Experiences of Some of Our Mentorship Grant Recipients
Reneé Haughton, MD Mentor: Amy McMichael, MD, Wake Forest University School of Medicine Mentorship Title: Central Centrifugal Cicatricial Alopecia Pathogenesis and Cultural Considerations I spent two weeks working with Dr. McMichael in her hair clinic, general dermatology clinic, and cosmetics clinic. Her practice locations during my time included Wake Forest’s Atrium Health clinic in Winston Salem, Wake Forest’s Greensboro clinic, and a resident-run clinic for the underinsured. This was my first rotation in dermatology and as such I was a little anxious on the first day not knowing what to expect and fearful that my knowledgebase would not be up to par. Dr. McMichael, the residents, physician’s assistants, and all of the team members at the Atrium Health clinic that first day were so welcoming that my fears quickly dissipated. Maybe it was their sweet, charming southern drawl or the way they treated all of their patients like old friends. The anxiety aside, I was able to focus my energies on taking in all the knowledge about dermatology and patient care that was shared with me during my time. During the general dermatology clinics, I saw a range of conditions in children and adults from the bread-and-butter skin checks and mild acne to more complicated hidradenitis suppurativa, atopic dermatitis, psoriasis, and bullous pemphigoid. The patient population was diverse, so I learned about diagnosis and treatment of these conditions in skin of all colors. I was able to get hands on and assisted with minor procedures such as punch biopsies, shave biopsies, and cryotherapy. I learned about the cutting-edge theories, investigations, and therapies in hair loss, primarily traction alopecia and central centrifugal cicatricial alopecia, from Dr. McMichael and her research team during hair clinics. Every patient in her hair clinic was examined with trichoscopy by an expert on the research team who pointed out important features of various scalp disorders. After a day or two of shadowing the team, I was able to seamlessly integrate into the clinic workflow by seeing patients on my own. Dr. McMichael encouraged me to formulate my own assessments and plans for patients and from this my confidence grew exponentially during my short time. As evidence of how wonderful of a mentor Dr. McMichael is, she not only welcomed me into her clinics, she also welcomed me to the greater Wake Forest Community, her family, and Winston-Salem. It was clear from this experience with her that she genuinely cares about the professional as well as personal lives of those under her. I am fortunate to be able to continue a mentorship relationship with her even now that my time at Wake Forest has ended. We are currently working on a project to better understand shared decision making in central centrifugal cicatricial alopecia. In summary, I highly recommend this experience with Dr. McMichael for any budding dermatologists wanting to learn more about hair and scalp disorders. Thank you to the American Hair Research Society for funding this opportunity. Mentee: Adaora Ewulu, BS Mentor: Mariya Miteva, MD, University of Miami School of Medicine Mentorship Title: Scarring Alopecias By June 2023, I completed my AHRS mentorship experience with Dr. Mariya Miteva at the University of Miami Hospital. During my two weeks in Miami, Dr. Miteva and I began working on a research project that focuses on tracking progress of medical management of CCCA, and this project is still ongoing with plans to submit it to a journal before the end of 2023. Additionally, I had the pleasure of working with Dr. Miteva at her hair loss clinic which took place Monday-Friday from 8am to 5pm. Twice a week, she also allowed me to look at hair biopsies under the microscope while simultaneously giving brief lectures on different hair pathology and cycles of hair growth. I learned about treatment strategies that were effective depending on the type of alopecia the patient had. For example, someone with female-patterned hair loss might have more success with consistent use of minoxidil while someone with CCCA may struggle to see growth in areas where they have permanent damage to their hair follicles. One thing in particular that stood out to me about Dr. Miteva’s bedside manner was that she took her time with each patient. Whether it was a follow-up patient or a new patient, the vists lasted on average 40 minutes each. In detail, she spoke with them about their disease, realistic expectations they should have regarding hair growth, and what the recommended treatment options were. Patients reacted to her words with varying emotions. Some were surprised that they would have to wait several months to see even the smallest bit of hair growth. Others were excited there was a possibility that they could gain some of their confidence back. Alopecia can affect patients both physically and emotionally. There were older adult patients who shared stories of being bullied or ridiculed at their jobs for their appearance. There were adolescents who cried tears of frustration in the room because kids at their school teased them anytime their hair was exposed. One thing in common with these patients is that they all wanted a permanent solution to their hair growth and unfortunately, results from medications like minoxidil, finasteride, etc are not permanent and they come with their own side effects that may not be tolerable for some. I have been inspired to seek new ways of addressing hair loss in dermatology. My dream is to own a private practice that has a hair salon in it. Within this salon, I want to offer my own brand of hair prostheses for my hair loss patients who are open to hair camouflaging. A lot of people shy away from wearing wigs because of the risk of looking unnatural, but wig construction techniques have evolved over the years. I am determined to make sure my future brand offers natural-looking wigs personalized to each patient depending on their needs. Medical wigs are not focused on in dermatology residency training, but I think it is important for dermatologists to be educated on the different types so that they can suggest alternative options for hair loss patients outside of pharmacological management. While in Miami, I was connected with Dr. Nusbaum, a hair transplant surgeon and dermatologist who works at the Miami Hair Institute. He allowed me to shadow him for a day during my two weeks, and it was at that time that I was motivated to add to my skill set as a future hair loss specialist. Dr. Nusbaum started my day with a lecture on hair restoration and the different methods most commonly used today. He then allowed me to watch the transplant procedures being performed on his patients. As I watched, I felt sure that this was something I could and wanted to do in the future. Additionally, it was very rewarding seeing follow-up patients express overwhelming happiness with how successful their results had been since undergoing their initial procedure. I recently matched into dermatology residency in Southern California and have been intentionally trying to connect with hair transplant surgeons and dermatologists in that area. My time at the Miami Hair institute was brief, so I plan to seek further mentorship with other AHRS dermatologist/hair transplant surgeons who can train me both during and after residency. Mentee: Mariia Konchak, MD, Mentor: Antonella Tosti, MD, University of Miami School of Medicine Mentorship Title: Trichoscopy During JAK Inhibitors Treatment I am very grateful to AHRS for the opportunity to visit the University of Miami and participate in hair research with wonderful hair expert and my mentor Prof. Antonella Tosti. During this month, we treated many patients with alopecia areata , did trichoscopy and saw clear results of treatment with JAK inhibitors. I’m also grateful to Antonella Tosti for teaching me and showing all her tips in treatment of various types of alopecia. That will help me to work for the best results. Moreover I not only acquired valuable knowledges and skills in hair research but also met a great people which became my friends. It was very nice to work in such a warm and supportive atmosphere. All patients and residents love Dr. Tosti. She is very kind and generous to help and to share her knowledges. I was very pleased to stay there and didn’t want to come back home. Thank you AHRS for this unforgettable experience and I’m very happy that I can bring something new to Ukraine. Mentee: Divya Sharma, MD, FAAD Mentor: Maryanne Senna, MD, Lahey Dermatology Mentorship Title: Building a Hair Clinic I would like to express a huge thank you to the American Hair Research Society for the mentorship opportunity with Dr. Maryanne Senna. Dr. Senna is an outstanding mentor and I could not ask for a better person to learn from. She is an excellent teacher who is passionate about hair health and has an unbelievable fund of knowledge in a rapidly evolving space. Before the AHRS mentorship, I had introduced a hair specialty clinic and I was doing my best with self-directed learning and informal guidance. Over time, it became increasingly clear that I would have a higher chance of being a more effective and confident provider by learning more practical knowledge from someone with greater experience than me. Also, to be a high quality expert, in a time where unethical practices and unqualified providers are trying to dominate the hair space, I realized that I must at the cutting edge of clinical and research developments as well as pursue leadership and advocacy. Dr. Senna combines all these aspects as a genuine authority on hair loss. Through my mentorship experience, at Lahey Health from April 2023-May 2023, I had the chance to learn directly from Dr. Senna and understand the ins and outs of: running a subspecialty clinic, guiding patients from diagnosis to treatment, leading research efforts, and advocating for improved patient care. I could see Dr. Senna’s connection with patients firsthand; they really felt well-supported and taken care of because of her credibility, work ethic, and integrity with which she practices. I was also inspired by her enthusiasm for supporting her colleagues and fostering mentorship. As a mentee, I felt like Dr. Senna believed in me as a future colleague and wanted to equip me with the guidance and resources to develop my expertise. This mentorship opportunity has truly been a catalyst in my career as I have continued to build my expertise in hair loss as well as increase my involvement in advocacy and clinical research. I am looking forward to further establishing myself as a hair specialist and paying it forward.
Reneé Haughton, MD
Mentor: Amy McMichael, MD, Wake Forest University School of Medicine
Mentorship Title: Central Centrifugal Cicatricial Alopecia Pathogenesis and Cultural Considerations
I spent two weeks working with Dr. McMichael in her hair clinic, general dermatology clinic, and cosmetics clinic. Her practice locations during my time included Wake Forest’s Atrium Health clinic in Winston Salem, Wake Forest’s Greensboro clinic, and a resident-run clinic for the underinsured.
This was my first rotation in dermatology and as such I was a little anxious on the first day not knowing what to expect and fearful that my knowledgebase would not be up to par. Dr. McMichael, the residents, physician’s assistants, and all of the team members at the Atrium Health clinic that first day were so welcoming that my fears quickly dissipated. Maybe it was their sweet, charming southern drawl or the way they treated all of their patients like old friends. The anxiety aside, I was able to focus my energies on taking in all the knowledge about dermatology and patient care that was shared with me during my time.
During the general dermatology clinics, I saw a range of conditions in children and adults from the bread-and-butter skin checks and mild acne to more complicated hidradenitis suppurativa, atopic dermatitis, psoriasis, and bullous pemphigoid. The patient population was diverse, so I learned about diagnosis and treatment of these conditions in skin of all colors. I was able to get hands on and assisted with minor procedures such as punch biopsies, shave biopsies, and cryotherapy. I learned about the cutting-edge theories, investigations, and therapies in hair loss, primarily traction alopecia and central centrifugal cicatricial alopecia, from Dr. McMichael and her research team during hair clinics. Every patient in her hair clinic was examined with trichoscopy by an expert on the research team who pointed out important features of various scalp disorders. After a day or two of shadowing the team, I was able to seamlessly integrate into the clinic workflow by seeing patients on my own. Dr. McMichael encouraged me to formulate my own assessments and plans for patients and from this my confidence grew exponentially during my short time.
As evidence of how wonderful of a mentor Dr. McMichael is, she not only welcomed me into her clinics, she also welcomed me to the greater Wake Forest Community, her family, and Winston-Salem. It was clear from this experience with her that she genuinely cares about the professional as well as personal lives of those under her. I am fortunate to be able to continue a mentorship relationship with her even now that my time at Wake Forest has ended. We are currently working on a project to better understand shared decision making in central centrifugal cicatricial alopecia.
In summary, I highly recommend this experience with Dr. McMichael for any budding dermatologists wanting to learn more about hair and scalp disorders. Thank you to the American Hair Research Society for funding this opportunity.
Mentee: Adaora Ewulu, BS
Mentor: Mariya Miteva, MD, University of Miami School of Medicine
Mentorship Title: Scarring Alopecias
By June 2023, I completed my AHRS mentorship experience with Dr. Mariya Miteva at the University of Miami Hospital. During my two weeks in Miami, Dr. Miteva and I began working on a research project that focuses on tracking progress of medical management of CCCA, and this project is still ongoing with plans to submit it to a journal before the end of 2023. Additionally, I had the pleasure of working with Dr. Miteva at her hair loss clinic which took place Monday-Friday from 8am to 5pm. Twice a week, she also allowed me to look at hair biopsies under the microscope while simultaneously giving brief lectures on different hair pathology and cycles of hair growth. I learned about treatment strategies that were effective depending on the type of alopecia the patient had. For example, someone with female-patterned hair loss might have more success with consistent use of minoxidil while someone with CCCA may struggle to see growth in areas where they have permanent damage to their hair follicles. One thing in particular that stood out to me about Dr. Miteva’s bedside manner was that she took her time with each patient. Whether it was a follow-up patient or a new patient, the vists lasted on average 40 minutes each. In detail, she spoke with them about their disease, realistic expectations they should have regarding hair growth, and what the recommended treatment options were. Patients reacted to her words with varying emotions. Some were surprised that they would have to wait several months to see even the smallest bit of hair growth. Others were excited there was a possibility that they could gain some of their confidence back.
Alopecia can affect patients both physically and emotionally. There were older adult patients who shared stories of being bullied or ridiculed at their jobs for their appearance. There were adolescents who cried tears of frustration in the room because kids at their school teased them anytime their hair was exposed. One thing in common with these patients is that they all wanted a permanent solution to their hair growth and unfortunately, results from medications like minoxidil, finasteride, etc are not permanent and they come with their own side effects that may not be tolerable for some. I have been inspired to seek new ways of addressing hair loss in dermatology. My dream is to own a private practice that has a hair salon in it. Within this salon, I want to offer my own brand of hair prostheses for my hair loss patients who are open to hair camouflaging. A lot of people shy away from wearing wigs because of the risk of looking unnatural, but wig construction techniques have evolved over the years. I am determined to make sure my future brand offers natural-looking wigs personalized to each patient depending on their needs. Medical wigs are not focused on in dermatology residency training, but I think it is important for dermatologists to be educated on the different types so that they can suggest alternative options for hair loss patients outside of pharmacological management.
While in Miami, I was connected with Dr. Nusbaum, a hair transplant surgeon and dermatologist who works at the Miami Hair Institute. He allowed me to shadow him for a day during my two weeks, and it was at that time that I was motivated to add to my skill set as a future hair loss specialist. Dr. Nusbaum started my day with a lecture on hair restoration and the different methods most commonly used today. He then allowed me to watch the transplant procedures being performed on his patients. As I watched, I felt sure that this was something I could and wanted to do in the future. Additionally, it was very rewarding seeing follow-up patients express overwhelming happiness with how successful their results had been since undergoing their initial procedure.
I recently matched into dermatology residency in Southern California and have been intentionally trying to connect with hair transplant surgeons and dermatologists in that area. My time at the Miami Hair institute was brief, so I plan to seek further mentorship with other AHRS dermatologist/hair transplant surgeons who can train me both during and after residency.
