Hair Today, Gone Tomorrow: Alopecia Areata Explained

That Oscars moment put the word “alopecia” on everyone’s lips, but the real story is what happens when hair loss is autoimmune and how quickly it can change someone’s life. I sit down with board-certified dermatologist Dr. Eric Dominguez to explain alopecia areata in plain language, from the classic coin-shaped patches to the tougher presentations like diffuse thinning, ophiasis patterns, and isolated eyebrow or eyelash loss that can be even harder to hide.

We get practical about diagnosis and next steps: what we look for on exam, when a scalp biopsy helps confirm the cause, and why the scalp can feel like a uniquely stressful place to do a procedure. We also dig into the questions patients ask every day in clinic: Did stress trigger this? Is it genetic? What’s the risk of losing more hair or progressing to alopecia totalis or alopecia universalis? And if you have alopecia areata, what other autoimmune conditions like thyroid disease, vitiligo, eczema, or psoriasis should be on your radar?

Then we move to treatment, including why alopecia areata is not a cosmetic problem and why getting help early matters. We cover the full range, from topical and intralesional corticosteroids for localized disease to the newer FDA-approved oral JAK inhibitors that are changing what hair regrowth can look like for severe cases. We also set realistic expectations: this can be a chronic, relapsing condition, and stopping an effective medication may mean losing progress.

If you or someone you love is dealing with autoimmune hair loss, listen, share, and then subscribe, leave a review, and tell us what question you want us to tackle next.

Transcript

Why Scalp Hair Loss Hits Hard

SPEAKER_02 0:00

Patients, when they have a biopsy on their nose for a skin cancer, are less stressed out than if you go to biopsy their scalp.

SPEAKER_00 0:07

But what's the likelihood, you know, doc, I'm gonna lose all my hair or I'm gonna lose every hair on my body.

SPEAKER_02 0:12

Well, we know that over 50% of patients, and once we treat them and we're able to regrow their hair, they are smiling. They want to hug you, they are so happy, and it really makes your job as a dermatologist so much more rewarding. As a general rule of thumb, if you stop the treatment, you will likely lose the progress that you've made.

SPEAKER_01 0:31

Now Welcome to Dermot Trotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.

SPEAKER_00 0:51

Welcome to the Dermitrotter Don't Swear About Skin Care podcast. We are excited to be here today to talk more about inflammatory disease, but hair loss, guys, the things we're all worried about. I've got Dr. Eric Dominguez here on the show today. He's a board-certified derm, owner of modern dermatology. He's an assistant clinical professor at the University of Massachusetts Chan Medical School, and he loves anything with inflammation in the skin. So hair loss is his jam. Welcome to the podcast, Eric. It's great to have you here.

What Alopecia Areata Really Is

SPEAKER_02 1:21

Thanks so much, Chan. I'm so happy to be here and to discuss alopecia riata in particular.

SPEAKER_00 1:26

Well, one thing I'm going to have you break down is just that term you use, alopecia. I don't know how many times have people come and say, oh, do I have alopecia? And I think that we understand like how broad of a term that really is, right? That it refers to multiple types of parallels, but you and I are going to talk about a very specific subtype of that, alopeciariata today, that we know as autoimmune in nature. I'm going to have you explain that a little bit for our audience because they may be more curious about it. But I think what got interest and attention, I love to mention, is that slap herd around the world at the Oscars, Jada Pickensmith, Will Smith, you know, that was really a popular instance, you know, when that happened and really drew attention to the word alopecia, but more specifically, she was talking about alopiciata. So I want you to break it down for me. What is alopiciariata?

SPEAKER_02 2:07

So alpiciariata is actually a very common autoimmune skin condition where essentially your body's inflammation cells decide to attack the hair follicles. And when they attack the hair follicles, the hair falls out. It's one of those types of hair loss that you can go to bed one night with a full head of hair and wake up the next morning missing all of your hair potentially, or just patches of hair loss. And it can be quite detrimental to someone's emotional health. And yes, it's one of those conditions that patients certainly are quite concerned about. And I like the point that you bring up about alopecia. What is alopecia? So alopecia just means hair loss, right? There are several different types, as you alluded to. A very common one certainly is alopeciariata. We have the female and male pattern hair loss, other types of alopecia as well, where you lose your hair. But of course, alopeciariata is certainly one of the most common ones that we see in many different ages, a lot of times even presenting in children, young adults, adolescents, teenagers, but certainly can occur at any age.

