Differentiating Between Different Types of Alopecia, with Jerry Shapiro, MD

At the Maui Derm NP+PA Fall 2024 conference in Nashville, held from September 15-18, a presentation was given titled ‘Hair Update 2024,’ featuring a comprehensive discussion on non-scarring and scarring alopecias.

The talk was given by Jerry Shapiro, MD, professor and director of disorders of the hair and scalp at New York University's Grossman School of Medicine, who was interviewed by the HCPLive editorial team following the presentation to discuss its most important highlights. He was first asked about differentiating between different types of alopecia.

“It can be very difficult,” Shapiro said. “Some are obvious like frontal fibrosing alopecia, where many times we don't need to do a biopsy. We can tell what that is. Alopecia areata is a very restricted, circumscribed patch. We don't need a biopsy. We can tell what it is. Certain things are obvious, but when it's diffuse and all over the scalp and it may not be patchy, then we need to take a biopsy and try to figure out what it is.”

Shapiro was also asked about recent advancements in therapies that have had a significant effect on conditions such as scarring alopecia.

“There haven’t been too many that have been recent,” he said. “I was one of the first in the world whose tacrolimus topically to the area in a mixture with minoxidil. That's already 5 or 6 years old. But I think the big thing is the JAK inhibitors, and I'm trying to get it because it's not covered or approved for alopecia. I try to get it into the hands of our patients, because I really do think it makes a difference and puts out the fire.”

Shapiro was later asked about which updates he gave in his presentation to attendees, as well as steps for attendees to take in helping patients to manage disease.

“So what the NPs and PAs should take home is to give an algorithmic approach on what to do if there's less than 10% involvement, more than 10% involvement, how aggressive you should be, and what step-wise drugs to use. What's the first line? Hydroxychloroquine, doxycycline, injections. What's the second line? Then there are things like pioglitazone and naltrexone. And you need to have a plan of action.”

The quotes contained in this summary were edited for the purposes of clarity.

Shapiro has been a consultant for Pfizer and Lilly, and has been an investigator for Regen Lab and for Pfizer.