Author: drkingsley

DO YOU KNOW JAK?

One of the most important new treatments that many people in the trichological field are talking about are JAK inhibitors.  As Dr. Brett King, MD, PhD said at the summer 2018 American Academy of Dermatology meeting in Chicago, Illinois, “JAK inhibitors will be a very important — maybe the most important — drug class in dermatology because of their broad applicability across numerous conditions that patients commonly, and uncommonly, present within our clinics.”

With this in mind, I thought it fitting to devote this article explaining what a JAK is and why inhibiting it may help many of our trichological clients.

What does ‘JAK’ stand for and what is it?

JAK is short for “Janus Kinase”.  There are four types of Janus Kinases.

Janus kinases are involved in the process of signaling between cells (known as the JAK-STAT pathway). Cell signaling is important in how cells function and in coordinating important actions of cells.

Immune Disorders.

 Examples of the role of JAK-STAT pathways in cell functions are: the regulation of the immune system, responses to infection, immune responses, and inflammation.  If the regulation of the JAK-STAT pathway is disturbed, immune disorders may result.

For the trichologist, immune disorder conditions include alopecia areata, cicatricial alopecia, atopic dermatitis (a form of itchy eczema) and psoriasis.

What is a JAK inhibitor?

A JAK inhibitor is a substance that inhibits the JAK-STAT pathway, thus potentially reducing the immune disease.

JAK inhibitors target the processes that cause these diseases and, therefore, interrupt those processes to reverse the diseases or make them better.

JAK inhibitors in the news recently are Ruxolitinib and Tofacitinib which were approved by the FDA to treat rheumatoid arthritis and bone marrow disease. Some studies have shown the potential of these medications to also help improve moderate to severe atopic dermatitis and alopecia areata.

Case Reports

1) A sixteen patient study (all with Alopecia Universalis) used two topical JAK inhibitors, 2% tofacitinib and 1% ruxolitinib, for 28 weeks. Five patients (31%) demonstrated partial hair regrowth, two patients (12%) had significant regrowth over their entire scalp and eyebrows (see reference 1).

2) A 22-year-old man presented with a history of Alopecia Universalis (AU) that progressed over 5 years. He exhibited hair loss on the scalp, eyebrows, eyelashes, face, chest, and bilateral upper and lower extremities.  Skin biopsy results of the scalp were consistent with those of AU, which was previously treated with intralesional steroids with minimal improvement.  Because of the lack of response of the AU, the patient was started on off-label tofacitinib (JAK inhibitor) at a dose of 5 mg orally, twice daily. After 10 months of treatment, the patient experienced hair regrowth on all of the affected body parts. After treatment, the patient reported no adverse side-effects (see reference 5).

3) There have also been promising developments in other topical JAK inhibitors studies which have been shown to help patients with alopecia areata. These are currently in Phase II and Phase III trials that are assessing the JAK inhibitors’ efficacy (see reference 3).

Trichological Analysis

Before recommending a JAK inhibitor, I suggest a trichologist send their client/patient to a physician to check blood levels of vitamin D, vitamin B12, ferritin, and thyroid (TSH). 

It is also important to discuss a patient’s lifestyle and medical history such as, stress, diet, medications, family and health history.

Conclusion

Over the years, effective treatment(s) for alopecia areata, atopic dermatitis, etc. have been limited. It is hoped that over the next few years JAK inhibitors will provide a more reliable treatment option.  By working with a dermatologist or immunologist, a trichologist would be giving their clients the best possible supervision to help improve their condition.

Although JAK inhibitors have the potential to help improve certain trichological conditions, further studies are needed on long term safety, best dosages, vehicles used for topical formulations for skin penetration and reduced systemic absorption, and cost.

I hope that by 2020 these questions will have been successfully answered.

References

1) Bokari L, et al.Treatment of alopecia universalis with topical Janus kinase inhibitors – a double blind, placebo, and active controlled pilot study. International Journal of Dermatology, Aug 2018.