Common Patterns On Scalp And Face

SPEAKER_00 3:04

So we talked about, you know, it's autoimmune, our own immune cells, you know, those T cells or T lymphocytes we talked about are attacking, you know, the hair follicle, and then essentially cause, you know, that hair to fall out. How does it tend to present? Because I think a lot of people are wondering, well, I feel like I have shedding, I feel like I'm losing hair. Do I have alope chariata?

SPEAKER_02 3:22

Well, the most common way to present with allopiciata are these coin-shaped patches of hair loss, very commonly on the scalp, but can also impact the beard, eyebrows, eyelashes, arms, legs, or other areas on the body, but certainly the scalp, the eyebrows and the eyelashes can be the areas that certainly cause the most emotional distress because of areas that patients can't hide. And of course, that's when it's more localized. You can certainly present a little differently where there's really some diffuse thinning of your hair. And that can be a little bit difficult to distinguish between male or female pattern thinning versus diffuse alope chariata. And certainly you can also have just involvement of the eyebrows, just involvement of the eyelashes, or you can have a combination of all of these. A more difficult type to treat and to actually have is what we call the ophiasis pattern, where essentially you have hair loss that goes from the back of your scalp from ear to ear, back here, essentially. And it can be quite difficult to treat. But certainly, if someone sees a physician who treats patients with hair loss, with alopecia more specifically, you may certainly be able to have this diagnosed.

SPEAKER_00 4:27

And have you ever seen patients too that could have it just a particular, like just the eyebrows or just the eyelashes or just the beard, and maybe it's not hitting the scalp, or most people think of it as occurring first?

SPEAKER_02 4:38

Absolutely. You certainly can see that. I have patients in my clinic who present with just loss of their eyebrows, just loss of the eyelashes. And that at times can even be more detrimental than their scalp. As you can think, for a scalp, you could put a hat on, a wig potentially, but your eyebrows and eyelashes, you can't really hide that as well. And that can be very emotionally distressful for our patients.

How Dermatologists Diagnose Hair Loss

SPEAKER_00 5:00

I can speak from personal experience, not from alope shariata, but from overplucking in the 90s and lost most of my eyebrows. So I even get mine microbladed because without those eyebrows, I mean, your your face, it just frames your face, right? People can feel very different, and it's very hard to do something that looks authentic to replace that hair. Where I've had patients say the same thing. They're like, I can get something to put on my scalp, a hair prosthesis or a wig, and I feel like I can fix it, but eyebrows or eyelashes, man, that's tough. And you're right, that has an emotional toll. I mean, we definitely think of women, but it does affect men similarly, where it can take that emotional toll as well. So if somebody is wondering about alope shariata, like and they think they might have it, how would you diagnose it? Because I think that's probably one of the things people are thinking, again, I have hair thinning, but it looks kind of patchy, it's kind of diffuse. I mean, my eyebrows have starting to go away. Do I have it? How would you actually diagnose it in office?

SPEAKER_02 5:48

The number one way to really diagnose alope shariata is clinically. Basically, how does it look? Does it present similar to LP chariata? Is it missing other findings that you may see in other types of hair loss? Certainly, if you have eyebrow, eyelash involvement, and patchy scalp loss, that certainly can indicate LP chariata. But if you have just diffuse hair thinning, certainly, as we discussed earlier, that could be indicative of a male or female pattern thinning or diffuse LP chariata. If you see other signs, redness, scaling, it could certainly be another type of hair loss as well. We know that certain types of inflammation in the scalp, whether it could be severe psoriasis, can cause some hair loss, severe sebarrella, which is essentially a type of severe dandruff, can also cause some thinning of the hair. So really having that clinical presentation can be certainly very helpful. But when in doubt, a scalp biopsy can also be performed, and that certainly can also lead to a correct diagnosis if the diagnosis is in question and not completely conclusive for LP chariata.

SPEAKER_00 6:48

And a scalp biopsy, do you feel like that's a pretty intimidating thing to have done or pretty simple practice that you can use to help really define what's going on?