Mentee: Mariia Konchak, MD,
Mentor: Antonella Tosti, MD, University of Miami School of Medicine
Mentorship Title: Trichoscopy During JAK Inhibitors Treatment
I am very grateful to AHRS for the opportunity to visit the University of Miami and participate in hair research with wonderful hair expert and my mentor Prof. Antonella Tosti. During this month, we treated many patients with alopecia areata , did trichoscopy and saw clear results of treatment with JAK inhibitors. I’m also grateful to Antonella Tosti for teaching me and showing all her tips in treatment of various types of alopecia. That will help me to work for the best results. Moreover I not only acquired valuable knowledges and skills in hair research but also met a great people which became my friends.
It was very nice to work in such a warm and supportive atmosphere. All patients and residents love Dr. Tosti. She is very kind and generous to help and to share her knowledges. I was very pleased to stay there and didn’t want to come back home. Thank you AHRS for this unforgettable experience and I’m very happy that I can bring something new to Ukraine.
Mentee: Divya Sharma, MD, FAAD
Mentor: Maryanne Senna, MD, Lahey Dermatology
Mentorship Title: Building a Hair Clinic
I would like to express a huge thank you to the American Hair Research Society for the mentorship opportunity with Dr. Maryanne Senna. Dr. Senna is an outstanding mentor and I could not ask for a better person to learn from. She is an excellent teacher who is passionate about hair health and has an unbelievable fund of knowledge in a rapidly evolving space.
Before the AHRS mentorship, I had introduced a hair specialty clinic and I was doing my best with self-directed learning and informal guidance. Over time, it became increasingly clear that I would have a higher chance of being a more effective and confident provider by learning more practical knowledge from someone with greater experience than me. Also, to be a high quality expert, in a time where unethical practices and unqualified providers are trying to dominate the hair space, I realized that I must at the cutting edge of clinical and research developments as well as pursue leadership and advocacy. Dr. Senna combines all these aspects as a genuine authority on hair loss.
Through my mentorship experience, at Lahey Health from April 2023-May 2023, I had the chance to learn directly from Dr. Senna and understand the ins and outs of: running a subspecialty clinic, guiding patients from diagnosis to treatment, leading research efforts, and advocating for improved patient care. I could see Dr. Senna’s connection with patients firsthand; they really felt well-supported and taken care of because of her credibility, work ethic, and integrity with which she practices. I was also inspired by her enthusiasm for supporting her colleagues and fostering mentorship. As a mentee, I felt like Dr. Senna believed in me as a future colleague and wanted to equip me with the guidance and resources to develop my expertise.
This mentorship opportunity has truly been a catalyst in my career as I have continued to build my expertise in hair loss as well as increase my involvement in advocacy and clinical research. I am looking forward to further establishing myself as a hair specialist and paying it forward.
Andrea Bilger, PhD, University of Wisconsin, Madison
Mentor: John Sundberg, D.V.M., Ph.D., DACVP, The Jackson Laboratory
Mentorship Title: Histopathological Analysis of Hair Follicle Infection and Dysplasia
Thanks to the AHRS, I recently spent a week in Maine studying papillomavirus-induced hair follicle and skin histopathology with my mentor, Dr. John Sundberg, an expert on hair and skin diseases and a renowned veterinary pathologist. Dr. Sundberg was the first to describe many novel nonhuman papillomaviruses, including the focus of my research: MmuPV1, the first papillomavirus shown to infect laboratory mice. Hair follicles are an important target of infection by MmuPV1, as they are for a number of human papillomaviruses.
Histopathology, Dr. Sundberg's area of expertise, is central to my work. My research involves assessing the susceptibility of wild-type and mutant mouse strains to MmuPV1 infection and carcinogenesis, in large part through histopathological analysis of infected tissue sections. These studies are designed to identify the genes involved in mouse papillomavirus pathogenesis, and to create mouse models of disease that can be used to assess novel methods of detection and treatment.
Scientists often focus on the trees – molecules that respond to stimuli, for example – and have a poor grasp of the forest of cellular and tissue interactions that play a critical role in the biological processes they are studying. A deeper understanding of the anatomy of the hair follicle, its normal and pathological behavior, should provide me with better insights into its susceptibility to papillomavirus infection.
Specifically, I have been studying mice with mutations in the Tmc6 and Tmc8 genes, which are also mutated in people with epidermodysplasia verruciformis (EV). EV patients develop skin lesions and cancer due to chronic human papillomavirus infection. I brought to Maine slides of normal and mutant mouse ears infected with mouse papilloma virus, to learn how to assess normal and disease states visible in stained sections of mouse skin and especially hair follicles, which serve as a reservoir of papillomaviruses-infected cells. We assessed 11 aspects of injury- and papillomavirus-induced lesions. I learned about the hair follicle life cycle and variables that affect it, such as the part of the skin involved (e.g. back vs ear) or male versus female sex. Dr. Sundberg taught me how best to present these data and provided me with a powerpoint presentation that I could use to explain our findings to colleagues in Wisconsin.
Many thanks to the American Hair Research Society for making my wish to train with Dr. John Sundberg a reality. This week of intensive study has dramatically increased my understanding of histopathology, allowed me to teach fellow lab members some of what I had learned, and established an ongoing collaboration that has already inspired new experiments.
Genaro Briseño-Gascón, Pathology Resident, General Hospital
Mentor: Rodrigo Pirmez, Membro Efetivo da Sociedade Brasileira de Dermatologia, Centro de Estudos do Cabelo da Santa Casa de Misericórdia
Mentorship title: Clinicopathological correlation of lichen planopilaris and frontal fibrosing alopecia cases in association with seborrheic dermatitis, Demodex infestation or Pityrosporum infection
I am currently studying the last year of the specialty in Dermatology at the General Hospital “Dr. Manuel Gea González" in Mexico City and I requested this mentorship program from the American Hair Research Society because in my country we don’t have a specialized center for hair diseases, so this stay would allow me to complete my training in trichology.
I had the opportunity to stay with Professor Rodrigo Pirmez in Rio de Janeiro, Brazil, during June of this year.
This stay was made up of two parts, the first one was carried out at the Center for Hair Studies in Santa Casa de Misericórdia do Rio de Janeiro, where I learned directly from Professor Pirmez and several international experts in trichology about the clinical presentation, trichoscopic findings and therapeutic options in the different capillary pathologies.
I must confess that my experience was more than pleasant, since they are not only interested in pure knowledge about the pathologies, but also in how to approach the patient in a global aspect, follow certain steps during the physical examination and look for small details that can make an important diagnostic and therapeutic difference, always keeping an open mind to the comments and opinions of the residents and dermatologists who make up the service.
I learned a lot about infrequent cicatricial alopecias in my country, such as central centrifugal alopecia, dissecting cellulitis of the scalps and folliculitis decalvans, in patients presenting at different stages, which allowed me to identify early manifestations, forming a criterion for early diagnosis and treatment.
Another great lesson was considering the need for complementary studies such as biopsy, always guided by the evolution and trichoscopy findings, to obtain an adequate diagnosis through histological and clinical correlation.
The second part of my stay was in the private practice of Professor Pirmez which is dedicated solely to hair diseases. To begin with, the professor was always kind enough to answer my emails from the very first day I requested my stay with him, advising me on the ideal times and places for my stay, and continued to keep an eye on me from the first moment I arrived at Brazil. Throughout the practice, he explained to me how he approaches his patients, from the clinical history, how to emphasize some details during the anamnesis and keep an open mind to the possibilities.
Throughout the month he presented me with very interesting cases that were difficult to diagnose or treat, always asking for my opinion and pointing out some details that could be improved to obtain more information or reach a conclusion.
One of the strongest points of this stay was the trichoscopy, where Professor Pirmez is an expert, explaining every detail of the different findings in the patients. To be honest I had a lot of misconceptions about trichoscopic correlation which I corrected during this mentorship thanks to his guidance.
It has been one of the most enriching experiences of my life professionally and personally. I am most grateful to the American Hair Research Society and Professor Rodrigo Pirmez for the opportunity they gave me to take this first, but enormous step in the scientific world of trichology.
Briana Paiewonsky, MS4, Medical Student, Florida Atlantic University College of Medicine
Mentor: Leslie Castelo-Soccio, MD, PhD, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) & National Institutes of Health
Mentorship title: Pediatric Alopecia
I am so grateful for the opportunity to work with Dr. Leslie Castelo-Soccio, an attending physician at the National Institute of Arthritis and Musculoskeletal and Skin Diseases branch of the National Institute of Health (NIH). Dr. Castelo-Soccio also serves as the co-director of the Hair Disorders Focus Study Group for the Pediatric Dermatology Research Alliance. Her research focuses on pediatric alopecia including epidemiology, treatment options, and co-morbidities. Dr. Castelo-Soccio also investigates the microbiome and immune dysregulation of hair disease.
During my week at the NIH, I spent time observing in the Dermatology Consultation Clinic and attending various clinical and research meetings. I was fortunate to see incredibly rare cases of various primary immunodeficiencies, many of which had an alopecia component. I attended the NIH Grand Rounds, District of Columbia’s Grand Rounds session, and multiple dermatopathology sessions that took place during my visiting week. During these sessions, I learned from unique case presentations including one focused on a variant of traction alopecia, colloquially named “ponytail alopecia”, and gained knowledge about the scalp microbiome protocols currently underway at the NIH.
Throughout my experience working with Dr. Castelo-Soccio in clinic, she and I discussed the complex patient presentations, the signs and symptoms we observed during the scalp exam, and the various treatment options available for each patient. One of the most impactful conversations we had was a discussion regarding the use of janus kinase inhibitors to treat conditions such as alopecia areata, including evaluating their benefits and potential drawbacks. This conversation especially resonates with me as baricitinib was approved by the United States Food and Drug Administration just weeks after my mentorship experience concluded.
These snippets of my time with Dr. Castelo-Soccio are just a few examples of the valuable insights and experiences I gained during my week at the NIH. I plan to continue to learn and work with Dr. Castelo-Soccio and her team as we begin writing a review article focused on the various types of alopecia seen in primary immunodeficiencies.
Overall, working with Dr. Castelo-Soccio was an invaluable experience. She is a knowledgeable and amazing mentor, who always took time to answer questions, provide detailed explanations, and offer career advice. This experience further solidified my interest in hair research, especially within the pediatric population. I am incredibly thankful for the American Hair Research Society Mentorship grant that afforded me this opportunity and for Dr. Castelo-Soccio’s time and dedication to educating me.
Morinola Shobajo, BA, Medical Student, University of Illinois at Chicago College of Medicine
Mentor: Maria Hordinsky, MD; Chair Department of Dermatology, University of Minnesota
I would foremost like to thank the American Hair Research Society for having such a program that awards students with an interest in hair loss research and connects us to astounding mentors in dermatology. Without having this award, I would not have had the opportunity to form such a genuine relationship with my mentor, Dr. Hordinsky the Program Director of Dermatology at the University of Minnesota. I spent 4-weeks with Dr. Hordinsky and the amazing staff at the University working in the hair-loss clinic. I had an extensive learning experience, one of which utilizing artificial intelligence technologies, HairMetrix to assist in the diagnosis and management in patient’s care. Seeing how this device had been implemented into patient’s care was not only a unique diagnostic tool but was also as great educational tool that supported patient-centered medicine.
I had the incredible privilege to learn the facets of multiple hair loss disorders and management in non-scarring hair loss disorders like Alopecia Areata and Androgenic alopecia as well as scarring hair loss disorders, like Frontal Fibrosing Alopecia and Lichen Planopilaris. My experience was well-rounded. On Thursday evenings, we would examine patient hair fibers under the microscope to further assess and diagnose the health of patient’s hair strand. On Friday afternoons, we had Plasma Rich Platelet clinic a more cosmetic approach in the treatment of hair loss. I also had the bonus of working with Dr. Ronda Farah during in cosmetic clinic and Dr. Crutchfield in the skin of color clinic.
Outside of clinic, I connected with research fellows and residents. I was fortunate to attend grand-rounds and clinical research days where students, residents, and researchers from other institutions presented extraordinary research in dermatology. I was also able to volunteer with the Dermatology Student Interest Group at the University in hosting Alopecia Areata Field Day for children.
Working with Dr. Hordinsky and the team at the University of Minnesota has been an astonishing experience. Dr. Hordinsky has demonstrated phenomenal leadership in dermatology and hair-loss management and research, and I am more than inspired to contribute to hair-loss research, particularly in scarring hair loss disorders. I am forever thankful for Dr. Hordinsky, the American Hair Research Society and members for this award.
Bruno Florez, MD, Young Dermatologist, Caja de Seguro Social of Panama
Mentor: Marina Barletta, MD, Sociedad Brasileira De Dermatologia
Mentorship Title: Guideline to Distinguish Cicatricial Alopecia from Androgenetic Alopecia and Concomitant Seborrehic Dermatits to Select Good Candidates for Hair Transplantation
We performed a biopsy of the temporal area where the transplant had not been performed. Therefore, we excluded the possibility that these findings were post-transplant. We
hypothesized that the patient had subclinical lichen planus before surgery and androgenetic alopecia, so he had good results with hair transplantation initially. However, surgery may have been a trigger to developing a clinical case of lichen planus. Proper diagnosis and treatment were essential for hair regrowth and to maintain post-transplant results.
It is very important for the hair transplant surgeon to identify differences between clinical and trichoscopy signs of LPP, Fibrosing Alopecia in a pattern distribution (FAPD) and AGA because this may mean avoiding the HT in patients who haveactive LPP. However, in cases where the patient has subclinical LPP, doing the diagnosis before hair transplantation is a challenge.
We recommend assessing hair growth from the 12th month after hair transplantation. If it is insufficient and the patient has related symptoms to LPP, we could evaluate whether the LPP would be confirmed by trichoscopy and biopsy. A recent study demonstrated that is controversial to perform a biopsy before one year in the recipient area since the histopathology can be very similar in normal hair transplants having lymphocytic infiltrate and fibrosis as occurs in LPP for that. As shown in this case, in suspected cases of LPP after hair transplantation, is essential to carry out
early diagnosis and treatment to maintain the outcomes. In the case of a non-transplanted area being affected, taking a biopsy of that area would be the most appropriate.
