusively with Christiano, as well as fellow researcher Maria Hordinsky, M.D., chairwoman of the Department of Dermatology at the University of Minnesota in Minneapolis.
Looking at you now, your hair is thick, with lots of volume. What was it like when the disease first appeared?
Angela M. Christiano, Ph.D.: I started with two spots [of hair loss] about 15 years ago.
Eventually, over 1-1/2 years, I developed 10 spots.
I was treated with steroid injections, and it took another year or so for the hair to grow back.
But once you’ve had [symptoms of alopecia], it’s with you every day. You still check and make sure everything’s where it belongs.
Your hair is probably never quite the same afterward – the texture’s a little different and it’s thin in places.
But there’s enough [normal hair] to cover, so it’s OK.
Did your own experience lead you to research alopecia areata treatment?
Everybody reacts to the disease in their own way. Some people have fundraisers. I had a whole lab to play with.
So, for me, the obvious thing was to try to figure it out.
Why has there been so little research until now?
It isn’t life-threatening – it’s not a systemic disease that makes you sick in a [traditional] way.
But it has one of the highest “burdens of disease” – the emotional toll it takes is far greater than almost any other skin disease.
What surprised you about your findings?
We were fully prepared for genes that looked like psoriasis or other skin diseases.
But when we put it together, we realized they [were similar to] diabetes, [rheumatoid] arthritis and celiac disease.
It was a shock. It’s like getting on a plane believing you’re going to Italy and you land in South America.
It took us a while to recalibrate our thinking.
How does it resemble those other autoimmune disorders?
[In each condition], there’s something in the tissue that makes it think it’s damaged or has undergone some sort of attack – whether it’s the hair follicle [for alopecia areata], joint [for rheumatoid arthritis], gut [for celiac disease] or pancreas [for type 1 diabetes].
It turns on a signal that recruits a “danger” response.
In a normal person, that immune response turns itself off. In patients with autoimmune disease, it just keeps going.
How will that knowledge lead to an alopecia areata treatment?
There’s been a lot of research on those other diseases, and they’re way ahead of us with drugs on the market. So we’re piggybacking.
What’s next?
[The genetic research] is leading us in two directions: One is to start tinkering with those genes in mice to see if we can cause the disease and then figure out ways to block it.
The other is to [study] drugs that have already been developed against some of the gene targets we’ve identified.
That leads automatically to a fast track to clinical trials.
Do you think there could be a cure for symptoms of alopecia areata?
We have a great advantage in that the hair follicle can grow back [and] we can repeatedly treat the broken immune system.
That [may not be] the case for the joint in rheumatoid arthritis, or pancreas in type 1 diabetes.
Still, most autoimmune diseases are chronic, and patients [would have to] undergo lifelong treatment. But, most people would [think it’s worth it] to keep their hair or stay healthy.
Lifescript also spoke with Maria Hordinsky, M.D., a professor and chairwoman of the Department of Dermatology at the University of Minnesota and a leading researcher in hair diseases and hair follicle biology.
What treatments are available for the hair loss condition now?
Maria Hordinsky, M.D.: The most common alopecia areata treatment, and most successful, is injecting corticosteroids [into] the hair follicle.
It may require repeated injections every six weeks or so.
This approach has never passed a rigorous clinical trial, but everyone knows it works.
Are there side effects?
The main [problem] would be pain and discomfort as the medication is injected.
Beyond that, there can be thinning of skin, folliculitis [inflammation of the hair follicle] or even atrophy [rapid hair loss].
How promising are the drugs you’re investigating for alleviating symptoms of alopecia areata?
They have potential, but they all have to go through phase I, II and III clinical trials, starting with just a few patients.
If [a medication is successful against the condition] and not causing a lot of adverse experiences, the trials enlarge in number and scope.
Does the Alopecia Areata Registry sponsored by the National Institutes of Health help your research?
It’s a way for [researchers] to get immunological and genetic data from patients.
Over 11 years, about 8,000 people have entered the registry. There are about 3,000 blood samples available for research.
How does it help your research?
We now have an opportunity to ask questions in well-defined populations.
These patients have all been categorized and examined by a dermatologist who has been [recording] accurate clinical data for a decade.
When you look at the genetic data, it’s very solid.
That’s part of the reason that Dr. Christiano’s work has been so exciting – the information is based on excellent data.
What are the other benefits of being in the registry?
Patients can check a box indicating they would be interested in being contacted for future clinical trials.
That potentially allows [researchers] to contact 8,000 people [with symptoms of alopecia areata].
Get more information on the Alopecia Areata Registry.
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