Kyle Rhodes before treatment (with a little hair inside a plaque of psoriasis); promising growth after five months of treatment and a full head of hair, eight months into treatment.
Jill Margo Health editor
Between 200 and 300 emails a day have been flowing into Brett King's mail box since a series of images appeared in the international media in late June.
They are from people seeking help with hair restoration.
King, a dermatologist and assistant professor at Yale University's School of Medicine, is the first person in the world to crack through the impenetrable wall surrounding alopecia, a condition that causes hair loss.
He did this using a sophisticated biologic agent and the question now is whether it will be possible to crack through the other impenetrable wall that surrounds male pattern baldness.
These two forms of hair loss have different drivers.
Alopecia is an autoimmune condition where the body attacks its own hair follicles and causes the hair to fall out. Male pattern baldness has genetic and hormonal drivers.
But King is optimistic. 'This agent had such a profound result it is impossible for me to believe that this step forward will not renew energy for research that could benefit the rest of us who have male pattern baldness or other types of hair loss,' he says.
King, who just turned 44, describes himself as having two thirds of a head of hair due to typical male pattern baldness.
The photographs illustrate the astonishing restoration of hair in a young man burdened with both alopecia and the skin condition psoriasis.
Soon after they appeared in the Journal of Investigative Dermatology, they were flashed around the world.
King had treated the young man with the FDA-approved drug Tofacitinib citrate which is designed to treat rheumatoid arthritis. He says it wasn't an accident that it worked.
'This discovery was borne of science. Smart medicines like this do not happen by chance and they highlight the importance of investing in research.'
He believed the drug could potentially treat both alopecia and psoriasis.
It had been used successfully for psoriasis in humans and a scientist at Columbia University had shown it could reverse a less extreme form of hair loss in mice called alopecia areata.
King's patient had alopecia universalis which means he had total hair loss, including eye lashes, eyebrows, facial, body, groin and underarm hair.
King explains that traditional treatment for alopecia usually involves carpet bombing the immune system in the hope of suppressing the mechanism that affects hair.
'The problem is that it ransacks 30 different processes along the way in order to capture the process it wants.'
But this new drug is much smarter. It accurately targets the pathogenic mechanism that underpins alopecia.
In alopecia, the hair follicle sends out a distress signal. This signal recruits the body's immune system. When immune system attacks, the hair leaves the body.
'The distress signal shouldn't be there,' says King.
'The follicle is raising a flag for no good reason and this drug literally turns down the volume of the distress signal so it's not heard by the immune system.
This allows the hair cycle to resume and so the hair regrows.'
While the result is provocative, King says it needs to be repeated in clinical trials.
As this drug can have serious side effects and can also be lethal, he is developing a cream to avoid its systemic effects.
The cream would be for people with alopecia areata which causes spot loss of hair and is the most common auto immune disease in man.
For King, the email deluge has been enlightening. 'One thing you can't understand until you read 2000 emails is how devastating it is not to know if the hair you go to sleep with will be there in the morning.'
'That unpredictability exacts a toll because we are all accustomed to having a certain amount of control over our appearance and this is a disease where you have no control from day to day.'
King's wife, Brittany Craiglow, co-authored the paper on this case. A paediatric dermatologist at Yale, she persuaded him the case needed to be written up and because he was too busy, she did it for him.
In Australia, an estimated 100,000 Australians suffer from spot alopecia. Between five and ten thousand suffer from the universal form, according to Rod Sinclair, professor and director of dermatology at the Epworth Hospital and head of the Epworth Dermatology Research Centre.
He is cautious about the implications of the Yale case and about the effect it could have on research into male pattern balding.
'There has been a pharmacological revolution in past 15 years where new drugs have been identified that target specific inflammatory markers.
To date it has been disappointing finding one for alopecia areata. All the prospects did not work.'
Sinclair says while the Yale case is exciting and provides an anecdote on which to base future research, it can't be said to be a cure.
'We've seen it before with other biologic where they have been single case reports that fizzled.'
As this biologic is an anti-inflammatory which targets an inflammatory disease, it is unlikely to have any role at all in male pattern baldness which is not an inflammatory condition.
Pfizer, which makes the drug, issued a cautious statement saying the study was conducted independent of the company and it could not comment on the results. In the US the drug costs $25,000 a year.
Case study: arthritis drug works wonders for chronic, complete hair loss
Kyle Rhodes, now 25, had lived with his highly visible condition for many years. He had large scaly plaques of psoriasis on his head and no hair anywhere else.
He works at an engineering company in New York State, and when an experimental drug restored his hair in all the natural places, he became an instant television celebrity.
Rhodes described how he took off his hat at a dance when he was in seventh grade and found it full of hair. He'd suffered from spot hair loss since he was a toddler but the week he turned 18, all his hair fell out.
Although he had adjusted to the hair loss, his psoriasis was bad and he sought help from Brett King, a dermatologist at Yale University's school of medicine.
King was willing to try the drug Tofacitinib citrate, which is used for rheumatoid arthritis.
It worked quickly and after two months Rhodes began to grow scalp and facial hair.
After three more months he had a full head of hair and clearly visible eyebrows and eyelashes, as well as facial, armpit and other hair.
After eight months, he had full regrowth of his body hair.
He reported no side effects and laboratory tests detected no problems. The improvement in his psoriasis, however, was less dramatic.
While King describes Rhodes as 'laid back', he says he was enormously grateful for the transformation.
'All his life he never knew from one day to the next whether he would wake up with a pillowcase covered in hair. That is tough as an adult but it's really tough for a kid,' King says.
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