Arash Mostaghimi, MD, MPA, MPH: Pearls in Dermatopathology and Alopecia

Arash Mostaghimi, MD, MPA, MPH, is an assistant professor of dermatology, director of the Dermatology Inpatient Service, and co-director of the complex medical dermatology fellowship at Brigham and Women’s Hospital.

Mostaghimi sat down with Dermatology Times® to discuss key insights from 3 of his sessions presented at the Society of Dermatology Physician Assistants (SDPA) Annual Summer Dermatology Conference. These included, "Introduction to Dermatopathology: Understanding the Pathology Report and Basic Biopsies," "Advanced Dermatopathology: Beyond the H&E," and "Alopecia: Treating Challenging Cases."

Arash Mostaghimi, MD, MPA, MPH: Hi, I'm Arash Mostaghimi. I'm an associate professor of dermatology at Brigham and Women's Hospital in Boston, Massachusetts.

Dermatology Times: What are key highlights and takeaways from your dermatopathology sessions?

Mostaghimi: So when thinking about dermatopathology, the most important thing is that you think about the suspected pathology of the lesion that you're biopsying and making sure that the type of biopsy you're doing specifically with the depth, the amount of tissue, the number of biopsies you do, matches up with that, so you can make sure that you have the right answer after your biopsy has been obtained and evaluated.

Dermatology Times: What are key highlights and takeaways from your session, "Alopecia: Treating Challenging Cases?"

Mostaghimi: We're in a golden age for alopecia. We have old drugs such as minoxidil that we're getting used to using more and more often, particularly in the oral form, and we have a lot of new drugs, such as the oral JAK inhibitors for alopecia areata that are giving us new options and more efficacious treatments for patients.

So the introduction of JAK inhibitors for alopecia areata is a total game-changer. Baricitinib was approved 1 year ago, and ritlecitinib was just approved a couple of days before we're recording this session. And both of the drugs are the first and second FDA-approved drugs for alopecia areata, so they're substantially more efficacious for patients with moderate-to-severe disease—that means more than 50% hair loss—and have been shown to not only regrow hair on the scalp, but in the eyebrows and eyelashes as well. So physicians who become comfortable with these medications can add them to their arsenal of treatments for this disease.

Ultimately for both dermatopathology and for alopecia, the core message is the same: that you have to know the data, understand population-level information, but think specifically about your patient, the person that's in front of you, and how you can best manage him or her. So for every patient, we need to ask, why this patient? Why this treatment, and why right now? So that's whether or not you're doing a biopsy and saying, 'Why am I choosing to do this biopsy at this time? This type of biopsy? Or for a condition like alopecia? Why am I offering these treatments and not others, and how do I tailor this treatment to not only maximize the efficacy and the patient but make sure that I make it as safe as possible?'

[Transcript edited for clarity]