Trichozette

Most years in hair and scalp care are made of small steps. 2024 had a handful of larger ones, and they landed in all three of our fields at once. Some were medical, some regulatory and some commercial, but they share a theme: claims about hair were asked to meet a higher standard of evidence and honesty.

Alopecia areata reaches the NHS

In February 2024 NICE issued final draft guidance recommending ritlecitinib, an oral JAK inhibitor, for severe alopecia areata in people aged 12 and over, followed by final guidance, TA958, in March. It was the first time NICE had recommended a medicine for severe alopecia areata; baricitinib had been appraised in October 2023 and was not recommended on cost-effectiveness grounds. In July, the British Association of Dermatologists and the British Hair and Nail Society published supplementary guidance on how to put the recommendation into practice, and in October the BAD living guideline for alopecia areata appeared online. Across the Atlantic, the US Food and Drug Administration approved a further JAK inhibitor, deuruxolitinib, for adults with severe alopecia areata on 25 July.

Firmer words on finasteride and minoxidil

In April the MHRA reminded prescribers that finasteride has been associated with depression, suicidal thoughts and sexual dysfunction, that sexual side effects have in some cases persisted after treatment stopped, and that a patient card would be placed in every pack. In October the European Medicines Agency's safety committee began its own review of finasteride and dutasteride. Minoxidil came under scrutiny too: European regulators added a warning that infants had developed excess body hair after skin contact with a carer's application site.

The cosmetic rulebook moves

• In March the Advertising Standards Authority ruled that a television advert combining a money-back offer with the words clinically proven implied a guaranteed result for a hair-loss medicine, which the code forbids.
• In April the European Commission adopted Regulation (EU) 2024/996, setting new limits for vitamin A derivatives, arbutin and several other cosmetic ingredients, phased in from 2025.
• Through the year, the US FDA repeatedly missed its own target dates to propose a ban on formaldehyde in hair straightening and smoothing products.
• In December the Scottish Government opened a consultation on licensing non-surgical cosmetic procedures, with an age limit of 18.

What connects them

Each change asked the same thing of professionals: be precise about what a treatment or product can and cannot do, know its risks, and know when to pass the client on. That is the thread the rest of this edition follows.