[HN Gopher] FDA approves first systemic treatment for alopecia a...
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       FDA approves first systemic treatment for alopecia areata
        
       Author : birriel
       Score  : 69 points
       Date   : 2022-06-14 18:01 UTC (4 hours ago)
        
 (HTM) web link (www.fda.gov)
 (TXT) w3m dump (www.fda.gov)
        
       | [deleted]
        
       | meremortals wrote:
       | This is great, but note that Alopecia Areata is different from
       | male pattern baldness
        
         | LewisVerstappen wrote:
         | Yeah, but there is Finasteride for male pattern baldness which
         | has fantastic results and is incredibly cheap (I got a 3 month
         | supply for $12).
         | 
         | A 10 year study published by the Tokyo Medical Clinic of
         | finasteride carried out in Japan found that more than 99
         | percent of men with male pattern baldness experienced no
         | worsening of their hair loss during treatment [1]
         | 
         |  _Tons_ of additional clinical evidence showing that
         | Finasteride works.
         | 
         | [1] - https://www.researchgate.net/publication/337105943_Long-
         | term...
        
           | skrtskrt wrote:
           | The key being that it doesn't give any hair regrowth in the
           | vast majority of people, so you have to get people taking it
           | before they see much balding, which is an interesting
           | challenge - why worry about something you can barely see or
           | notice until it's already a problem?
           | 
           | There are ad campaigns from male order providers such as Hims
           | and Keeps around this, I wonder how effective they are.
           | 
           | I take it, and it stopped the balding progression as far as I
           | can tell, but I had to get an FUE hair transplant to get some
           | lost hair back.
        
             | maerF0x0 wrote:
             | iirc there's a largely genetic component to it, so one
             | could simply proactively take it if they carry the genes.
             | But the side effects can be unfortunate (depression,
             | libido) . Seems like topical is better than oral.
        
             | meremortals wrote:
             | Same. Not much, if any, regrowth
        
             | mywittyname wrote:
             | There's surgery to replace the lost hair (with hair moved
             | from somewhere else, granted). It's certainly much more
             | expensive than catching it early and treating it with minox
             | or whatever, but it's within the reach of many people
             | (<$10k).
        
               | bbarnett wrote:
               | I heard from a barber, that despite claims hairs from the
               | back of the head are different follicles, and won't die
               | off, this is all lies and marketing bs.
               | 
               | So you need endless treatments, or else take testosterone
               | blockers.
        
               | rjh29 wrote:
               | And you continue to recede so you will need follow-up
               | treatments for that. If you're too far gone it's just not
               | practical.
               | 
               | It's a meme at this point, but for most people shaving
               | their head is the right option.
        
               | skrtskrt wrote:
               | Well
               | 
               | 1. even back of head hair thins eventually in balding
               | people, but generally many decades later than the front
               | or crown. By the time you're losing that hair, you're
               | probably a lot older and care much less
               | 
               | 2. taking finasteride indefinitely is supposed to
               | drastically slow or stop further thinning or loss. Of
               | course as in point 1, you're probably going to lose that
               | battle eventually, but again you'll be much much older
               | when the damage gets serious than you would have been
               | otherwise
        
             | LewisVerstappen wrote:
             | > why worry about something you can barely see or notice
             | until it's already a problem?
             | 
             | So, you measure hair loss with the Norwood scale. You don't
             | go from 100% hair to bald spots immediately.
             | 
             | First, you'll see diffuse thinning where the thickness of
             | your hair drops significantly.
             | 
             | In the first stages of diffuse thinning, it won't be
             | apparently to 99% of people that your hair is thinning but
             | you'll immediately notice when you take a shower / apply
             | shampoo (it's really obvious when your hair is wet).
             | 
             | I'd say that's when most men realize they're losing their
             | hair and that's when they should get on Finasteride.
        
               | nsxwolf wrote:
               | It may still be too late at that point. In my experience
               | people who care about a man's hair (women, mostly) see
               | hair loss as a binary thing - you either have a full head
               | of hair, or you're balding. They don't see a guy in the
               | earliest stages of hair loss and say "Oh, he's got a
               | pretty decent Norwood score!", they say "he's bald".
               | 
               | I've known two women that mentioned they'd rather date a
               | man with a full head of hair who shaves his head than a
               | balding man who shaves his head. I pressed it as far as
               | asking "Well, what if they keep shaving it for life?"
               | Same answer.
        
