When Dr. Angela Christiano, a molecular dermatology professor at Columbia University, was diagnosed with the hair loss disease alopecia in 1996, specialists told her there wasn’t much they could do for her. So she decided to figure out how to do it for herself.
At Columbia, Christiano and her team are testing the efficacy of JAK inhibitors (or janus kinase inhibitors–medications traditionally used to treat autoimmune disorders such as rheumatoid arthritis) on balding heads. Should Christiano’s work pass FDA approval and become available over-the-counter, it will represent a major breakthrough.
According to Christiano, over 6 million people in the United States have been diagnosed with alopecia, making it as common of a condition as psoriasis. In addition to alopecia areata, in which the body rejects hair follicles as foreign invaders, there is so-called “scarring alopecia,” in which the body’s immune response damages stem cells. When stem cells in hair follicles are damaged, they turn themselves into skin and the body loses the ability to ever regrow it. Scarring alopecia is a condition that particularly affects women. “Scarring alopecia is a catch-all that includes 3 or 4 diseases, but two of them are almost exclusively found in women,” says Christiano, “and we don’t know why.”
Included in that “catch all” is frontal fibrosing alopecia, a condition that affects the eyebrows and frontal hairline, and was virtually unknown before the 1990s. Experts like Christiano’s team at Columbia aren’t entirely sure why the prevalence has gone up: Christiano guesses it could be from exposure to a certain class of drugs, or possibly just styling products. There’s also central centrifugal cicatricial alopecia (CCCA), a form of scarring alopecia common mostly among African American women. In this form, hair on top of the head begins to thin in a circle formation, and it spreads from there.
The discovery that anti-immune drugs might help with hair loss came about somewhat accidentally. People using Xeljanz, a drug used to treat rheumatoid arthritis, and Ruxolitinib, a drug used for myelofibrosis, also reported a huge reduction of hair loss. Currently in Christiano’s lab, she is experimenting with giving mice both oral and topical JAK inhibitors to study male pattern baldness, alopecia, and even scarring alopecia, which was previously thought to be incurable.
In the mice, she’s found that applying JAK inhibitors as a gel is more effective for hair regrowth. But even when given orally, JAK inhibitors can also quiet down the immune cells and activate the hair cycle in alopecia areata patients.
Once FDA approved, dermatological drugs typically become available via prescription and then over-the-counter. (Rogaine was originally a prescription and then the prescription dosage was formulated at a lower efficacy to be sold without requiring a prescription. The same happened with Retinoid.)
Eventually we may be able to see the same pattern take place for JAK inhibitors. There are at least four or five drug companies looking into JAK inhibitors for alopecia, some topical and some oral.
We’re still a few years away from the widespread use topical JAK inhibitors, but Christiano is hopeful that her research and patent will begin aiding humans in hair growth in the next few years.