Topical tofacitinib for FFA : Yes, it's on the list!
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
4d ago
Topical tofacitinib for LPP and FFA Oral and topical JAK inhibitors continue to be studied in scarring alopecia. A small number of studies point to potential benefits of oral and topical JAK inhibitors in the treatment of lichen planopilaris and frontal fibrosing alopecia. Topical JAK inhibitors have an obvious interest given that they have less systemic absorption than oral JAK inhibitors. This is important given that oral JAK inhibitors come with their share of side effects including infections, blood test abnormalities, and other issues. To date, there have only been a limited number of pat ..read more
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Baricitinib for Pediatric Patients with Severe AA
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
4d ago
New Study Supports Effectiveness of Baricitinib in Pediatric Patients JAK inhibitors are increasingly used for the treatment of severe AA. In 2023, the JAK inhibitor ritlecitinib became the first drug approved by FDA for treating alopecia areata in individuals in the 12 - 18 age group. Of course, the drug is approved for adults as well. But what’s unique about ritlecitinib is its approval in the 12-18 age group. I can only imagine that we’ll be seeing more and more and more approvals for alopecia areata drugs in the pediatric population. Advanced alopecia areata affects a significant number of ..read more
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Generic Tofacitinib for Treating Severe Alopecia Areata: Where does it fit in?
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
4d ago
Generic Tofacitinib for Alopecia Areata The JAK inhibitors ritlecitinib and baricitinib are approved by many health regulatory bodies across the world for the treatment of advanced alopecia. Baricitinib was FDA approved on June 13, 2022 and ritlecitinib was FDA approved on June 23 2023. Even though it’s not formally stamped with the seal of approval, tofacitinib has been used ‘off-label’ for treating alopecia areata since 2015. The world has a lot of experience treating alopecia areata with tofacitinib. While the clinical trial data is not as rigorous for tofacitinib as for baricitinib or rit ..read more
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Vaccination before Starting Biologics: Are We Going a Good Job?
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
2w ago
New study Suggests We Don’t Vaccinated Enough - Especially our Younger Patients There is a great deal of information that must be conveyed to patients before starting JAK inhibitors. One of these is a review of infections and ways to reduce the risk of infection through vaccination. Immunization against zoster, influenza and pneumococcus are generally recommended before starting JAK inhibitors. For example, zoster is recommended at age 19 or above now by the CDC (and 50 years of age and over in the general population). Influenza is recommended yearly. Pneumococcous is now recommended at 19 an ..read more
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Infectious Diseases with JAK Inhibitors for Alopecia Areata
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
2w ago
 1 in 3 Patients Using JAK Inhibitors Will Have Some Sort of Infection Authors from Italy set out to retrospectively review infectious disease events in patients receiving JAK inhibitors over the period from July 2021 to October 2023. There were 91 patients in their study, including 85 treated with baricitinib and 6 with upadacitinib. There were no patients treated with ritlecitinib in this particular study as ritlecitinib had not been approved in Europe until Sept 2023. The authors observed 34 infectious events in 28 patients (30.8%). Five patients had multiple infectious events (5.5 ..read more
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Minoxidil and Occular Hypertension: Is there a link ?
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
2w ago
Are there any concerns about minoxidil use in patients with glaucoma? There is no good evidence to date that topical minoxidil has a major effect on ocular pressures. However, there are dozens and dozens of reports in the medical literature about eye-related side effects with minoxidil. The question then becomes - is minoxidil truly responsible for a particular side effect and if so - how common is this side effect? This is the case for minoxidil and glaucoma. Over the years, there have been grumblings that minoxidil somehow affects eye pressures in some people. Despite the grumblings, there ..read more
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Hair Repigmentation from the Drug Acitretin in an 80 Year old Man
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
2w ago
50 mg Acitretin Caused Hair Repigmentation after 20 months of Treatment I read with great interest a nice report by Dr Eunice Chow and Dr Thomas Salopek from the University of Alberta regarding an 80-year-old man who had remarkable hair repigmentation after using the vitamin A derivative acitretin. The man was diagnosed with a skin condition known as pityriasis rubra pilaris (PRP) and was started on acitretin 40 mg daily and then increased to 50 mg once daily. His medical history included hypertension and diabetes. His medication list also included aspirin, betamethasone valerate 0.1% cream, h ..read more
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Hair Loss with Tepezza
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
2w ago
TEPEZZA (teprotumumab-trbw) Causes Hair Loss TEPEZZA (teprotumumab-trbw) is an insulin-like growth factor-1 receptor inhibitor indicated for the treatment of thyroid eye disease. Clinical studies have shown that about 13 % of patients using this drug have hair loss compared to 8% of controls. I was interested to read a report by Wang et al of side effects of TEPEZZA (teprotumumab-trbw) found in the FDA Adverse Events Reporting System database. Alopecia was ranked the sixth most common side effect and had a reporting odds ratio of 7.84 (with a confidence interval of 6.75–9.1). This study remind ..read more
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Bicalutamide 50 mg Superior to Spironolactone 100 mg in FPHL
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
2w ago
Bicalutamide 50 mg more effective than Spironolactone 100 mg I was very interested to read a study from India which set out to compare the effectiveness of spironolactone and bicalutamide in the treatment of female-pattern hair loss (FPHL). The study was a retrospective study of 120 female patients 18-50 years of age who used these drugs. Group A comprised patients who were taking 100 mg of spironolactone once daily, along with 2% minoxidil and Group B comprised patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2%. Patients were analysed at approximately 24 ..read more
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Thinking of Using Oral Minoxidil Above 5 mg? Maybe think again!
Donovan Hair Clinic Blog
by Dr. Jeff Donovan
2w ago
Higher Doses of Oral Minoxidil Increase Heart Rate I read with interest another nice study by our Brazilian colleagues. The authors set out to understand the effects of higher doses of oral minoxidil (ie above 5 mg) on blood pressure and heart rate in males. The authors studied 11 males. These males had been using 5 mg oral minoxidil for 24 weeks as part of the authors’ prior research. At 24 weeks, the dose was increased to 7.5 mg. The authors wanted to see what would happen to various hemodynamic parameters like blood pressure and heart rate in males using higher doses. The mean age of pati ..read more
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