SPEAKER_02 6:57

I would say as a clinician, uh dermatologist, I find scalp biopsies to be fairly simple because when I was a resident, we did a lot of these. However, as a patient, I can imagine it's actually very stressful. I will tell you the truth. Patients, when they have a biopsy on their nose for a skin cancer, are less stressed out than if you go to biopsy their scalp. We know the scalp is certainly one of those areas that bleeds quite a bit. And for a novice clinician, that might be something very difficult to consider because all that bleeding that can certainly happen. What I've learned is if I have a patient doing a scalp biopsy, I have you come in 30 minutes early. We're going to numb up that area, let the numbing sit there as long as we can. And actually, by doing so, also those patients will bleed less. That's really my tidbit of advice that I give to, you know, newer clinicians out there is let the numbing sit there, lidocaine with epinephrine, let it sit there for 30 minutes. It also gives the patient comfort knowing that the numbing has really kicked in and is certainly not going to be a painful process for the patient.

Triggers Stress Genetics Illness

SPEAKER_00 7:50

Yeah, and I like how you highlight, you know, clinically we often can make the diagnosis, but there are times where it's trickier, like that diffuse variant that you mentioned, or alopecia area incognito, where it can be a little bit more difficult, you know, to figure out what's going on. And then strikingly enough, in some folks, there might even be an overlap of hair loss that's going on, especially in patients that might be older that do have that male or female thinning, or even early on, some patients will experience that too. So I think biopsies can be helpful to clarify that picture. But you're right, it can be a little scary if you're the one going through it. And also on the clinician side, if you're not experienced performing the procedure as well. And I think for those that are sitting there wondering, okay, if I have alopeciariata and know somebody who's got it, you know, is there something that we can think of that maybe triggered it? I think that's always, you know, a common question in the office, right? What did I do that caused this? Was it something I ate? Was it something I took, like a medication? You know, is it family history? What actually contributes to the fact that they've even got alopiciariata in the first place?

SPEAKER_02 8:49

That's a great question. I think one thing that patients always like to find out is is there something that I did or that I'm doing that's causing this? I think we're very quick to blame ourselves for this happening when it does happen to ourselves. But we know that, you know, there are several things that have been known to potentially trigger this, whether it be stress, whether it be illness, we know certain vaccines have done it, maybe some medications, but a lot of this also has a genetic predisposition. Many of our patients who have LP stariata have a parent or a sibling who have also had a similar condition in the past. I myself, in college, had an episode of LP shariata in my beard. And it happened without a family history. And, you know, college as a chemistry major, very stressful, a lot of long nights of studying, not sleeping enough, and that type of stress on the body certainly could have triggered it. And it's happened maybe once or twice since then, but really not something that persisted. But we know that for other patients, certainly it can persist. But certainly stress will potentially trigger this for some patients, along with that genetic susceptibility.

Progression Risks Totalis Universalis

SPEAKER_00 9:48

And I think everyone knows stress all too well these days, right? I I feel like everyone's feeling it, you know, whether it's us, you know, a day-to-day work and battling insurance companies and trying to get medications for our patients and keep up with day-to-day activities and our patients coming in, you know, work, life, I mean, stress just I think has infiltrated so many aspects of, you know, where we're at. And it can be challenging. And, you know, I think people sort of brush it off, right? Oh, it's just stress and don't realize it can have a toll on the body. And you're right, that link to autoimmune disease like allopatriotic can happen. I always like to remind patients too, you know, we we see this when you talked about that genetic predisposition that can run in families that, you know, there are a lot of families that just have what we call that kind of autoimmune look to them, or what we call phenotype, where you look in the family and somebody's got, you know, thyroid problems and somebody else has lupus and somebody has psoriasis and they just happen to have alopetriota. And like, why is that? And then I just tell them, you know what? Genetically, your immune system is really primed to just be hyperactive. And how it then presents in these different conditions, probably a mix of things we don't totally understand, but also the uniqueness of your own immune system. And so autoimmune disease does like to ride in families. So that genetic predisposition, as you mentioned, totally a real thing that we have to educate patients on as well. And and I think too, when they wind up getting alopiciata, which can be obviously distressing, and especially if they're presenting that patch form that you mentioned, you know, I wanted to circle back to that because you mentioned like how, you know, you could have the patch form where it's these discrete, like very well-defined areas that might look like, you know, dime size or quarter size on the scalp, or it can be diffused patchy where it's a little bit more ill-defined and a little bit broader with those patches, or maybe it's diffuse overall where it mimics, you know, male or female thinning. And then, of course, you have those patients where it's involved their entire scalp. And then those folks that go on to have involvement of their entire body hair. You know, I wanted you to talk about those two different types of alope chariata. And then also, if you start off with just a little, what's that likelihood of progression? Because I think that's what a lot of people are fearful of, right? Like this is what I've got, but what's the likelihood, you know, doc, I'm gonna lose all my hair or I'm gonna lose every hair on my body?

