Evidence Based Hair

Season 7, Episode 8: Effectiveness of Generic Tofacitinib in Treating Alopecia Areata

Welcome back to another episode of the Evidence-Based Hair Podcast!  In this episode, we delve into a fascinating study on the use of generic tofacitinib for treating alopecia areata.
This study, published in the Archives of Dermatologic Research, explores the effectiveness and safety of generic tofacitinib. With the recent availability of this cost-effective alternative in Canada, the study provides valuable insights into whether switching from brand name options (Xeljanz) is a viable choice for patients.
The retrospective study included 20 patients with advanced alopecia areata, and the results were promising. A significant number of patients experienced noticeable improvements in hair regrowth, with low incidence of side effects. This episode discusses the study's findings and the broader implications for treatment options in alopecia areata.
Join me as we explore how this study might change the landscape of hair loss treatment and what it means for patients and practitioners alike. Don't miss next week's episode, where we'll discuss the use of baricitinib in young children.
 
 
STUDY REFERENCED
Jian  J et al. Effectiveness and safety of generic tofacitinib in alopecia areata: is the generic a cost-effective option? A retrospective study. Arch Dermatol Res. 2024 May 11;316(5):154. doi: 10.1007/s00403-024-02879-4.

Season 7, Episode 7: Infectious Diseases and Vaccinations Among JAK Inhibitor Users

In this June series of the podcast, we focus on JAK inhibitors. This episode kicks off with a detailed review of an Italian study published in Expert Opinion in Drug Safety, which examines the incidence and management of infections in patients with alopecia areata treated with JAK inhibitors. Dr. Donovan discusses the findings, emphasizing that about one in three patients on JAK inhibitors may develop infections, highlighting the need for careful monitoring and potential treatment pauses.
Additionally, Dr. Donovan reviews a study from New York in Archives of Dermatologic Research, which reveals low vaccination rates among patients with immune-mediated diseases on biologics and JAK inhibitors. The study underscores the importance of pre-treatment vaccinations to mitigate infection risks.
Join us next week as we explore the efficacy and cost benefits of generic tofacitinib in managing alopecia areata, part of our ongoing series on JAK inhibitors. Stay tuned for more insights and expert analysis on the Evidence-Based Hair Podcast.
 
STUDIES REFERENCE IN THIS WEEK'S EPISODE  
 
Giacomo Caldarola et al. Infectious events in patients with alopecia areata treated with JAK inhibitors: low burden and minimal impact on persistence in treatment. Expert Opin Drug Saf. 2024 May 8:1-5.
 
Hren MG and Khattri S. Low rates of vaccination among atopic dermatitis, alopecia areata, psoriasis, and psoriatic arthritis patients on biologics. Arch Dermatol Res. 2024 May 25;316(6):285

Season 7, Episode 6: Topical Minoxidil for Facial Hair Enhancement

In this episode, Dr. Jeff Donovan, a dermatologist and hair loss specialist, examines the effect of topical minoxidil in enhancing beard hair growth in men 
Dr. Donovan focuses on a study published in Sage Open Medicine Case Reports titled, "Facial Hair Enhancement with Minoxidil and Off-Label Use". This study highlights the impact of using topical minoxidil for beard hair growth. As a subject frequently questioned by men worldwide, understanding the benefits, side effects, and the result of its use is vital.
A noteworthy part of this study was that it compared the use of topical minoxidil by two identical twins. Only one of the twins applied minoxidil on his face, and as early as the first month, finer, lighter-colored hairs appeared on his beard and mustache. He experienced hair shedding for a few months but still showed overall improvement in hair density and count after using minoxidil for 16 months.
Despite mild side effects such as skin dryness and hypertrichosis on ears and forehead, as well as increased body hair in other areas, the study shows that minoxidil can be an effective strategy for males wishing to enhance their facial hair. The patient in the case report switched to topical minoxidil foam due to dry flakiness caused by the solution, suggesting that the foam might be a preferable choice for some users.
To sum up, this 16-month-long study provides valuable insights on the potential effectiveness of using minoxidil for beard growth. Despite the side effects and need for more long-term data, the results suggest that it is a reasonably safe and potentially helpful approach for those who desire to improve their facial hair density.

