J. Shapiro

University of British Columbia | UBC · Department of Dermatology and Skin Science

Platelet-rich plasma (PRP) is autologous plasma with a platelet concentration that is on average five times greater than baseline, and has been extensively investigated for its potential applications across various medical fields, including orthopaedics, dermatology, wound healing, maxillofacial surgery, and others. This review article aims to prov...

Introduction: Baricitinib is approved for the treatment of patients with severe alopecia areata (AA). The efficacy results from the down-titration portion of the phase 3 trial BRAVE-AA2 have been reported up to Week-104. Here we report both long-term efficacy outcomes from the down-titration portion of BRAVE-AA2, and recapture data after retreatmen...

Introduction: In pivotal BRAVE-AA1 and AA2 phase 3 clinical trials, the Janus kinase (JAK)1/JAK2 inhibitor baricitinib has demonstrated efficacy in achieving clinically meaningful regrowth of hair in patients with severe alopecia areata. While a significant proportion of patients achieve regrowth by weeks 36 and 52 on baricitinib versus placebo, ot...

Background: Baricitinib is approved for the treatment of adults with severe alopecia areata (AA). In the absence of robust data on the patterns of regrowth during treatment of severe AA, there is a gap in the knowledge regarding treatment expectations. Objectives: To examine whether different clinical response subgroups could be identified in ba...

In this response to a recent article on off-label use of baricitinib for pediatric alopecia areata (AA) patients, we raise additional points regarding the relationship between viral infections and AA relapse on JAK inhibitor therapy, and the potential benefits of concomitant oral minoxidil therapy in mitigating relapse risk during JAK-inhibitor dos...

This article discusses drug-induced hair loss, which can occur with many drugs including cytotoxic agents, biologics, and immunomodulating agents, among others. It outlines the diagnosis and management of drug-induced alopecia, with a focus on recently implicated drugs.

What is this summary about?: This is a summary of the results of the ALLEGRO phase 2b/3 clinical trial, originally published in The Lancet. ALLEGRO-2b/3 looked at how well and safely the study medicine, ritlecitinib, works in treating people with alopecia areata ('AA' for short). The immune system protects your body from outside invaders such as b...

Background: Mesotherapy, a technique of transdermal microinjections of specific preparations, is increasingly used in fields such as dermatology and specifically for alopecia treatment. Its popularity stems from its ability to deliver drugs in a targeted manner while minimizing systemic side effects. Objective: To assess and review current knowl...

The incidence of allergic contact dermatitis (ACD) due to personal care products is rising in parallel with increasing product availability and consumer interest. Hair products specifically represent a significant source of potential allergens, including preservatives, surfactants, emulsifiers, fragrances, adhesives, and dyes. ACD due to hair care...

Introduction: The physical impact of alopecia areata (AA) is visible, but the psychological and social consequences and emotional burden are often underrecognized. Methods: In this cross-sectional study, 547 participants recruited via the National Alopecia Areata Foundation completed a survey encompassing demographics; AA illness characteristics...

Background: Alopecia areata is characterised by non-scarring loss of scalp, face, or body hair. We investigated the efficacy and safety of ritlecitinib, an oral, selective dual JAK3/TEC family kinase inhibitor, in patients with alopecia areata. Methods: In this randomised, double-blind, multicentre, phase 2b-3 trial done at 118 sites in 18 count...

Alopecia, the loss of hair on the scalp and/or body, experienced by millions of people worldwide, can be a very debilitating condition. Specifically, androgenetic alopecia (AGA), commonly known as male or female pattern baldness, is the most common form of hair loss. In the African diaspora, oils have traditionally been used to promote hair growth...

Female patterned hair loss (FPHL) is a common form of androgenetic alopecia in women and is characterized by a hormonally directed diffuse hair loss on the scalp. Management of FPHL is well described in the literature, however treatment of FPHL in patients with co-morbid polycystic ovarian syndrome (PCOS), an endocrinologic condition found in repro...

The treatment of primary scarring alopecias is challenging and patients may be susceptible to koebnerization. This predisposes cicatricial alopecia patients to worsening of their disease following procedural treatments or interventions. Research and recommendations surrounding the risk for koebnerization within scarring alopecias is extremely limit...

Introduction: Digital health solutions, specifically direct-to-consumer platforms, have been touted to make care accessible and convenient for patients. The aim of this article is to evaluate patients' reported reasons for choosing a platform for the treatment of hair loss and their experience. This platform (Keeps) is focused exclusively on the t...

Lichen planopilaris (LPP) is a cicatricial alopecia that presents with patchy or diffuse hair loss at the vertex or parietal scalp. The literature has limited evidence on treatments for this challenging disease, with most reports involving small groups of patients with varied or suboptimal clinical responses. Amongst individuals who do respond to t...

Dear Editor, Hair loss has a profound impact on psychosocial health and quality of life.¹ Patients living with alopecia may be at increased risk of depression, anxiety and low self‐esteem.² Alopecia also presents a significant financial expense, with 25·2% of patients describing a serious economic burden and 18·2% indicating income loss due to miss...

