Autoimmune condition causes loss of hair

Question: Can you shed any light on recent studies for alopecia? My 9-year-old granddaughter had a beautiful head of hair, which totally fell out four years ago.

She has seen many doctors, but nothing has helped. Is there anything that can be done for this life-altering disease? Any promising studies either here or abroad?

Answer: There is a new type of medication that offers some hope against alopecia areata, an autoimmune condition in which the immune system attacks patches of hair follicles, causing partial or complete baldness.

Dermatologists at the Cleveland Clinic have reported on a preliminary study involving a powerful drug approved for treating rheumatoid arthritis (JAMA Dermatology, online, March 29, 2017). The drug, tofacitinib (Xeljanz), is known as a Janus kinase inhibitor. The researchers found that it helped regrow hair, though there was tremendous variability of success.

This medication carries a risk of serious infections or cancer, so it will not be used casually. The price is prohibitive, and it is unlikely that insurance will cover it. The good news is that this research might open the door to develop safer treatments.

Question: I have been taking arthritis-strength acetaminophen (Tylenol) for my joint pain and recently noticed that my tinnitus is more intense. Is this a possible side effect of the pain reliever?

Answer: Frequent use of over-the-counter pain relievers such as acetaminophen or ibuprofen can cause hearing loss (American Journal of Epidemiology, Sept. 15, 2012). One study determined that acetaminophen can damage hair cells crucial for normal hearing (Hearing Research, July 2014). We have not found studies linking normal use of acetaminophen to ringing in the ears (tinnitus). That said, when people begin to lose their hearing, they may develop tinnitus.

Because most other over-the-counter pain relievers also can trigger tinnitus, you might need nondrug approaches for inflammation relief. Our "Guide to Alternatives for Arthritis" offers several natural ways to ease joint pain. This online resource is available at www.PeoplesPharmacy.com.

Question: I ended up in the hospital "off my gourd." I didn't even know what had happened until later in the week. I am on several anticholinergic medications such as amitriptyline, Benadryl, Vistaril, Phenergan, Claritin, Zantac and tizanidine.

Answer: We are astonished that you can function at all with so many anticholinergic drugs. Such medications interfere with an important neurochemical called acetylcholine. Several medicines you are taking have strong anticholinergic activity. They include amitriptyline (Elavil), diphenhydramine (Benadryl), hydroxyzine (Vistaril), promethazine (Phenergan) and tizanidine (Zanaflex).

These drugs can cause dry mouth, constipation, blurred vision and difficult urination. They also may lead to confusion and memory problems, especially when many are combined. You'll find a list of anticholinergic drugs at www.PeoplesPharmacy.com. You should ask your doctor whether there are any alternatives that might be substituted for these prescriptions.

Question: I was prescribed pregabalin (Lyrica) for fibromyalgia. It did not relieve my pain. Worse, it made me narcoleptic, more or less. I was standing at the kitchen sink actively washing dishes and walking down the hallway carrying a basket of folded laundry to a bedroom when – bam! – I was instantly asleep and dreaming while still in motion. I shook myself awake both times, alarmed at what had happened. There was no forewarning other than feeling a bit tired.

I told the doctor that Lyrica had not worked and about the side effects it caused. I find all too often that even otherwise great doctors seem to rely on information from drug company representatives. I wish they would check drug studies to see what the potential side effects can be.

Answer: The prescribing information for Lyrica lists "sleep disorder" as a rare side effect. There is no explicit reference to narcolepsy in the medical literature. Such sudden sleep attacks during the day could be dangerous. Thank you for letting us know about your experience.

Question: My cardiologist prescribed Repatha. This drug lowered my LDL cholesterol significantly, but I cannot keep taking it because of its cost.

My insurance will cover Repatha, but with a copay of $488 per month. I have tried every statin on the market and have experienced bad reactions to every one of them. What can I do now?

Answer: Evolocumab (Repatha) is a new way to lower bad LDL cholesterol dramatically. A study in the New England Journal of Medicine (online, March 17, 2017) demonstrated that this injected medication reduced the risk of a heart attack or stroke when added to a statin.

The Food and Drug Administration has approved Repatha for use only in conjunction with other cholesterol-lowering drugs. We suspect, however, that many physicians are prescribing it for people like you, who cannot tolerate statins.

Repatha has a list price of about $14,000 per year, so it's not surprising that your copay is so high. The manufacturer, Amgen, offers financial assistance to patients who find their insurance copay unaffordable. If you go to Repatha.com, you could sign up for the program.

Question: When I was 18, I went to join the Army Reserve. I weighed 165 pounds and was in great physical condition, but when they took my blood pressure, it was 200 over 70. I was told to go straight to my doctor. The pill he prescribed made me feel like a zombie.

I bought a home blood pressure monitor; my pressure was 130 over 70 when I took it. I recently bought a digital blood-pressure unit and log my pressure regularly. To this day, 35 years later, I still have white-coat hypertension. Last week my blood pressure was 200 over 90 in the doctor's office and 125 over 80 at home.

Answer: Yours is indeed a classic case of white-coat hypertension. Most experts think home blood-pressure readings (especially continuous 24-hour monitoring) are better at determining the actual risk from elevated blood pressure (Current Opinion in Cardiology, online, March 16, 2017).

Joe Graedon is a pharmacologist; Dr. Teresa Graedon is a medical anthropologist and nutrition expert. Questions for the Graedons can be sent to them using their website, www.peoplespharmacy.com, or by writing to the following address: Graedons' People's Pharmacy, King Features Syndicate, 300 W. 57th St., 15th Floor, New York, NY 10019

 

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