2) Gotthardt D, et al. STATs in nK-Cells: The Good, the Bad, and the Ugly. Frontiers in Immunology, 2017; 7: 694.

3) Hosking AE, et al. Topical Janus kinase inhibitors: A review of applications in dermatology. Journal of American Academy Dermatology, 2018; 9: 535-544.

4) Iorizzo M, et al. Emerging drugs for alopecia areata: JAK inhibitors. Expert Opinions on Emerging Drugs,Mar 2018; 23(1): 77-81.

5) Morris GM, et al. Simultaneous improvement of alopecia universalis and atopic dermatitis in a patient treated with a JAK inhibitor. JAAD Case Reports, 2018; 4: 515-517.

6) Rawling JS, et al. The JAK/STAT signaling pathway.Journal of Cell Science, 2004; 117(8): 1281-1283.

7) Seif F, et al. The role of JAK-STAT signaling pathway and its regulators in the fate of T helper cells.Cell Communication and Signaling, 2017; 15: 23.

©2018 World Trichology Society       www.WorldTrichologySociety.org    

 

This is the most common cause of hair loss in both

men and women. Genetic hair loss is caused by

more than one gene so both sides of your family can

influence your hair loss. Your hair colour and texture

could also be a combination of your maternal and

paternal hair types.

 

Genetic hair loss is caused, in the main, by a

sensitivity of the hair follicle to the male hormone

dihydrotestosterone (DHT). The DHT causes the

growing phase of the hair cycle to become shorter

and, consequently, the resting phase to become

longer. There is also a reduction in the size of

the affected follicles causing the hair to become

increasingly shorter and finer.

 

Dr. Kingsley’s solutions for Genetic Hair Loss:

Try one of these treatments individually or in combination:

1. Minoxidil.

Usually the 5 percent solution is recommended for

men and the 2 percent for women. It should be

applied directly to the scalp twice a day.

2.  Laser Light Therapy.

Low-level laser light uses low-intensity phototherapy

that is cool to the touch. It should be used three times

a week by men or women.

3.  Propecia.

It works by reducing the amount of DHT present. It is a

prescription medicine that is for men only.

4.  Saw Palmetto.

This is a herb which has been purported to help

reduce DHT production with few side-effects. It is for

men or post-menopausal women.

5.  Spironolactone.

Also known as Aldactone, it may be capable of slowing

the course of female pattern hair loss. It should only be

used by women.

 

Please call 718-698-4700 to make an appointment to see Dr. Kingsley.

©2018 British Science Corporation

 

Stress can affect your hair cycle, and losing your hair

can cause a lot of stress! Under most circumstances,

increased hair shedding occurs between four and

sixteen weeks after the stress trigger has occurred.

Although it is often difficult to pinpoint a specific

stress episode as the cause of your hair loss, acute and

chronic stress may precipitate hair-loss conditions such

as genetic hair loss, telogen effluvium (hair shedding)

and alopecia areata (patchy hair loss). In addition to

stress causing hair loss, hair loss undoubtedly causes

stress for the sufferer. It affects one’s self esteem and

quality of life, which in turn can cause more hair loss.

Dr. David Kingsley’s solutions for Stress Induced Hair Loss

1. Exercise.

Exercising can be very effective at relieving mild to

moderate stress and depression. You should exercise

at least three times a week for more than thirty

minutes. When you are under more stress, increase

your exercise frequency to five or six times a week. Any

exercise that you enjoy should be adequate, as long as

it increases your heart rate. Go for a walk or take yoga.

Exercise has been shown to reduce anxiety, increase

oxygen supply in the body and reduce stress-related

problems that can affect the hair cycle.

2.  Stay Flexible.

If you are too rigid with your plans, you may be putting

more stress on yourself. So stay flexible with your plans

to help reduce this type of stress.