SPEAKER_02 11:53

Well, we know that over 50% of patients do develop additional patches within the first six months. So if you have allop chariata, you really want to get that addressed as soon as possible. We also know that if someone has at least 50% scalp involvement, there's a less than 10% chance of spontaneous remission. Therefore, if your scalp is getting worse, if you're getting more patches, you need to have this addressed immediately. I almost call it like a medical emergency. You have this risk of certainly losing all of your scalp hair, potentially losing all of your body hair. When you lose all of your scalp hair, it's called alopecia totalis. When you lose all of the hair on your body, it's alopecia universalis. Interestingly, when I have seen that in some patients, females in particular will complain and say, Doc, I've lost all my hair except for my armpits. I still have to shave my armpits. You're dealing with losing the hair, and certainly you still have to deal with shaving in an area that is very inconvenient. Now, luckily, now things have changed. We're certainly have treatments to discuss, but this is years ago when we we didn't really have any consistently effective treatments. Um we also know that about one-third of patients have disease lasting more than a year. And I'll see this. I have patients who will treat them, they do better, they wax and wane. You treat, they come back six months later, Doc, I have a new spot that popped up. And these patients know to call us right away. And in my clinic, we know if someone is having a flirt of their LP chariata, we consider that a quote unquote emergency. Let's get that patient in within a week to really address what's going on because again, we know that they can progress to lose all of their scalp hair and potentially even lose all of their body hair as well.

Related Autoimmune Conditions To Watch

SPEAKER_00 13:24

Yeah, and it's got to be such a scary thought. You know, you're already dealing with the stress of what you have, which can add to the hair loss even further, obviously. And to know that progression is a real thing, you know, I think linking that to treatment is something we'll touch on in just a moment. But going back to kind of, you know, thinking about p chariata a little bit more on a complex level from the standpoint that, okay, we know it involves obviously the hair follicle, but what other conditions? Because people probably wonder if allopiciata, am I at risk or potentially are there other conditions associated with it that I need to be on the lookout for or that I'm more likely to develop? How do you educate your patients on what they could be potentially at risk for or what's associated with alopiciariata?

SPEAKER_02 14:04

I like to let patients know that alope chariata itself does not cause other conditions. However, the cells that are attacking your hair follicles are attacking other parts of your body. We know that thyroid disease is certainly one of the most common that we see in patients. I also have patients who have other skin conditions as well. Vitiligo is a common chronic autoimmune skin condition, psoriasis, eczema. We can also see lupus, pernicious anemia, so really any of these types of autoimmune conditions certainly can also be impacted and result along with allopice ariana. What I do is I basically just get a good history. And a lot of times these patients already have a diagnosis of thyroid disease or type 1 diabetes or pernicious anemia or lupus, et cetera. But certainly getting a good history and then also discussing with the primary care team, these are things I'm worried about. When you check regular labs, please also consider checking these labs as well. Because sometimes patients don't want to do extra labs with us. They say, Doc, I already did labs with my primary care doctor. Can't I just do it with them? However, if I have a strong suspicion, I will also check some lab work to primarily really rule out thyroid disease and also look for other skin conditions on examination as well that can be associated. But again, making the point that your alope shariata did not cause these other conditions. I also like to note that if someone does have eczema along with alpha chariata, there's some evidence that shows that those patients tend to have a worse prognosis as well, just keeping that in mind. So certainly wanting to look out for that other concomitant diagnosis if they do have allop chariata.

