“Spotlighting Alopecia” with Emma Guttman-Yassky, MD, PhD featured a discussion with Dr. Louis DePalo from the Health Center at Hudson Yards. Several forms of alopecia, including scarring alopecia, and the emotional stress patients have in dealing with hair loss were explored. Dr. Guttman-Yassky's research is finding new treatment options, such as biologics and targeted therapies, being used off-label to help patients with the devastating effects of alopecia.
um Hello everyone. I'm dr lewis dipaolo. I am the medical director of the House Hunter Hudson yards. And today it's my great privilege to introduce um dr Emma Guttman dr Edmund Gutman Gase is an M. D. PhD and she is the waldman Professor and assistant chair of dermatology and immunology at the Icahn School of Medicine at Mount Sinai in new york city. She is director of the Center of Excellence in eczema and the occupational dermatitis clinic and director of the laboratory for inflammatory skin diseases. She earned her MD from Sackler University School of Medicine and a PhD from bali in university in Israel. After obtaining her Israeli board certification dermatology. Uh she went on to I knew her work in the United States and pursue a two year postdoctoral fellowship at the Rockefeller University in the laboratory for investigative dermatology. Upon completion of her fellowship she became board certified by the american board of dermatology. Dr new york dr Guttmann major clinical research focuses on a topic dermatitis, eczema and alopecia Areata. Her research made paradigm shifting discoveries on the biologic basis of a topic dermatitis in adults and in Children, enriching the understanding of the path of physiology of this common disorder. Opening the door and accelerating testing of novel immune pathway specific targeted therapies for a topic dermatitis. Recently dr government also extended the research interest in the hair loss disorders such as alopecia Areata and scarring hair loss disorders, chronic hand X. And the key Lloyd's ethio sis and other skin diseases that the government is considered one of the world's leading experts in inflammatory skin disease. Her achievements have been repeatedly highlighted by the media, including the new york Times Abc CBS News, Daily News where it is Wall Street Journal new york and others I can go on, but I think your CV speaks for itself. Um and I'd like to begin with the fact that the unfortunate events around Jada Pinkett smith really highlighted um really the emotional suffering of most families and patients. Uh the lack of public awareness and the need for an informed conversation around the subject of alopecia in all of its various forms and presentations so that the government may 1st begin with the question, what is alopecia? Sure. So there are several flavors of alopecia or several types of alopecia. The one that Jada has is alopecia Areata and that's an autoimmune condition that basically there is an attack of immune molecules on the hair follicles causing uh at the end lack of hair. It starts usually with patchy hair loss and then it spreads to be many times a total scalp or total body hair loss. And there are other types of alopecia that we see more in either a middle aged women or for men, but more in female patients, scarring. Alopecia is called frontal alopecia or like in planet hilarious. And there is also a form that is quite common in, in in particularly in african american women. They can also be young in which they start losing hair in the top of the scalp or the frontal scalp And that's also causing a lot of distress to patients as well. And we are going to take care of these patients as well because now we have some major discoveries in that type of alopecia as well. Thank you so much. You alluded to uh you know the emotional stress and we certainly saw that in a very public form. Um can you give us some insights to you know little girls and and women and men I assume who are faced with this, what kind of um stress they experience both for themselves, maybe socially uh and what the impact can be sure. So in alopecia Areata can affect all ages and all races and in in both men and women and Children. Even very young Children receiving babies with alopecia Areata it causes a lot of distress to the patient and to the family. I've seen a really terrible cases and and the reason being is that we currently do not have anything approved for patients with alopecia. Yeah, I know it sounds terrible but that's the case. We really don't have anything approved to give patients and particularly devastating I think are the cases in which there is significant heroes when we are talking about major parts of the scalp and the body being lost. You know here is in a way your identity and particularly when you also lose a eyebrows and eyelashes, You look in the mirror and you see somebody different and you can imagine for kids they are being bullied in school not invited to parties. And also I have many patients that at the workplace they start looking differently at them many times they think they have cancer right? Because you are bold, you lose hair, you probably aren't treated with chemotherapy. And I have a patient that is a lawyer was coming in front of a judge, the judge was asking him how is your chemotherapy going? You know things of this sort on a daily basis. So aside from the obvious uh presentation, you talked about the hair loss um how do you diagnose these different types of alopecia? We sometimes hear stress causes hair