Evidence Based Hair

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)

Season 6, Episode 6 (Alopecia Areata Triggered by COVID19 Vaccination)

STUDIES REFERENCED IN THIS EPISODE
 
Pastukhova E et al. Alopecia Areata as a Sequela of COVID-19 Vaccination: A Systematic Review J Cutan Med Surg. 2023 Jan-Feb;27(1):64-65.
 
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.
 
Genco L et al. Alopecia Areata after COVID-19 Vaccines. Skin Appendage Disord. 2023 Mar;9(2):141-143.
 
 

Season 6, Episode 5 (COVID 19 Infection and the Risk of Autoimmune Disease)

STUDIES REVIEWED THIS WEEK:
 
Chang R et al. Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study. EClinicalMedicine. 2023 Feb;56:101783
 
Tesch F et al. Incident autoimmune diseases in association with SARS-CoV-2 infection: a matched cohort study. Clin Rheumatol. 2023 Oct;42(10):2905-2914. 
 
Lim SG et al. Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19  JAMA Netw Open. 2023 Oct 2;6(10):e2336120.
 
 
Pastukhova E et al. Alopecia Areata as a Sequela of COVID-19 Vaccination: A Systematic Review J Cutan Med Surg. 2023 Jan-Feb;27(1):64-65.
 
 
STUDIES TO BE REVIEWED NEXT WEEK (PREVIEW)
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.
 
Genco L et al.  Alopecia Areata after COVID-19 Vaccines. Skin Appendage Disord. 2023 Mar;9(2):141-143.

Season 6 Episode 4 (Baricitinib for CCCA, LED laser therapy for CCCA)

STUDIES REFERENCED IN THIS EPISODE:
Workman K and Kindred C (starts at 2:10). Hair regrowth in a patient with central centrifugal cicatricial alopecia after a 2-month trial of baricitinib. JAAD Case Rep. 2023 Jul 28:39:109-111.
 
Cook M et al (starts at 12:07). Use of low-level light therapy in management of central centrifugal cicatricial alopecia: A case series of four patients. Photodermatol Photoimmunol Photomed. 2023 Aug 23.
 

Season 6, Episode3 (Effect of Oral Minoxidil on Blood Pressure, Oral Minoxidil Use in Patients with High Blood Pressure and Arrhythmia)

ARTICLES COVERED THIS WEEK  
 
STUDY 1:
Ong M et al (starts at 5:12). Low-dose oral minoxidil for androgenetic alopecia is not associated with clinically significant blood-pressure changes: a retrospective study. J Am Acad Dermatol. 2023 Oct 13:S0190-9622(23)02976-6. 
 
Sanabria et al. Prospective cardiovascular evaluation with 24-h Holter and 24-h ambulatory blood pressure monitoring in men using 5 mg oral minoxidil for androgenetic alopecia. J Am Acad Dermatol. 2022 May 18;
 
Jimenez-Cauhe J et al. Before-after study with 24-hour ambulatory blood pressure monitoring after the first dose of 5 mg oral minoxidil. J Am Acad Dermatol. 2022 Dec;87(6):e235-e237
 
STUDY 2: 
Imhof R et al (starts at 16:35). Safety and tolerability of low dose oral minoxidil monotherapy in female pattern hair loss: A retrospective review with longitudinal ambulatory blood pressure monitoring. JAAD Int. 2023 Aug 12:13:50-52.
 
Ramos PM et al.  Minoxidil 1 mg versus minoxidil 5 % topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. J Am Acad Dermatol Jan 2020;82(1):252-253.
 
STUDY 3: 
Jimenez-Cauhe J  et al (starts at 24:27). 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.
 
Vano-Galvan S et al. Safety of  low dose oral  minoxidil for hair loss: A multicenter study of 1404 patients. JAAD 2021; 84: 1644-51.
 
Sanabria B et al. Adverse effects of low dose oral minoxidil for
androgenetic alopecia in 435 patients. JAAD 2021; 84: 1175-78.
 
 
ARITCLES COVERED NEXT WEEK (PREVIEW)
 
Cook M et al. Use of low-level light therapy in management of central centrifugal cicatricial alopecia: A case series of four patients. Photodermatol Photoimmunol Photomed. 2023 Aug 23.
 
Workman K and Kindred C. Hair regrowth in a patient with central centrifugal cicatricial alopecia after a 2-month trial of baricitinib. JAAD Case Rep. 2023 Jul 28:39:109-111

Season 6, Episode 2 (A Closer Look at Randomized Controlled Trials and Real World Non RCT Data)

ARTICLES REFERENCED IN THIS EPISODE
 
Krauss A (starts at 12:44). Why all randomised controlled trials produce biased results. Ann Med. 2018 Jun;50(4):312-322.
 
Van Noreen R (starts at 15:33). Medicine is plagued by untrustworthy clinical trials. How many studies are faked or flawed? Nature. 2023 Jul;619(7970):454-458. Listen at https://youtu.be/_QLvzCr6nz4?feature=shared
 
Carlisle JB (starts at 16:28). False individual patient data and zombie randomised controlled trials submitted to Anaesthesia. Anaesthesia. 2021 Apr;76(4):472-479.
 
 
 
PREVIEW STUDIES FOR NEXT WEEK  (SEASON 6, EPISODE 3)
Ong M et al. Low-dose oral minoxidil for androgenetic alopecia is not associated with clinically significant blood-pressure changes: a retrospective study. J Am Acad Dermatol. 2023 Oct 13:S0190-9622(23)02976-6. doi: 10.1016/j.jaad.2023.10.010. Online ahead of print.
Jimenez-Cauhe 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.
Imhof R et al. Safety and tolerability of low dose oral minoxidil monotherapy in female pattern hair loss: A retrospective review with longitudinal ambulatory blood pressure monitoring. JAAD Int. 2023 Aug 12:13:50-52.