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Invited Commentary: Can the genetic TrichoTest help optimize treatment for hair loss?

May/June 2021 HAIR TR ANSPLANT FORUM INTERNATIONAL Can the genetic TrichoTest help optimize treatment for hair loss? Sharon A. Keene, MD, FISHRS I Tucson, Arizona, USA At first glance, utilizing the TrichoTest as a pharmacogenomic tool to provide personalized medicine and optimize individual treatment for hair loss patients appears to be an admirable and useful goal—like the patients mentioned, I embrace this idea. The question is whether the TrichoTest is an effective tool that achieves this goal. While there are several genes and single nucleotide polymorphisms (SNPs) included in this test, my focus will be limited to a look at some of the genes being tested relative to the most common cause of hair loss, androgenetic alopecia (AGA), and the pharmacogenomics of the most common therapies we prescribe to treat it. There are currently only two FDA approved pharmacologic agents approved to treat AGA: finasteride and topical minoxidil. I am unaware of other pharmacologic or non-pharmacologic therapies with comparable research and track records for AGA response. Both therapies have limitations for patient acceptance and individual efficacy, hence the reason to address individual responses. In the context of the TrichoTest it begs the question: can testing particular genes and their SNPs overcome current medication limitations for use or efficacy? If there were a way to accurately predict patient response to a particular medication or those patients most likely to experience side effects, it is easy to surmise the utility of such a test to patients and doctors. Finasteride has a high clinical response rate (>90% stabilization, 66% regrowth)1 making the question of some References 1. Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004 Feb; 150(2):186-194. 2. Rundegren J. A one-year observational study with minoxidil 5% solution in Germany: results of independent efficacy evaluation by physicians and patients. J Am Acad Dermatol. 2004; 50(3):91. 3. Stratified, personalised or P4 medicine: a new direction for placing the patient at the centre of healthcare and health education (Technical report). Supported by the Academy of Medical Sciences. May 2015. Archived from the original on 27 October 2016. Retrieved 6 January 2016. 4. Cunliffe WJ, et al. Vitiligo, thyroid disease and autoimmunity. Br J Dermatol. 1968(Mar); 80(3):135-139. 5. Kumar B, Sharma VK, Sehgal S. Antismooth muscle and antiparietal cell antibodies in Indians with alopecia areata. Int J Dermatol. 1995(Aug); 34(8):542-545. 6. Corazza GR, et al. Celiac disease and alopecia areata: report of a new association. Gastroenterol. 1995(Oct); 109(4):1333-1337. 7. Petukhova L, et al. Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature. 2010(Jul 1); 466(7302):113-117. 8. Trueb RM, et al. Precision medicine and the practice of trichiatry: adapting the concept. Skin Appendage Disord. 2019; 5:338-343. 9. Whiting DA. Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. J Am Acad Dermatol. 1993(May); 28(5 Pt 1):755-763. Ø CONTINUED FROM PAGE 105