Physician Spotlight: Crystal Aguh, MD

What is new in the treatment of alopecia areata?

Crystal Aguh, MD: Alopecia areata is an autoimmune condition. Patients with alopecia areata may notice small patches of hair loss or loss of hair on their entire body. For patients with the most severe forms of alopecia areata, few treatment options existed as recently as a few years ago. JAK inhibitors have recently been identified as a promising treatment for alopecia areata. These medications target a specific part of the immune system and can be an amazing treatment option for moderate to severe alopecia areata, alopecia totalis, and alopecia universalis. For many patients who have not responded to other therapies, JAK inhibitors can lead to full hair regrowth. Unfortunately, these drugs are not FDA approved to treat alopecia areata yet, but we expect that there will likely be a JAK inhibitor approved for alopecia in the next two to three years. Both Concert Pharmaceuticals and Pfizer are working on JAK inhibitors for alopecia areata.

How do hair disorders affect quality of life?

Dr. Aguh: We have a lot of great studies on how hair loss impacts quality of life. It can have a dramatic impact on men and women. For a lot of people, hair represents a part of who they are. For example, when someone is undergoing chemotherapy for cancer, hair loss is often one of the more devastating side effects. When people experience hair loss on their scalp, eyebrows, and eyelashes, it can impact self-esteem, self worth, and even their ability to secure a job. It can be devastating. While some forms of hair loss can improve with treatment, other forms of alopecia can be permanent, especially when advanced.

What is new in treating and diagnosing Central Centrifugal Cicatricial Alopecia (CCCA)?

Dr. Aguh: Several years ago we knew very little about CCCA. When it was first described, it was thought that the condition was caused by hairstyling practices and that if women avoided those practices, they would not develop the disease. This is not true. Now there is reason to believe that genetic or other environmental factors may play a role in the development of CCCA. For example, PADI3 is a gene mutation identified in about a quarter of women with CCCA. We also know that women with CCCA are more likely to have fibroids, especially in comparison with women of similar race and age who don’t have CCCA. The closer we get to understanding the etiology, the closer we can get to a therapeutic option for these patients.

Any thoughts on supplements for hair regrowth?

Dr. Aguh: Because hair loss can take such an emotional toll on affected individuals, it’s not usual to encounter patients who have spent $100s or even $1000s on supplements and essential oils that promise to grow hair. Unfortunately, over-the-counter products do not have to undergo any testing by the FDA, and some of their claims are not substantiated. One popular hair loss supplement is biotin, which may pose some serious risks due to its ability to interfere with lab work. For example, high levels of biotin can produce a falsely low result for troponin, a clinically important biomarker to aid in the diagnosis of heart attacks. It can also alter the results of routine labs, and the FDA has warned patients to avoid taking biotin two to seven days before any lab work.

Can you share an update on frontal fibrosing alopecia in skin of color patients?

Dr. Aguh: We are seeing an increase in the prevalence of frontal fibrosing alopecia (FFA) in women; the cause for this is not clear. I believe black women in particular are being under diagnosed because hair loss along their frontal hairline can often be confused with traction alopecia. We believe there are some environmental factors at play. A few years ago there was concern that sunscreen may be a causative factor, but the evidence today does not support this.