How ‘the slap’ is leading to alopecia awareness

The 2022 Academy Awards were characterized by historic wins.^[] Troy Kotsur became the first deaf man to win an Oscar for best actor in a supporting role, Coda became the first movie from a streaming service to win the Oscar for best picture, and Ariana DeBose won an Oscar for best actress in a leading role, becoming the first openly Queer woman of color to do so.

However, these historic wins were overshadowed by an unexpected controversy involving host and comedian Chris Rock and actor Will Smith. Viewers at home and those in attendance watched in disbelief as Will Smith got on stage and slapped Chris Rock after he made a joke aimed at Smith’s wife, Jada Pinkett Smith, for her shaved head.

Along with it, Jada Pinkett Smith’s medical condition, alopecia areata, has also been thrust onto the national stage, making headlines and raising awareness about the condition.

Shedding light on alopecia areata 

It's an autoimmune disease that occurs when the immune system attacks hair follicles, leading to hair loss that can occur in the scalp, eyebrows, and eyelashes.

Smith first publicly discussed her alopecia diagnosis in 2018 on an episode of her show “Red Table Talk.”^[] Reflecting on a moment where she discovered handfuls of her hair falling out in the shower, Smith said, “It was one of those times in my life where I was literally shaking in fear. That's why I cut my hair, and why I continue to cut it,” highlighting the emotional toll that often accompanies this diagnosis.

How common is alopecia areata? 

A 2020 Clinical, Cosmetic and Investigational Dermatology study determined that alopecia areata affects 0.21% of the US population, amounting to 700,000 individuals living with this disease.^[] Furthermore, the authors estimate that as many as 8.2 million individuals have had alopecia areata in their lifetime. To gauge US alopecia prevalence, the study included 45,016 participants, who, as a representative sample of the population, filled out a cross-sectional survey online. Participants who self-screened as having alopecia submitted pictures, which were further evaluated by clinicians.

How will 2022 Oscars impact patients 

Although it remains unclear whether alopecia areata patients will feel empowered by the events at the 2022 Oscars, Amy McMichael, MD, professor and chair of the Dermatology Department at Wake Forest School of Medicine, noted in a WebMD article that she hopes the events that transpired at the Oscars will show people the “many faces of hair loss” and raise awareness that this disease can affect people of various ages, ethnicities, and genders.^[]

Dr. McMichael acknowledged that patients who experience hair loss often feel helpless and confused. For these patients, Dr. McMichael stresses the importance of scheduling an appointment with a board-certified dermatologist.

Dermatologists can also connect alopecia patients with organizations that are dedicated to helping them deal with both the emotional and physical burdens of hair loss, such as the National Alopecia Areata Foundation and the Scarring Alopecia Foundation.

Latest alopecia research

However, baricitinib, an inhibitor of Janus kinases 1 and 2 (JAK1 and JAK2), is a promising therapeutic option, according to results of two randomized, placebo-controlled, phase 3 trials involving adults with severe alopecia areata. Baricitinib may interfere with cytokine signaling, which has been implicated in alopecia areata progression.

In these two studies published in 2022 in The New England Journal of Medicine, patients were randomly assigned to receive once-a-day baricitinib at a dose of 4 mg, or baricitinib at a dose of 2 mg, or placebo.^[] The primary outcome of the study was a Severity of Alopecia Tool (SALT) score of 20 or less at week 36. Investigators found that with respect to hair regrowth at 36 weeks, baricitinib was superior to placebo.

“This is so exciting, because the data clearly show how effective baricitinib is,” said Brett King, MD, PhD, in a press release.^[] Dr. King is associate professor of dermatology at the Yale School of Medicine and lead author of the study.

Similarly, Pfizer has had success in clinical trials with ritlecitinib, a JAK3 inhibitor, as a treatment option for alopecia.^[] Ritlecitinib was granted Breakthrough Therapy designation from the FDA for the treatment of alopecia areata in September 2018.

In a phase 2b/3 trial where patients with at least 50% scalp hair loss took either 30 or 50 mg of ritlecitinib once a day or placebo, the trial met its primary efficacy endpoint of improving scalp hair regrowth.