The Use of Janus Kinase Inhibitors in Alopecia Areata: A Review of the Literature.

Alopecia areata (AA) is a chronic, immune-mediated disorder that targets hair follicle epithelium, thereby restricting hair growth in localized patches. Although several therapies for AA have been tested, responses with traditional therapies have been limited. In recent years, numerous reports have been published of patients with AA responding to Janus kinase (JAK) inhibitors. This literature review aims to describe AA pathophysiology, explore how and why JAK inhibitors can be used for AA treatment, and review published case reports, case series, and open-label studies published to date. Pathogenesis of AA includes interactions between genetic, environmental, and immune factors and is mediated by the cytokines interferon-γ and interleukin (IL)-15. JAK inhibition resulting in hair regrowth in some cases supports that AA is associated with the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. The emergence of JAK inhibitors for AA therapy is changing the way health care providers think about and treat AA. A mixture of animal model studies and human case studies have reported the use of baricitinib (JAK 1/2), ruxolitinib (JAK 1/2), and tofacitinib (JAK 1/3) for the management of AA. JAK inhibition has shown potential as an effective AA therapy when used in case studies, case series, and open-label trials. Formal clinical trials are ongoing and will yield more definitive conclusions about the safety and efficacy of JAK inhibitors.

Intravenous glutathione as a skin lightening agent: A pilot study on its efficacy and safety

BACKGROUND: Glutathione has been used therapeutically for many disease conditions, with a number of studies showing evidence of its anti-oxidant effect in many organ systems. However, in Asian countries particularly the Philippines, glutathione has been widely used as a whitening agent. OBJECTIVES: This study aims to determine the efficacy and safety of 10 weekly doses of intravenous reduced glutathione as a lightening agent based on melanin index readings and subjective assessment of the participants. METHODS: This is a before-and-after, open-label clinical trial. Twenty-two (22) women, most of whom have Fitzpatrick skin type IV, joined the study. Reduced glutathione (600mg/ml) diluted in 4 ml distilled water was injected into an antecubital or hand vein of each participant over 5-15 minutes. Each dose was administered weekly for ten consecutive weeks. Primary outcome measured in this study was the change in the subject's melanin index at 11 weeks from baseline. Subjective assessment of change in skin and color was also recorded. To evaluate safety, opthalmologic and serologic tests were determined at baseline and at 11 weeks. RESULTS: Twenty-one (21) subjects completed the study. One participant was not included in the analysis because she only received 9 treatments before dropping out of the study due to a transfer of work site. Thirteen (13) out of 21 subjects had lower post-treatment mexameter scores than the baseline. The mean difference in the melanin indices was 9.23 ± 19.6 with a percent reduction of 4.1% from baseline. Eight (8) claimed that their complexion become lighter after the study. However, of these 8 subjects, only five (5) had actual decrease in pigment as measured by mexameter. Only three participants were satisfied with the outcome. One subject had serum glutamic oxaloacetic transaminase (SGOT) increase beyond the normal range. Other serologic tests and opthalmologic tests were within normal limits at the end of the study period. Transient adverse reactions among 3 subjects were reported: myalgia and tired feeling (n=2) and chest discomfort followed by headache (n=1). CONCLUSION: There was a statistically significant difference between the mean melanin index at baseline and at eleven weeks. However, the level of reduction in mexameter reading was not sufficient to show clinically evident skin lightening. Intravenous glutathione resulted in sytemic and cutaneous adverse events in this small sample of volunteers.