Arthritis Drug Tofacitinib Cures Vitiligo: Dr. Brett King

I was not planning to write a post so soon after my prior one, but a new development from today is very interesting and exciting.

Regular blog readers will agree that last year’s most exciting developments in the hair loss world were alopecia areata being cured in a few patients. This feat was achieved by arthritis drug tofacitinib, and then again by bone marrow cancer drug ruxolitinib.

Dr. Brett King from Yale University led the work with tofacitinib, and he was interviewed on the Bald Truth show shortly thereafter. Most people on hair loss forums have not been too optimistic about a cure for alopecia areata also working on patients suffering from androgenetic alopecia (aka male pattern baldness). However, in that interview, Dr. King seemed to imply that it was definitely a possibility.

Since that time, myself and numerous others have eagerly hoped that Dr. King would start testing tofacitinib on patients suffering from male pattern baldness. This is by far the most common form of hair loss in both men and women.

Tofacitinib Cures Vitiligo

Instead, today Dr. King shocked the dermatological world for a second time for a totally different reason. Apparently, tofacitinib citrate cured one of Dr. King’s 53 year old female patient’s vitiligo. This latter condition is a devastating skin disease (Michael Jackson supposedly suffered from it).

Tofacitinib Vitiligo Reversal
Tofacitinib Vitiligo Reversal. Source: JAMA Dermatology.

Tofacitinib is a JAK 1/3 inhibitor that was approved by the US FDA in 2012 for the treatment of rheumatoid arthritis. Below are the before and after images from Dr. King’s latest groundbreaking findings. The source of these images is the full study that can be found in JAMA Dermatology.

Quite a few media outlets have covered this study today, including the UK’s Telegraph and US based CBS News. Here’s to hoping that in 2016 (or sooner), Dr. King publishes yet one more study that finally shows tofacitinib also curing androgenetic alopecia. At least in some patients in which there is also an inflammatory component to the disease.

So far, all of Dr. King’s results from last year and this year suggest that tofacitinib does not lead to any kind of severe side effects when taken under doctor supervision. It should also be noted that Pfizer has filed for FDA approval to treat psoriasis with tofacitinib after successful phase 3 trials.  This is all very encouraging when it comes to the safety profile of this seemingly miraculous drug.

Finally, it seems like tofacitinib might also successfully convert white fat (bad) into brown fat (good).  An important study on this was published in 2014.

Spironolactone for Hair Loss

Spironolactone and Hair Loss
Spironolactone for hair loss.

On this blog, I have often discussed the only two (Finasteride and Minoxidil) FDA approved drugs to treat hair loss. Finasteride is an oral drug that inhibits the enzyme 5α-reductase, which in effect then reduces the harmful-to-hair dihydrotestosterone (DHT). Minoxidil is an antihypertensive medication that also happens to benefit scalp hair when used topically. This post will cover a hair growth medication called Spironolactone.

Anti-Androgens

When it comes to hair loss medications, one area that I have neglected is anti-androgens such as Spironolactone, which have many favorable reviews. I did discuss RU-58841 in one post at the start of this year, but there are numerous other anti-androgens out there. In general, the potential side effects from anti-androgens are more severe than from Finasteride and Minoxidil, while scalp hair regrowth is typically less significant than from Finasteride (although there are some exceptions).

Note that while some strict definitions consider Finasteride to also be an anti-androgen due to its inhibition of DHT, I only consider drugs that inhibit the binding of testosterone to androgen receptors as being anti-androgens. Finasteride, while reducing DHT, actually raises testosterone levels by around 10 percent. Also worth noting is that the popular Nizoral shampoo might have some anti-androgenic properties per several recent studies.

In this post I will discuss the most popular “true” anti-androgen in the world: Spironolactone.

Spironolactone for Hair Loss

Spironolactone (generally sold under the brand name Aldactone) is also referred to as “Spiro” and is a synthetic drug available via prescription. It belongs to a class of drugs known as potassium-sparing diuretics, and is used primarily as a diuretic and antihypertensive in the treatment of heart failure and hypertension.

However, secondary anti-androgenic applications have become more prevalent in recent decades. Spironolactone can stop hair loss, reduce body hair (hirsutism), reduce acne, help women with polycystic ovary syndrome (PCOS) and improve seborrheic dermatitis.

In 2020, a study found topical Spironolactone 1% gel and Minoxidil 5% gel to be an effective combination treatment for hair loss. An older study from 1998 concluded that topical Spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands

Spironolactone Side Effects

While this drug may seem like a miracle product that can kill many birds with one stone, potential side effects are significant and plentiful. For men, feminization is a real danger when taking Spironolatone, meaning that you can developed gynecomastia (larger breasts) and see your testicles shrink. Men can also develop premature ejaculation and become infertile (although in most cases it seems like this side effect is not permanent) when taking this drug.

Less traumatic side effects include drowsiness, dry skin, excess urination, headache, nausea and vomiting. Spiro can potentially even lead to death from severe allergic reactions, hyperkalemia, kidney failure and more, although I have not read about this happening to any hair loss forum members. In general, the doses that hair loss patients take tend to be on the lower side. You can learn a lot more about Spiro and its use to treat hair loss by tracking patients that take this product and post about it in the various online hair loss forums. I have never tried to take Spironolactone since I am very cautious when it comes to taking any kind of drug.

Mechanism of Action

Aldactone (Spironolactone) is a specific pharmacologic antagonist of aldosterone. It primarily acts through competitive binding of receptors at the aldosterone dependent sodium-potassium exchange site. Aldactone causes an increase in sodium and water excretion rates, while potassium is retained. The drug therefore acts as both a diuretic as well as an antihypertensive via this dual mechanism.

Spironolatone for Male-To-Female Transsexuals

I first learnt about Spironolactone when I read testimonials and forum posts from numerous male-to-female (MTF) transsexuals out of my own curiosity many year ago. It seems like estrogen and Spiro are the two main drugs that MTF transsexuals are almost always given. Moreover, transsexuals often have to take a much higher dosage (100-200 mg per day to start, and considerably higher doses if ineffective) of Spiro compared to men or women who are only tackling balding. It is therefore important for you to visit transsexual/transgender forums on the internet and ask questions if you ever intend to take Spiro.