Doctor Mariana Hammerschmidt, among your publications, you recently had a peer-reviewed manuscript titled, “Efficacy and safety of methotrexate in alopecia areata.” Can you tell us in a simple manner, and 1-2 sentences, what the take away is for the average person who has hair loss and would be interested in your work?
Alopecia Areata is a type of hair loss characterized by hair falling out in round patches that may occur in outbreaks or lead to progressive and complete loss of hair on the scalp and elsewhere on the body. It is a chronic and difficult to treat a disease which brings great impact on quality of life of patients. The Methotrexate is a promising immunosuppressive treatment to control a disease.
You mention methotrexate therapy for alopecia areata, can you tell us what things you first try before moving to this medication or is it one of your first choices for treatment?
Treatment modalities usually are considered first according to the extent of hair loss and the patient’s age. For example, in patients with less than 50% scalp involvement, intralesional or topic steroids and topic minoxidil 5% are used. The methotrexate is a therapeutic option for severe forms of alopecia areata (multifocal, universalis, totalis, and diffuse). Other therapeutic options can be used before the methotrexate, such as corticosteroids (topical, intralesional, oral), or topical immunotherapy (diphencyprone). Methotrexate is a good option for patients that have no contraindication to its use, such as liver disease, pregnancy, active tuberculosis infection.
What general advice do you give to the typical male or female with alopecia?
Most cases of hair loss are due to telogen effluvium that appears as a diffuse thinning of hair on the scalp. The trigger factors are stress, postpartum, restrictive diets, thyroid disease, etc. The telogen effluvium resolves between 3-6 months when the trigger is removed. You should worry about hair loss that lasts more than six months and who leave regrowth failures or recession on the hairline of the scalp. Look for a dermatologist to examine it and give the best treatment.
Approximately, how often do you do a scalp biopsy on a hair loss patient
Currently, we can diagnose several types of hair loss through trichogram (microscopic examination of the hair) and trichoscopy (hair and scalp dermoscopy). In alopecia areata, for example, the exclamation-mark hair is a specific marker of the disease. The biopsy is rarely performed except in those cases where trichogram and dermoscopy are inconclusive, especially in cases of scarring alopecia.
What do you see as the most promising development in hair loss research in the next 5 years that will have a practical/clinical application?
I believe that research in dermoscopy and confocal microscopy will be of great aid in the diagnosis and monitoring of cases of hair loss.
Also, I believe that research of genetic therapies may help in the treatment of diseases with genetic factors involved. Also, research will help with immunobiological usage in alopecia when autoimmune factors are involved.
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