Alopecia - Scalp Dermatitis - Memphis Dermatologist
George Woodbury MD 3/17/2023
Alopecia is a term used by Dermatologists like myself for a collection of many causes of scalp hair loss – which most commonly include Psoriasis, Atopic Dermatitis (Eczema), Contact Dermatitis, and even conditions such as Alopecia Areata, Scalp Lupus and Sarcoidosis. Alopecia can take a bit psychosocial toll on many patients, because our hair is a big part of our identity as people. So let’s take a look at new management strategies, from my perspective as a Memphis Dermatologist, practicing as a Dermatologist Cordova TN at Rheumatology and Dermatology Associates (www.Rheumderm.com: 1-901-753-0168) since 1993.
When many Dermatologists are first evaluating Alopecia, we may consider using one or more of scalp tests to sort out the proper diagnosis, including a skin surgery or excision, to look for autoimmune causes of scalp hair loss, such as scalp Lupus, or sometimes we take a fungal culture test, to evaluate for possible yeast or fungus causing loss of hair. Sometimes we take a special type of scalp biopsy called an immunofluorescence biopsy, to check for immune deposits in the skin. We also sometimes run bloodwork tests, to evaluate for low iron levels or autoantibodies, or even hormone levels or protein levels in the skin, reflecting the patient’s level of nutrition.
Atopic Dermatitis or Eczema often develops on the arms and legs, but it can also certainly occur on the body and even the scalp, and it affects about 3% or more of the population. It runs in families along with asthma, hay fever, and food allergies, and seems to be more common among Asian-Americans and African-Americans, though it affects all racial groups, and it can certainly lead to Alopecia.
Sometimes allergies to certain fragrances, dyes, preservatives, or components within latex or certain metals can cause scalp rashes and even Alopecia: what’s called a Contact Dermatitis. As a member of the American Contact Dermatitis Society, at Rheumatology and Dermatology Associates I offer extended Allergy Patch Testing to help search for trigger chemicals. This type of Skin Allergy Testing can sometimes lead to a “cure” from the itching and/or Alopecia (Hair Loss) of Contact Dermatitis, because if we can identify the trigger factors, which could be a preservative or fragrance in a hair care product, avoidance tends to bring back the growth of hair.
In 2021, the good news is that even if the diagnosis is a more rare condition like Alopecia Areata, Lupus, or Sarcoidosis, Dermatologists have a growing arsenal of medications to help to alleviate Alopecia. We have the topical steroids, of which there are over 30 available, most of which are by prescription only. Topical steroids must be used carefully, to minimize thinning of the skin, and stretch marks. Dermatologists also sometimes use oral agents like prednisone or injectable steroids like methylprednisolone to help scalp flares, or sometimes oral medications like Griseofulvin or Ketoconazole tablets.
We now also have a number of promising steroid-free prescription medications:
· Tacrolimus ointment;
· Pimecrolimus ointment; and
· Atopiclair®, and
· Crisaborole Ointment (Eucrisa®), a new steroid-free medication based upon boron research.
· Opzelura® Cream (Ruxolitinib), a new topical Janus kinase inhibitor that works on the Interleukin system involved in itching,
· and several new systemic treatments for Atopic Dermatitis:
· Dupixent® (Dupilumab) subcutaneous injections, a type of monoclonal antibody;
· Upadacitinib (Rinvoq®) and abrocitinib (Cibinqo®) and two promising new non-steroid JAK-1 inhibitor medicines newly approved by the FDA for management of stubborn Atopic Dermatitis, which can certainly be implicated as causing Alopecia.
In 2017, Dermatologists also began using a new injectable agent called Dupixent® that acts upon the immune system to decrease what is called cytokine signaling between the white blood cells.
And in 2016, I became President of Big River Silk Skincare Inc., to manufacture and distribute three lines of helpful lubricating agents (moisturizers) containing an Alpha-Hydroxy chemical (AHA) called Glycolic Acid: GLYCOSHEA® Hand&Body Cream/Standard Strength (1 oz: $19.95; 2 oz: $29.95; 8 oz: $89.95); GLYCOSHEA® Hand&Body Cream/High Strength (1 oz: $29.95; 2 oz: $44.95; 8 oz: $139.95); and GLYCOSHEA® Facial&Neck Cream (1 oz: $39.95/2 oz; $59.95; 8 oz: $179.95). GLYCOSHEA is helpful in both moisturizing the skin and decreasing the appearance of fine lines in the skin, promoting skin smoothness, making it into an Anti-Wrinkle Cream.
Big River Silk also manufactures a special gentle moisturizer for babies, senior, and those with especially sensitive skin, a hypoallergic moisturizer: HypoShea™ Moisturizer Cream (1 oz: $12.95; 2 oz: $18.95; 8 oz: $39.94).
So if you or family members are suffering from Alopecia, consider getting your condition properly diagnosed, to help to sort out what skin condition is causing the Alopecia. My own Dermatology practice – with Rheumatology and Dermatology – is with Rheumatology and Dermatology Associates, at 8143 Walnut Grove Road, Cordova TN, a suburb of Memphis TN. Or you can find a Dermatologist close to you by going to the American Academy of Dermatology web site, to the “Find a Dermatologist” tab: just plug in your zip code, and you’ll get a list of Board-certified Dermatologists closer to you.
George Woodbury Jr. M.D.
Board-certified Dermatologist at Rheumatology and Dermatology Associates
8143 Walnut Grove Road
Cordova TN 38018
President of Big River Silk Skincare Inc.
8143 Walnut Grove Road
Cordova TN 38018