Arash Mostaghimi, MD: Treating Challenging Cases of Alopecia

During his HCPLive interview, Arash Mostaghimi, MD, MPA, MPH, discussed some current trends with regard to alopecia treatment as well as major takeaways from his conference talk titled ‘Alopecia: Treating Challenging Cases.’

“So there's a couple of new treatments in alopecia that we're learning more about,” Mostaghimi explained. “One is an old treatment that's oral minoxidil. And that's a medication that we've been using for years but has come more into vogue over the past year after being highlighted in our recent New York Times article.”

He pointed out that oral minoxidil is highly efficacious, adding that usually a dose of 2.5 milligrams is used for women and up to 5 milligrams for men.

“And the safety and efficacy of this drug has been established for low dose oral minoxidil,” Mostaghimi stated. “It's really important that when we're counseling our patients, we're thinking about the data that we realized that the data from regular minoxidil which was given a much higher dose doesn't apply to the same population.”

Mostaghimi then main risks that clinicians see with these populations are hypertrichosis, involving growing too much hair and hair in places that one does not want.

“And there's a small number of patients who have excessive water retention, sometimes tachycardia, some mild cardiovascular effects, but overall over 98% of people are able to continue the medication once it's been started,” he said. “And since it works so well, across all different types of alopecia you can use it either as a primary or adjunct agent, and everything ranging from androgenetic alopecia to scarring alopecia is to alopecia areata, etc.”

Mostaghimi later discussed his hopes for the future of treatment, as well as takeaways he hopes viewers of his lecture walked away with.

“One of the main challenges with alopecia treatment in general, and alopecia areata specifically, is that it is still seen as a cosmetic disease by many folks,” he said. “Even though we as clinicians understand the profound psychosocial impact that can have on patients, they often don't have access to not only the Medicaid, the newer medications and treatments, but also for camouflaging agents such as wigs and other hairpieces.”

Mostaghimi then added that, on a positive note, this phenomenon is changing.

“There's a lot of efforts at the state level, which are mandating care,” he explained. “And we recently published a paper that looked across the United States at different areas as to how Medicare and Medicaid expansion at the state level is improving access to these. So there's 2 issues: 1 is whether or not wigs are covered at all, and sometimes they're not. The second is when they aren't covered, how often can you get a wig and what is the amount of money that it takes a nice hairpiece that can often be several thousands of dollars.”

Mostaghimi further explained some of the ways in which this issue is being looked at, specifically by advancing new legislation.

To find out more about the information in this interview, view the full video above.

The quotes contained in this interview description were edited for clarity.