               | skrtskrt wrote:
               | It also depends on your head shape, I see a lot of men
               | who are very good looking still with a fair amount
               | visible recession, and they do quite well with their
               | dating life.
               | 
               | Personally I just felt like the relatively small amount
               | of recession I had looked terrible on me because I
               | already had a tall forehead to begin with, and I'm still
               | in my 20s.
        
             | bennysomething wrote:
             | I've been on finastride for about 12 years. I'm never sure
             | if it's working or not. Scared to stop!
             | 
             | How well did the hair transplant work?
        
               | skrtskrt wrote:
               | Never stop!
               | 
               | Hair transplant worked really well. Natural-looking
               | hairline, which is the most important part. You'll see a
               | lot of before and afters where the hairline looks like a
               | Lego block hair piece was snapped into place - choose
               | your doctor carefully here.
               | 
               | You'd only notice if you're looking really closely, where
               | you'll see that the hairs are quite a bit thicker, as
               | they were transferred from the back of my head where
               | everyone's hairs are thick, but I have especially thick
               | hair in general.
        
               | 01100011 wrote:
               | One thing I think worth mentioning is that you should
               | anticipate having to get multiple transplants if you
               | expect to have much future hair loss. I just saw a guy a
               | few weeks ago who had gone mostly bald on top but had an
               | obvious row of hair across his hairline. It looked like
               | he had gotten a transplant early on and then didn't
               | continue as his hairloss progressed.
        
             | rjh29 wrote:
             | I took it way too late and it didn't really help. I shaved
             | after and I'm really happy with that decision.
        
           | agent008t wrote:
           | Given the potential serious, life-changing adverse effects
           | that persist even after stopping use - no thanks. Just cut
           | your hair short / shave your head.
        
             | rjh29 wrote:
             | Maybe in the 70s/80s it was weird to be bald, but there are
             | so many bald people now, it's like whatever. If you think
             | I'm ugly or you're not into it fine, but there are plenty
             | of women who are.
        
               | the_only_law wrote:
               | I think it depends, bigger and stockier guys seem to pull
               | it off pretty well.
               | 
               | I don't think I could pull it off though, at least right
               | now. I have a taller, lankier statue and I worry I'd look
               | like a skinhead.
               | 
               | I've seen some smaller guys pull it off as well, but
               | they're usually shorter. Most guys that go clean shaven
               | with my kinda build end up looking goofy.
               | 
               | On the flip side, long hair on bigger guys always looks
               | odd to me.
        
             | nsxwolf wrote:
             | What ever happened to toupees? Young men seem to not even
             | consider them as an option, even though the quality is
             | better now than ever.
        
               | failrate wrote:
               | You never notice the good toupees.
        
       | xchip wrote:
       | - The most common side effects associated with Olumiant include:
       | 
       | upper respiratory tract infections, headache, acne, high
       | cholesterol (hyperlipidemia), increase of an enzyme called
       | creatinine phosphokinase, urinary tract infection, liver enzyme
       | elevations, inflammation of hair follicles (folliculitis),
       | fatigue, lower respiratory tract infections, nausea, genital
       | yeast infections (Candida infections), anemia, low number of
       | certain types of white blood cells (neutropenia), abdominal pain,
       | shingles (herpes zoster) and weight increase.
       | 
       | - Olumiant comes with a boxed warning for serious infections,
       | mortality, malignancy, major adverse cardiovascular events and
       | thrombosis.
        
         | yieldcrv wrote:
         | I wish that illicit scheduled drugs, like the ones legal at the
         | state level, just had the mere standardized _study_ for any
         | side effect
         | 
         | I hate that we are relying on anecdotes, and for recreational
         | state level approval we have approved for _every_ use case and
         | that this is the best we can do while debating the polar
         | opposite style of federal prohibition
         | 
         | Federal FDA approvals for _everything else_ are for a single
         | use case or ailment at a time, and then we get all the side
         | effects they found for an informed decision.
         | 
         | States approvals have.... nothing. California industry just
         | throws a random "maybe cancer" logo on it and calls it a day!
        
       | user3939382 wrote:
       | I feel like there's a Jada Smith joke in here somewhere... I
       | never heard the term alopecia in my life until that "slap"
       | incident and subsequently heard it 1000 times in reference to
       | that. Hard not to see this headline and think of it.
        