loss. How do you how do you differentiate, how do you approach a diagnosis diagnosis? Sure. And so many times we do need to do a biopsy and you do need to go to a dermatologist because it is important to know what type of politicians you have. So that will be able to treat you the right way because treatments may be different and sometimes there is even a little bit confusion because for example, maybe a guy, a young guy let's say starts to have male pattern hair loss. But then on top of that male pattern hair loss. He also has alopecia areata and maybe that we can treat an we have examples of patients that in clinical trials they grow their hair in full in areas that they could grow in full. But you know in frontal Scout, they still have that male pattern baldness. However, most of their hair is already back. So important to go to the dermatologist and many times we do need a biopsy just to make sure that you know what type of alopecia it is. And 11 thing that we also need to talk about is the fact that now in this covid era we see many cases of hair loss, some due to stress. But now we start understanding that maybe having covid maybe shifts a little bit the immune phenotype of the body. And we see many, many more cases of alopecia. Areata primarily either after covid and sometimes even after a vaccine. Thank you for that. So, you know, for the men in the audience who like me suffer from male pattern baldness. We've we've heard about pills, we've used pills, we've used creams, a lot of products on the market. Uh, some people have gotten injections and transplant transmits. So what right now is the current state for treatment for not male pattern baldness but for alopecia or any of these drugs, you know applicable. What's there for our patients right now? Yeah, it's a great question and I wish I had great news for male pattern baldness. But to be truthful, I think the big discoveries now and the big advances are primarily for alopecia areata. That's the one that Jada Pinkett smith has and also for the patients who was carrying alopecia. There are also big advances there too for male pattern baldness. I think we still are a little bit behind. And there are things that we can do with variable success rates like prp platelet rich plasma and of course we we can do hair transplantation. And there are some pills that are available as well that were introduced as pills for blood pressure and then they were adapted for hair loss again with variable efficacy but we don't yet have something that is super impressive for a male pattern baldness. Unlike alopecia Areata in which we can take patients in with total scalp clothes all over the body and bring their hair back which is ratifying. Is there a way to prevent the diagnosis? Uh if there's an early loss, is there something the patient can do before they go to medicines to prevent further loss? That's an excellent question. So for male pattern baldness, we see for example that we have patients that come early in the twenties and these are patients that their parents already or their father lost her already in the thirties and forties. And we see that when they start early, I would appeal and then they do prevent that. Heros. So I do tell patients come early to your doctor and maybe start early on medications because when you already have major hair loss then medications will not do much and you'll need a hair transport, likely patients. And for patients with alopecia, can they get in the way of their progressive hair loss or were they are they sort of destined to meet therapies? Uh Is there anything lifestyle changes they can do to help their hair loss? You're talking about alopecia? All of the allocation of spectrum? Yeah. So definitely in alopecia in general treating early I think is the name of the game in alopecia reata we now have some studies showing that when you treat in the first few years from when you have alopecia areata and primarily the 1st 10 years, your results will be much better than if you waited 20 years to seek help. And if you treat in the first seven years, it's even better now. We we talk about the seven years since the last Harry grows. Another important thing is if you see that your hair is shedding, but then it's coming back with different treatments. It's a very good sign. It means you have active disease and that's what we can actually treat with immune based treatments. The same by the way with some scarring girl officials. We don't want to have a untreated disease for many, many years because then we may reach a kind of a dead end disease and that's why it's so important to get help early in the game. Thank you very much for that. Um Obviously we've we've talked about the impact on families and family dynamic when someone suffers from alopecia. What about um siblings of someone who has alopecia? What are their genetic factors? How concerned should they be if there's a sibling who does have have hair loss? That's an excellent question. So, first of all, alopecia does run in the family, but it's not only alopecia, we now know that it runs in families of patients with eczema and allergies. So for example, and this was previously unappreciated until recently. But now we know that patients with eczema, asthma, hay fever and you know, hives, they will tend to have more alopecia and also patients that have some thyroid issues. They also will have more alopecia. So definitely first of all, when we have a patient with alopecia, we usually check for the others and we do some