Naiem Issa, MD, PhD, Dermatology Resident, University of Miami Leonard M. Miller School of Medicine
Mentor: Sergio Vaño-Galván, MD, PhD, Ramon Y Cajal Hospital
Mentorship title: Tricology - Epidemiology, Clinical, Trichoscopy and Therapeutic Options in Scarring Alopecias
Thanks to the AHRS Mentorship Program, I was able to be paired with the esteemed Dr. Sergio Vano-Galvan during 2021-2022. This was an excellent opportunity, especially during the Covid epidemic to receive international mentorship in hair medicine during a time that was difficult to travel. Dr. Vano-Galvan and I got to discuss novel treatments for hair disorders as well as my career aspirations and how to launch my hair practice after residency. It was particularly wonderful to compare our unique experiences in treating hair disorders in the USA and Spain/Europe. The mentorship program has allowed me to get a global perspective from a wonderful mentor and to become confident in taking the next step in my practice of hair medicine as I have just graduated from dermatology residency at the University of Miami in Florida in June of 2022. I am also grateful for our opportunity to meet at this year’s AHRS meeting at the American Academy of Dermatology meeting in Boston, USA. While our experience has been virtual for the past year, our relation will continue far beyond. Thanks to the AHRS Mentorship Program, I now have an excellent mentor and friend for life.
Betty Nguyen, BS, Medical Student, University of California Riverside School of Medicine
Mentor: Antonella Tosti, MD, University of Miami, School of Medicine
Mentorship title: The Types and Prevalence of Alopecia in COVID-19 Patients
I would like to express my gratitude to the American Hair Research Society for supporting a one-year research fellowship with Dr. Antonella Tosti in the Department of Dermatology and Cutaneous Surgery at the University of Miami. Under Dr. Tosti’s mentorship, I learned to formulate novel research questions, design robust studies, and carry projects to publication. During my research year, I completed a number of studies with Dr. Tosti, including several that investigated the intersectionality of hair loss and COVID-19. Through a systematic review and meta-analysis, we found that androgenetic alopecia was a risk factor for, and telogen effluvium a sequelae of, COVID-19. More interestingly, we found several reports describing relapses of alopecia areata in COVID-19 patients. Fascinated, I designed an original cross-sectional study to investigate this further, finding that both COVID-19 infection and vaccination could be correlated with relapses of alopecia areata in certain individuals.
Outside of our research projects, I had the opportunity to work directly with dermatology residents in Dr. Tosti’s clinic, where I learned to evaluate and manage patients with hair and nail conditions. Watching Dr. Tosti listen attentively to her patients, put them at ease, and patiently answer their questions, I learned that providing effective care relies just as much on sound medical knowledge as effective and compassionate communication. Watching Dr. Tosti’s patients improve on novel treatments, I saw the importance of contributing to the advancement of medicine through clinical and translational studies, and I envision myself continuing research as an academic clinician.
It goes without saying that I am immensely grateful for all of Dr. Tosti’s guidance, wisdom, and mentorship that has inspired me to pursue a career in hair dermatology. I would like to thank Dr. Tosti and her wonderful team for teaching me more than I could have imagined this past year. It will be difficult, if not impossible, to find a mentor more kind, more supportive, more patient, and more caring than Dr. Tosti. Thank you again to the American Hair Research Society for making this incredibly formative and memorable experience possible.
Camille Robinson, BS, Medical Student, Duke University School of Medicine
Mentor: Amy McMichael, MD, Wake Forest Baptist Medical Center Department of Dermatology
Mentorship Title: Traction and Central Centrifugal Cicatricial Alopecia: Advancements, Treatment and Review/Update of Literature
Participating in the AHRS Mentorship program has been such a rewarding experience. I am so grateful to Dr. McMichael for her mentorship and providing me with an opportunity to be pushed to new heights professionally, socially and personally. This experience gave me a new found confidence to pursue dermatology with a focus on hair loss and I cannot see myself doing anything else. I was so excited each day to learn about the nuances and intricacies of hair loss, while also learning different techniques that are used specifically for the skin of color community
when addressing hair loss. I was pushed to think critically about patients, which helped me further define my clinical approach.
With Dr. McMichael being a world renowned hair loss expert, I used this opportunity to self reflect and gain a deeper understanding of the kind of hair loss leader I want to be. Prior to this mentorship experience, I was interested in learning more about traction and central centrifugal cicatricial alopecia (CCCA) with the intention of building the knowledge I needed to eventually become an expert in these niches of hair loss. However, this mentorship experience
opened my eyes to the diversity within hair loss. While I am still interested in traction alopecia and CCCA, I am now more excited and motivated to learn how I can develop new treatment options and procedures that can be used to treat less common forms of alopecia. By the end of my mentorship experience, I was more comfortable and confident in being able to diagnose the various types of alopecia and knew the stepwise treatment approaches.
I was also able to heavily develop my research and writing skills. Dr. McMichael gave a number of presentations regarding hair loss and skin of color issues referencing many articles I did not know about prior to starting. I was not only able to gain knowledge through reading many of these articles throughout our time together, but I also developed an approach to systematically reviewing research articles and creating research questions. I additionally had the opportunity to work on a research letter with Dr. McMichael discussing the clinical considerations and treatment approach for Black patients with seborrheic dermatitis.
This mentorship experience provided me with the framework for my future career in hair loss and research by providing me with a network of future colleagues, access to education and advancements being made, and general exposure to the field of hair loss and the future direction of the field. I felt that this was vital as I continue to develop my goals and interests. Overall, this program was a key element to my professional aspirations because through this program, I was able to work with a leader in hair loss who looks like me who makes a difference and I am looking forward to the opportunity to one day do the same.
Kelli Goggans, BS, Graduate Research Assistant, University of Alabama at Birmingham
Mentor: Helen Everts, R.D.N., PhD, Texas Woman's University
Mentorship Title: Assessment of Retinoic Acid Biosynthesis in the Hair Cycle.
I greatly appreciate the opportunity provided to me through the American Hair Research Mentorship Program to work alongside and learn from Dr. Helen Everts at Texas Woman’s University. Despite the challenges the COVID-19 pandemic brought, the AHRS has been understanding and supportive as Dr. Everts and I pursued this mentorship virtually. Dr. Everts is a leading expert in retinoic acid biosynthesis in the pilosebaceous unit, and her mentorship has been an essential part of my work in characterizing a novel retinol dehydrogenase in the pilosebaceous unit throughout the hair cycle.
During my mentorship, I learned invaluable techniques for the preparation and histological staining of murine dorsal skin sections. Dr. Everts guided me through the morphology of the pilosebaceous unit and how it is altered in our genetically modified mouse model. I also learned how to stage hair follicles, since our model has accelerated hair growth, and used this knowledge as the foundation for my dissertation work where I characterize our enzyme of interest across numerous stages of the hair cycle. Additionally, as an expert in immunohistochemistry, Dr. Everts advised me in the nuances of immunohistochemistry in skin and proper optimization for various antibodies. These techniques allow me to not only confirm certain hair cycle stages, but further interrogate proteins involved in retinoic acid biosynthesis and signaling in our mouse model.
Finally, Dr. Everts introduced me to the AHRS, which has led not only to this invaluable mentorship opportunity, but also allowed me access to numerous seminars and presentations from the AHRS. My laboratory had limited experience in skin and hair, and it is only thanks to Dr. Everts and the AHRS that I have been able to accomplish my studies to the level of excellence that I have. I have become a residing hair expert not only in my laboratory, but across my university. Thank you for your support and generosity.
Zachary Goldstein, MD, Dermatopathology Fellow, University of California, Los Angeles
Mentor: Lynne Goldberg, MD, Boston University
Mentorship title: Fundamentals of the Hair Biopsy and Potential Application to Machine Learning.
I am beyond grateful to have received the AHRS mentorship grant award as my time I spent with Dr. Lynne Goldberg was fantastic. The experience really sharpened my approach to alopecia biopsies and created a great foundation for my research interests. I hit the jackpot with Dr. Goldberg as she truly was a wonderful mentor and an absolute joy to work alongside.
Rachel Sennett, MD, PhD, Dermatology Resident, University of California, San Diego
Mentor: Lynne Goldberg, MD, Boston University
Mentorship title: Dermatopathology in Diagnosing Alopecia.
I was tremendously fortunate to benefit from the AHRS mentorship award, which allowed me the opportunity to work with Dr. Lynne Goldberg at Boston University. I have held a longstanding interest in understanding the complexities of the hair cycle and pathogenesis of hair loss, and more recently I developed an interest in dermatopathology through my residency training. Dr. Goldberg is a world-renowned expert in the dermatopathology of alopecia, representing a combination of my two current passions. I jumped at the chance to travel to Boston and learn from her expertise in person.
From our initial meeting I was immediately drawn to Dr. Goldberg’s warmth and humor. She is a dedicated and engaging teacher, eager to pass her knowledge on to her trainees. I was invited to join every sign-out, consensus conference, and lecture series during my visit. During sign-out I was particularly thrilled when, even during examination of cases not necessarily related to alopecia, she would get excited to find stray hair follicles and point out details of normal anatomy - mirroring my own thought process when I examine slides.
Dr. Goldberg specifically took the time to teach me her unique approach to analyzing horizontal sections in the assessment of alopecia. Her methods are well-organized and rigorous; after explaining her process to me in detail, I was given several tries to analyze cases on my own with subsequent feedback. I greatly valued this practice and look forward to trying to apply her algorithm when I examine my own alopecia cases throughout the rest of residency and beyond.
At the end of our rotation, she invited me to submit one of her notable cases to the American Society of Dermatopathology website. While drafting the case together, I had another chance to benefit from her hands-on mentorship. Working with Dr. Goldberg solidified my dedication to pursue translational research related to hair growth, while continuing to see patients with alopecia in clinic. I am confident that my improved understanding of scalp dermatopathology will help me make accurate diagnoses and subsequently craft individualized treatment plans for each of my future patients.
I want to offer a sincere thanks to the AHRS mentorship program, along with Dr. Goldberg and her fellows who generously hosted me at Boston University, for an incredibly enriching and memorable learning experience!
Susie Suh, BA, Medical Student, Case Western Reserve University
Mentor: Natasha Mesinkovska, MD, PhD, UCI Dermatology
Mentorship Title: The Efficacy of PDO Threads for Hair Regrowth.
I would like to thank the American Hair Research Society mentorship program for granting me the opportunity to work with Dr. Natasha Mesinkovska and her team at the dermatology clinic at the University of California, Irvine. Coming from the basic science research background as an MD/PhD student, I have been particularly interested in understanding the underlying mechanisms of various hair disorders and developing effective treatments for these conditions. During the preclinical years of medical school, my exposure to dermatology has been limited and the chance to see patients with hair disorder was rare. Therefore, I was particularly excited to have a focused mentorship with Dr. Mesinkovska, who specialized in hair disorders, and expand my knowledge and learn more about current limitations and future directions in hair disorder research.
While shadowing Dr. Mesinkovska, I was able to meet many patients with diverse types of alopecia and learn about different clinical manifestation of each condition. I also learned about various treatment approaches and diagnostic tools for alopecia. Particularly, I focused on evaluating the efficacy of polydioxanone (PDO) monofilament thread inserts for hair follicle induction. PDO threads are widely used as sutures in surgeries, and more recently as face-lifting tools for their effectiveness in stimulating collagen production. A few reports recently showed that PDO threads insertion to the scalp can stimulate hair regrowth in androgenic alopecia.
To further investigate this recent finding, I worked with Dr. Mesinkovska and her team to evaluate the hair regrowth in non-scarring and scarring alopecia patients following PDO insertions. Through this study, we found that both scarring and non-scarring patients showed slight improvement in hair regrowth on average, but it was performed with a small sample size and would require a controlled trial. Nevertheless, through this experience, I was able to learn examining hair disorders and designing a clinical study.
Outside of the clinic, I attended the grand rounds, lectures and clinical research meetings led by Dr. Mesinkovska, who is also the Director of the Dermatology Clinical Research Center. I was able to observe how Dr. Mesinkovska combines her research skills and clinical perspectives to conduct a number of research studies.
Through this mentorship experience with Dr. Mesinkovska, I not only gained a broader perspective and knowledge about hair, but also learned her bedside manner. Dr. Mesinkovska is a great example of a compassionate and knowledgeable doctor. Dr. Mesinkovska patiently listens to her patient’s concerns and openly discusses about her thoughts on what would be the best strategy for the patient. Her genuine approach towards patients created the trust between the doctor and patient and shaped the way I will approach my future patients. I thank again to the AHRS mentorship program for giving me this great opportunity, which provided me valuable insights as I pursue a career in dermatology research.
Shashank Bhargava, MD, Dermatology Senior Resident, R.D. Gardi Medical College
Mentor: Antonella Tosti, MD, University of Miami, School of Medicine
Mentorship Title: Trichoscopy of Androgenetic Alopecia in Patients of Different Ethnicities.
There were lots of tips and tricks which I imbibed after being the mentee under the great mentor Prof Tosti. She is just superb and the best. I was amazed to see patients from far off places in the US and many international patients travelling long distances to take treatment from her. I could learn the basics of trichoscopy and recent advances in management of Androgenetic Alopecia (AGA). In India, we do not give oral Minoxidil for AGA and Low light Laser therapy for different alopecia, which were new to me. It was great to learn about the use of nerve block before Platelet rich Plasma therapy from Dr. Morrison. This mentorship will definitely help me a lot to learn and serve patients later in my life.
I am deeply grateful to the American Hair Research Society for selecting me for the mentorship program under Prof Antonella Tosti. I had always been eager to learn more about trichoscopy and management of different alopecia. During my residency in Dermatology in India, I observed that there was a huge gap in the treatment of hair disorders when compared with treatment options in developed countries. There are many lacunae which need to be filled to serve patients in a developing country like India. There is paucity of trained dermatologists using newer drugs for management of various alopecia like AGA, Alopecia Areata, and Lichen Plano Pilaris etc. With the encouragement from my faculty, I decided the learn trichoscopy abroad for at least short period of time.
Thanks to the generous scholarship provided by AHRS, I was able to able to visit the prestigious Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Florida, USA under the superb mentorship of Prof. Antonella Tosti. Despite her busy schedule Dr. Tosti was really prompt with replies and helped me to get the US visa in time. She has an extremely warm & friendly personality & is always ready to answer any queries and clear all my doubts. She is very passionate about her patients and gives enough time to them.
