Discussion about Alopecia Areata and other Hair Loss after Will Smith Oscar Slap

Dr. Marc Darst, a Charlotte, NC board certified Dermatologist has be treating patients with various forms of alopecia (hair loss) for decades and he felt that based on Chris Rock’s recent joke at the Oscars about Jada Pinkett Smith’s baldness that there needs to be clarification on this medical condition.

Alopecia is an overarching term for hair loss.  There are several subtypes of Alopecia, one of which is Alopecia Areata (AA).  AA is an autoimmune disease caused when the body attacks itself and sends white blood cells to attack the hair follicles.  The cells encircle the base of the hair follicle, the hair bulb, and cause the hair to become narrower over time, until it snaps off at the skin surface.   AA is fairly common and affects up to 2% of people over their lifetime, similar to the incidence of Psoriasis.

There are five major patterns of AA – Patch, Totalis and Universalis as well as Ophiasis and Sisaipho. The most common form of AA is Patch Type which leads to small to large bald patches over the scalp or beard area.   Alopecia Totalis is total hair loss over the scalp and can include the eyelashes and eyebrows.  Alopecia Universalis is the rarest of the subtypes and leads to loss of hair all over the body. Ophiasis spares the hair around the edges of the scalp (think classic illustration of a monk) and Sisiapho is the opposite of Ophiasis.

While  limited treatment options for AA exist,  oftentimes steroids are  injected into the area of the hair bulbs which drives the inflammation out of the area and allows the hair follicles to recuperate. In my experience, topical steroids have not been very effective. For larger or more recalcitrant areas, we can use squaric acid to induce all allergic reaction and then use a low dose of squaric acid topically to induce a mild irritation, which paradoxically drives inflammation out of the scalp. This process lends to the reasoning why I believe  Nioxxin shampoo has a possible role in the treatment of AA. Nioxxin contains stinging nettle, which is a natural low level irritant.

Recently, there has been interest in a certain type of biologic agent called JAK inhibitors to treat AA. JAK inhibitors target a cellular inflammatory pathway, the Janus Kinase pathway.  At Darst Dermatology, we are participating in clinical research studies of a unique JAK inhibitor, with the goal of demonstrating that this drug helps resolve Alopecia Areata, especially Totalis and Universalis.

Hopefully in the near future more affordable and effective therapies will be discovered and made available to people everywhere.