3.  Stop Multi-‐Tasking.

Try your best to concentrate on one activity at a time.

You’ll feel less stressed and do a better job at your tasks

if you work on them individually.

4.  Get Some Sleep.

Not getting enough sleep can cause stress and

depression. Try to go to bed earlier to make sure you

get in a full 7-8 hours every night.

5.  Meditate.

Another way to help stress is to meditate. A few

minutes three to four times a week can really help

to relieve stress. A good time to meditate is after you

have exercised, when you tend to be a little tired

and can relax more easily (although don’t fall asleep

during meditation or you will lose some of its benefits).

Relaxing the mind helps your body relax and improves

both physical and mental health.

6.  Deep breathing.

While sitting, take slow deep breaths and count to five

as you inhale and five as you exhale. Repeat this three

to five times.

7.  Muscle relaxation.

While lying down, tense and then relax your arm

and leg muscles one at a time. First, clench and then

unclench your fists one at a time, relaxing your arms

on the floor. Second, lift and then lower your legs one

at a time, leaving them relaxed on the floor. Lay relaxed

for at least five minutes.

8.  Listen to Music.

While sitting, listen to gentle music (preferably music

without words). Music often helps soothe people’s

stress. Continue sitting for at least five minutes.

9.  Have a Bath.

Lie in a warm bath for a few minutes. It often helps to

relax your body’s muscles and can also help ease your

anxiety.

10. Positive Thoughts.

Try to think of positive life events rather than dwelling

on negative ones. Try to concentrate on something

positive you did today or something you are looking

forward to doing. Ignore any negative thoughts that

may ‘try’ to enter your mind.

11.  Talk to Someone Close.

I find that it helps to talk to someone close to you

about your hair anxieties. Often discussing your

concerns about losing or thinning hair helps to

diminish the stress that hair loss can cause.

 

Please call 718-698-4700 to make an appointment to see Dr. Kingsley.

©2018 British Science Corporation

 

Your hair needs a plentiful supply of protein, energy producing

molecules (carbohydrates) and certain

vitamins and minerals for optimal growth to occur. As

the hair follicle is a nonessential tissue and, therefore,

one of the last tissues to receive nutritious substances

(or the first to have them reduced), any long-term

deficiencies may lead to premature hair loss.

Also, hair is one of the fastest-growing tissues in the

body. If you pulled together all the hair that grows

on your scalp in a month to form a single strand, the

strand would be approximately 3/4 mile or 1 kilometer

in length! Any nutritional disturbance to the hair

follicle can cause an increase in shedding and slower

regrowth.

 

Dr. David Kingsley’s solutions for Diet Induced Hair Loss:

1. Protein.

Protein is a building block for hair growth. I suggest

that you should eat at least 5 ounces (approximately

150 grams) of protein a day. You can eat protein in

many forms, including meat, chicken, fish, beans, eggs,

cheese and tofu. Because your hair is made of 80 to 95

percent protein, this is an important area of your diet.

2.  Amino acids.

Amino acids are substances that make proteins. I

suggest taking 500 milligrams of l-lysine and 250

milligrams of l-cysteine per day.

3. Carbohydrates.

Carbohydrates help supply energy for hair growth.

Glucose, a simple carbohydrate derived from more

complex carbohydrates such as fruits, vegetables,

bread, pasta and rice, is used by our cells to make

energy (called ATP). You need to eat regularly (every

four hours) to maintain adequate energy levels for your

hair follicles. I suggest you either eat six small meals

per day or have three meals supplemented with small

snacks in between.

4.  Protein/Carbohydrate Diet.

Although I suggest protein in your diet, I do not

advocate very high-protein,low-carbohydrate diets.

I believe your hair needs a balance. With too little

protein, your body may lack the raw materials to build

your hair; with too little carbohydrates, your body

may lack enough “fuel” to drive the machinery that

produces your hair.