The entire dermatology department at University of Miami has a very friendly atmosphere to learn. I managed to meet the Head of the Department Prof Robert Kirsner and others great mentors like Prof Keyvan Nouri & Prof Romanelli during my mentorship period. The residents were super supportive and accommodative and I made a few friends for life. The other fellows working under Prof Tosti were also very helping and she has an amazing team to work and learn from. She even invited me along with other residents for the dinner at her place before the Christmas holidays; I was really touched by her sweet gesture.
It was life changing experience for me to learn about the practice in developed countries, which we lack in India. It will promote advancement and exchange of scientific and clinical dermatological information. The mentorship program shall bring out the best in me and which will help the entire department of my institute in the future. When the skills and knowledge I acquired and apply in my practice become a vehicle of change, I would have a sense of fulfillment and a life well lived. I am thankful to Dr. Tosti and the UM Department of Dermatology for their warm welcome and amazing hospitality. I am deeply grateful to the American Hair Research Society from granting me this opportunity to further explore my clinical interests.
Thomas W. Chu, MD, Dermatology Resident, Post-Graduate Year 3, Wayne State University School of Medicine
Mentor: Kevin McElwee, PhD, University of British Columbia, Dermatology & Skin Sciences
Mentorship title: Dermoscopy/Trichoscopy
I would like to thank the American Hair Research Society for the Mentorship Grant that gave me an opportunity to learn from Dr. Kevin McElwee, the assistant professor in the Department of Dermatology and Skin Sciences at the University of British Columbia in Canada. Dr. McElwee’s Hair Research Laboratory is dedicated to understanding the biology of the human hair follicle and the role it plays in the skin and a variety of immunologic disorders such as alopecia areata.
During this mentorship I learned how to dissect and isolate the dermal papilla from the hair follicle under 10X magnification. After carefully isolating the dermal papilla, I was introduced to the art and science of culturing the dermal papilla cells. Dr. McElwee is a pioneer in hair follicle research and has developed protocols and patents for growing dermal sheath cup cells (part of the dermal papilla). During this time, I also refined a protocol for activating platelet rich plasma for future studies. I gained valuable insights and learned techniques that are applicable to basic science hair research.
I enjoyed this learning experience because Dr. McElwee is an excellent and knowledgeable mentor. The AHRS Mentorship Grant has allowed me to gain some fundamental knowledge and skills for further basic science hair research. Dr. McElwee’s dedication is an inspiration and a role model for my career. I would like to thank AHRS again for this unique opportunity to experience hair research bench-side.
Christine Pham, BS, Medical Student, University of California, Irvine School of Medicine
Mentor: Antonella Tosti, MD, University of Miami, School of Medicine
Mentorship title: Trichoscopy and Scarring and Nonscarring Alopecia
I cannot thank the American Hair Research Society Mentorship Program enough for allowing me the opportunity to work with Dr. Antonella Tosti at the University of Miami. The goal of my mentorship was to learn about trichoscopy and its use in hair and nail disorders. I was able to be apart of Dr. Tosti and her team in clinic and learn her approach to hair and nail conditions and contact dermatitis management. I saw a variety of hair disorders from frontal fibrosing alopecia to alopecia areata to trichoteiromania. She introduced me to novel non-invasive imaging devices, which I was able to work with on patient hair and nail cases. Seeing how these trichoscopy devices were utilized in the clinical setting made me realize their value not only as diagnostic tools but also as great educational tools for patients and students. By the end of the mentorship program, I was more comfortable forming differential diagnoses with trichoscopy images and identifying treatment options. The learning opportunity also continued outside the clinic as I had the opportunity to work on an alopecia and diet research project with Dr. Tosti.
On the days where there was no clinic, I was able to work with the residents and research fellows, attend management conferences where we discussed unique dermatological patient cases, and attend grand rounds. I was also able to listen to some very interesting lectures at the International Miami-Pisa Dermatology Meeting, which was being held while I was there.
Working with Dr. Tosti and her team was a wonderful experience. She is an exceptional educator and wonderful mentor, being generous in sharing her experiences and always taking time to answer any questions I had. In addition, the way she is so patient, attentive, and alleviates the worries of her patients are inspiring and have helped shaped the way I will approach my future patients. This experience has further confirmed my interest in hair research and I look forward to continuing to learn more about hair disorders. Thank you Dr. Tosti and the American Hair Research Society for this invaluable experience!
Manuel Valdebran, MD, Scholar
Mentor: Dirk Elston, MD, Medical University of South Carolina
Histopathologic Assessment of Inflammatory Infiltrate in Pattern Hair Loss.
I would like to thank the American Hair Research Society for the opportunity to work with Dr. Elston to study the histological features seen in pattern hair loss. During the mentorship, I learned about features such as perifollicular inflammation and fibrosis which can be present in non-scarring hair loss processes such in patterned hair loss. I prepared for the project for months in advance, getting all methods ready and collecting all slides needed. During the following days of reviewing the slides and gathering data we have all information processed and submitted for pulblication.
I have learned a lot from Dr. Elston and his leadership style. I am very thankful for the opportunity the grant has helped to establish a longer-term relationship and has increased my interest in hair disorders, not only pathologically but also clinically. This study was a seminal as we have designed other studies evaluating inflammation and fibrosis in other conditions such as alopecia areata.
It is my hope to continue studying clinical and histological features of hair loss.
Crystal Aguh, MD, Junior Faculty, John Hopkins School of Medicine(left)
Mentor: Maria K. Hordinsky, MD, University of Minnesota
Mentorship title: Exploring Novel Treatment Options for Alopecia
I had an amazing experience working with Dr. Maria Hordinsky for my AHRS mentorship experience. Dr. Hordinsky allowed me to work with her in her clinic and attend research meetings that helped shed light on how to conduct successful research studies. I also had the opportunity to discuss my research ideas to Dr. Hordinsky who provided important advice to me. There are no words that can stress how valuable this experience was. I will continue following up on my progress with Dr. Hordinky over the course of the next year.
The goal of my mentorship experience was to spend time with Dr. Hordinsky and to learn how to develop meaingiful research projects that will further our understanding of disease processes. I was able to shadow her in her clinic to learn how she treats and recruits patients for research. Dr. Hordinsky also invited me to attend lectures given by visiting faculty and made sure to introduce me to her trainees and colleagues. Overall, I felt very welcomed and continue to keep in touch with some of the researchers I met while at University of Minnesota.
Since Dr. Hordinsky is a specialist in cicatricial alopecias, we often interact at scientific meetings that address the newest developments in hair research. She has been very supportive in helping to establish me as a leader in the field of CCCA research, and even recommended that I serve as lead author on the UpToDate section on CCCA, an opportunity that I certainly would not have had with out this experience.
Dr. Hordinsky is such an amazing mentor. I really feel that this experience is just the start of a lasting mentorship relationship we will have together.
Katherine Omueti Ayoade, MD, PhD, Assistant Professor, UT Southwestern Department of Dermatology(left)
Mentor: Angela Christiano, PhD, Columbia University College of Physicians & Surgeons
Mentorship title: Scalp Microbiome in patients with Central Centrifugal Cicatricial Alopecia
Gratitude. I would like to begin my summary by expressing my extreme gratitude to Dr. Angela Christiano, all the members of her research laboratory, most especially, Brigitte Sallee MD, her Translational Research Fellow, and the Department of Dermatology at Columbia University particularly, clinical faculty, Dr. Lindsey Bordone, for hosting me for an extraordinary week of learning. I visited with Dr. Angela Christiano’s group the week of July 23rd, 2018 under the support received by the American Hair Research Society Mentorship grant. As a physician-scientist trained board-certified dermatologist, I was interested in learning how to develop my interest in hair loss disorders, specifically scarring alopecias, from a mere curiosity to hopefully what will long term become investigating mechanisms into the pathophysiology of one or several of the disorders that fall into this category of alopecias. I hope that this will further lead to the development of better treatments for this class of disorders. Dr. Christiano's personal interests and career, exemplifies this in many ways, most especially for her contribution to the field of Alopecia Areata.
While a most recent article in the New England Journal of Medicine (NEJM) reported a gene of interest, the PADI3 gene, as a risk factor towards the later development of the primary cicatricial alopecia (PCA) called Central Centrifugal Cicatricial Alopecia (CCCA), its pathophysiology is still unknown. One idea that had occurred to me, stemming from my graduate training in Toll-like receptor biology and how microbes induce inflammation in general, was investigating the microbiome niche of persons with CCCA. Dr. Christiano and members of her lab are investigating the microbiome niche in persons with Alopecia Areata, hence learning the intricacies of how such research was carried out, from the best, was crucial.
I also had the great opportunity to shadow one of Dr. Christiano’s clinical collaborators during my visit, Columbia University Hair expert, Dr. Lindsey Bordone. Shadowing Dr. Bordone reinforced a lot of clinical pearls from my residency training. However, I learned many new pearls including clinical practice management relating to clinical flow, efficiency, particularly for the hair loss patient, all of which I have incorporated into my clinical practice. Shadowing Dr. Bordone in her clinic was also part of the experience to better understand how patients are recruited, enrolled and subsequently followed in clinical studies, something that I had limited experience with given my training in basic science research ‘til date.
Overall, the mentorship afforded to me by the American Hair Research Society was extremely valuable. My sincere thanks again to Dr. Angela Christiano, her group and collaborators. I want to end my summary by extending this gratitude to the American Hair Research Society for the opportunity, as this experience supported my growth as a dermatologist and pursuits in starting translational hair research projects.
Felicia Ekpo, DO, PGY-4 Dermatology Resident, St. Joseph Mercy Dermatology
Mentor: Wilma Bergfeld, MD, FAAD, Cleveland Clinic Foundation
Mentorship title: Retrospective cohort study to assess the prevalence of different factors of metabolic syndrome in CCCA/LPP patients
The AHRS mentorship experience allowed me to foster a lifelong mentor-mentee relationship with Dr. Bergfeld. This has helped me enhance my future leadership skills and promote advancements in hair research. During my mentorship experience I gained IRB approval for a Cleveland Clinic study on CCCA/LPP in African American women. I worked on a database to evaluate the role of socioeconomic factors, personal and past medical history, and various lab abnormalities in the development of CCCA/LPP, which aided in discovering associated risk factors and outcomes. I also assessed several databases for scalp biopsy reports from patients seen at the Cleveland Clinic Foundation (CCF) Department of Dermatology who had a clinical and histopathological diagnosis of CCCA/LPP.
It was such a wonderful opportunity working with Dr. Bergfeld. She is an intelligent woman of prestige, yet full of humility. I witnessed her genuine care for her patients and her willingness to help me succeed in dermatology and advancing hair research. The Cleveland Clinic’s mentorship with Dr. Bergfeld, Dr. Piliang, and her colleagues helped expose me to a large volume of patients with hair disorders, their evaluation, therapies and therapeutic outcomes. In addition, Dr. Bergfeld’s involvement as an advisor, consultant, and primary investigator for many new pharmaceutical and biologic trials for alopecia areata and androgenetic alopecia helped me expand my learning. The management of these trials served as an educational experience for me. My experience from this mentorship gave me the skills to promote advancements in hair research.
My mentorship experience enhanced my research skills by learning how to formulate a project, write an IRB proposal, and implement a research project. Collaborating with various specialties including dermatopathology, the CCF research department, CCF residents, statisticians, and other CCF staff taught me the fundamentals of proper communication, organization, and teamwork required for successful implementation of my research project. I personally witnessed how Dr. Bergfeld helps her mentees complete their projects from implementation to publication, which allowed me to learn the tools needed to enhance my future leadership skills in hair research. Dr. Bergfeld’s national and international recognition in hair research, dermatology, and dermatopathology exposed me to several networking opportunities that helped me excel in my future career in hair research and serve as a mentor to others.
The AHRS mentorship grant helped me get closer to my future goals of training medical students and residents in dermatology, with an emphasis on hair disorders and research. My experience increased my involvement in the Skin of Color Society in order to further understand the higher prevalence of Central Centrifugal Cicatricial Alopecia (CCCA) and the need for further research and treatment in this area. I am even more inspired to dedicate my efforts to cicatricial alopecia research in hopes of providing new discoveries and treatment options for patients afflicted with CCCA and various hair disorders. Dr. Bergfeld exposed me to the Cicatricial Alopecia Research Foundation (CARF) and how it has designated CCCA and lichen planopilaris (LPP) as a primary importance. After working with Dr. Bergfeld, I am even more motivated to achieve my future endeavors of becoming an exceptional dermatologist, educator, and future leader in the AHRS through patient advocacy, service, mentorship, and research.
Lauren Lam, BScH, MD, Dermatology Resident, Post-Graduate Year 3, University of Alberta(left)
Mentor: Carolyn Goh, MD, University of California Los Angeles, Dermatology
Mentorship title: Therapeutics for Hair Loss Disorders
I want to sincerely thank you for enabling me to have a Mentorship opportunity with Dr. Carolyn Goh at the University of California Los Angeles. As a Canadian dermatology resident, there are limited opportunities for Mentorship for hair disorders in Canada, so I was thrilled to learn one-on-one from such a distinguished a hair specialist as Dr. Goh.
Currently, there are no academic hair specialists practising in Western Canada. Hair disorders is an interest of mine that I wanted to explore and gain more exposure to through this mentorship experience. Ultimately, I hoped to sharpen my clinical acumen and strengthen my comfort with therapies beyond the first few lines of treatment. I am especially appreciative that, to my delight, my experience was much greater than simply academics.
While working with Dr. Goh, she took the time outside of clinic to personally get to know me and my career goals. We had the opportunity to participate in the Autoimmune Walk in Culver City and engage with the local community.
I also had the opportunity to attend UCLA Resident Hair Clinics and Dermatology Grand Rounds, where I had the chance to meet other dermatology residents and experience great learning and discussion of cases in a dedicated academic hair disorders clinic. In addition, I had the opportunity to see the work of JAK inhibitors in many alopecia areata patients - something I had read a great deal about, but had not had the opportunity to see in person yet, as this is not a widely accessible treatment in Canada. This was something I had hoped I would encounter during my time in the United States and was very excited to witness.
