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Hair loss (alopecia) is a common problem that has been shown to have a significant impact on psychological well-being and quality of life, and can sometimes also signify an underlying medical problem. Treatment of hair loss disorders is often challenging due to a number of factors, including limited understanding of the natural history of the condition, poor disease definitions, lack of validated severity scales and generally poor quality of evidence for treatment. Only a limited number of hair loss disorders have good quality randomised controlled trial (RCT) evidence to guide treatment choices. Further, access to supportive therapies (e.g. psychological support, wig provision, etc) can vary across the country and evidence for the most effective use of these interventions is generally poor. With kind funding from Alopecia UK, the British Hair and Nail Society proposed a priority setting partnership to encompass all types of hair loss with an aim of focusing clinical hair research on areas that meant the most to people with hair loss and clinicians/healthcare professionals alike. Inspired by previous PSPs in the field of dermatology, we hope to draw the attention of potential research funders to the unmet need in this distressing and under-researched group of conditions. The challenge of our particular PSP is how to reach, and harvest questions from, individuals representing many different, and rare, hair loss conditions. Many sufferers do not know their specific diagnosis and possibly do not seek treatment or are not able to access secondary and tertiary care specialists to achieve this. We feel that by keeping the process as open as possible we can harness expertise and opinions from individuals who have previously felt that their concerns and research priorities may have gone unheard. The process is off to a flying start with the initial survey under revision after a successful pilot, with the aim of the survey going live in early September. The steering group is currently in the process of identifying and engaging potential partners who will help publicise the survey. The steering group consists of 12 members including Jennifer Chambers (Patient and Admin lead), Paul Farrant (Dermatologist), Matt Harries (Dermatologist), Nigel Hunt (Psychologist), Andrew Messenger (Dermatologist), Carole Michaelides (Trichologist), Karena Moore-Millar (Patient and researcher in wig technology), Rachael Robinson (General Practitioner with Special Interest in Dermatology), Julie Rodgers (Patient), Jackie Tomlison (Alopecia UK trustee, nurse and patient), Sheela Upadhyaya (JLA Adviser and chair), and me (Dermatologist).

Are JAK inhibitors the future for management of Alopecia Areata? In a recent edition of Nature an exciting new approach to managing alopecia areata was discussed. The research team demonstrated the crucial role of a particular white blood cell, known as the cytotoxic CD 8 T lymphocyte, more specifically the CD8 NKG2D T Cell. In a mouse model it was demonstrated that this cell promotes the development of alopecia areata and leads to the autoimmune attack on the hair follicle. It is likely that the CD8 cells produce Interferon gamma which leads to collapse of the normal immune privilege that surrounds a healthy hair follicle. In turn another cytokine (chemical messenger) is produced, - interleukin 15. These chemical messengers exert their effect by various pathways and one of the crucial elements downstream is maintained by the Janus Kinase (JAK) family of proteins. Blocking the JAK pathway would therefore prevent inflammation that leads to hair loss. The researchers demonstrated that by blocking the JAK pathway in mice, using inhibitors already developed for other diseases they were able to cause the mice with alopecia to completely regrow their hair. A systemic form of the same drug has been tested on a few patients with advanced and longstanding alopecia and this has caused hair regrowth too. Any maybe most exciting of all, topical formulations of the same drugs were shown to work too, meaning it may be possible to treat humans with alopecia with a topical JAK inhibitor. Of course this is very early days and larger studies need to investigate both efficacy and potential side effects and whether the topical formulation will work as well as systemic drugs, but for the first time ever new knowledge of a disease process is being used to develop a specific targeted therapy for alopecia areata.

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