Why Treatment Is Not Cosmetic

SPEAKER_00 15:34

And like you said, it's not that uncommon. If that immune system's flipped, it's not surprising. Then it may be other places, you know, it's kind of off balance and throwing the skin a little bit haywire and developing things like eczema. But the good news, as you know, I mean, we're in an era of treatments for eczema atopic derpentitis that we've never seen before. You know, obviously clinical trials for oral therapy for vitiligo that we've never seen with one FDA-approved medication we've got topically. So it's an exciting time, you know, to a degree if you have allopetriata, that we may have some options that could benefit you. And I think that's where people don't know, you know, where do I even start with treatment? And some people even forget you go to the dermatologist for treatment for these types of things because automatically they might even ask their salon, you know, partner they work with if they're with their beautician or whoever's working on their hair, their hair artists, and say, hey, what do I need to do for this? And not even recognize it's a medical condition. But I think you're probably as excited as I am to talk about treatment because of all the later latest developments that we have now for alloped chariata.

SPEAKER_02 16:33

I I think that's extremely important. I remember years ago, we didn't have many treatments for LP chariata. We had some topicals, some steroids, et cetera, and really have really come into this arena now with so many therapeutic options and many more in the pipeline for our patients, which certainly makes it very exciting to treat this condition. You know, to your point, I think it's very important to recognize and that everyone recognizes that alpha chariata is not a cosmetic condition. Fortunately, that thought has really gone out the door. However, it is still very important to stress that because we know that alpha chariata, again, can be very emotionally distressing to a lot of patients, no matter what the age, not just women, not just adolescents or teenagers or children, but also males, older patients, it really can be quite a distressing condition. And when these patients come in and we make an impact on their quality of life, I've had patients who come in in tears. And once we treat them and we're able to regrow their hair, they are smiling. They want to hug you, they are so happy. And it really makes your job as a dermatologist so much more rewarding. One of my favorite aspects is being able to treat these patients and getting it out there that this is not a cosmetic condition. We are here to help you. There are things that we can do, and let's do it together and really improve your skin condition.

Steroids And Older Treatment Options

SPEAKER_00 17:47

Powerful message for me, Eric. I I really love that because you're right. I think patients, you know, are like this definitely to them is not a cosmetic concern. And unfortunately, it takes us a while to convince our payers and sometimes the insurance companies that this is truly a medical condition that's deserving of time and attention. And just like anything else that we treat, because you can see the impact on a patient's quality of life. I mean, they don't want to go out and socialize, they don't go to work, school, you know, kids get made fun of, they get bullied. Even for adults, it can really impact their productivity. And just what I talk about being in that, you know, game of life. If you have your best skin, you're able to be your best self in this world. So you're right, we have a great opportunity to impact people there. But treatment, as you know, has really come a long way. So I'm gonna mention the yes word because I know a lot of my patients hate to hear this word, you know, steroids, right? Like, you know, kind of starting, you know, back from kind of just where we've started with treatment, topical or intralional steroids. So it's gonna have you kind of go through sort of, you know, the evolution of treatment, even some of these treatments we still use today, obviously, and why, you know, they can be effective and you know, kind of highlight where we're at now, which I know is an exciting time.