Seeing numerous diagnostically challenging & very progressed cases with Dr. Goh was invaluable. Her familiarity with third and fourth line treatments for a small pool of ethnically diverse patients and asessing the efficacy of these therapies was expertise which I could not have experienced through smaller dermatology residency programs. Currently, we are in the process of preparing a case report of an intriguing patient of hers.
What stood out most to me during my time with Dr. Goh is her appreciation for the personal impact hair disorders have on a patient. The positive inspiration and support she provided to her patients was clearly very much appreciated, and even for end-stage cicatricial alopecia patients, it was evident she was making a difference for them despite their disease course. This is something I know I will carry forward as a practising dermatologist.
So, thank you AHRS for enabling me to have this mentorship experience. I feel grateful to have a truly invested mentor through this mentorship experience. I look forward to continuing my knowledge in hair disorders through my residency and future practise!
Michelle Oboite, MD, Dermatology Resident
Mentor: Amy McMichael, MD, Wake Forest Baptist Medical Center
Mentorship title: Hair and Scalp Disease, Medical and Procedural treatments
I spent a month working with Dr. McMichael and her team in clinics at the Wake Forest University Department of Dermatology learning about the medical management of scarring and non-scarring alopecias. It was one of the most impactful mentorship opportunities I have had in my medical career. Dr. McMichael not only taught me how to care for patients with challenging cases of alopecia, but she curated a memorable, exciting experience in a collegial, respectful environment. She introduced me to a model of developing research questions in the midst of a busy clinical practice that I hope to implement in my career (hopefully, as well as she does!) She also connected me to other outstanding physicians in the hair field.
I was able to spend time with a hair transplant surgeon in Charlotte, North Carolina learning more about protocols for platelet rich plasma and hair restoration in scarring and non-scarring alopecias. Currently, I am working with Dr. McMichael and her team to identify clinical, dermatoscopic, and/or histopathological features of central centrifugal cicatricial alopecia that could guide and optimize treatment selection for patients. I am thankful to Dr. McMichael for her continued mentorship and leadership: she motivates me and everyone around her to be better for our patients and for one another. I still don't know how she finds time to do everything she does! I am extremely grateful to the American Hair Research Society for their support with the mentorship award: I truly believe it has changed the trajectory of my career for the better.
Koen van de Wetering, PhD, DVM, Thomas Jefferson University
Mentor: John Sundberg, DVM, PhD, Dipl. ACVP, The Jackson Laboratory
Mentorship title: Quantification of ectopic mineralization surrounding the hair follicle.
I want to thank the AHRS for the unique opportunity they offered to me, to learn and work with Dr. Sundberg.
Our research group studies diseases associated with ectopic calcification, i.e. the precipitation of calcium and phosphate in soft, connective tissues. One of the diseases we study is pseudoxanthoma elasticum (PXE) a slowly progressive calcification disorder affecting skin, eyes and vasculature. In our studies, we use rodent models recapitulating human disease. A peculiar feature of these disease models is the calcification of the capsule surrounding the vibrissae, a specific hair structure involved in tactile sensing. Interestingly, most mammals have vibrissae, including all primates except humans. Although absent in humans, calcification of the tissue surrounding the vibrissae is an excellent biomarker to follow for disease progression in rodent animal models of ectopic calcification. It is therefore crucial to analyze these structures in a standardized manner in order to get reliable scientific data.
Marina Barletta, MD, Clinical Research
Mentor: Antonella Tosti, MD, University of Miami, Miller School of Medicine
Mentorship title: Hair and Nail Disorders and Contact Dermatitis
I would like to thank the AHRS for this unique opportunity, to learn and work with Dr. Tosti.
In April 2017 I spent five weeks at the University of Miami with her. Since I did my residency in dermatology, when I began to be interested in hair diseases, I wanted to take this fellowship with Dr. Antonella. It was a great pleasure when I received the news from AHRS that I won the grant for a mentorship program with her. She is an amazing researcher and so generous in sharing her knowledge with everyone who works with her. She is a worldwide-recognized scientist for her many scientific articles, and she is also a wonderful human being.
I was able to observe Dr. Tosti and the residents seeing patients with hair and nail disorders and contact dermatitis. I have discussed many cases ranging from the simplest to the most complex and interesting. I learned new approaches in the treatment of hair and scalp diseases. And I had the opportunity to learn more about tricoscopy. She inspired me to develop research protocols in Brazil to treat diseases of hair and to continue studying more and more for the benefit of my patient.
This mentorship was very important for my personal growth and for my professional career. And I recommend to all students and dermatologists who are interested in hair research to participate in this AHRS mentorship program.
Elena Bernardis, PhD, Research Associate
Mentor: Leslie Castelo-Soccio MD, PhD, Children's Hospital of Philadelphia and University of Pennsylvania
Mentorship title: Time-lapse Biology of Alopecia Areata
Working with Dr. Leslie Castelo-Soccio has been an ongoing positive learning experience. Thanks to the mentorship award, I continued learning about the visual appearance of alopecia areata and how to quantify hair loss to help the clinician assess disease progress over time efficiently. Having one of the best experts on hair disorders as my mentor helped me gain invaluable insights not only about the skin condition itself but also on how to tailor computational imaging tools for everyday use in the hair clinic.
Leslie Castelo-Soccio, MD, PhD, Dermatology Resident
Mentor: Nanette Silverberg MD, Mount Sinai Medical School
Mentorship title: Pediatric Alopecia Areata and Immunotherapy
Among contact allergens that are frequently used in the treatment of alopecia areata (AA), squaric acid dibutylester (SADBE) stands out for its good tolerability and its mild side effects. Additionally DPCP another contact sensitizer has been safely used in children but one that was not used at Children’s Hospital of Philadelphia. Over a course of 6 months I was able to learn this technique from one of the United States Experts in therapy for children, Dr. Nanette Silverberg. Protocols were shared and discussions about common adverse events occurred. Other forms of contact sensitization were also learned and have been applied in the clinic setting at Children’s Hospital of Philadelphia. Additionally this mentorship has led to a partnership to create a prospective registry for alopecia areata in children and to create protocols for standardizing clinic care.
Aldo Galvez, MD, Dermatology Resident
Mentor: Leonard Sperling, MD, Uniformed Services University of the Health Sciences
Mentorship title: Comparing and Contrasting Histologic Findings in Lichen Planopilaris Versus Frontal Fibrosing Alopecia
To begin with, I would like to thank AHRS and Dr. Sperling for giving me the opportunity of making this mentorship possible. I have been waiting for this rotation since the initial stages of my residency program, when I realized about my interest in hair diseases. In Peru, my native country, there are no dermatologists specialized in hair diseases and this encouraged me to apply for this external rotation.The mentorship was scheduled for two weeks in the Uniformed Services University of the Health Sciences, located in Bethesda - Maryland. In the first week Dr. Sperling gave me many different boxes with slides that were constantly increasing in difficulty, which I had to see by myself and then we reviewed them together. We moved from the basic to the advanced alopecia box and then to the boxes for each specific entity, which allowed me to see the spectrum of the histopathological findings in these diseases. Thanks to Dr. Sperling, this process was made simple and the learning experience was delightful. I was also able to join Dr. Sperling in the hair clinics and dermatopathology sessions at Walter Reed Hospital. After gaining significant experience in hair pathology, we dedicated the second week to our project, in which we compared and contrasted the histopathological findings in LPP and FFA.Besides being my mentor in hair diseases and pathology, Dr. Sperling also dedicated some of his time counseling me about my professional and personal life. He showed me the importance of achieving a balance between life and work.Finally, I sincerely appreciated the support given to me by AHRS and Dr. Sperling. Thanks to them, I had a wonderful experience and achieved the objectives I expected.
Kaveri Korgavkar, MD, Dermatology Resident
Mentor: Amy McMichael, MD, Wake Forest Baptist Medical Center
Mentorship title: Hair Disorders Research
My mentorship experience with Dr. McMichael was one of the most insightful experiences of my residency training. Through a scholarship made possible by the AHRS, I spent a week shadowing Dr. McMichael in her clinics at Wake Forest Baptist Medical Center. I was able to explore my interest in addressing hair loss disorders during this experience. I learned important management and treatment strategies for various nonscarring and scarring forms of alopecia, and also learned to navigate the nuances of personal, cultural, and psychosocial aspects of hair loss. The lessons I learned during this experience have been very useful to me as I pursue my interest in hair loss disorders treating patients in my clinic in the New York City area. I find myself drawing upon many of the tips and tricks I learned from Dr. McMichael.
Specifically, I learned how to safely yet effectively prescribe medications such as oral minoxidil, finasteride, and spironolactone for androgenetic alopecia. I learned strategies to manage alopecia areata, traction alopecia, Central Centrifugal Cicatricial Alopecia (CCCA), and other types of hair loss. A vital aspect of effectively managing patients with hair loss is being able to compassionately and effectively provide counseling, which Dr. McMichael exemplifies well.
Importantly, this experience was not only a way to connect with someone advanced and accomplished in the field I am pursuing, but a way to develop a lifelong mentor. I feel comfortable going to Dr. McMichael with any question pertaining to hair loss disorders, research, dermatology in general, and even my personal life. She is an incredible example of a role model in dermatology and in life- chairwoman of Wake Forest Dermatology, an expert in both research and clinical work, active on a policy level, loved by her patients, and also very personable, approachable, and fun-loving. My experience with Dr. McMichael gave me renewed enthusiasm to follow in her steps in the future myself. I am thankful for this experience on both a professional and personal level.
Sarah Linn, BS, Dermatology Resident
Mentor: John Sundberg DVM, PhD, DACVP, The Jackson Laboratory
Mentorship title: Mouse Modeling of Skin and Hair Disease
From September 18th to October 13th, 2017, I was able to work for Dr. John Sundberg in his lab working on dermatopathology research at The Jackson Laboratory in Bar Harbor, Maine. Dr. Sundberg is well known in the field and knowledgeable about the various laboratory mouse strains. My project was a retrospective analysis of mouse nail slides within a previously published large scale aging study from 2007. This study looked at diseases of 30 aging mice strains from The Jackson Laboratory at 12 and 20 months and also during a longitudinal study. Dr. Sundberg noticed that the NON/ShiLtJ mice had a high prevalence of dystrophic nail lesions along with some other strains but at lower rate. He hoped to characterize the lesion further and kept the slides until Allison Mustonen and I came for our externships. Analysis of the slides showed nail dystrophy, subungual inflammation, remodeling of the distal phalanx, hyperplasia of the nail matrix and nail bed, and occasionally protrusion of the distal phalanx through the hyponychium. The lesions were also seen in the C57BR/cdJ, C57BL/6J, FVB/NJ, KK/H1J, MRL/MpJ, NZO/H1LtJ, NZW/LacJ, SM/J, and SWR/J strains. We gathered samples from younger NON/ShiLtJ breeders to see if the lesion was present at earlier ages which there were some mice that were affected. Complete analysis of the slides allowed us to propose a specific pathogenesis for this lesion which was described in our article published in the Journal of Experimental Dermatology in July 2018.
During the slide analysis, Allison and I discovered that about 40% of slides were not diagnostic for us to evaluate the nails. Mouse nails are hard to section because of their small size, varying tissues within the nail unit, and difficulty orienting the feet within paraffin. Our other project was to develop a better means of sectioning mouse nails in order to evaluate strains for phenotyping. We worked with the histology technicians at The Jackson Laboratory to see what fixatives and decalcification protocols would work best for sectioning. Starting with C57BL/6J females of the same age, we developed a protocol that worked well for sectioning the tissues, orienting the nails in wax, and immunohistochemical staining of the slides. We hope to publish our results after repeating the methods for various strains and males versus females.
Aside from these projects, I attended the 16th Annual Workshop on the Pathology of Mouse Models of Human Disease. I was able to network with leaders in the field of mouse pathology and make valuable connections for my career. Allison and I also presented our work at the conference which was well received by the attendees.
Overall, I had a valuable career experience with Dr. Sundberg. He was a great mentor throughout the externship and taught me what a veterinary pathologist can achieve at an institution like The Jackson Laboratory. I truly appreciate AHRS’s financial assistance for my externship and am thankful for the training I received.
Daiane Matana, MD, Dermatology Resident (left)
Paula Jacomini Sobral, MD, Dermatology Resident (right)
Mentor: Antonella Tosti, MD, University of Miami, Miller School of Medicine
Mentorship title: Dermoscopy of Hair Disorders
Thanks to the (North) American Hair Research Society, the Mentorship Program did support and offer us a great opportunity to learn with Dr. Antonella Tosti.
We had the pleasure to stay with Dr. Tosti and the residents during her daily activities at the outpatient center, see all kinds of hair and nails diseases, learn more about tricoscopy, have information about the best and new treatments available and evidence-based, attend some Grand Rounds and lectures. Above all, Dr. Tosti inspired us with her manner with patients. She educated all of her patients on their disease processes and explained the reasons behind her treatment suggestions. With her sincerity she was able to put her patients to ease and win their trust.
We spent the last 2 months (Aug. - Sept.) with Dr. Tosti and her wonderful staff at the University of Miami and we are sure that was the best academic experience, that was very important for our personal and professional career.
We thank (N)AHRS for this unique opportunity and we’ll use all this knowledge for the benefit of our patients.
Sophia Rangwala, MD, Dermatopathology Fellow
Mentor: Leonard Sperling, MD, Uniformed Services University of the Health Sciences
Mentorship title: Comparing and Contrasting Histologic Findings in Lichen Planopilaris Versus Frontal Fibrosing Alopecia Histological Diagnosis and Clinical Management of Complex Hair Disorders
In June 2017, I had the honor of completing a mentorship with Dr. Leonard Sperling at the Walter Reed Medical Center in Bethesda, MD. Although brief, the mentorship gave me a fantastic overview of Dr. Sperling's clinical and pathologic practice. During my 2016-2017 dermatopathology fellowship at Johns Hopkins University, I developed an interest in hair pathology and had become very familiar with Dr. Sperling's contribution to the field via the study of his textbook, his many research papers, and his lectures given at the ASDP annual and board review meetings. While I have been fortunate to have received excellent training in hair pathology during my fellowship, my time with Dr. Sperling significantly advanced this skill as I had the chance to learn and practice his methodology, study his extensive alopecia slide sets, and ask questions I have had regarding alopecia which were not yet answered in my training up to that point. In his resident clinic, I learned about his approach towards scarring and non-scarring alopecias, and came away with very useful tips and recommendations for management.I want to thank the American Hair Research Society for providing me the opportunity to meet and learn from the amazing Dr. Sperling. The subject of alopecia can often be challenging, but Dr. Sperling has a gift in providing clarity to even the most difficult cases. This experience has boosted my confidence in diagnosing and managing the pathologic and clinical aspects of alopecia, and encourages me to pursue care of these patients once I begin practice as a dermatologist and dermatopathologist in Golden, CO.