Season 7, Episode 5: Alcohol Hangover and Hair Discoloration

In this episode, we will dive into fascinating recent studies about the side effects of Minoxidil, a widely-known medication for hair loss treatment.
This podcast highlights new research regarding what Dr. Donovan calls "the OMAHA effect" (ORAL MINOXIDIL ALCOHOL HANGOVER ASSOCIATION), the surprising association between oral minoxidil use and exacerbated alcohol hangover symptoms. This phenomenon challenges previous conceptions in the medical field and warrants further investigation into potential implications for patients using oral Minoxidil.
However, though intriguing, the data about the OMAHA effect lacks detailed and quantitative information about the patients involved and their experiences. This calls for more precise and extensive research on the matter. Dr. Donovan emphasizes the need to gather more information before this knowledge can lead to changes in medical practice.
Moving forward, the episode also examines another study analyzing the association between topical Minoxidil and hair discoloration. This study equips you with more concrete data, reporting that about one-fourth of patients using Minoxidil perceive that the treatment has led to their hair graying. Despite the product monograph advising patients to stop minoxidil use when hair discoloration is noticed, the podcast argues that this abrupt termination might not be practical as patients risk losing the new hair growth achieved with Minoxidil when they stop the treatment.
Overall, this discussion underscores how hair graying and discoloration, like hair loss, also significantly impacts individuals' lives. As researchers dedicate more attention to understanding these issues, expect more practical guidelines and breakthroughs in combatting them.
Join Dr. Donovan every week for insightful discussions about ground-breaking studies relevant to hair loss and its treatment. Stay tuned for our next episode where we look into topical Minoxidil use for beard growth.

Season 7, Episode 4: Views of Dermatology Practitioners on Oral Minoxidil

In this episode, we dive into a thought-provoking study by Sanfilippo and Friedman, "Survey of Dermatology Practitioners' Opinions and Prescribing Habits of Oral Minoxidil for the Treatment of Androgenetic Hair Loss".
 
The study provides valuable insights into the perceptions of practitioners on oral minoxidil, an increasingly popular option for treating hair loss.
 
We discuss the results of this survey and compare it with previous studies, shedding light not only on the effectiveness of oral minoxidil but also on the practitioners' comfort level in prescribing it and patients' satisfaction with its results.
The pulse of the global community and the evidence provided by well-conducted studies play a significant role in shaping our understanding of oral minoxidil. There's a critical need for long-term evaluations and more comprehensive studies to establish its effects and side effects over years of use.
Stay tuned for more in-depth discussions as we continue to explore the realm of hair loss treatments.
And don't forget, if you want to immerse yourself in the study of hair loss and acquire advanced clinical and problem-solving skills, consider applying for a training position in the Evidence-Based Hair Fellowship, the world's most comprehensive program for physicians and allied health professionals.

Season 7, Episode 3: Oral vs Topical Minoxidil for Androgenetic Alopecia

In this episode of the Evidence-Based Hair Podcast hair loss specialist Dr. Jeff Donovan breaks down the findings of a recent study comparing oral minoxidil and topical minoxidil in the treatment of male androgenetic alopecia. Published in JAMA Dermatology, the study challenged popular opinions by revealing similar performance between the two types of minoxidil, putting a spotlight on the importance of robust evidence from randomized controlled trials.
Interestingly, Dr. Donovan examined the historical usage of oral minoxidil, once a blood pressure medication, in treating hair loss and the subsequent need for more rigorous studies to solidify its effectiveness. The episode also covers the surprising conclusion that oral minoxidil did not significantly outperform its topical counterpart, contrary to what the mainstream assumes.
Diving deeper into the debate, Dr. Donovan explored differing perspectives derived from the Pantchprateep et al and Penha et al studies of oral minoxidil. Where the Panchaprateep et al study suggested that all patients saw some improvement, the Penha et al study showed that not all participants experienced the same positive results.
In an in-depth examination of the 'Oral Minoxidil versus Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial', the potential side effects, including minor adverse effects of both treatments were also discussed. While not definitive in recommending one treatment over the other, the episode sparks stimulating discussions around the efficacy of oral minoxidil, its comparison to topical minoxidil, and the potential of randomized controlled trials in determining the optimal treatment for male androgenetic hair loss.
 
