Inclusive Care in Alopecia: Beyond Diagnosis
Transcript: Yolanda Lenzy on AA treatments
Dr. Yolanda Lenzy
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So the way I treat alopecia areata is really based on the severity, with probably the first-line treatment that I do for very minimal cases. Maybe someone's coming in with one patch, a quarter size patch, I would definitely offer them a potent topical steroid medication that has been shown to be very effective in helping to regrow. I will also present to patients the opportunity to do a steroid injections into the area, which in my experience, could work a little bit faster. Some patients just wanna start with a topical and then maybe go to injections later. When a patient has more significant involvement, like more than 50% or getting close to that 50% mark, then we wanna kinda talk about maybe some systemic options that can be added in to the treatment. So, but prior to a few years ago, when some of the newer medications came out, we would do topical immunotherapy treatment, where the patient is sensitised to an irritant.
And what that irritant does is it makes the body perceive a threat and there's an immune response that happens. And then those immuno cells that are involved with the alopecia areata are basically attacked by the patient's own immune system and it can cause a regrowth of hair. So having used that a lot in the last couple of years, because of the onset of a new class of medications, well, new to dermatology, called the JAK or Janus Kinase Inhibitors. And so the first ones were FDA approved, probably a few years ago now, and we found them to be very effective in patients with more moderate to severe involvement. We're talking about maybe over 40 to 50% involvement of alopecia areata. And we can see somewhere like 60% of patients develop complete regrowth with these agents, but they can take a long time. So a lot of education around encouraging patients to stick with the treatment as long as they are a good candidate and they don't have any pre-existing conditions, upon, which would make them not a good candidate. It can take somewhere up to nine months to over a year for us to see improvement. But when, sometimes it just clicks on and the patients start exhibiting like a lot of hair growth. So very, very exciting time in the alopecia areata treatment area with the onset of these medications.
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