JAK Inhibitors And Modern Breakthroughs

SPEAKER_02 18:52

Absolutely. So, you know, early on, if someone has localized LP chariot, just a few patches, really still one of my favorite go-tos are topical steroids for children. You can also use topical steroids for adults. In my experience, I find that topicals work better for children. And of course, adults can tolerate intralegional steroids. So essentially, we are injecting cortisone right under the skin where you have patches of hair loss on your scalp or eyebrows, for example. And what that does is it decreases the inflammation. Essentially, if you want to think about it very simply, it kills off those immune cells, sends them away. So the hair is then allowed to regrow. Because alopecia is alpha chariata, excuse me, is not a scarring alopecia. The hair can still regrow. Certainly, other types of hair loss where you have scarring, topicals are not going to do much. Once you get rid of the hair follicle because of scarring, you can no longer regrow a hair. But with alpha chariata, that hair follicle can still regrow if you get rid of that inflammation. So for localized disease, topicals, intralegional steroids. Now, one thing we used to use as well in conjunction with this, if somebody was progressing, was oral steroids, or prednisone. I remember treating patients with weeks and months of prednisone and trying to get them on a stable dose. But that required a lot of monitoring, regular bone scans because of the risk of osteopenia, osteoporosis, ocular exams to rule out cataracts and glaucoma, and then really keeping an eye on blood sugar and everything else that comes along with long-term steroid use. We also had methotrexate, also in addition to pretnisome, that also required a lot of aggressive labor monitoring, liver, kidney function tests, et cetera. And now we've really advanced further, where now we have JAK inhibitors, oral and topical JAC inhibitors. In my experience, topical JAC inhibitors, not that effective. However, oral JAC inhibitors, we now have three of them FDE approved for severe LP shariata. And one thing to know from a clinician perspective is that severe LP shariata is defined as at least 50% loss of the scalp here. Now, if somebody has eyebrow or eyelash involvement and they have less than 50%, I still call that severe. That's still a severe LP chariata case. In that case, those patients still qualify. And the three that are approved right now are Ritless Sitnib, Baristitnib, and Duroxolitnib. And those are certainly effective options for our patients. They're FDA approved and certainly can be used in a wide variety of our LP chariata patients. Other things that have been used, of course, in the past, you have topicals such as squaric acid, which essentially creates almost like a contact dermatitis poison ivy-like reaction to essentially cause inflammation and then decrease the inflammation that's causing the LP chariata. Antherolin is another one topically, light therapy has been used. But I would say that my go to's now are intralegional steroids, topical steroids for localized disease. And now I go straight to the oral jack inhibitors for patients with severe LP chariotta. And even one that's called TOFA Sitnib, which is not FDA approved for LP shariata, that's one of the first ones. I still have patients on. That medication, and even though it's not FD approved, their hair is regrown. They don't want to change, they don't want to switch medications. My hair's regrown. I don't want to risk going on something else that may be less effective.

SPEAKER_00 22:10

I'm going to break down a few things you mentioned there. So, one, just when you mentioned, hey, I don't want to stop it. My hair is doing better. What kind of expectations do you set for treatment? And again, we can probably break this down, right? If you have more localized, like maybe individual patches versus more severe disease, how do you really explain, you know, what the expectations are? You know, is this going to regrow permanently? Should you have cycling? Do I get to stop my medication? Because that's that's what a lot of people want to know, right? Can you give them something for a few months and boom, the hair's back and then you're done? I'll let you deliver the bad news, Eric, because we know what the truth is. Yeah.

SPEAKER_02 22:46

Yeah. So, you know, in essence, especially for more severe forms of LP shariata, you're probably going to be on the treatment long term. And I will say, most patients, if they've lost all of their hair and they've regrown it, I don't really get much of that pushback saying, you know what, my hair regrew. I want to stop it now. Most patients say, you know, there's a risk that I'm going to lose. And I tell them, yes, it is a very real risk that you will lose some of that progress. Now, the good news is if you do stop for a reason and you resume, in most cases, that hair tends to regrow again. But again, you're going to need that long-term fall because every patient's a little bit different. Can I say that every patient will lose their hair regrowth if they stop the jack inhibitor, for example? I can't say that, but I would say as a general rule of thumb, if you stop the treatment, you will likely lose the progress that you've made. Now, for localized disease, I have patients that I will regrow them with intralegional steroids or topicals in younger patients. And many times that hair will stay regrown. However, if they develop a new patch, they know to call the office. You need to have this open door policy where if a patient calls saying, you know, I have this new patch, or I think I have a new patch, a little bit thinner, you know, this air on the back of my scalp, you bring them right in. And sometimes they're wrong. It's actually totally fine. Other times, you know what? They're having a recurrence of their disease, and you can inject them right away and then promote that regrowth. And that, of course, requires monthly visits until they fully regrow. And then once they fully regrow, I then space out those visits two, three, four months, eventually, just as needed. And again, calling us back if it recurs. So it's very patient-dependent. As I say to everybody, your body does what it what your body wants to do. You may regrow, you may not regrow off of treatment. But one thing that I know for sure is if you did well with the treatment, certainly continuing it is, in my opinion, the best option.