 
 
STUDIES REVIEWED IN THIS EPISODE
Penha MA et al. Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial. JAMA Dermatol . 2024 Apr 10:e240284. doi: 10.1001/jamadermatol.2024.0284. Online ahead of print
 
 
Panchaprateep et al. Efficacy and Safety of Oral Minoxidil 5 mg Once Daily in the Treatment of Male Patients with Androgenetic Alopecia: An Open-Label and Global Photographic Assessment. Dermatol Ther. 2020 Dec;10(6):1345-1357

Season 7, Episode 2: Drug-Induced Alopecia Areata

This episode is dedicated to a fascinating subject – drug-induced alopecia areata. In addition to genetic factors, alopecia areata is also influenced by environmental factors such as infections and medications. In this episode, Dr Donovan highlights two studies: “A Cross-Sectional Analysis of Medications Used by Patients Reporting Alopecia Areata on the FDA Adverse Events Reporting System” by Ravapati et al and “Drug-Induced Alopecia Areata: A Systematic Review” by Ezemma et al. These studies present an intensive exploration of drugs possibly causing alopecia areata.
Studies show that monoclonal antibodies are common culprits, and reports of drug-induced alopecia areata are rising every over time. 
Surprisingly, it has been observed that the onset of drug-induced alopecia areata could be delayed by as much as a year. Also, patients who discontinued the alleged drug stimulating alopecia areata experienced regrowth of hair, while those who didn't, failed unless treated.
Email is info@donovanhairacademy.com or visit our website www.donovanhairacademy.com.
Thank you all for joining. See you next week!

Season 7, Episode 1: Unraveling the Link Between Dupilumab and Cutaneous T-Cell Lymphoma

Welcome to a new episode of the Evidence-Based Hair Podcast, where we discuss some questions surrounding the relationship between dupilumab and lymphoma. This episode dives deep into a study by Hasan and colleagues that explores the fascinating and somewhat controversial relationship between Dupilumab, a drug often used to treat atopic dermatitis patients with alopecia areata, and an increased risk of Cutaneous T-Cell Lymphoma (CTCL). Despite its potential benefits, does Dupilumab truly cause CTCL, or does it simply unmask the disease in patients who were previously misdiagnosed?
Using information from a vast database, authors examined whether patients using dupilumab showed an increased incidence of CTCL compared to those who did not. Findings suggest that users of the drug have a four-fold increased risk of CTCL.  
While uncertainties remain on whether Dupilumab triggers lymphomas, causes benign lymphoid reactions, or accelerates existing CTCL, this episode underscores the drug's potential risks and the importance of careful diagnostics before prescribing it.
As we continue to gather data and debate the varying viewpoints, we invite you to join us in disentangling the complex relationship between Dupilumab and CTCL.  Stay tuned for our next episode, where we explore drug-induced alopecia areata and the potential triggering effects of new monoclonal antibodies.
 
 
donovanmedical
 Edited•
Season 7 of the Evidence Based Hair Podcast has started. This week I review several fascinating studies: The podcast can be accessed wherever you listen to your podcasts or via the DonovanMedical youtube channel.
REFERENCES IN THIS EPISODE
 
Hasan I et al. Dupilumab therapy for atopic dermatitis is associated with increased risk of cutaneous T cell lymphoma: a retrospective cohort study. J Am Acad Dermatol. 2024 Apr 6:S0190-9622(24)00566-8. doi: 10.1016/j.jaad.2024.03.039. Online ahead of print.Jfri A et al. Diagnosis of mycosis fungoides or Sézary syndrome after dupilumab use: A systematic review. J Am Acad Dermatol . 2023 May;88(5):1164-1166. doi: 10.1016/j.jaad.2022.12.001. Epub 2022 Dec 5.Espinosa ML et al. Progression of cutaneous T-cell lymphoma after dupilumab: Case review of 7 patients. J Am Acad Dermatol . 2020 Jul;83(1):197-199. doi: 10.1016/j.jaad.2020.03.050. Epub 2020 Mar 27.

Top 20 Hair Research Studies of 2023

This is a recording from the live webinar was conducted live December 13, 2023. This is an annual event that is held every year in mid-December celebrating the top hair research studies. 
 
DERMATOPATHOLOGY
 
Douglas A et al. Scalp Biopsy Influences Diagnostic Accuracy and Treatment in Black Women with Alopecia: A Retrospective Study. J Am Acad Dermatol. 2023 Jan 31;S0190-9622(23)00157-3.
 
