In Germany alone, over a million people suffer from circular hair loss, the so-called alopecia areata. So far there is no cure for it. Now, for the first time in the USA, a drug against the insidious disease has been approved, which could soon also be approved in Germany.

This year’s Oscars in the spring drew public attention to the inflammatory hair loss disease alopecia areata. After Oscar host and comedian Chris Rock made a joke about actress Jada Pinkett Smith’s shaved head, husband Will Smith gave the host a resounding slap on the stage. What Rock allegedly did not know: Jada Pinkett Smith suffers from alopecia areata and had her head shaved because of the clearly visible hair loss.

So far, alopecia areata has been considered incurable. Pharmaceutical companies have been researching a drug against hair loss for a long time. The first systemic drug for the disease has now been approved in the United States.

According to the FDA, the US Food and Drug Administration (FDA) has approved Eli Lilly’s active ingredient Olumiant. The drug is to be used in the future for systemic treatment with tablets for alopecia areata. When ingested, it affects the entire body and not just specific areas.

In Europe, the same active ingredient has been approved for the treatment of rheumatoid arthritis and neurodermatitis in adults for five years. An early approval for severe alopecia areata is therefore also conceivable here. In mid-May, the European Medicines Agency (EMA) recommended that the European Commission approve the drug against the disease.

The drug, newly approved in the USA, is a glimmer of hope for a large number of those affected worldwide. Olumiant is taken as a tablet. According to the FDA, it was tested in two studies involving subjects who had lost at least 50 percent of their total hair.

The drug’s effectiveness was judged by how many patients regained at least 80 percent of their total hair after 36 weeks. In the first study, Olumiant was effective in 22 percent of the 184 patients who received 2 milligrams of the drug and 35 percent of the 281 patients who received 4 milligrams. In a placebo group of 189 patients, only 5 percent experienced an improvement.

In the second study, 17 percent of 156 patients who received 2 milligrams of Olumiant and 32 percent of 234 patients who received 4 milligrams achieved hair regression throughout the affected areas. In the 156 patients with a placebo, on the other hand, it was 3 percent.

Alopecia areata is circular hair loss that can occur in one or more places on the head, the eyebrows or – in men – in the beard growth. The hair falls out so much that circular bald spots appear. In 80 percent of those affected, the hair loss is limited to the head area, but in some cases the whole body is also affected by hair loss.

One speaks of alopecia totalis when all the hair on the head has fallen out and of alopecia universalis when the hair loss also includes body hair. The affected areas usually do not contain a single hair and spread further from the middle.

The psychological stress and the extent of the suffering associated with incurable hair loss are hard to imagine. Complete hair loss can occur quickly and within a few weeks, or it can gradually last for many months.

Alopecia areata occurs in women and men of all ages, but is more common in young people. According to estimates, around 1.5 million people are affected in Germany alone. The exact causes of the disease have not yet been clarified. However, experts suspect an autoimmune reaction as the trigger: an attack by the immune system disrupts the growth of the hair to such an extent that it falls out.

Previous forms of therapy were considered unsafe and unproven – taking dietary supplements such as zinc or treatment with cortisone was often recommended. The latter is ordered when hair falls out suddenly and in clumps. The downside: The treatment is usually associated with side effects such as weight gain and almost never leads to sustainable hair growth.

Another possibility is topical immunotherapy with a contact allergen such as diphencyprone (DCP). However, this is not approved as a drug – it is a chemical that is applied to the scalp. The irritation is intended to stimulate hair growth again. In the worst case, however, it can cause a rash all over the body.

Some doctors also recommend immunosuppressive treatment, as done for psoriasis and rheumatism. The immune system is suppressed with medication, which is intended to prevent hair loss. An increased susceptibility to infection are possible side effects of the unproven form of therapy.