5.  Minerals.

Iron deficiency is a major cause of hair loss especially in

women or men who are vegetarian. So if you are iron

deficient or anaemic, then taking iron could be helpful

for your hair. To find out whether you are iron deficient

or anaemic, see your physician for a blood test. Other

important minerals for healthy hair functioning are: zinc

(found in seafood and cereals), silica (found in potatoes,

red and green peppers and bean sprouts), magnesium

(found in green vegetables and nuts), and essential fatty

acids (such as omega fatty acids found in fish).

6.  Vitamins.

An adequate amount of B complex vitamins–such as

biotin (100 to 500 micrograms per day), vitamin B12

(25 to 200 micrograms per day) and folic acid (200 to

400 micrograms per day)–can help the hair. Biotin can

be found in oatmeal, egg yolk and soy; vitamin B12

in dairy, meat, and fish; and folic acid in beans, grains,

vegetables and fruit.

Vitamin D, found in milk, fish, eggs and mushrooms

may also be helpful for hair growth. Take 400-800

International Units per day.

Beware of taking too much vitamin A (in excess of

25,000 IU per day). It can cause hair loss if taken in

extremely high dosages.

7.  Lifestyle Diet.

I suggest that you follow a general lifestyle diet rather

than continually dieting as rapid weight gain or loss

can cause hair loss. This means that you should try

and eat balanced meals every day, not just when you

decide to go on a diet. Frequent (six) small meals or

three meals supplemented with regular snacks are the

best type of “lifestyle diets”.

8.  See Healthcare Provider

Consult with a knowledgeable healthcare provider

for advice about eating a balanced diet or taking

supplements.

Please call 718-698-4700 to make an appointment to see Dr. Kingsley.

©2018 British Science Corporation

 

Losing hair can be devastating. An increase in the

amount of hair falling out or a widening of the hair

parting can cause you anxiety and distress, affect your

self-esteem or cause you to cancel your social life.

Although the most common cause of hair loss is

genetics, there are many other factors that can also

cause the problem.

 

Dr. David Kingsley’s Solution:

1. Find Out Why You Are Losing Your Hair.

Even if genetic hair loss is the most obvious reason

for losing your hair, other factors could also be

contributing to your hair loss or making it worse and

should be explored. It is important to understand and

find all the contributing factors, however minor.

2.  Treat Each of the Causes of Your Hair Loss.

Once the causes of your hair loss have been

ascertained, try and correct the ones that can be

corrected, even if they are only playing a very small

role in your hair loss. Be pro-active.

3.  Multi-treatment.

Use more than one treatment to get the best results to

help your hair loss. The more treatments that you use

that are orientated to the reasons why you are losing

hair, the better the chance of improvement.

Also, just because a treatment didn’t work for a friend

doesn’t mean it won’t work for you. Try a treatment

regimen for about 3 to 6 months to see if it’s working.

Please call 718-698-4700 to make an appointment to see Dr. Kingsley.

©2018 British Science Corporation

Hair loss is often not caused by just one problem, but by a combination of two, three, or even more factors that affect the hair cycle. In order to properly treat your own hair loss it is important to first recognize the specific reasons that may be responsible for why you are losing your hair. Dr. Kingsley has identified seven main causes of hair loss, which he calls the “7 Hs of Hair Loss”©.

1.  Heredity

Heredity or genetic influences on the hair follicle are the most common causes of hair loss in both men and women. While genes passed down to you from your parents play a big role in hair loss they are not, in and of themselves, guaranteed to make you lose your hair. Obviously, if most of the people in your family, whether on your mother’s or father’s side, are losing hair, then you have an increased chance of also losing hair. That said, some scientific evidence suggest that about 20 percent of people exhibiting genetic hair loss don’t have any known family members with the condition.

Besides the uncertainty of which hair loss genes you are going to receive from your family, the type of hair loss is also important when discussing hereditary influences. Male pattern alopecia and female pattern hair loss are the most common hair loss conditions connected with heredity factors, however, certain other hair loss conditions, such as alopecia areata may also be caused, in part, from genetic influences.

