Transcript
Announcer:
Welcome to DermConsult on ReachMD. On this episode, we’re joined by Dr. Benjamin Ungar, who’s the Director of both the Alopecia Center of Excellence and the Rosacea and Seborrheic Dermatitis Clinic at the Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai. He’ll be discussing the evaluation of scarring and non-scarring alopecia, which he spoke about at the 2026 Maui Derm NP+PA meeting. Let’s hear from Dr. Ungar now.
Dr. Ungar:
Evaluation and ultimately achieving long-term disease control in scarring alopecia patients is very crucial to get accurate as quickly as possible because there is a ticking clock on when the inflammatory process leads to damage of the hair follicles and ultimately that scarring, which at this point is irreversible. That can be associated with really burdensome symptoms as well in many cases, which can be very bothersome to patients. But I would say for the most part, it's really the hair loss that is the priority.
So the evaluation of scarring alopecia for me is, number one, assessing as accurately as possible how active the inflammatory process is. From my perspective, to produce long-term results that are as good as we can get in terms of maintaining the hair that exists and to the greatest extent possible regrowing some of the hair that has fallen out more recently requires excellent control of the inflammatory process and maintenance of that low level of inflammation. And so the initial evaluation is how active the inflammation is with the goal of reducing it, and then there's a shift towards maintaining that low inflammation long term.
For non-scarring alopecia, the diagnosis and treatment in 2026 is an evolving process, and it's dynamic and different from patient to patient. So I think the first step is really identifying what the cause of the hair loss is to the extent that we can. Very often, there's a component of male- or female-pattern hair loss. In many cases, there's also a contributing factor of telogen effluvium, a more acute stress-related onset of hair shedding. And having both can really exacerbate each other and lead to patients feeling very distressed about the extent of their hair loss. And once we identify to the extent possible what's going on from an etiologic perspective, then the question becomes: how can we address that from a treatment perspective?
The considerations for treatment can be quite varied person to person. And as with many kinds of treatments for different conditions—and I think in some respects, it's particularly relevant in the treatment of hair loss—there is ultimately a balancing act between the benefits of treatment and the potential downsides, whether they be costs, side effects, risks, and so on. And at the end of the day, there's no one treatment that's going to be a best fit for everyone. And part of the challenge or process for treating hair loss is identifying for each patient what makes sense for them.
Announcer:
That was Dr. Benjamin Ungar talking about how we can evaluate scarring and non-scarring alopecia. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