Christina Tejeda, Medical Student, Columbia College of Physicians and Surgeons
Mentor: Antonella Tosti, MD, Leonard M. Miller School of Medicine
Mentorship title: Alopecia Areata
I spent two weeks with Dr. Tosti at the University of Miami learning about the diagnosis and management of various alopecia disorders. I worked with her in the outpatient center and was able to see a very diverse patient population. I not only developed a better understand the hair follicle and the hair cycle, but also learned about the importance of dermoscopy. Through this experience I learned how to properly use dermoscopy to diagnose hair diseases. I was also exposed to the intricacies of hair, specifically alopecia areata. Alopecia areata is an important area of hair disease as it affects about 6.8 million people in the United States and is detrimental to the individual in a psychosocial and physical way.
The mentorship I received from Dr. Tosti was amazing and truly educational. The two weeks went by so fast and it was the most inspiring experiences of my medical school training. I used all the information I learned in my future Dermatology rotations and in my research. I am grateful to AHRS for providing this grant and connecting me with an amazing mentor. This program builds strong mentorship between students and leaders in hair.
Tiffany Alexander, BA, Medical Student
Mentor: Amy McMichael, MD, Wake Forest Baptist Medical Center
Mentorship title: Central Centrifugal Cicatricial Alopecia
The North American Hair Research Society Mentorship Grant program has been an invaluable experience. Through my mentor Dr. Amy McMichael, I gained extensive clinical and basic science knowledge about Central Centrifugal Cicatricial Alopecia (CCCA) and Frontal Fibrosing Alopecia (FFA). Not much is known about the pathogenesis of CCCA on the molecular level. Thus, my goal was to investigate the pathogenesis of CCCA and its relation to other scarring diseases such as FFA, scleroderma and chronic kidney disease. The analysis of scarring diseases that lead to fibrosis may help clarify the scarring mechanism of CCCA. We theorized that by examining the mechanisms for other scarring disorders that are common in African American patients can help to guide us about the mechanism of CCCA.
We reviewed the pathology literature on CCCA, FFA, scleroderma, and FKD and the mechanism of action for numerous treatments for each disease. We then analyzed the collected information to determine additional mechanisms of action to propose novel targets for medication. It was found that TGF-ß is involved in each disease pathogenesis and it induces epithelial to mesenchymal transformation. However, there are two effectors in FFA that contribute to fibrosis and thus, may also be present in CCCA. Snail1 is a marker of epithelial to mesenchymal transition and is found in increased amounts in FFA. Peroxisome proliferator-activated receptor gamma (PPAR-γ) is a counter regulatory mechanism for TGF-β signaling. There is a reduced amount in pilosebaceous units. Targeted therapy for FFA includes anti-inflammatory agents, hydroxychloroquine, pioglitazone and topical calcineurin inhibitors. More studies should be done to evaluate these effectors and whether or not they largely contribute to the pathogenesis of CCCA.
My research on CCCA and FFA has been an exciting challenge since there are many unanswered questions about them both. This mentorship program provided me with the chance to interact with CCCA patients and gave me the ability to readily identify them. I have thoroughly enjoyed this opportunity and I am grateful that the AHRS Mentorship Grant program has equipped me with more dermatologic knowledge and experience.
Ariana Eginli, BS, Medical Student
Mentor: Amy McMichael, MD, Wake Forest Baptist Medical Center
Mentorship title: Side Effect Profile of 5 Alpha Reductase Inhibitors in Women with Female Pattern Hair Loss and Frontal Fibrosing Alopecia
I sincerely thank AHRS for sponsoring my research. It is through their generosity and continued interest in bolstering hair research that my project was able to come into fruition.
After my third year of medical school, I pursued a research year in Dermatology. I had the honor of having Dr. Amy McMichael as my mentor. Her vast variety of publications in hair research, ranging from genetics to quality of life issues, reflect her ingenuity, innovativeness, and leadership within this niche of dermatology. My experience working with her proved no different. I was responsible for organizing and collecting data on a variety of projects, including the project that the AHRS mentorship grant funded: understanding sexual side effects from using 5 alpha reductase inhibitors in women with androgenic alopecia or frontal fibrosing alopecia. In addition to my research responsibilities, I had the pleasure of working alongside Dr. McMichael in her hair clinic, where I gained hands-on clinical knowledge on how to counsel and treat patients with alopecia.
Ultimately, this mentorship helped me gain exposure to a field within dermatology that I previously had very little exposure to. The knowledge I have gained has significally helped me during my clinical rotations as a 4th year medical student. Additionally, I now realize my interest in working in hair loss in the future, and I am so thankful that I had the opportunity to work with an expert early on in my career.
I am certain that my experience learning how to structure and start research projects will serve me well in the future and will motivate me to continue to do research in hair loss disorders. My goal is to ultimately emulate Dr. McMichael's career by working in academics and performing clinical research in hair loss and skin of color. Thank you to AHRS and Dr. McMichael for guiding me through this unforgettable learning experience.
Ana Lucia Ariano Junqueria, MD
Mentor: Maria Hordinsky, MD, University of Minnesota
Mentorship title: The Treatment of Frontal Fibrosing Alopecia with Platelet Rich Plasma
Dear North American Hair Research Society Mentorship Committee:
I would like to express my sincere gratitude to AHRS for granting me this opportunity of working with Dr. Maria Hordinsky and Dr. Ronda Farah, at the University of Minnesota, in Minneapolis. During the month I spent there I was exposed to several dermatologic conditions affecting the hair and scalp, including visits in the outpatient clinic, cases presentation and discussions, lectures and meetings. My research task was primarily to write the protocol for a pilot study about treatment of frontal fibrosing alopecia with platelet rich plasma. While reviewing the literature for this project I was able to better understand the clinical aspects, the increase in prevalence of this hair condition in the past few years and the need for more research into effective treatments. I would like to specially thank Dr. Farah for her assistance with the development of the protocol, for always answering my questions and for her advices to succeed in my career. She is an extremely talented clinician and researcher, and also a wonderful person.
Through this preceptorship, I also participated in Grand Rounds and worked with patients recruitment for clinical studies. During the outpatients clinic visits with Dr. Hordinsky, I was able to see and learn different clinical characteristics of several hair diseases, as well as the appropriate management. Dr.Hordinsky is not only smart and perspicacious in clinic, but also pleasant, empathetic and loveable with each of her patients. She took time to teach me and answered all of my questions about specific conditions and research development. It was a honor to work with her and she is definily an example for me to follow.
I would like to thank all of the University of Minnesota faculty and staff that helped and supported me during my stay. Thanks again to AHRS for providing me this unique and amazing learning experience!
Heather Rosengard, MPH
Mentor: George Cotsarelis, MD, Department of Dermatology, University of Pennsylvania
Mentorship title: Analysis of the Regenerative Capacity of Cultured Keratinocytes
I would like to express my sincere gratitude for affording me the opportunity to work with Dr. George Cotsarelis at the University of Pennsylvania. My interest in hair physiology was established prior to working with Dr. Cotsarelis, when I interacted with patients suffering from hair loss. However, since working in Dr. Cotsarelis’ laboratory, I have gained a deeper appreciation for the complex nature of hair research and the unique intricacies of the hair follicle niche.
Since beginning my mentorship I have spent the majority of my time bench-side, gaining proficiency in a wide variety of techniques currently utilized to investigate hair biology and cellular mechanisms. These include epidermal and dermal cell isolation, cell culture, hair follicle micro-dissection, hair follicle organ culture, histologic evaluation, immunofluorescence staining and confocal microscopy, and FACS analysis. Knowledge of, and experience with, these critical investigative tools will not only be useful in my future research endeavors, but also will enable me to better understand and interpret the research of my peers.
Of course, these skills were not learned in a vacuum, but rather in the context of planning and performing experiments under the analytical guidance of Dr. Cotsarelis and the meticulous scientists in his lab. Throughout this time, we learned a great deal about the hair follicle stem and progenitor cells and how they are influenced by various treatment modalities.
Still, learning more about the cellular dynamics in the hair follicle paled in comparison to what I learned from Dr. Cotsarelis’ scientific mentorship. In weekly lab meetings Dr. Cotsarelis would help me and the other members of the lab interpret our data, always considering alternative conclusions or explanations for our findings. In planning future experiments, he would help us precisely define our core question and design protocols with strong controls and consistent reproducibility. Further, he pushed me and my colleagues to present our data succinctly and effectively, consistently emphasizing the power of communication.
I also was able to witness Dr. Cotsarelis’ beside manner and clinical aptitude when accompanying him to his weekly clinic and the weekly Duhring Dermatology Grand Rounds at Upenn. It was wonderful watching him utilize his analytical mind to thoroughly evaluate a patient and translate his own nuanced understanding of hair follicle biology into clear answers to patients’ questions. Having personally become interested in hair research through my patients, it was exciting to see that Dr. Cotsarelis was still inspired by his patients.
In all, his mentorship has prepared me for a career as a physician-scientist committed to hair research and I thank the AHRS for supporting this invaluable experience.
Alexandria Marier Schauer, DVM, BA, Veterinary Medicine Student
Mentor: John P. Sundberg, DVM, PhD, DACVP, The Jackson Laboratory
Mentorship title: Characterizing Spontaneous Mutant or Created Models of Human Hair Diseases
My training at The Jackson Laboratory with Dr. John P. Sundberg would have been financially impossible without the support of the North American Hair Research Society Mentorship grant. The cost of veterinary school is debilitating as is, and having the financial support to spend two months at a world renowned institution to study hair and skin diseases has been extremely rewarding. It has been an indispensable experience to my future career as a veterinary researcher, combining lab animal pathology training with specialized methods to study hair biology. I was involved on several projects that sought to characterize hair and skin mutants, but my main project focused on characterizing a knockin mouse model created by the Sundberg lab for psoriasis and psoriatic arthritis. I learned basic laboratory techniques, including Western analyses, in situ hybridization, and immunohistochemistry that are invaluable skills that I can take with me as a part of my “tool kit” as a veterinary research candidate.
Another large part of my training was learning to identify the fundamentals of hair biology, training that I have not received as a part of the veterinary medical curriculum. I am now confident in my ability to understand the hair cycle, identify the components of the hair follicle, and have a basic understanding of a wide array of hair diseases. I also appreciate the impact and burden that hair and skin disorders have on patients including the need for scientific focus. I also spent a considerable amount of time learning the fundamentals of necropsy and slide review that has given me an advantage with the next step of my career as a resident of anatomic pathology.
I have accepted a position as an anatomic pathology resident at the Institute of Animal Pathology at the University of Bern in Switzerland, to begin in 2017 upon my graduation from veterinary school at the University of Minnesota. Their institute has a renowned dermatopathology program, which was a large part of my decision to accept their offer. Hair and skin disease research is an underserved field, and is in need of highly qualified researchers, particularly those that specialize in veterinary dermatopathology. My experience at The Jackson Laboratory that was made possible by the North American Hair Research Society Mentorship Program has given me the confidence and an invaluable skill set that will set me apart from other veterinary research candidates when I pursue a Ph.D. after completion of my anatomic pathologyresidency. The mentorship program that your society provides is greatly appreciated, and I strongly urge you to continue the program into the future. My interest in skin and hair diseases has been strengthened, and I now feel I have a focus and intent as I go through the next steps of my training. I look forward to joining the ranks of other hair and skin scientists.
Alexandria M. Schauer
Vidhi Shah, BA, Medical Student
Mentor: Amy McMichael, MD, Wake Forest Baptist Medical Center
Mentorship title: Hair Loss and Scalp Disorder with Special Consideration in Ethnic Skin
Having spent two weeks working with Dr. Amy McMichael, I now know and appreciate the value of strong clinical training and mentorship. With Dr. McMichael, I was exposed to a spectrum of hair and scalp disorders during her hair care and general dermatology clinics. I witnessed the diagnosis, treatment, and management of hair disorders including, but not limited to, central centrifugal cicatricial alopecia, lichen planopilaris, androgenetic alopecia, alopecia areata, and alopecia universalis. Dr. McMichael provided compassionate and focused treatment for these patients afflicted with hair loss. The exceptional level of care she provides is the kind I aspire to provide to my own patients as a future academic dermatologist.
My research with her focused upon writing a review article focusing upon the hair care practices in young African American women and its consequences on physical exercise. I developed a newfound awareness for not only for the nature of hair care burdens encountered by African Americans, but also its psychosocial issues and influence on an individual’s overall health. In addition to research, I was also offered the exciting opportunity to give a short presentation on Janus-kinas (JAK) inhibitors for the treatment of alopecia areata to the Department of Dermatology at Wake Forest School of Medicine. I was impressed with the sense of warmth and community I experienced from the residents and other faculty members, many of whom went out of their way to speak to me and make me feel at home.
Dr. McMichael is an outstanding role model. I cannot express how much I have learned, grown, and enjoyed working with her. In addition to her clinical and academic responsibilities as Chairman of Dermatology, she took the time to get to know me on a personal level and provide me with constructive feedback regarding my application to dermatology. After working with her, I am inspired to build my own future in dermatology and contribute to the advancement in academic medicine.
I am forever grateful to the North American Hair Research Society for providing me the resources for this wonderful opportunity, without which this experience would not have been possible. I sincerely appreciated the entire Wake Forest Dermatology Department and Dr. McMichael for their teaching, guidance, and support.