2.  Health

The health of your hair is a barometer of your overall health, meaning that there are many health factors that can influence your hair cycle. For example, surgery requiring anesthesia can disrupt the hair cycle as can a high fever, in particular, a temperature greater than 101 degrees Fahrenheit.

In addition, numerous other general health factors can be important. Lupus (an autoimmune disease), digestive problems and infections may be relevant to your condition, causing conditions such as telogen effluvium (hair shedding) or cicatricial alopecia (scarring hair loss). The most important health influences are often the ones that occurred approximately four to sixteen weeks before the hair loss even became noticeable.

3.  Hunger (Nutrition)

Published research has shown that your hair needs a plentiful supply of protein, energy-producing molecules (glucose) and certain vitamins and minerals for optimal growth to occur. As the hair follicle is a nonessential tissue and, therefore, one of the last tissues to receive nutritional substances (or one of the first to have them reduced), any long-term deficiencies may lead to hair loss.

Protein deficiency can be a frequent cause of hair loss, because protein helps the body build hair fibers, which consist of 80 to 95 percent protein (this is especially relevant for vegetarians). For those who eat infrequently, the amount of energy available at your hair growth site may be deficient, causing the fair to fall out prematurely. The most common nutritionally related hair loss occurs while dieting. Severe weight loss due to dieting can often cause a temporary increase in hair shedding (telogen effluvium) due to metabolic changes in the body. 

4.  Hassle (Stress)

Stress can affect your hair cycle, and losing your hair can cause a lot of stress! Under most circumstances, as with many other hair loss causes, increased hair shedding occurs between four and sixteen weeks after the trigger has occurred.  Yet most people attribute an increase in hair shedding to what happened yesterday or last week, not a couple months ago. Although it can be difficult to pinpoint a specific stress episode as the cause of hair loss, there is evidence that acute and chronic stress may precipitate hair loss conditions, such as genetic hair loss, telogen effuvium (hair shedding), alopecia areata (patchy hair loss) and trichotillomania (compulsive hair pulling).

5.  Healing (Medications)

Taking certain medications can cause hair loss in some people while the same medicine may not cause hair loss in others. Stopping a certain medication can also cause hair loss in some, but not in others.  In addition, certain medications can cause hair loss the first time they are taken, but not subsequent times (once the body adjusts to the medicine, the hair loss stops), or they don’t cause hair loss the first time but do subsequent times (possibly due to the medicine accumulating in the body).

It’s difficult to categorically say that one particular medicine causes hair loss and another doesn’t, as medicines can react differently in different people. However, some of the medications most commonly reported to cause hair loss are: chemotherapy medications, antidepressants, thyroid medicines, oral contraceptive pills and cholesterol medicines. The hair loss condition often caused by medications is called telogen effluvium (hair shedding).

6.  Hormones

Hormones control hair growth to a large extent and there are many hormonal irregularities that can affect the hair cycle. Often these produce other symptoms that can indicate their presence, although even if there is an absence of any other symptom, it does not rule out that a hormonal factor is present. Men using anabolic steroids (either for medical or recreational purposes) may experience increased hair loss.  For women, hormonal influences on their hair may be indicated by irregular menstrual cycles, polycystic ovarian syndrome, menopause and post-partum. Hormonal problems can contribute to certain hair loss conditions, in particular, heredity hair loss and telogen effluvium (hair shedding).

7.  Hairdressing

Although not technically hair loss from the scalp, losing hair through breakage (traction alopecia) can cause hair thinning and slow growth. Breakage can occur due to chemical over-processing and/or incorrect styling, drying or brushing techniques. For example, using a dryer that is too hot can cause the hair to burn, often so much so that you can smell it burning as you dry. Vigorous brushing can also cause the hair to break.

©2018 British Science Corporation