Alopecia Areata: Progressing Practice
Transcript: Addressing unmet needs in AA
Rodney Sinclair, MBBS, MD, FACD
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So one of the important questions that gets asked is, what are the unmet needs in alopecia areata, and how do some of these new, and emerging, and innovative treatments address those unmet needs that patients experience with alopecia areata? So the first aspect is what are the unmet needs? What we know is that patients are severely impacted by their hair loss. They describe it as a life-changing event.
They're often taught not to expect too much from medical therapies, that there's limitations in the medical therapies, and that the treatments may not ever regrow their hair, and they may be destined to a life with a changed physical appearance. And it's a negative impact on their physical appearance. Patients universally agree that the loss of their hair has a negative impact on their physical appearance. And the need, and the impact that this has is it makes people feel less attractive. It makes people feel as though they are weakened. It makes people feel as though they are unhealthy. And they also recognize that other people, when they see them, are less attracted to them.
They feel that they're less capable. And they're often less likely to be chosen as a friend, as a partner, as a colleague than people with their hair. And we can understand this in terms of a stigma. So the definition of a stigma is a visible sign that is a marker of an illness or marker of a disease.
And so obviously, the loss of hair is a stigma in that it marks someone who has had a changed physical appearance. But the stigma's also perceived as a blemish or negative attribute, or something that tarnishes someone's reputation. And there's an external stigma, and internal stigma, and also a stigma by proxy. So an external stigma is when someone sees a bald person and thinks of them as diminished, as less attractive, less capable, less healthy. There's an internal stigma where you perceive yourself as less attractive, less capable, and that you don't think other people would want to be your friend, other people who'd wanna work alongside you or work for you. And then of course, there's the stigma by proxy, whereby if you are the parent of a child with alopecia, you might find that people react to you differently.
Or if you're a child of a parent with alopecia, you might find that your friends don't invite you around to their house, and you can actually be stigmatized by proxy. What we found with these new, and emerging, and highly effective treatments for alopecia areata, the Janus kinase inhibitors, is that they were able to reverse the hair loss. And when the hair loss was reversed, the stigma associated with having no hair was also lifted, and patients could get on and function and have a normal life. And this was actually born out in a session organized by one of the pharmaceutical manufacturers of one of these drugs where they actually brought patients in, and they asked them to recount what their life experience was with alopecia. And they said that when the alopecia happened, they were caught by surprise. This was not a new experience to them. It was something that profoundly affected their self-esteem.
It profoundly affected their relationships. It profoundly affected their performance at school, their performance at work, and how they were able to integrate socially. And then when their hair returned, they were able to get on and lead a normal life. And this was actually beautifully expressed by one of the patients who came along, who said that, "At the moment, I'm functioning well, my life is great. But when I look back when my hair loss was severe, it profoundly affected every aspect of my life. And if I had to make a choice to live out a full and otherwise healthy life but with no hair and a life expectancy in the mid-80s, which is the life expectancy of the average Australian, would I be happy with that to be bald and live to my mid-80s?
Or I much rather live a shorter life but with my hair?" And they were prepared to exchange between 10, 15, 20 life years to have a life with a normal head of hair, because the normal head of hair enabled them to achieve their full potential to live a normal life. And to them, that was more valuable than a long life. A normal life where they could be fully engaged with their peers, their work colleagues, was more important to them than to have a long life where they were going to be bald and isolated or rejected by their contemporaries. And so what we know is that the burden of disease associated with alopecia areata is alleviated by regrowing the hair. So the psychological morbidity, the psychological impact can all be fully reversed by restoring their hair back to normal.
Developed by EPG Health. This content has been developed independently of the sponsor, Pfizer, which has reviewed the content only for scientific accuracy. EPG Health received funding from the sponsor in order to help provide healthcare professionals with access to the highest quality medical and scientific information, education and associated relevant content.