Julio C. Jasso-Olivares, MD
Mentor: Antonella Tosti, MD, University of Miami
Mentorship title: Hair and scalp activity, trichoscopy and pathological correlation in patients with dermatomyositis
For the month of June I had experience working with Dr. Sundberg at The Jackson Laboratory, Bar Harbor, Maine. Thanks to the North American Hair Research Society, the Mentorship Program did support and offer me a great opportunity to participate in the research that Dr. Sundberg is working on. This gave me access to his broad knowledge of genetics and pathology in mice. The world reknown facility, The Jackson Laboratory, regularly provides seminars on site. With Dr. Sundberg’s encouragement and support, I also attended several lectures which helped to broaden my research vision. This program will not only facilitate my ongoing research projects but also improve my research techniques in the future.
In April 2015 I had the opportunity to be at the University of Miami with Dr. Tosti (and her wonderful staff) that made me one my best academic experiences. In addition to examining the results of my protocol about scalp activity in patients with dermatomyositis, I had the privilege to stay with Dr. Tosti during her daily activities at the outpatient center, and see all kinds of hair diseases with pathologic correlation including the explanation from a world-wide expert like her.
Besides aim to finish my study, I also learned the way of dealing with clinical cases (even the most difficult cases), I had information about treatments (most of them evidence-based), their follow-up, attending some lectures, management grand conferences and finally recognize the health system in a country with lots of technological advances like the United States.
In conclusion, I would to thank the AHRS for this unique opportunity because in my country we have not this kind of training that I received a lot of academic satisfaction in the form of knowledge that I will use for the benefit of my patients and intend to continue participating in hair diseases research.
Mentor: Amy McMichael, MD, Wake Forest School of Medicine
Mentorship title: Clinical Studies in Hair Loss
In my seven weeks with Dr. Amy McMichael at Wake Forest School of Medicine, I gained extensive exposure to dermatologic conditions affecting the hair and scalp, and deepened my commitment to pursuing a career in dermatology. My research tasks included writing a review article on the use of 5 alpha reductase inhibitors for the treatment of female pattern hair loss, as well as the completion of a protocol for a survey of symptoms related to treatment with this class of drugs. In reviewing the literature for both of these projects and through my work consenting patients for clinical studies, I became more aware of the need for more research into effective treatments for hair loss affecting women. As I consented patients for studies on frontal fibrosing alopecia and central centrifugal cicatricial alopecia, I witnessed firsthand how many women affected by this disease were immensely impacted by a lessened quality of life due to their condition.
Dr. McMichael was an excellent mentor, exceeding all my expectations for the summer by welcoming me into the clinic and being an excellent example of being both clinically astute and empathetic with each of her patients. She took time to teach me and answered all of my questions about specific conditions as well as how to best prepare for applying to residency programs in dermatology. My time with her has strengthened my desire to not only work as a dermatologist and serve individuals affected by hair loss, but to also be committed to excellence in academic medicine as well. I would like to wholeheartedly thank AHRS, the Wake Forest Dermatology Department faculty, staff and residents, and Dr. McMichael for all of their support, wisdom, and guidance as I continue to pursue a career in dermatology.
Wendi Wohltmann, MD
Mentor: Leonard Sperling, MD, Uniformed Services University of the Health Sciences
Mentorship title: Histopathologic Diagnosis of Multifactorial Alopecia
Dear AHRS Mentorship Committee members,
Thank you for granting me an AHRS mentorship with Dr Leonard Sperling! I just completed my rotation in Bethesda, MD, working closely with Dr Sperling for two weeks. The mentorship absolutely exceeded my expectations. During the first few days, we used one-on-one scope sessions, his textbook, and vast collection of alopecia slides to hone my diagnostic skills. Dr Sperling’s teaching format was very clear and easy to understand for such a difficult topic. The rest of my time was spent researching the histopathologic features of multifactorial alopecia, a topic not previously covered in the medical literature. We are in the final stages of writing a paper entitled "The histopathologic diagnosis of multifactorial alopecia."
Dr Sperling has the kind of career I aspire to, facing a different challenge each day. Even though he is known as an alopecia expert, he still reads general dermpath slides weekly, staffs dermatology residents in general derm clinic, sees his own patients in a hair loss clinic, participates in dermpath consensus conference, and somehow finds the time to be the Vice Chair of the military medical school admissions committee. He also reads alopecia slides at night as part of a private practice, and would bring these cases in to show me what “real alopecia” slides look like, as opposed to the “perfect” teaching slides (hint: they are much more difficult). He kindly invited me to attend dermatopathology signouts and consensus conferences, as well as his hair loss clinic, where I got to see him interact with dermatology and pathology residents as well as the dermpath fellow. This portion of the mentorship experience will specifically aid me in teaching dermatology residents at my next duty station at Wilford Hall Medical Center (WHMC) in Texas.
I was delighted to discover that Dr Sperling is not only a gifted clinician and dermatopathologist, but also a wonderful person. I saw firsthand the positive effect he has on others, with his calm and patient demeanor. He is also an exceptional listener and advisor. He gave me sound advice about future research ideas, career progression, and just life in general. As a retired Army Colonel, he was able to specifically tailor his advice to my unique situation as an active duty Air Force dermatopathologist. As a direct result of this mentorship, I plan on starting a hair loss clinic at WHMC. My ultimate career goals include academic dermatopathology, both in and after the military, with a focus on hair loss. Dr Sperling will no doubt be a valuable mentor throughout my career. This 2-week rotation cemented his approach to the histopathologic diagnosis of alopecia, helped guide future alopecia research interests, and gave me special “Sperling” teaching methods to teach future residents. Thank you again, AHRS, for supporting this educational endeavor!
Wendi Wohltmann, MD
Syu-Jhe (Keith) Chien
Mentor: John P. Sundberg, DVM, PhD, The Jackson Laboratory
Mentorship title: Pathogenesis of the inflammatory process and alopecia in eosinophilic skin diseases from Sharpincpdm mice
For the month of June I had experience working with Dr. Sundberg at The Jackson Laboratory, Bar Harbor, Maine. Thanks to the North American Hair Research Society, the Mentorship Program did support and offer me a great opportunity to participate in the research that Dr. Sundberg is working on. This gave me access to his broad knowledge of genetics and pathology in mice. The world reknown facility, The Jackson Laboratory, regularly provides seminars on site. With Dr. Sundberg’s encouragement and support, I also attended several lectures which helped to broaden my research vision. This program will not only facilitate my ongoing research projects but also improve my research techniques in the future.
Current project I am working on deals with the Sharpin null mice (C57BL/KaLawRij-Sharpincpdm/Sharpincpdm RijSunJ; hereafter SHARPINcpdm/cpdm) which Dr. Sundberg keeps this mouse colony. Mice carrying a spontaneous mutation in the Sharpin gene develop systemic inflammation in various organs, including the signature lesion, chronic proliferative dermatitis (cpdm), affecting the skin. We reviewed the lesions that these mutant mice develop and focused on changes in the skin and hair follicles associated with changes in the vasculature. This involved immunohistochemistry as well as analysis of transcriptome changes in the skin over time as the disease progressed.
In addition to learning about project design and how the actual work was conducted, Dr. Sundberg also shared his personal experiences on career development with me. He told me that dealing with various topics simultaneous as a routine job for a principal investigator to survive in the current competitive academic world along with running a primary project. Working with specialists form various backgrounds to build connections and partnerships can always bring in new ideas and provide techniques and skill that one may lack.
I want to thank the AHRS for giving me this great opportunity, to learn and work with Dr. Sundberg at The Jackson Laboratory. I am thankful to Dr. Sundberg for his patience, lessons, and guidance in addition to the generous financial support from the Mentorship Program of AHRS to make this trip come true. Figure 1. Double scoping with Dr. Sundberg in his office for our project.
Navid Ezra, MD
Mentor: Ken Washenik, MD, PhD, Bosley's Medical Director
Mentorship title: Hair Restoration
I would like to express my heartfelt gratitude to the AHRS for giving me the opportunity to work with Dr. Ken Washenik at Bosley Medical Group in Beverly Hills, CA. Through this preceptorship, I observed leading-edge techniques in hair transplantation by highly trained surgeons, Drs. Suddleson, Deutsch, and Andrews. During my time at Bosley, I observed many advanced hair transplantation techniques including trichophytic closures, follicular unit extraction, eyebrow restoration, and robotic surgery. Dr. Washenik took time out of his busy schedule to discuss novel follicular neogenesis research and advancements in cellular based hair restoration. We also discussed the process of assessing hair loss and determining the best candidates for the FUE hair transplant procedure versus other therapies such as propecia, topical minoxidil, light technology, intralesional steroid injections, biotin supplementation, and other medical therapies.
I was able to see a variety of interesting clinical cases from the first consultation for hair transplantation, to surgical techniques in difficult cases, to the post-operative visit, and long-term post-operative check. After seeing each patient, the physicians at Bosley took the time to provide valuable take home points and emphasize significant clinical findings. By the end of my rotation, I felt very comfortable assessing a patient for hair transplantation and formulating a plan for the best surgical outcome. The AHRS mentorship program offered exposure to leaders in the field of hair transplantation which has significantly enhanced my knowledge base and skills in the management of hair loss. I also received important career advice from the faculty and have found a lifelong mentor in Dr. Washenik.
Claire Higgins, PhD
Mentor: Prof. Colin Jahoda
Mentorship title: Building on foundations to inspire future development
For two weeks in March 2014 I had the pleasure to work with Prof. Colin Jahoda at Durham University in the UK. I had worked with Colin previously, when I was a PhD student in his lab. However, when I was a student I was so focused on my own project, I forgot to look up and learn from my surroundings. My goal during this mentorship was to make sure I used this ‘second chance’ to discuss everything from hair regeneration through to changing science cultures, and benefit from Colin’s wealth of expertise in hair follicle development.
During the mentorship period I had protected time to focus solely on the goals of the application. We discussed age old hair induction techniques, and evaluated how the field had changed over the past 30 years. We debated which scientific challenges relating to hair development remain to be solved, and tried to piece together recent developments, fitting them into the hair regeneration puzzle. It was a brilliant two weeks, and we were quite productive, writing a ‘roadmap’ style review of condensate development and hair research. The finishing touches are still outstanding, but we hope to submit this roadmap to a peer-reviewed journal in the near future.
Shortly before my mentorship, I was offered a lectureship at Imperial College, London. Hence, I partook in the mentorship program knowing I was soon to start my own research lab. This was highly beneficial, and my general discussions with Colin about hair research have certainly broadened my research horizons. He also freely dispensed his advice on running a successful team of researchers. I would like to thank the North American Hair Research Society for giving me this great opportunity, to learn and work with Dr. Jahoda, at such a crucial time in the progression of my career.
Llorenia Muir-Green, MD
Mentor: Valerie Callender, MD
Mentorship title: General Management of Hair Disorders and Techniques used in Successful Hair Transplantation
Thank you AHRS for granting me this opportunity to work with Dr. Valerie Callender. I have always had a keen interest in hair research and hair disorders and have in the past read many of her articles. Never would I have dreamed that I would have this opportunity to not only meet her but also to work with her.
On completion of my fellowship in Hair Disorders at the University of British Columbia, I felt that I needed added exposure to patients of African descent. Though my competency in the management of hair disorders improved significantly at the UBC, my exposure to hair disorders in persons of African descent was somewhat limited due to the small percentage of this racial demographic in the total population of British Columbia. This 2-week experience was just what I needed as I was able to see the management of these disorders in persons of African descent, quite necessary for someone who is from a country that is 98% of African ancestry.
Dr. Callender has proven to be an excellent teacher, mentor and motivator. I learnt so much from her with respect to not only the management of patients but also how to run a successful practice. We discussed in detail all aspects of her management of patients with such disorders as Traction Alopecia, Frontal Fibrosing Alopecia, and Central Centrifugal Cicatricial Alopecia. This bolstered my confidence in treating hair disorders unique to this group. From this we are proposing a review article on the effects of hair care practices on hair disorders presenting in women of African descent.
Thanks again to AHRS and Dr. Callender for allowing me this opportunity. I look forward to utilizing the practical tips I learnt in this preceptorship.
Margareth Pierre-Louis, MD, MBA
Mentor: Leonard Sperling, MD
Mentorship title: Clinical and histopathologic evaluation and management of scarring alopecias
Dear North American Hair Research Society Mentorship Committee:
I spent an enriching two weeks in Bethesda, MD, in late April 2014 with Dr. Leonard Sperling at Uniformed Health Sciences University studying hair pathology. I was very fortunate to have this opportunity because the experience had numerous defining moments. My goal in completing the mentorship was to better understand the various facets of hair disorders related to clinical presentation, histopathological characteristics, and how these features may guide and impact management. Through a combination of alopecia histology slide self-study, literature review, multiple daily collaborative slide review and teaching sessions with Dr. Sperling, and consensus conferences, I feel that my goal was accomplished.
The most critical lessons learned were in the histopathologic evaluation of alopecia, a topic in which Dr. Sperling has significant expertise. Through self-study and teaching by Dr. Sperling, I began to understand alopecia as representative of a spectrum of disorders and less as static disease states in which a patient’s clinical presentation correlated specifically to one histologic finding. I observed numerous histologic examples of telogen effluvium in the setting of androgenetic alopecia. In addition, I observed examples of patients with not only folliculitis decalvans histologically but also with features of central centrifugal cicatricial alopecia (CCCA). This knowledge debunked the rudimentary algorithms I had created in my approach to alopecia. I realized that specific alopecias, whether scarring or non-scarring, may have distinct pathological etiologies but also may share overlapping features with other alopecia processes that we have yet to fully understand. Ultimately, I realized that more study and research is needed to determine the pathogenesis of these disorders and the corresponding histological findings.
A form of alopecia that I was previously unfamiliar with was psoriatic alopecia. While I have an interest in psoriasis and have treated numerous patients with variable skin and joint involvement, I had not associated alopecia with this chronic disease. I was able to learn about its characteristic histologic findings and how treatment could impact the prognosis of this hair loss.
In addition to histopathology study, I had the opportunity to learn from patients who I encountered. In the clinic setting with Dr. Sperling, I observed approaches to the treatment of lichen planopilaris and CCCA unique from my home institution at the University of Minnesota. Specifically with CCCA, the use of oral antibiotics, such as doxycycline to help treat inflammation appeared to be the standard of care, coupled with high potency topical or intralesional steroids.
