Severe Scalp Hair Loss Associated with Greater Eyebrow, Eyelash Loss in Patients With Alopecia Areata

Increased severity of scalp hair loss in patients with alopecia areata (AA) is associated with increased eyebrow and eyelash hair loss, according to the results of a recent study presented at the American Academy of Dermatology’s 2023 annual meeting.

The authors aimed to better understand the distribution of eyebrow and eyelash loss across various degrees of scalp hair loss severity among adults with severe AA who were enrolled in either the BRAVE-AA1 or BRAVE-AA2 phase 3 clinical trials. The BRAVE trials examined the efficacy of baricitinib, an oral selective JAK inhibitor, on hair regrowth in this patient population.

To be included as part of this additional study, all participants must have had a Severity of Alopecia Tool (SALT) score of 50 or greater, indicating 50% or greater scalp hair loss, as well as the current episode of AA lasting at least 6 months but no longer than 8 years and no spontaneous improvement in hair loss in the 6 months prior to screening.

The researchers utilized the Clinician-Reported Outcome Measure for Eyebrow Hair Loss (ClinRO Eyebrow) and the ClinRO Measure for Eyelash Hair Loss (ClinRO Eyelash). For both measures, full coverage or minimal gaps was defined as scores of 0/1, while significant gaps or no notable hair was defined as scores of 2/3.

To determine the scores, clinicians should examine both eyebrows from 2 feet away. The researchers developed photo guides to help raters determine their scores. The guide also helped standardize ratings across raters and offered clear instructions for examining signs of AA (in this case, eyebrow and eyelash hair loss).

“In the BRAVE-AA study population, the proportions of patients with significant gaps or no notable eyebrow or eyelash hair increased with higher degrees of scalp hair loss,” the researchers said of the study results.

Among the 338 patients with SALT scores of 50-74, the proportion of ClinRO Eyebrow scores of 0/1 was 58.6%, while 2/3 was 41.4%. Further, 70.1% had ClinRO Eyelash scores of 0/1 while 29.9% had scores of 2/3.

In the 220 patients with SALT scores of 75-94, 39.5% and 60.5% had ClinRO Eyebrow scores of 0/1 and 2/3, whereas 54.1% and 45.9% had similar ClinRO Eyelash scores.

Lastly, among the 633 total patients with 95-100 SALT scores, ClinRO Eyebrow scores of 0/1 and 2/3 were seen in 12.8% and 87.2% of these patients. ClinRO Eyelash scores of 0/1 and 2/3 were seen in 22.4% and 77.6% of this group, respectively.

“These data help further our understanding of the patterns of disease presentation and disease burden in patients with severe AA,” the researchers concluded.

Reference:

Shapiro J, Ko J, Egeberg A, et al. Baseline distribution of eyebrow and eyelash loss by severity of scalp hair loss in phase 3 trials of baricitinib for alopecia areata. Poster presented at: American Academy of Dermatology’s 2023 annual meeting; March 17-21, 2023; New Orleans, LA. Accessed March 21, 2023. https://eposters.aad.org/abstracts/41247