Episode 13 - Eyebrow and eyelash involvement with baricitinib in patients with AA

In this episode of BJD Talks, Sam and Meera discuss the article ‘Understanding eyebrow and eyelash involvement in patients with alopecia areata and responsiveness to treatment with baricitinib’ by Mostaghimi et al. The full article can be accessed at https://doi.org/10.1093/bjd/ljaf088. 

*This podcast was generated by an AI tool created by 67Bricks for the British Association of Dermatologists* 

Transcript

SPEAKER_00 0:00

Welcome to BJD Talks, the official podcast of the BJD. I'm Sam.

SPEAKER_01 0:04

And I'm Mira. In this episode, we will be discussing the article by Arash Mostagimi et al. Understanding eyebrow and eyelash involvement in patients with alopecia ariata and responsiveness to treatment with baricitinib from April 2025.

SPEAKER_00 0:20

Alopecia ariata, or AA, is a challenging autoimmune condition where the immune system attacks hair follicles. While scalp hair loss is its most visible hallmark, AA can also affect eyebrows and eyelashes, further impacting patients physically and psychologically.

SPEAKER_01 0:35

Exactly. This study offers a more inclusive view of treatment by focusing on eyebrow and eyelash regrowth as markers of success, areas less explored previously. It examines baracitinib, a jack inhibitor, and its effects on these specific hair sites. Shall we outline how the research was conducted?

SPEAKER_00 0:54

Sure. The findings come from the Brave AA1 and Brave AA2 trials. Phase 3 studies covering 10 countries with data from 1,200 patients. These were randomized double-blind placebo-controlled trials looking at the effects of placebo, 2 mg of baricitonib or 4 mg of baricitonib over 52 weeks. They evaluated eyebrow and eyelash loss using Clin RO scores alongside SALT scores for scalp hair loss.

SPEAKER_01 1:21

The baseline data showed a strong link between severe eyebrow and eyelash hair loss and high salt scores. Patients with near-complete scalp hair loss, salt scores around 100, were often those with no eyebrow or eyelash hair as well. It highlights how connected these regions are in AA.

SPEAKER_00 1:40

The results after treatment were compelling. By week 36, 44.3% of patients on the 4 mg dose experienced significant eyebrow regrowth, compared to 12.6% in the placebo group. For eyelashes, the improvement was slightly higher, 46.4% versus 12.4%. Some patients even saw progress as early as week 8.

SPEAKER_01 2:05

And eyebrow and eyelash regrowth aligned closely. Roughly 80% of patients who regrew hair in one area saw regrowth in the other. What stood out to me was that nearly half of patients who did not achieve substantial scalp regrowth, defined as salt scores of 20 or less, still regrew their eyebrows and eyelashes.

SPEAKER_00 2:25

Indeed, it suggests eyebrow and eyelash regrowth might happen independently of scalp recovery in AA. For patients, restoring these facial hair features can significantly enhance confidence, facial expression, and even physical health. Eyelashes, for instance, protect the eyes from irritants.

SPEAKER_01 2:42

It could also shift treatment priorities. Instead of solely targeting scalp regrowth, clinicians might consider a more patient-centered approach, aiming for holistic regrowth, especially when facial hair is seen as more important cosmetically or functionally.

SPEAKER_00 2:58

But there are limitations. The study relied on CLIN RO scores to measure regrowth, which reflect the clinician's view. We still need patient-reported outcomes to understand how these improvements affect quality of life or whether they match patient expectations.

SPEAKER_01 3:12

Agreed. Future research could explore broader aspects like patient satisfaction and baricitinibs' effect on other areas, such as beard or body hair, to gain a fuller picture of its potential.

SPEAKER_00 3:24

To summarize, this study highlights eyebrow and eyelash loss as significant aspects of AA. Baricitinib showed notable efficacy, delivering results early and sustaining them over 52 weeks. In some cases, regrowth on these sites progressed more than on the scalp, hinting at a unique mechanism.

SPEAKER_01 3:42

It's a promising step. The findings encourage a holistic view and treatment goals, tailoring them to patients' needs and priorities for managing this complex condition. And thank you for listening to BJD Talks. See you next episode.