Oscars drama puts alopecia in spotlight

Dermatologist Dirk Elston, M.D., never expected alopecia to become part of the drama on Oscar night. But he knows from treating hundreds of hair loss patients how devastating the condition can be.

“I think it tells you how emotional an issue it is for people,” the professor and chairman of the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina said of the Academy Awards controversy that started with a joke about Jada Pinkett Smith’s shaved head.

“Loss of hair, both scarring and non-scarring, can cause severe depression and social anxiety.”

Pinkett Smith, an actress, musician and talk show host, has shared her struggles with hair loss. At one point, she called it terrifying. More recently, she said all she can do about it is laugh. Her willingness to talk about the ups and downs of a condition that some people prefer to hide has helped shine a national spotlight on alopecia.

 

Elston, a past president of the American Academy of Dermatology and the American Society of Dermatopathology, said it’s important to understand the terms and treatments involved with alopecia. For starters: “Alopecia just means hair loss. It doesn't specify any particular type of hair loss.”

Elston has done extensive research on alopecia and serves as a national expert on existing and emerging treatments. Here, he explains various forms of non-scarring and scarring alopecia.

Alopecia areata

“This is a reversible form of non-scarring alopecia that can occur in localized patches, involve the entire scalp or affect every hair on the body. Localized patches can respond to injections, and we now have medications that work for the majority of patients, even those with widespread involvement. These new treatments include oral Janus kinase inhibitors, also known as JAK inhibitors,” Elston said.

In this type of alopecia, an autoimmune disease causes the body to attack hair follicles. “The hairs are there. They're capable of regrowing, but they're miniaturized to the point that you can't see them because of inflammation at the level of the hair matrix,” Elston said.

“But one of the nice things with alopecia areata is that even when it's very advanced, they have the potential to regrow hair. This is in stark contrast to scarring forms of alopecia.”

Scarring forms of alopecia

These types of alopecia are caused by inflammatory conditions such as lupus and the inflammatory disorder lichen planopilaris. Scar tissue replaces the hair follicles. “Treatment should be started as soon as possible as hairs that are permanently scarred are lost forever. Early intervention is particularly important for scarring forms of hair loss,” Elston said.

Waiting can lead to permanent physical and emotional scarring. “When patients are allowed to rate the severity of their own illness, severe scarring alopecia is often graded as more devastating to them than a new diagnosis of cancer. With the scarring alopecia patients, sometimes by the time they get to us, it's so advanced that what we can do is only surgical at that point. It is far better if they come to us earlier.” 

Pattern alopecia

This type of alopecia, inherited baldness, is the most common cause of hair loss. “We now have treatments for that that are quite good for balding men and women, especially if they take action early,” Elston said. “Treatments include medications such as minoxidil, finasteride, dutasteride and spironolactone along with platelet-rich plasma therapy and hair transplants.”

Pinkett Smith, the actress, singer and host of the show “Red Table Talk,” whose hair loss took center stage at the Oscars, has said she doesn’t know what caused her alopecia. Published reports say she has alopecia areata.

Whatever kind of alopecia someone has, Elston said it’s important to see a specialist who’s knowledgeable about hair loss. “Dermatologists are the physicians who have special expertise in diseases of the skin, hair and nails. They have the expertise to evaluate, determine what form of alopecia they have and treat it appropriately.”