20 of the Most Influential Hair Loss Research Studies of 2020

The Top 20 Studies of 2020: A Year in Review

On Dec 9, 2020 I hosted a public webinar “The 20 Most Influential Hair Loss Studies of 2020.” I have highlighted these 20 studies here with a brief outline of the key message and importance of the study.

STUDY 1

Chretien et al. Direct acting oral anticoagulants and alopecia: to go further with data mining in  pharmacovigilance databases. Eur J Clin Pharmacol 2020 Aug 76(8):1197-1198

Key message: Direct acting oral anticoagulants include drugs like  dabigatran  rivaroxaban, apixaban, edoxaban, and betrixaban. Direct acting anticoagulants carry a slightly increased risk of hair loss. Fortunately, most users will not experience hair loss

Link to description in video  Chretien et al, 2020.

STUDY 2

Moreno-Arrones et al. SARS-CoV-2 induced telogen effluvium: a multicentric study. J Eur Acad Dermatol Venereol 2020 Nov 

Key message: Hair shedding occurs in some patients experiencing COVID19 infection. Shedding occurs on average 58 days after diagnosis. Up  to 13 % of the 214 patients in the study were asymptomatic meaning  that  they were completely surprised  their shedding ultimately  ended up  being due to COVID 19. We need to consider COVID 19 infection  in  all patients  who  experience hair shedding. 

Link to description in video  Moreno-Arrones et al, 2020.

STUDY 3

Goren et al. A preliminary observation: male pattern hair loss among hospitalized COVID-19 patients in Spain – a potential clue to the role of androgens in COVID-19 severity. April 2020

Key message: This was one of the first studies in the  dermatological literature to draw attention to the relationship between male balding and thee risk of more severe COVID 19 infections.  This  study set the stage for further studies. 

Link to description in video:  Goren et al, 2020. 

STUDY 4

Ying-Xiu D et al.  Bidirectional association between alopecia areata and major depressive disorder among probands and unaffected siblings: A nationwide population-based study. J Am Acad Dermatol May 2020

Key message: This study illustrated  the complex relationship between alopecia areata and depression and highlighted the complexity of the genetic links between  these issues.  Patients  with  alopecia areata were more likely than controls  to  experience depression – but so were their siblings. Patients with  depression were more likely than controls  to  experience alopecia areata – but so were their siblings.

Link to description in video:  Ying-Xiu D et al, 2020

STUDY 5

Lee et al.  Epidemiology of alopecia areata, ophiasis, totalis and universalis: A systematic review and meta-analysis. J Am Acad Dermatol March 2020

Key message: This study evaluated the changing  epidemiology  of alopecia  areata. The authors suggested that the prevalence of  alopecia areata may be increasing over time. 

Link to description in video:  Lee et al, 2020 

STUDY 6: Yee et al. Efficacy of different concentrations of intralesional triamcinolone acetonide for alopecia areata: A systematic review and meta-analysis. J Am Acad Dermatol April 2020

Key message: This study showed that low concentrations (below 5 mg per mL) of triamcinolone acetonide can be helpful in alopecia areata although 5 mg per mL concentrations are probably the most consistently effective. The risk of atrophy was estimated to  be 20 % with 10 mg/mL and only 3 % with 5 mg/mL concentrations. 

Link to description in video: Yee et al, 2020 

STUDY 7

Conic RR.  Prevalence of cardiac and metabolic diseases among patients with alopecia areata. J Eur Acad Dermatol Venereol. Aug 2020

Key message: This very large study highlighted the increased risk of cardiac disease and metabolic dysfunction in patients with alopecia areata. In regression models, patients with AA had significantly increased odds for hypertension, hyperlipidemia, obesity, diabetes mellitus, metabolic syndrome,  coronary artery disease, atrial fibrillation and stroke.

Link to description in video: Conic et al, 2020 

STUDY 8: Waskiel-Burnat et al.  Alopecia areata predictive score: A new Trichoscopy-based tool to predict treatment outcome in patients with patchy alopecia areata. J Cosmet Dermatol. Mar 2020

Key message: In patients with patchy alopecia areata, 6 trichoscopic features 2 months after starting treatment can help predict whether or not patients will ultimately regrow hair. 

 Link to description in video: Waskiel-Burnat et al, 2020 

STUDY 9

Ramos PM et al.  Minoxidil 1 mg versus minoxidil 5 % topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. J Am Acad Dermatol Jan 2020

Key message: In a small study comparing 5 % minoxidil solution to 1 mg orally, results were found to be similar. 5 % minoxidil solution caused more irritation although 1 mg caused more hair growth on the face and body. 

