Video Blog: Hair Disorders: How I Treat The Hard Stuff

In this video blog, Jerry Shapiro, MD, discusses highlights from his lecture, Hair Disorders: How I Treat the Hard Stuff, on July 27, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.

In this video

Dr. Shapiro frames his approach around one distinction: scarring versus non-scarring alopecia. The "hard stuff" is the scarring alopecias ifrontal fibrosing alopecia, lichen planopilaris, and folliculitis decalvans iwhich he calls "trichologic emergencies" because once the hair is lost, it doesn't grow back. That urgency drives an aggressive, diagnosis-first strategy, using tools like intralesional corticosteroids, doxycycline, and antimalarials off a flow sheet keyed to the diagnosis. He confirms the diagnosis with a single scalp biopsy read in horizontal sections by a team at NYU that knows how he wants it cut.

For androgenetic hair loss, Dr. Shapiro prefers low-dose oral minoxidil over topical ieasier for patients, less messy, and in his practice better results iand uses PRP as an add-on rather than a standalone. He quotes roughly a 60% success rate with PRP in androgenetic alopecia, notes it's expensive and painful, and is not convinced it helps in cicatricial alopecia or alopecia areata. On sunscreen and FFA, he says the link is still up in the air but steers patients toward physical, zinc-based sunscreens over chemical ones like oxybenzone and avobenzone.

• Sort every hair loss patient into scarring versus non-scarring first; scarring alopecias (FFA, lichen planopilaris, folliculitis decalvans) are "trichologic emergencies" that need aggressive early treatment because the hair won't come back.
• One scalp biopsy is enough when read in horizontal sections ibut make sure your lab knows how to cut it.
• For androgenetic alopecia, he favors low-dose oral minoxidil over the topical solution ieasier, less messy, and better results in his hands.
• Steer FFA-concerned patients toward physical zinc sunscreens rather than chemical ones (oxybenzone, avobenzone); the causal link is still unproven but there is published concern.
• PRP is a roughly 60% option for androgenetic alopecia, used in combination (often with oral minoxidil), never alone iand not something he relies on for cicatricial alopecia or alopecia areata.