Faculty Bibliography

Androgenetic alopecia (AGA) is a chronic, progressive condition with limited Food and Drug Administration-approved treatments. Therefore, there is increasing interest in adjunctive options among patients and physicians. This clinical review synthesizes and critically appraises current evidence on nutritional supplements and nutraceuticals, light-based therapies, topical agents, and lifestyle modifications to guide their integration into evidence-based AGA management. Mechanistic and histologic studies indicate that inflammatory, oxidative, and microvascular alterations may contribute to follicular miniaturization, supporting interest in adjunctive strategies that promote scalp homeostasis. Among reviewed interventions, some demonstrate modest benefit, whereas many others lack adequate data. Significant gaps persist, including small sample sizes, heterogeneous methodologies, limited long-term safety data, and inconsistent outcome measures. Social media and direct-to-consumer hair loss companies remain major sources of AGA misinformation, underscoring the need for high-quality digital patient education and physician-guided resource curation. Future independently funded randomized controlled trials and mechanistic studies are essential to define optimal use parameters and support evidence-based, individualized, multimodal AGA therapy for patients.

Disorders affecting the hair follicle (HF) and pilosebaceous unit impose psychosocial and financial burdens on patients and may signal risk for other medical conditions. Human genetic studies help to identify key physiological mechanisms that govern health and are increasingly used to improve drug development. GWASs identify genetic variants that are common in the population and implicate disease mechanisms that are widely shared among patients. In this study, we synthesize knowledge about the biology of the pilosebaceous unit that has been derived from GWASs of hair-related diseases. We identify the key genetic drivers and reveal fundamental biological themes that cut across diseases to identify crucial regulators of HF health.

Androgenetic alopecia (AGA) affects nearly 50% of women during their lifetime, representing the most prevalent form of chronic hair loss in this population. Despite its high incidence, AGA in women remains underdiagnosed and undertreated, with significant psychosocial consequences including diminished self-esteem, impaired social functioning, and reduced quality of life that often exceed impacts observed in men. AGA pathophysiology involves complex interactions between hormonal, genetic, and environmental factors. Androgens promote follicular miniaturization through progressive shortening of the anagen phase, while estrogens may provide protective effects. Genetic studies reveal sex-specific differences in disease mechanisms, and environmental factors like oxidative stress and pollution may contribute to disease progression. Clinical evaluation requires careful consideration of differential diagnoses including chronic telogen effluvium, diffuse alopecia areata, and scarring alopecias. Diagnostic tools include trichoscopy, pull testing, and trichometric measurements to assess hair density and miniaturization patterns. Currently, topical minoxidil is the only FDA-approved treatment for female AGA, also referred to as female pattern hair loss (FPHL). Off-label therapies include low-dose oral minoxidil, anti-androgens such as spironolactone and 5-alpha reductase inhibitors (finasteride and dutasteride), and hair transplantation. Adjunctive treatments like low-level light therapy and platelet-rich plasma may further augment improvement and are often best used in conjunction with medical therapies. Critical research gaps persist, including the paucity of randomized controlled trials for AGA that include female patients. There is an urgent need for additional FDA-approved therapies for AGA in women to increase treatment access and reduce its psychosocial burden.

BACKGROUND/UNASSIGNED:Academic dermatologists manage a broad array of responsibilities, often extending beyond clinical duties to include education, research, mentorship, and administrative work. OBJECTIVE/UNASSIGNED:This study aimed to quantify the scope of paid and unpaid responsibilities among academic dermatologists in the United States and identify disparities based on gender, career stage, and geography. METHODS/UNASSIGNED:A cross-sectional survey of 63 board-certified academic dermatologists from 12 institutions collected data on demographics, workweek allocation, after-hours tasks, compensation, burnout, and resilience from January to May 2025. RESULTS/UNASSIGNED:Respondents reported spending 58.3% of their time on clinical care, 15.9% on administrative duties, 13.8% on education, and 11.9% on research. Nearly half received 11 to 50 daily patient messages via the clinical inbox, and over 80% took hospital call duties, with most receiving no extra compensation. Burnout affected 63.5% of respondents and was significantly more prevalent among women, early-career physicians, and those in the Mid-Atlantic and Northeast regions. Resilience scores were lower among women. Consulting opportunities, often associated with supplemental income and career advancement, were more common among male and senior physicians. Parental leave policies were inconsistently applied and poorly understood; nearly 20% of respondents had 8 or fewer weeks of paid parental leave. LIMITATIONS/UNASSIGNED:Study limitations include the relatively small sample size and overrepresentation of the Northeast region, potentially hindering generalizability. Additionally, no significant race-based differences were observed, which may be due to insufficient sample sizes within comparator groups. CONCLUSION/UNASSIGNED:These findings highlight the cumulative burden of undercompensated labor, inadequate institutional support, and gender disparities in workload and opportunity. Structural changes in compensation transparency, workload distribution, recognition of academic labor, and support for early-career and female physicians are essential to fostering sustainability and equity within academic dermatology.