Update on hair disorders

Dr Roquet-Gravy summarised some recent advances in the management of hair disorders presented at EADV, offering valuable updates for clinical practice.

A major focus was androgenetic alopecia. Oral finasteride was discussed as a second-line therapy after dutasteride. However, recent regulatory alerts have drawn attention to safety concerns. The U.S. Food and Drug Administration has issued a warning regarding an association between finasteride and suicide risk, based on real-world pharmacovigilance data. Subsequently, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency recommended further risk-minimization measures when prescribing this drug. Oral minoxidil, increasingly used in this indication, was highlighted for its risk of hypertrichosis, with Latin American cohorts estimating an incidence between 15% and 40%. Paediatric treatment strategies were also reviewed: topical minoxidil 2% is considered appropriate in prepubertal patients, while 5% formulations are reserved for postpubertal individuals. If only partial improvement is achieved, oral minoxidil may be introduced at a maximum dose of 0.5 mg daily. Additionally, emerging data suggest that glucagon-like peptide-1 receptor agonists may induce hair loss, raising questions regarding weight reduction as a potential contributing factor.

Alopecia areata was another central topic. This condition exerts profound psychosocial and quality-of-life burdens, particularly in severe forms. Janus kinase (JAK) inhibitors now provide an effective therapeutic option, with baricitinib recently reimbursed in Belgium. Clinical experience indicates that treatment response may require considerable time; in some severe and slow-responding cases, up to two years of therapy are necessary for significant regrowth. Combination therapy with corticosteroids has demonstrated additive benefit, particularly when 4 mg of baricitinib is supplemented with corticosteroids, leading to improved SALT scores. Predictive factors of favourable outcomes include recent disease onset, initial use of intravenous corticosteroids, and female sex, whereas poor prognosis is associated with severe alopecia areata or ophiasis pattern. Sustained efficacy requires continuation of therapy, and discontinuation should be avoided unless medically indicated.

Lichen planopilaris was also addressed. Current therapeutic algorithms recommend intralesional triamcinolone in combination with doxycycline and topical tacrolimus. Data presented by Dr. Shapiro demonstrated that low-dose doxycycline (20 mg daily) is equally effective as the conventional 100 mg regimen but with fewer adverse effects. In refractory cases, low-dose naltrexone (3 mg daily) may be considered as an adjunct.

Overall, the session emphasised the dynamic evolution of therapeutic approaches in scalp disorders, underscoring the balance between efficacy, safety, and long-term disease management.