Introduction: Alopecia areata (AA) is an autoimmune disease characterized by hair loss. Patients with AA experience a range of social and emotional impacts, and the lack of effective treatments and multiple affected locations can deepen the burden of illness. The objective of the current study was to assess health-related quality of life (HRQL) am...

Although alopecia areata (AA) severity is often defined by the degree of scalp hair loss, its impact on quality of life (QoL) can also be a defining measure of severity. In this cross-sectional study (AA Disease Specific Program [AA DSP™]), 259 patients were surveyed for demographics, AA illness characteristics, QoL (Skindex-16 AA), and daily impai...

While topical minoxidil has been a mainstay androgenetic alopecia (AGA) treatment, oral minoxidil has only been studied recently. Previous studies indicate low‐dose oral minoxidil (LDOM) is an efficacious, well‐tolerated AGA therapy, and our study aims to contribute to the growing LDOM literature an analysis of quantitative outcomes at multiple are...

Cutaneous involvement of the scalp is a common manifestation of dermatomyositis (DM), occurring in up to 82% percent of adults with DM. Scalp DM predominantly affects women and is characterized by dermatitis, alopecia, pruritus, and/or burning. While cutaneous dermatomyositis negatively impacts quality‐of‐life, scalp symptoms in particular are ofte...

Background Cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, post-infectious telogen effluvium and trichodynia have also been reported. Objective To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to other signs...

Background The current classification for Alopecia Areata (AA) does not provide a consistent assessment of disease severity. Objective To develop an AA severity scale based on expert experience. Methods A Modified Delphi process was utilized. An advisory group of 22 US-based AA clinical experts was formed to develop this AA scale. Representatives...

Antiandrogens have demonstrated a protective effect for COVOD-19 patients in observational and interventional studies. The goal of this study was to determine if proxalutamide, an androgen receptor antagonist, could be an effective treatment for men with COVID-19 in an outpatient setting. A randomized, double-blinded, placebo-controlled clinical tr...

Background Although many hair disorders can be readily diagnosed based on their clinical appearance, their progression and response to treatment are often difficult to monitor, particularly in quantitative terms. We introduce an innovative technique utilizing a smartphone and computerized image analysis to expeditiously and automatically measure an...

Background Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide, but lacks clear aetiology and robust clinical trial evidence for efficacy and safety of agents currently used for treatment. Objectives To enable data to be collected worldwide on FFA using common criteria and assessment methods....

Background Minoxidil is a widely used over the counter topical treatment for hair loss. The response rate for topical minoxidil is relatively low. Minoxidil is a pro-drug, converted to its active form, minoxidil sulfate, by SULT1A1 enzymes located in the scalp. Recently, a novel topical formula that increases the activity of SULT1A1 in hair follicl...

Funding sources: none. Conflicts of interest: J.S. is a consultant for Lilly, Pfizer, Eirion Therapeutics, Applied Biology, DS Laboratories and Keeps; he holds stock in RepliCel Life Sciences, has been an investigator for RegenLab® USA and is an investigator for Pfizer. V.C., C.Y. and P.J. are investigators for Lilly. V.C. is a consultant for Lilly...

Importance: A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata. Objective: To generate core domains and domain items...

Importance: A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata. Objective: To generate core domains and domain items fo...

Background The entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into type II pneumocytes is dependent on a modification of viral spike proteins by transmembrane protease serine 2 (TMPRSS2) expressed on the surface of human cells. TMPRSS2 is regulated by the androgen receptor, hence, SARS-CoV-2 infectivity is indirectly dependen...

Background: We previously reported The Alopecia Areata Consensus of Experts (ACE) Study: Results of an International Expert Opinion on Treatments for Alopecia Areata (AA). Objective: To report the results of the ACE international expert opinion on diagnosis and laboratory evaluation for AA. Methods: Fifty hair experts from 5 continents were in...

Background Topical minoxidil is the only US FDA‐approved drug for the treatment of female pattern hair loss (FPHL). While the safety profile of topical minoxidil is excellent, the efficacy of minoxidil in hair growth is extremely low. A recent survey of 8000 people observed that only 4% of hair loss patients using an over‐the‐counter minoxidil were...

Topical minoxidil has been used as a topical treatment for androgenetic alopecia (AGA) for more than 30 years. Approximately 60 to 70% of patients do not achieve hair growth. Minoxidil is a pro‐drug. In order to exert biological activity, minoxidil requires conversion to minoxidil sulfate by sulfotransferase enzymes (SULT1A1). We have reported exte...

Racial disparities in COVID‐19 infection rates and disease severity are due to a multifactorial etiology that can include socioeconomic as well as other factors. Nevertheless, genetic factors in different ethnic groups often contribute to disease severity and treatment response. In particular, the frequency of genetic variations in the androgen rec...