thyroid functions again. Coming to the point that they need to go to a doctor and seek some help and and let's say if you're somebody in the family has alopecia, you cannot do anything preventatively. But the moment you actually start having any symptoms, you should go seek help because again treatment should be early in the game. Thank you. So as a pulmonologist, you began to sing my song when you mention the house for allergy. We've we've come to learn that a topic uh as a topic actively go together. Um you know, there's theories that part of the reason at least in asthma. It's it's it's a disease of civilized of, you know of civilized societies uh you know societies that are industrialized um and then we moved away from the farm and our kids are no longer rolling in the dirt so they're no longer getting exposed to antigens early in life. And we're beginning to think that's part of the reason why asthma is so prevalent in um industrialized society. Is that true in skin diseases as well? You know in a topic dermatitis is interestingly enough, the same theory holds true and and probably it's it has some truth because for example asia right, Japan is such a clean country. They're number one in in eczema. So probably there is some truth to it. But eczema and alopecia go together to some extent they will not be a similar to asthma and eczema. Actually not have the same severity at the same time. For example. Right? If you have a patient with severe asthma usually the patient will have mild A. D. And the opposite but but there is a tendency to run in the family. Thank you very much for that. Um So you've alluded to the treatment options uh in terms of biologics and targeted therapy um None of them as I understand are FDA approved yet. So they're being used off label. Yeah label in clinical trials. So if you have eczema you are lucky in a way because we can prescribe a biologics for alopecia and by the way at Sinai we will have a study for patients without eczema actually so they can enjoy this biologic if they have a in an A top in the family or high I. G. Which will we will check because we found that patients with high I. G. Or some atrophy in the family will respond better. So we will have a study for both adults and Children that will have that are prone to to atrophy. And there are studies also with JAK inhibitors. Different JAK inhibitors are also now going into all official and additional targets the target Pd one and others. And I think the good news for patients is that now both physicians and pharma really partner together to find the cell solution for this disease. And that's why we also formed the Sinai this center because we want to really full steam ahead and provide research that will identify new targets. And we want to follow this with clinical trials directed to those new targets. Thank you so much for that. So if there's someone interested in the audience that you know hearing this, there's obviously a degree of desperation in some of these patients because of all the things you've alluded to. But then you hear not FDA approved for clinical trial, what are the risks of these treatments or are their risk and what are they? And and if there are risk what are they? Yeah you made a very good point just yesterday I saw a patient in the clinic and they had to bring her story. So she went to an institute and I'd never heard not a medical institute. It's some beauticians or I do not know what type of institute it is that has hair in the name and she has scarring alopecia that started in the frontal scalp. And then they started to put a different adhesives and artificial hair supposedly to help her grow her hair. And that actually in a very short time got her to lose her hair. So because the people are so desperate there are many people taking advantage unfortunately and not providing really a benefit but even causing damage. And unfortunately I hear that on a daily basis. So I think the most important thing is to stick with physicians that are known for this disease. And either physician scientists that like me or people that really you can trust that made a name for themselves in this disease. And a I think in terms of benefits and benefit and risk ratio I think we always need to consider for any disease we treat. But definitely in alopecia when we deal also with many young patients, very young, even 12 and up and even lower than that. We definitely need to consider safety. That's very important to me. So for example, this is the reason why in my practice I would not give off label a facility that's gelson's that's a pan Jack. I know that many people out there are giving this to alopecia. But we need to remember gelson's was not approved for psoriasis because of the safety profile. So why on earth would I put a patient with alopecia sometimes a child on nelson's own label, Because the moment they stopped the drugs, they will lose all their hair. So they are doomed to use drugs that may not be as safe for many, many years. And I don't think that's what we need. We need to really try to target specific as we can. And that's what we are trying to do either off label when it's possible or in clinical trials that are unique to us or or to Not many centers, thank you for that. You know, I chair the pharmacy and therapeutics committee and I thank you for your fine work for people in the audience. Um The work of the pharmacy and therapeutics committee is to make sure that drugs are safe, have a safe profile. Uh and dr government, your