A patient with scarring alopecia constitutes a “trichologic emergency,” according to Dr. Jerry Shapiro, a professor of dermatology at NYU Grossman School of Medicine. Speaking at the Maui Derm NP+PA Fall 2024 conference, Dr. Shapiro emphasized the urgency for healthcare providers to act swiftly to mitigate further hair loss in these patients.
Dr. Shapiro also discussed the integration of artificial intelligence (AI) in dermatology, the role of JAK inhibitors in treating alopecia, and the complex treatment algorithms for lichen planopilaris.
Importance of Education in Dermatology
In an interview with Dermatology Times, Dr. Shapiro underscored the significance of his session on hair health. “Alopecia has become a major concern in dermatology,” he stated. “With the introduction of new treatments, we now have the capability to significantly improve patients’ lives. When I began my career over 30 years ago, options were extremely limited. Today, we can offer a variety of treatment options tailored to individual patient needs.”
Recent Advancements in Hair Loss Treatment
Dr. Shapiro expressed enthusiasm for recent advancements, particularly the use of JAK inhibitors. “These drugs not only benefit alopecia areata but also cicatricial alopecia by reducing inflammation, which helps manage the condition more effectively,” he explained. He noted a growing trend in prescribing low-dose oral minoxidil for androgenetic alopecia, which he believes enhances the effectiveness of JAK inhibitors and promotes overall hair growth.
Distinguishing Between Scarring and Non-Scarring Alopecia
When discussing the differences between scarring and non-scarring alopecia, Dr. Shapiro pointed out that scarring alopecia results in permanent hair loss due to the destruction of hair follicle stem cells. In contrast, alopecia areata is reversible, as the immune response targets a different area of the follicle.
Treatment Strategies for Lichen Planopilaris
Dr. Shapiro detailed the complicated treatment algorithm for lichen planopilaris, emphasizing the need to tailor approaches based on the extent of hair loss. For patients with limited scalp involvement, he recommends cortisone injections and topical treatments containing tacrolimus, clobetasol, and minoxidil. In more severe cases, stronger medications and injections may be necessary. He also mentioned the use of 5α-reductase inhibitors, such as dutasteride, for conditions like frontal fibrosing alopecia.
The Role of AI in Dermatology
Dr. Shapiro highlighted the transformative impact of AI on his practice, noting its efficiency in quantifying hair density. “AI allows us to obtain precise measurements of hair count and width in seconds, vastly improving our diagnostic capabilities,” he said. Previously, manual counting could take up to nine minutes; now, results can be generated in about 45 seconds.
Conclusion
Dr. Shapiro concluded with a crucial reminder: “Scarring alopecia is a trichologic emergency. Every hair lost is permanent, making prompt intervention essential. Patients must seek treatment without delay to prevent irreversible damage.” He recounted recent encounters with patients whose conditions had been neglected, underscoring the necessity for timely dermatological care.