A preliminary observation of high frequency of male pattern hair loss among admitted COVID‐19 patients, and suggest that androgen expression might be a clue to COVID‐19 severity.

https://onlinelibrary.wiley.com/doi/full/10.1111/dth.13365

Background A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high quality randomized controlled trials (RCTs). Objective To produce an international consensus statement on the use and utility of various treatments for AA. Methods Fifty hair experts from 5 contin...

Alopecia areata (AA) is thought to be an autoimmune process. In other autoimmune diseases, the innate immune system and Toll‐like receptors (TLRs) can play a significant role. Expression of TLR7, TLR9, and associated inducible genes were evaluated by quantitative PCR in peripheral blood mononuclear cells (PBMCs) from 10 healthy individuals and 19 A...

Background: The frequency of different types of alopecia is not clearly reported in recent studies. Objective: To analyze the frequency of the types of alopecia in patients consulting at specialist hair clinics (SHC) and to assess for global variations. Methods: Multicenter retrospective study including data from patients evaluated at referral...

Background: Approximately 40% of women experience excessive hair shedding when washing their hair. Previously, we have demonstrated that a topically applied α1 adrenergic receptor agonist can be used to contract the arrector pili muscle of the follicular unit (ie, produce "goose bumps"), increasing the force required to pluck hair by as much as 40...

Topical minoxidil is the only US FDA approved OTC drug for the treatment of androgenetic alopecia (AGA). Minoxidil is a pro‐drug converted into its active form, minoxidil sulfate, by the sulfotransferase enzymes in the outer root sheath of hair follicles. Previously, we demonstrated that sulfotransferase activity in hair follicles predicts response...

The Structure, Biology & Hair Curl, Colour, and Luster Session included two invited presentations and three selected from submitted abstracts. These presentations taken together highlight current progress in linking follicle biology to the tensile/physical properties of hair. They show progress in understanding the development of the hair fiber, an...

Approximately 40% of women experience excessive hair shedding during styling (e.g., hair brushing). Previously, we demonstrated that topically applied phenylephrine, a potent α1 adrenergic receptor agonist, can be used to contract the arrector pili muscle of the follicular unit; thus, increasing the force required to pluck hair and reducing sheddin...

Background: Although alopecia areata is a common disorder, it has no FDA approved treatment and evidence-based therapeutic data is lacking. Objective: To develop guidelines for the diagnosis, evaluation, assessment, response criteria and endpoints for alopecia areata. Methods: Literature review and expert opinion of a group of dermatologists s...

In recent years, dermatologists have observed an increase in the incidence of male androgenetic alopecia (AGA). In a survey of 41 dermatologists, 88% reported an increase in incidence of AGA in men younger than 30 years. This phenomenon has no apparent explanation. However, due to the strong genetic inheritance component of AGA, a social or environ...

Scalp imaging techniques are necessary tools for the trichological practice and for visualization of permeation, penetration and absorption processes into and through the scalp and for the research on drug delivery and toxicology. The present letter reviews different scalp imaging techniques and discusses their utility. Moreover, two different stud...

A subset of basal cell carcinomas (BCCs) are directly derived from hair follicles (HFs). In some respects, HFs can be defined as 'ordered' skin appendage growths, while BCCs can be regarded as 'disordered' skin appendage growths. The aim of the present study was to examine HFs and BCCs to define the expression of common and unique signaling pathway...

Hair shedding in female patients is a frequent complaint in dermatological, endocrinological, and gynecological consults. Previously, the Sinclair Hair Shedding Scale was developed to assess normal versus excessive hair shedding in female pattern hair loss (FPHL) subjects. However, the prevalence of hair shedding in females not suffering from FPHL...

Alopecia areata (AA) is believed to be a cell-mediated autoimmune hair loss disease. Both CD4 and cytotoxic CD8 T-cells (CTLs) are important for the onset and progression of AA. Hair follicle (HF) keratinocyte and/or melanocyte antigen epitopes are suspected potential targets of auto-reactive CTLs, but the specific epitopes have not yet been identi...

Alopecia areata (AA) development is associated with both innate and adaptive immune cell activation, migration to peri- and intra-follicular regions, and hair follicle disruption. Both CD4+ and CD8+ lymphocytes are abundant in AA lesions; however, CD8+ cytotoxic T lymphocytes are more likely to enter inside hair follicles, circumstantially suggesti...

Scarring or cicatricial alopecias represent a group of poorly understood and uncommon disorders that cause permanent hair loss. Scarring alopecias are regarded as trichologic emergencies as hair loss is irreversible, rapidly progressive, and can be disfiguring. Patients could experience tremendous anxiety, low self-esteem, and extreme psychosocial...

The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.

Immunosuppressive drugs successfully prevent rejection of islet allografts in the treatment of type I diabetes. However, the drugs also suppress systemic immunity increasing the risk of opportunistic infection and cancer development in allograft recipients. In this study, we investigated a new treatment for autoimmune diabetes using naturally immun...

The relationship between sexual maturity and hair loss was recognized for the first time by Aristotle. Since then, many steps have been undertaken to convert that observation to scientific fact. Androgens, which were found to be responsible for sexual maturity, also have a major role in normal hair growth and induction of certain hair diseases. The...