Link to description in video: Ramos et al, 2020

STUDY 10

Sanabria et al. Adverse Effects of Low-dose Oral Minoxidil for Androgenetic Alopecia in 435 patients.  J Am Acad Dermatol Nov 2020

Key message: Oral minoxidil comes with certain side effects that all physicians  and users must know about. These increase excessive hair growth on the body, hair shedding, swelling  in the  feet and face, headaches, dizziness, insomnia and heart palpitations. 

Link to description in video: Sanabria et al, 2020

STUDY 11 and STUDY 12

Ismail et al. Safety of Oral Bicalutamide in female pattern hair loss: A retrospective review of 316 patients. J Am Acad Dermatol. Nov 2020

Fernandez-Nieto et al. Bicalutamide: A potential pure anti-androgens with Potential Benefit in Treating Female Androgenetic Alopecia. J Am Acad Dermatol. Nov 2020

Key message: The pure antiandrogen bicalutamide may be an option for some patients with female androgenetic alopecia.  Ismail et al was a study of 316 patients receiving bicalutamide and Fernandez Nieto was a study of 44 patients. Side effects need to be understood by all prescribers and users and include a low incidence of liver enzyme elevation.  Other side effects include gastrointestintal upset, edema, shedding, headaches may also occur.  

Link to description in video: Bicalutamide Studies

STUDY  13

Nguyen et al. Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride. JAMA Dermatology Nov 2020

Key message: A pharmacovigilance study suggested that young male users of finasteride  1 mg may be at increased risk of suicidal thoughts but not completed suicide. 

Link to description in video: Nguyen et al, 2020

STUDY 14

Vano-Galvan S et al. Effectiveness and safety of oral dutasteride for male androgenetic alopecia in real clinical practice. Dermatol Ther Jan 2020

Key message: Dutasteride 0.5 mg used 5 to 7 times weekly can be a useful  treatment for male  pattern balding.  Side effects occur in  6.5 % of users and 2.6 % needed to stop the medication due to side effects such as decreased libido, gynecomastia, mood changes and erectile dysfunction. Low dose oral dutasteride (less than 3 times weekly) was not associated with side  effects in  this small study. 

Link to description in video: Vano-Galvan et al, 2020

STUDY  15

Starace M et al. Atypical Presentation of Congenital Triangular Alopecia: A Case Series in Italy. Dermatol Pract Concept Oct 2020. 

Key message: Congenital  triangular alopecia could possibly affect other areas besides the temples.  

Link to description in video: Starace et al, 2020 

STUDY 16

Lajevardi et al. The efficacy and safety of oral low dose naltrexone versus placebo in the patients with lichen planopilaris: a randomized controlled trial. J Dermatol Treat. Jun 2020

Key message: Low dose naltrexone does not appear to add any benefit to patients with lichen planopilaris receiving treatment with topical clobetasol.

Link to description in video: Lajevardi et al, 2020

STUDY 17

Trager et al. Prevalence Estimates for Lichen Planopilaris and Frontal Fibrosing Alopecia in a New York City Health Care System J Am Acad Dermatol Oct 2020

Key message: The first study of its kind to attempt to systematically estimate  the prevalence of LPP and FFA in a defined population. Overall, the prevalence of LPP was estimate to be 1 in 5882 and the prevalence of FFA was estimate to be 1 in 6666. 

Link to description in video: Trager et al, 2020

STUDY 18

Pindado-Ortega C et al.  Effectiveness of dutasteride in a large series of patients with frontal fibrosing alopecia. J Am Acad Dermatol Oct 2020

Key message: Dutasteride appears to be more effective than standard treatments like doxycycline, hydroxychloroquine, isotretinoin and finasteride. Dutasteride 5 to 7 times weekly is more effective than 3 times weekly although lower doses can still be effective. 

Link to description in video: Pindado-Ortega et al, 2020

STUDY 19: Prasad et al. Patch testing and contact allergen avoidance in patients with lichen planopilaris and/or frontal fibrosing alopecia: A cohort study. J Am Acad Dermatol Aug 2020

Key message: There may be an association between being diagnosed with lichen planopilaris and frontal fibrosing alopecia and having positive patch test reactions to various agents such as fragrance, linalool, gallates and MCI/MI. Patients found to have specific allergies and ultimately avoided these allergens in their daily life ultimately experienced reduced disease activity.

Link to description in video: Prasad et al, 2020

STUDY 20

Erinolaoluwa F et al. Hair regrowth in 2 patients with recalcitrant central centrifugal cicatricial alopecia after use of topical metformin. JAAD Case Reports Feb 2020

Key message: Topical 10 % metformin may have benefit in the treatment of central centrifugal cicatricial alopecia.

Link to description in video: Erinolaoluwa et al, 2020