Real Patient Stories And Confidence

SPEAKER_00 24:38

And I think there's a lot of truth to that. You know, there is some unpredictable nature to all these inflammatory skin conditions we treat, whether it's psoriasis or alope chariata, and you know, there are people that don't follow the playbook, right? And so you have people that do, you know, well on therapy for a while and then they lose again and then they rebound back and they start to grow hair again. But I think it really highlights the chronicity, right? This is a chronic condition we treat because in dermatology, I think a lot of people think what we do is so short term that we're just treating people for a few months, they have a skin issue, and boom, done. But we treat a tremendous amount of chronic disease in dermatology. And this is a great example where we're looking for things, yes, to improve what you have. But unfortunately, then there's probably going to be a maintenance plan that we got to put on board and to get you maintained for that period of time. Because, you know, that typically, we, as we know with allop triata, you're going to have recurrence once we stop therapy. And people can have periods where, you know, things worsen. Maybe they do get stressed or something happens and kind of ears off course, but we can bring you back to a good baseline with some of the medications that we have today. And I think too, you highlight too how it's important, you know, the oldies but goodies that may still have a role, especially in patients that may not be good candidates for our newer therapies. And sometimes we're mixing, you know, things up too. We're we're doing more than one thing to achieve optimal results for patients as well. But it's so exciting to know where we're at. And then the emotional part of the treatment part, we've we've hinted around this throughout our conversation today. I wonder if you had a patient example that you could share with us in our last couple minutes about just the impact, you know, that, you know, the suffering they went through having LP shariata, the opportunity you had to treat them, and how it really changed their life.

SPEAKER_02 26:11

I can give a few examples, but I'll kind of group them into a group of kiddos, for example, uh, adolescents. So I volunteered for camp discovery for almost 20 years now. And of course, 20 years ago, we didn't have these medications for LP shariata. Not, of course, for children, not even for adults. I've seen children who come to camp, have no hair whatsoever, they're embarrassed, they're shy, and then coming back, you know, a year or two later, their hair is regrown. And just seeing the impact, you know, they were sad, emotionally distressed, and now they're totally different. That confidence that they have, especially going to their you know, teenage years, where certainly bullying is such a big issue for kids without alpecia. You had alpesiariata. Unfortunately, some of these kids, people who are not aware of this condition, especially when they have alpecia totalis, losing all of their scalp hair, they think that they're sick, that they have cancer, for example. And now they've regrown their hair in this newfound confidence that we just see in these children, these adolescents, is certainly tremendously impactful. And I also see this in my adult patients, patients who certainly are professionals, who now they want to work from home. They don't want to go to work because they've lost their hair, whether it be the scalp, the eyebrows, and the eyelashes. And I've seen this. I can think of a couple of my female patients where they certainly had this impact and they want to start working from home, wearing a wig, so nobody could tell that they had quote unquote fake hair. They had a wig, right? We put them on these medications, going back to work, regaining that confidence. Because let's be honest, when these patients do not have that emotional stability because they've lost their hair and they're emotionally distressed, it certainly has an impact on their quality of work, their quality of life, and it impacts them all around. And certainly, again, one of my favorite parts is just seeing the change in these patients when they come back to our clinic and they are totally different, where they're happy, they're hugging. Uh, it just they can't say enough. They say, you know, we're we're God sent. And I said, listen, we just know which medications to give you, how to treat your skin disease. And I tell them, don't give me too much credit because 15, 16 years ago, there wasn't too much I could have given you without affecting your bones and your eyes and everything else.

Where To Get Help And Closing

SPEAKER_00 28:22

Yeah, what an impact we can have on people, you know, with our medications. And, you know, if you're out there and you think you have allopitriata, you know somebody that does, go see, you know, your dermatologist. Dermatology is here to help with this. We have great tools at our disposal. It's not something you just have to put up with. We can really make a difference for you. Eric, I want to thank you so much for coming on the podcast today. It was great to hear your perspectives on allopiteriata. Thanks so much for having me, Shannon. Of course. And stay tuned for the next episode of Dermitrotter Don't Swear About Skin Care.

SPEAKER_01 28:52

Thanks for listening to Dermotrotter. For more about skincare, visit dermittrotter.com. Don't forget to subscribe, leave a review, and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.