A Hairy Q&A With Jerry Shapiro, MD

Jerry Shapiro, MD, professor and director of disorders of the hair and scalp at New York University's Grossman School of Medicine in New York, New York, was the first dermatologist to devote his entire practice to the study of hair and has a career spanning 36 years. He presented pearls, research, and innovative treatment options during the session "Hair Disorders Update 2023" at Maui Derm NP+PA Fall 2023 in Asheville, North Carolina September 27-30.

Shapiro joined Dermatology Times® for a Q&A on top takeaways and considerations for hair and scalp treatment.

Dermatology Times: What inspired you to devote your entire practice to the study and treatment of hair?

Shapiro: I was asked by the head of our department in Canada, the University of British Columbia to do hair, because there was nobody in Canada and very few in the United States. So, I decided I would do it, and we started having success stories. We were publishing and I really, really got interested. Then, I had fellows from all over the world who wanted to come and learn under me. I felt if I was still doing eczema, acne and psoriasis, you know, that I'm not an expert in. These people came from all over the world from 4 different continents to spend a year with me. I had to focus just on hair. One day a week, initially, we did general dermatology without the fellows, but it was almost all dedicated to hair. Then after a few years, I just did everything in hair, I didn't do any general derm at all.

Dermatology Times: Tell us the take home pearls to treat scarring alopecia.

Shapiro: The most important take home pearl is that it's a trichologic emergency. Every hair that they lose, they will lose forever. So, we have to get on top of it. It behooves every dermatologist to get on top of it and treat aggressively. There are different kinds of cicatricial alopecias and they require different treatments. Different forms of scarring alopecias require certain anti inflammatories and we go through the topicals. We go through the orals and the injectables that may help individuals who have scarring hair loss. A biopsy usually needs to be made to help confirm that this is what it is. But sometimes it's so obvious, like something called frontal fibrosing alopecia, you don't necessarily have to do a biopsy.

Dermatology Times: How is your practice integrating innovative mesotherapy into cosmetic treatments with the use of dutasteride?

Shapiro: Mesotherapy therapy just means injecting, so we were injecting things into the scalp or wherever. We've been using mesotherapy for years with intralesional cortisone. But we have never, at least I had never injected anti androgens into the scalp, and there are so many successful papers that show that it works. These are from Europe and South America. There are wonderful, randomized control trials that show that it works. So we decided to start it at our clinic [with dutasteride]. We only started recently, and so far, the few patients that we've started seems to work, but it's too early. It's an it's anecdotal right now. I can't really say until I've done quite a number of patients. But I think that it is something that really might become something important based on what I've heard from my South American colleagues, particularly Brazilians, who have come to my clinic to learn from me, and then I'm learning from them about this thing. Then my European colleagues also have shown that it works. So I felt, we have to be cutting edge here. This is cutting edge for the United States.

Dermatology Times: What research and experiences have you had when treating hair loss for patients in certain cultures, careers, and lifestyles?

Shapiro: There are all sorts of head coverings that can cause hair loss. We've recently submitted to journals, a whole article on this kind of thing. And if you pull too tightly on hair for a long period of time, it may not grow back. I'd seen a lot of that when I worked in Vancouver where there are a lot of Sikh children who wear of these tight, tight hairstyles underneath a head covering. And then later, they don't want to wear it anymore. When they get older, they decide they want to go a little more modern, and then they've got this area that it may grow back. But if they've held it really tight, for a long period of time, the hair won't grow back. Then we then consider other options like like minoxidil won't really work that well on someone who's pulled their hair for so long. What we usually do is refer to surgery for them because they pulled so tight on their hair. And you know, it's not necessarily so much a cultural-type thing. There are ballerinas who have these things where the hair is pulled so tightly back, they lose their hair, so you mustn't do it for too long. We tell people that if you pulled your hair so long in the same position for 10 years, you're probably not gonna grow back.

Transcript edited for clarity