research is really moving the drugs to on label use with that is data driven by your clinical trials. So that way they can wind their way on formulas and patients can be confident when they take a drug that it's it's really past the seal of approval. So again, thank you for your contribution to all of that. Um So how best can family members support the affected patients? And what kind of family member do either in terms of lifestyle or obviously emotional support? What can they do? Um, in terms of helping patients their family members. Yeah, so I think support should be of two types. One is to help them seek help because I think the message to patients is in a way a good message we now have ability to treat. We have the ability to take patients with no hair or minimal hair and regrow full hair either full or some to some extent. So we can change the natural course of the disease with effective treatment. So I think one is to find a physicians that can help that patient and centers like us that can help. That's one way to help then the other a one is there are associations like the National Alopecia Areata Foundation that have actually patient support groups that I think are very good both for, for kids. You know, sometimes the kids need some resources that the family cannot provide kids, adolescents and young adults, they feel really ostracized and and not fitting. And I think it's important that they meet patients like them. It's very helpful. And also I found that the support groups are also very good for parents to these Children because I've seen some parents really a too much wanting their child to be on any treatment to the point that they don't even care about the safety. They just want the child to grow here and you know, I don't think this is the right approach. I mean, I think you need to wait for the right drug for for the patient. You cannot take safety risks and just you know, to grow hair. And I'm gonna answer my own question in a minute. But let me ask you about what about normalizing the hair loss and saying, you know, uh allowing a young child to not take therapy at all and say, you know, you're beautiful without your hair. Is that you know, because you're right. There is stress on the on the on the child sometimes to be normal. That word comes with ramifications. Is that part of this at some point? Or absolutely, I I think that's a big part of it. I think it's first of all to tell the child, listen the way you are, you are beautiful, will accept you, everybody will accept you. And I'll tell you when I was a resident at Cornell, you know, you you alluded that I trained in two countries. So I did the training in Israel in their anthology and I retrained in the United States at Cornell, M. S. K. C. C. And actually one of my co residents in universities. And actually she also does her, she works on her now in California and you know, she had a very beautiful life. She was married, she now has Children. She accepted herself the way she is. And so I'm not saying you do need to seek help, but I I think you need to embrace who you are r and and nothing is wrong with you and this is a disease that only um basically attacks the hair follicles. It's not going to cause any additional things. And I think both are important to accept that for either parents or patients and to seek help. I I do think you need to do what you can, but if God forbid it's not happening. So there are things to do their wigs. You know, I think we need to work on both. Thank you and I'm gonna take a stab and answer my own question about how you can help by making a shameless plug here, which is number one to support clinical trials, support scientists like dr government because the way these drugs we come on will become accepted the mainstream is only through clinical trials. So that's one way if you have a family member or you yourself have alopecia to participate in clinical trials and even, you know, if you don't and this resonates with you finance, support the institutions that do this work. You know, philanthropic efforts are also very important in a way to help uh you know, you're affected loved ones. Um we're gonna close with. Is there anything I did not ask you doctor government that I should have asked to help you really get your message out to patients. You know, you asked about really everything. 11 thing to say is that al like many times patients ask what are the triggers. And I think you mentioned stress stress is a very big factor. We have many times Children. For example, somebody died in their family. Covid put a lot of stress on many people and actually even infections and that's why Covid plays a role. Probably a dual role here, infections also sometimes stress the body and patients may lose any hair and and in terms of the scarring politicians a lot is still unknown and we are still learning. But the important thing for both types of politicians, scarring politicians and that we discuss that are different ones including the skin of color and the and now I think the hopeful message to patients is that we now have targets and we had new treatments which probably a few years ago we didn't have. So you just need to seek help because in real help. I mean physician help and I think you you may be surprised in a good way. On that positive note, I will close thank the government and I want to thank you personally for you reaching out to our patients and uh caring and being so generous with your time. Thank you so much and thank you for having me
