In episode 66 of Derms and Conditions, our host, Dr James Q. Del Rosso, sits down with Dr Jeff Donovan, a board-certified dermatologist who practices in Whistler, Canada, with his dermatology clinic dedicated only to management of hair disorders. In part one of this series, they discuss how to approach patients with alopecia areata.

Dr Donovan starts by discussing conditions that can mimic alopecia areata and when a biopsy may be needed to confirm the diagnosis, prompting him to share his suggestions on biopsy caliber, appropriate sites for biopsy, and utilizing the right pathologist to review the sample.

Next, the pair discusses topical treatments for patchy alopecia areata, including topical clobetasol and topical minoxidil, and the important role of intralesional corticosteroid injections. They then discuss available study data and experience with the use of oral baricitinib (a JAK inhibitor) and oral ritlecitinib (a JAK-3 and TEC kinase inhibitor) in patients with severe alopecia areata. Specific recommendations were reviewed including important efficacy and safety findings, clinical and laboratory monitoring, and certain limitations with currently available studies. Both look forward to promising developments that are anticipated with longer-term data for both baricitinib and ritlecitinib.

They conclude by discussing the use of minoxidil in alopecia areata, including anecdotal evidence. Dr Donovan notes that more studies examining the effects of minoxidil in alopecia areata are needed.

Tune in to the episode to find out more from a dermatologist who treats patients with hair disorders throughout his entire workday whenever he is in clinic!