Jada Pinkett Smith’s Alopecia | MedPage today

The 2022 Oscars can be noted for its many historic firsts – including the first deaf man to win an acting Oscar (Troy Kotsur; Best Supporting Actor), among others. Sadly, however, the night will likely be remembered for another first – when actor Will Smith slapped Chris Rock on live TV.

Rock had just taken the stage to present the Best Documentary Award, when he noticed Smith and his wife Jada Pinkett Smith sitting in front of the audience. Rock remarked, “Jada, I love you. GI Jane 2can’t wait to see you” in response to Pinkett Smith’s extremely short hairstyle. Pinkett Smith has openly stated that she suffers from the autoimmune disease, alopecia areata, which has caused her to lose much of her hair.

Shortly after the remark, Smith got up from his seat, approached Rock and slapped him in the face. A shocked Rock replied, “Wow man, that was a G.I. Jane joke.” Smith then yelled at him to, “Keep my wife’s name out of your fucking mouth!” (The exchange was muted by the network for about 30 seconds.)

Pinkett Smith revealed her diagnosis in 2018 on her Red table discussion series. She remembered how scary it was when she started losing her hair. “I was in the shower one day and I only had a fistful of hair in my hands and I was like, ‘Oh my god, am I going bald?'” She started wearing turbans and getting cut short hair. She is currently receiving steroid injections, which “seem to be helping”, she said.

What is alopecia areata?

Alopecia areata is a common disorder that causes hair loss. In most people with the disease, the hair falls out in small, round patches, leaving areas of bare skin the size of a coin. This patchy hair loss most commonly occurs on the scalp, but can affect other parts of the body as well. Rarely, hair loss involves the whole scalp (in which case the condition is known as alopecia totalis) or the whole body (alopecia universalis). Other rare forms of alopecia areata, which have different patterns of hair loss, have also been reported.

Alopecia areata affects people of all ages, although it most often appears in adolescence or early adulthood. Hair loss occurs over a period of several weeks. Hair usually regrows after several months, although it may fall out. In some cases, unpredictable cycles of hair loss followed by regrowth can last for years. In addition to hair loss, some affected individuals experience nail and toenail abnormalities, such as pitting on the surface of the nails.

Alopecia areata affects one in every 500 to 1,000 people in the United States. It is one of many recognized forms of alopecia; Alopecia areata is the second most common form after androgenetic alopecia (male and female pattern baldness). Alopecia areata affects men and women equally and can occur in people of all ethnic backgrounds.

The mode of inheritance of alopecia areata is unclear as several genetic and environmental factors appear to be involved. Overall, the risk of developing the disease is higher in first-degree relatives of affected individuals than in the general population. People with alopecia areata are also more likely to have family members with other autoimmune diseases (see below).

What causes alopecia areata?

The causes of alopecia areata are complex and poorly understood. A combination of factors likely underlies the disease, including changes in many genes that function in hair and skin and in the immune system.

Alopecia areata is one of a large group of immune system diseases classified as autoimmune diseases. For reasons that are unclear, in alopecia areata the immune system targets the hair follicles, stopping hair growth. However, the condition does not permanently damage the follicles, which is why hair may grow back later.

Many genes associated with alopecia areata participate in the body’s immune response. These include several genes belonging to a gene family called the human leukocyte antigen complex, which distinguishes proteins in the body from proteins made by foreign invaders.

Some of the genetic variations associated with alopecia areata have been identified in people with other autoimmune diseases, suggesting that this group of diseases may share some genetic risk factors. People with alopecia areata have an increased risk of developing other autoimmune diseases, including vitiligo, systemic lupus erythematosus, atopic dermatitis, allergic asthma, and autoimmune thyroid diseases (such as thyroiditis Hashimoto’s disease and Graves’ disease). Likewise, people with these autoimmune diseases have an increased risk of developing alopecia areata.

In many cases, it is not known what triggers hair loss in people with alopecia areata. It is possible that environmental factors, such as emotional stress, physical injury, or illness, can cause an abnormal immune response in people at risk. However, in most affected individuals, the onset of hair loss has no clear explanation.

How is alopecia areata treated?

Although up to 50% of people with alopecia have spontaneous hair regrowth, most will relapse at some point. Currently, there is no cure for alopecia, and there are few well-designed studies that examine the effectiveness of current forms of therapy.

Although for most patients alopecia is a cosmetic problem, for some it can cause major emotional problems. For these patients, clinical psychologists or support groups can play an important role in helping patients adjust to hair loss. Additionally, the National Alopecia Areata Foundation can be an important resource for patients and their families.

A few first-line therapies are available for patients who wish to try treatment. In general, these work best for patients with limited, patchy hair loss and may not be permanent solutions. Intralesional corticosteroids (using triamcinolone) have been shown to have some success in hair regrowth in patients with isolated patches of hair loss. However, local skin effects such as skin atrophy, telangiectasias and hypopigmentation limit long-term use.

Potent topical corticosteroids have also been used to treat patches of hair loss, despite limited evidence of effectiveness. Side effects similar to those of intralesional corticosteroids are possible.

For people with extensive or recurrent scalp involvement, topical immunotherapy may be the most effective treatment. It involves applying chemicals such as diphencyprone, dinitrochlorobenzene, or squaric acid dibutyl ester to the scalp. These work by inducing contact dermatitis in the affected area and in doing so can modulate the immune response surrounding the affected hair follicles.

A 2018 retrospective study of 252 patients, by Zerbinati et al., found that 112 patients (44.05%, P

For patients who do not wish to try the treatment, cosmetic procedures are available. These can include wigs, scarves and head shaving. Temporary tattoos can help with missing eyebrows, and artificial eyelashes can be used for patients with missing eyelashes.

A list of ongoing clinical trials is available at ClinicalTrials.gov.

Michele R. Berman, MD, is a pediatrician turned medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Its mission is both journalistic and educational: to report on common diseases affecting uncommon people and to summarize the evidence-based medicine behind the headlines.