         | nailer wrote:
         | Jada Pinkett Smith doesn't have alopecia, she has a facelift
         | scar.
         | 
         | https://youtu.be/DdPmmlvhpHk
        
           | gnicholas wrote:
           | That was speculation by a doctor who hasn't treated her.
           | Timestamped link: https://youtu.be/DdPmmlvhpHk?t=694
        
             | nailer wrote:
             | That is correct, however the doctor is a hair loss
             | specialist (and also has alopecia himself, which I feel may
             | mean he is quite familiar with the condition).
        
               | gnicholas wrote:
               | Agree that he can weigh in on whether the scar is not
               | alopecia, but less so on whether it is a scar (or from
               | what). Also, he's not saying that the balding is from a
               | scar, which was the impression I got when I first read
               | your comment.
        
       | [deleted]
        
         | blobbers wrote:
        
       | sabujp wrote:
       | relevant https://www.cnn.com/2022/03/29/health/what-is-alopecia-
       | areat...
        
       | LosWochosWeek wrote:
       | What a coincidence. I just got my first appearance of alopecia
       | areata (only one spot, has been there for 10 weeks now --- hoping
       | more dont pop up). It's quite annoying. Unfortunately, living in
       | the EU I'll have to wait for you guys to figure it out first.
       | 
       | PS: Anyone in the know who wants to give me the straight answer
       | to whether or not I should be expecting more holes to pop up?
        
         | jonlucc wrote:
         | Yes, alopecia areata is generally a progressive disease. It
         | might be worth discussing with your doctor early. I'm not too
         | familiar with the European regulatory landscape, but I would
         | guess any JAK inhibitor would need to prove efficacy in a
         | European-listed trial of AA to seek approval there, and maybe
         | you'd be a candidate.
        
         | washedup wrote:
         | Sample-size of 1 here: Yeah, I would prepare myself to see
         | more. Mine came on kinda strong, both scalp and beard. Doing
         | full shave now, still have eyebrows though!
        
           | LosWochosWeek wrote:
           | May I ask after much time had passed after you got your first
           | hole before you got the other holes?
        
         | SoftTalker wrote:
         | I had it in my facial hair a few years ago. Two bare patches.
         | My barber said it was likely stress-related (though I didn't
         | feel stressed out at all). Then a year or two later it went
         | away for no apparent reason. Nothing had really changed in my
         | life that I could think would affect my stress levels. In other
         | words, both its appearance and disappearance are a complete
         | mystery.
         | 
         | I also have almost no hair on my legs below my mid-calf, and I
         | did when I was younger.
        
         | voldacar wrote:
         | This drug (baricitinib) seems to be approved for use in the EU
         | (https://www.ema.europa.eu/en/medicines/human/EPAR/olumiant),
         | but if EU pharmacies don't have it yet you might be able to
         | order it on some online gray market source, which is pretty
         | easy these days for a variety of substances.
        
       | swayvil wrote:
       | After perusing this thread, maybe the article too, head on over
       | to reddit. Dimes to donuts a "hair loss remedy" advertisement
       | pops up.
       | 
       | Just a reminder, Google is watching.
        
       | takk309 wrote:
       | It will be interesting to hear how this drug impacts those with
       | alopecia universalis, a sub type of alopecia areata. My sister
       | has universalis from birth. I doubt she would want to do anything
       | about it at this point, she is in her 40's.
        
         | georgyo wrote:
         | My sister, also now in her 40s, got alopecia universalis when
         | she was 17. Truly tramatic to a teenager.
         | 
         | The treatments at the time were mostly steroids, which did not
         | help and caused all sorts of other problems.
         | 
         | This is an immunosuppressant, so I am curious at the long term
         | implications of this. The current list of side effects is
         | pretty scary.
        
           | takk309 wrote:
           | Yeah, for sure. I would imagine for those that have learned
           | to live with it, the side effects won't be worth the
           | benefits.
        
       | wing-_-nuts wrote:
       | Given that alopecia is a kind of autoimmune disease it makes me
       | wonder if this can also be used to treat other autoimmune
       | diseases as well? I know they previously had some luck treating
       | alopecia with biologics for example.
        
         | nonameiguess wrote:
         | The announcement says this same drug was originally approved
         | for treating rheumatoid arthritis in 2018, so apparently yes.
        
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