Managing Alopecia Areata and Coexisting Conditions

Kristen Whitney, DO, FAAD, dermatologist at Allegheny Health Network.

Kristen Whitney, DO, FAAD, dermatologist at Allegheny Health Network, discussed the complex management of alopecia areata, often in conjunction with other autoimmune conditions. She emphasized the role of Janus kinase (JAK) inhibitors in treating both alopecia areata and other autoimmune diseases.

Whitney also highlighted the significant advancements in dermatology, including new medications and advanced diagnostic tools like dermoscopy, which have improved patient outcomes and diagnostic accuracy.

Transcript

The American Journal of Managed Care^® (AJMC^®): Many people with alopecia also have other autoimmune conditions. How do you manage these coexisting conditions to optimize patient outcomes?

Whitney: It depends on the other autoimmune condition(s), but dermatologists often work with other specialists such as rheumatology or gastroenterology to try to treat both of the patients’ conditions, potentially with 1 medication.

For example, the JAK inhibitors aren't only approved for severe alopecia areata. They also have indications for rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, and Crohn disease.

There are times when we are not able to use one medication, and we might need to use multiple medications to treat different autoimmune diseases. The patient's team of physicians then formulates individualized treatment plans based on their medical history, severity of conditions and other factors.

Sometimes the treatment approach is simple, such as a patient with thyroid disease that developed localized alopecia areata. Endocrinology will manage their thyroid, and dermatology can treat the focal alopecia areata with topical steroids or steroid injections into the scalp and they often do quite well. We don't always have to use systemic medications.

AJMC: How have recent developments in dermatology, such as new medications and advanced diagnostic tools like dermoscopy, impacted the treatment and management of conditions like alopecia areata?

Whitney: For a lot of inflammatory skin conditions, like alopecia areata, eczema or psoriasis, we have had so many new treatment options for patients in the last 5 to 10 years.

We had the same systemic options for several years; many had a lot of side effects or required frequent blood work monitoring. But now, it's an exciting time for dermatology because we have so many wonderful new drugs out there for several conditions. It’s exciting to see these treatments get the media attention, for patients to know that we have great treatments out there, and we can help them achieve healthy skin.

Even dermoscopy, we're getting better with this technology as we can use it not just in skin cancer screening exams, but we can also use it to differentiate different forms of hair loss or to detect certain infections of the skin, like scabies, for example.

The indications for its use are expanding and it's exciting to see because it makes us more efficient, more accurate, and can often save patients from a biopsy.