ANDROGENETIC ALOPECIA
Gupta AK et al.The relative efficacy of monotherapy with 5-alpha reductase inhibitors and minoxidil for female pattern hair loss: A network meta-analysis study. J Cosmet Dermatol. 2023 Jun 29
Jimenez-Cauhe J et al. Safety of Low-Dose Oral Minoxidil in Patients With Hypertension and Arrhythmia: A Multicenter Study of 264 Patients. Actas Dermosifiliogr. 2023 Aug 29:S0001-7310(23)00679-8.
 
ALOPECIA AREATA
 
Gandhi et al.The Association of Alopecia Areata-Related Emotional Symptoms with Work Productivity and Daily Activity Among Patients with Alopecia Areata. Dermatol Ther (Heidelb). 2023 Jan;13(1):285-298.
 
Li SJ et al. Experiencing Workplace Bullying in Patients with Alopecia Areata: A Cross-Sectional Survey Study. Skin Appendage Disord. 2023 Aug;9(4):258-261
 
Kazmi A et al. Switching between tofacitinib and baricitinib in alopecia areata: A review of clinical response. J Am Acad Dermatol. 2023 Apr 4;S0190-9622(23)00532-7.
 
King B et al. Efficacy and safety of ritlecitinib in adults and adolescents with alopecia areata: a randomised, double-blind, multicentre, phase 2b-3 trial. Lancet. 2023 May 6;401(10387):1518-1529.
 
George P et al. Incidence Rates of Infections, Malignancies, Thromboembolism, and Cardiovascular Events in an Alopecia Areata Cohort from a US Claims Database., Dermatol Ther (Heidelb). 2023 Aug; 13(8): 1733–1746.
 
Wang C-W et al. Clinical characteristics and immune profiles of patients with immune-mediated alopecia associated with COVID-19 vaccinations. Clin Immunol. 2023 Oct:255:109737.
 
Chen J et al. The Incidence of Alopecia Areata in a COVID-19- Vaccinated Population: A Single-Center Review. Cureus 2023
 
TELOGEN EFFLUVIUM
 
Michelini S et al. Telogen Effluvium in SARS-CoV-2 Infection: histological aspects. J Eur Acad Dermatol Venereol. 2023 Mar 8.
 
TINEA CAPITIS
Gold, JA et al. Inadequate diagnostic testing and systemic antifungal prescribing for tinea capitis in an observational cohort study of 3.9 million children, United States. J Am Acad Dermatol. 2023 Feb 15;S0190-9622(23)00189-5.
 
COSMETIC DERMATOLOGY
Landau M et al. Nonscarring alopecia after temporal lifting technique with dermal fillers. JAAD Case Rep. 2023 May 12;37
 
FOLLICULITIS DECALVANS
Matard B et al. Folliculitis decalvans and dystrophic epidermolysis bullosa: a significant association. Br J Dermatol 2022 Dec;187(6):1026-1028.
DISCOID LUPUS
Fredeau L et al. Risk factors of progression from discoid lupus to severe systemic lupus erythematosus: a registry-based cohort study of 164 patients. J Am Acad Dermatol. 2023 Mar;88(3):551-559.
 
DISSECTING CELLULITIS
Cajas-Garcia MS et al.  Distinct presentations of scalp dissecting cellulitis manifesting with furrows and gyri. J Eur Acad Dermatol Venereol. 2023 Feb 3.
 
LICHEN PLANOPILARIS Lim SH et al. Prevalence and Incidence of Comorbid Diseases and Mortality Risk Associated with Lichen Planopilaris: A Korean Nationwide Population-Based Study. Clin Exp Dermatol. 2023 Jul 11;llad235
GENERAL SCARRING ALOPECIA
Kim SR et al.  Association of Primary Cicatricial Alopecia with Subsequent Cardiovascular Disease. J Invest Dermatol. 2023 Nov 19:S
 
CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA
Joshi TP et al.  Comorbidities in patients with central centrifugal cicatricial alopecia: a case-control study. Int J Dermatol. 2023 Nov 23.
 
ACNE KELOIDALIS NUCHAE
Lobato-Berezo A et al. Acne keloidalis nuchae: An international multicentric review of 79 patients. J Eur Acad Dermatol Venereol. 2023 Nov 1.

Season 6, Episode 7 (JAK Inhibitors in Skin Disease - Risk of Cardiovascular Disease, Blood Clots, and Acne)