Furthermore, I learned about alternative therapies for alopecia areata. Dyphencyprone is somewhat popular in Europe for the treatment of alopecia areata. I learned about topical immunotherapy with dyphencyprone and was also able to observe Dr. Sperling’s use of this therapy on a patient. It was fascinating to see how the use of an allergen could “redirect” an altered immune system so that hair may grow as it focuses its efforts on the allergic contact dermatitis response. This also led me to read and learn more about squaric acid dibutyl ester and its potential role in treating alopecia areata recalcitrant to more common therapies.
To the AHRS Mentorship Committee: thank you for the professional and financial support that enabled me to participate in this mentorship experience. I learned a tremendous amount about hair dermatopathology and continue to share a passion for these disorders. I have now graduated from residency and look forward to incorporating all that I have learned into the care of patients and potential future research endeavors.
Margareth Pierre-Louis, MD, MBA
Alessandra Anzai, MD
Mentor: Antonella Tosti, MD, University of Miami
Mentorship title: Dermoscopy in cicatricial alopecia
I am a dermatologist and fellow in trichology in Brazil and I had the privilege to stay a month (November 2014) in contact with Dr. Tosti during her activities at the outpatient center of University of Miami. I was able to observe Dr. Tosti and the residents attending patients with hair and nail disorders and contact dermatitis, which are her areas of expertise. I learned a lot discussing simple and complex cases in all aspects: history, clinical exam including dermoscopy, dermatopathology, current and emerging treatments and follow up. Also, I was inspired by the way she deals with her patients, being always kind, attentive and in a good mood. She is a worldwide-recognized scientist but above all she is an amazing human being.
In addition, I attended some lectures and Grand rounds once a week and had the opportunity to write case reports and a project in dermoscopy of cicatricial alopecia that will interchange ideas between Miami and Sao Paulo.
Besides consolidating my scientific knowledge in diagnosis and treatment of hair diseases, it was very interesting to see how the health system works in United States and analyse the cultural differences between US and Brazil regarding doctor–patient relationship.
I want to thank the AHRS for this unique opportunity, to learn and work with Dr. Tosti. She is a great researcher, a very experienced dermatologist and a leader and I thank her very much for being so generous in sharing her knowledge. This mentorship enhanced my personal growth and strengthens my academic pursuits and I am sure this contact is the beginning of a prosperous partnership.
Tee Wei Siah, MRCP, BSc, MBChB
Mentor: Leonard Sperling, MD
Mentorship title: Hair Pathology with Clinical Correlations
I would like to thank AHRS for giving me this unique opportunity to work with Dr Sperling in Bethesda, Maryland. I would also like to express my heartfelt gratitude to Dr Sperling for his world class expertise in hair pathology and his hospitality.
I am new to the field of hair pathology and this experience has certainly broadened my horizons and improved my knowledge. The mentorship was 2 week long. On the first day, I was given the chance to take self-assessment tests in hair pathology which I found challenging. However, the self-assessment tests were useful as I had time to think over cases. Dr Sperling took time out of his busy schedule to discuss the cases and I was given opportunities to ask questions. During my first week, I spent time at the microscope reviewing Dr Sperling’s collection of hair specimens followed by a discussion at the microscope on daily basis. These sessions were particularly useful and I expended my knowledge on the assessment of horizontal sections. I spent the second week working on a project on hair pathology.
Other than spending time at the microscope, Dr Sperling also showed me the importance of achieving work-life balance as we went for nice afternoon walks between microscope sessions.
I thoroughly enjoyed my experience through the generosity of this mentorship award and I would like to thank everyone at AHRS who made this very valuable learning experience possible. Dr Sperling is truly an excellent mentor who shares his knowledge and experiences, provides guidance and inspires.
Timothy K. Cooper DVM, PhD., Dipl. ACVP, Summary of Experience with the Sundberg Lab
I would like to thank the AHRS, grant contributors and sponsors, and the grant selection committee for making possible the excellent experience and mentorship I gained as a result of their generosity. I would of course also like to thank Dr. Sundberg for his world class expertise and his hospitality, both professionally and personally.
As part of the grant I spent two weeks in the Sundberg lab at the Jackson Laboratory in Bar Harbor, ME, in July and August. This provided unmatched experience for hair research from several vantage points. I was able to work with Dr. Sundberg's excellent technicians, Kathleen Silva and Victoria Kennedy, to see firsthand how hair and skin samples are collected and prepared for analysis. Dr. Sundberg has a well-annotated and extensive collection of hair and skin slides from many of the mutant mice maintained at the Jackson Laboratory. I was able to review these slides individually and then together with Dr. Sundberg at a two headed microscope (see attached photo). This provided not only an opportunity to see a wide variety of phenotypes, but to ask questions about differences and similarities between phenotypes. On a number of occasions I was able to sit in on meetings with co-investigators at different stages in the evaluation of new skin and hair phenotypes. I had ample opportunity during lunches, walks, or at his house in the evenings for dinner to pick his brain, itself a valuable experience, regarding skin and hair phenotypes I had encountered and was in the process of working up. Even in my free time I was able to avail myself to his library to review appropriate textbooks, some of which are out of print or difficult to find. This provided me with the quality specialized references that I can use later.
Looking forward, I am presently immunostaining hair follicles with Dr. Sundberg to characterize cell populations involved in catagen regression. If successful, this would be a valuable scientific manuscript. Finally, Dr. Sundberg included me as a co-author on an invited review detailing the systematic evaluation of skin phenotypes in mutant mice for the journal Experimental Dermatology. This is in addition to several other papers on which we anticipate collaborating.
Again, I would like to thank everyone at AHRS who made this very valuable learning experience possible. Dr. Sundberg is an excellent mentor, for hair and skin in particular as well as career (and life) in general, and I am happy to have benefitted from this opportunity.
Temitayo A. Ogunleye, MD, Dermatologist, Amy McMichael, MD, Wake Forest University, Department of Dermatology, Ethnic skin and hair management
As a recent graduate from residency who had chosen to remain in academics, I was faced with the somewhat daunting task of choosing an area of interest or “expertise.” When I reminisced on factors that initially attracted me to medicine, the theme of serving underserved communities, and my passion for teaching were constant. As a result, one of my interests is skin of color, as I believe that as the demographic of the United States continues to change, there will be a greater need for dermatologists interested in treating this patient population. Since common complaints of darker skinned patients include hair disorders, such as alopecia and hirsutism, cultivating my interest in hair disorders seemed like a natural extension of this interest. Dr. McMichael is the quintessential academic dermatologist, and as some of my interests mirror hers, I felt that she would serve as the perfect mentor. Thanks to the generosity of AHRS, I was able to pursue this career changing and invaluable mentoring experience.
In addition to the expected practical gems regarding the diagnosis and treatment of hair disease, I also received unexpected lessons regarding the art of practicing medicine and being a mentor. Once out of residency, it is rare to be able to observe, without expectation or duty, a talented, experienced physician practice medicine. How much more worthwhile is this experience after one has formed his/her own practices, and can better understand the subtleties that distinguish between good and great physicians? The nuances of skilled history taking and the physical exam necessary for diagnosis of hair disorders, (for example, I learned that I have NEVER properly completed a hair pull test), and even the subtleties of dealing with the “difficult” patient are some of the lessons that I learned from Dr. McMichael and will incorporate into my future practice. Dr. McMichael was also interested in my personal goals and expectations for the mentoring experience, ensuring that my time spent would be as enriching and fulfilling as possible. As a result, I was able to begin collaborations on a few projects with her that will extend past the boundaries of my seemingly short 2 week experience.
Furthermore, the warmth of Dr. McMichael, the faculty and staff were unparalleled, as I received my first tastes of “southern hospitality.” Even as a staunch Northeasterner, I instantly felt at home, adding to the richness of my experience. Dr. McMichael embodies the essence of a mentor, taking time not only to educate and guide, but to also cultivate a more personal relationship. I thoroughly enjoyed my experience made possible through the generosity of this mentorship award, and will be forever grateful to the AHRS and Dr. McMichael. I look forward to enacting the practical lessons I have learned clinically, as well as hopefully passing similar experiences forward as an educator and mentor.
Emilia Peuhu, PhD
Mentor: John Sundberg, MD
Mentorship title: Hair and Skin pathology of the Sharpin null mouse models
Owing to the AHRS Mentorship grant I was able to visit Dr. John Sundberg at The Jackson Laboratory in Bar Harbor in June. During this visit and after, I have gained tremendous amount of insight to mouse skin and hair pathology, but also to genetic mouse models, in general. Establishing personal contact with Dr. Sundberg and his great laboratory has been instrumental in taking my research forward. I would like to express my deep gratitude to AHRS for awarding this mentorship grant.
During my visit to Bar Harbor I became acquainted with the research activities at Jackson Laboratory. For example, I had the opportunity to follow their standardized procedures for mouse necropsies and tissue sample preparation, attend seminars and follow individual researchers in their work in specific projects related to the cutaneous histopathology of the Sharpin null mouse models.
Most importantly, Dr. Sundberg trained me in how to investigate histological skin samples by light microscopy. I learnt to detect and recognize the basic structures as well as many pathological features of the mammalian skin. In the process, I became familiar with samples from different mutant mouse models exhibiting abnormal skin and hair, which gave me valuable perspective to understanding the scaly skin phenotype of the Sharpin null mouse.
Since the visit, we have been in close contact by email and skype, and our research collaboration has continued. I have received histological and whole mount samples from conditional Sharpin knockout animals, and I am currently working on their immunohistochemical analysis.
Not only did this mentorship give me specific knowhow on mouse skin and hair pathology, but I also had the privilege to discuss with Dr. Sundberg broader themes from scientific nomenclature and research funding to lifelong career as a scientist. I felt most welcome and inspired while visiting Dr. Sundberg at Bar Harbor and I thank him for this opportunity.
Natalie Yin, BS, Medical Student, Amy McMichael, MD, Wake Forest University, Department of Dermatology, Clinical approach to hair disorders
I would like to express my heartfelt gratitude to the AHRS for giving me the opportunity to work with Dr. Amy McMichael at Wake Forest this summer. Through the program, not only did I gain significant knowledge regarding clinical hair disorders, but more importantly, I returned home with a new field of interest.
During my two week mentorship, Dr. McMichael went out of her way to schedule several of her hair patient clinics. As a result, I was able to see a variety of interesting clinical cases, ranging from alopecia universalis to LPP to CCCA. After seeing each patient, Dr. McMichael took the time to provide valuable take home points and emphasize significant clinical findings. By the end of my rotation, I felt very comfortable formulating differential diagnoses and identifying treatment options for the various presentations of hair disease. The AHRS mentorship program confirmed my desire to specialize in hair disease as a future dermatologist.
As Dr. McMichael cares for a very diverse patient population and is a leading expert in skin of color, I had the opportunity to learn the distinct presentations as well as management options for the various dermatologic diseases in pigmented skin. In addition to the clinic work, I was able to co-author a review with Dr. McMichael on acne treatments for patients with skin of color during my rotation, which further enriched my learning in the field.
On the days when Dr. McMichael did not have clinic, I had the pleasure of working with many of the other dermatology faculty members at Wake Forest, including Drs. Fleischer, Jorizzo, Huang, Pichardo-Geisinger, and Taylor. I greatly benefited from working with these mentors, as they were all very generous in sharing with me their knowledge and expertise.
Above all, Dr. McMichael inspired me most with her impressive bedside manner. She educated all of her patients on their disease processes and explained the reasons behind her treatment suggestions. With her genuine warmth, sincerity, openness and great sense of humor, she was able to quickly put her patients at ease and win their trust. I hope to one day emulate Dr. McMichael’s doctoring skills and cannot thank the AHRS enough for this exceptionally rewarding experience.
Julia Escandon, MD, Dual MD-PhD Student; Mentor: George Cotsarelis, MD, University of Pennsylvania, Immunostaining in protein expression of various stem cell markers in mouse and human skin
I am writing to inform you about my experience during the two week rotation I took at the University of Pennsylvania from October 1-12 2012 with Dr. George Cotsarelis.
During the time I spent in UPenn, I was able to join the Department of Dermatology in scientific and clinical conferences, shadow Dr. Cotsarelis in the hair clinic and spend time in his laboratory where I performed immunofluorescence staining on human and mouse tissue to look at the expression of prostaglandin synthases and receptors.
In spite of the responsibilities of Dr. Cotsarelis as Chairman of Dermatology in UPenn, he made time to get to know my particular interests and opinions in research, clinical practice and Dermatology and give me feedback. I believe we accomplished the purpose of the Mentorship Program which is to establish a relationship between a senior researcher and a trainee and I believe this rotation has opened opportunities of collaboration between our institutions.
I am thankful for the opportunity that the AHRS gave me and the support of the Cancer Biology Graduate Program and the Department of Dermatology of the University of Miami, and for the hospitality of the University of Pennsylvania. This experience has truly confirmed my vocation as a researcher and dermatologist and motivated me to pursue a career in academia.
Mentee: Qiaoli Li, PhD, Thomas Jefferson University
Mentor: John P. Sundberg, DVM, PhD, The Jackson Laboratory
Period of support: March 2012 – February 2013
As a junior faculty member (Assistant Professor) in the Department of Dermatology and Cutaneous Biology at Thomas Jefferson University in Philadelphia, I work with Dr. Jouni Uitto on pseudoxanthoma elasticum (PXE), a prototype of heritable connective tissue diseases manifesting with ectopic mineralization, using the targeted Abcc6tm1Jfk mouse as a model system.
In September 2011, I attended a basic mouse genetics course at The Jackson Laboratory where I met Dr. John Sundberg. This led me to apply for and receive a Mentorship Grant from the North American Hair Research Society to return to work with Dr. Sundberg in March 2012 for two weeks. Dr. Sundberg provided me with access to his data on a large scale, high throughput, pathological phenotyping study of 31 strains of inbred mice that had been aged. This study identified several strains that had lesions consistent with PXE associated with spontaneous mutations in their Abcc6 gene. Working with Dr. Sundberg was an extremely rewarding experience. Besides the time and hands-on experience that he dedicated to me at the microscope, I was also welcomed to his lab and lab meetings. He trained me not only in the basics of mouse skin and hair pathology, but also the wide diversity mouse genetic tools that I can use, both technical and biological, for studying mouse models of human diseases. The mentorship and collaborative efforts have resulted in two publications in high impact journals, one accepted pending revision, and two in preparation (see below). Sufficient preliminary data were generated which enabled me to a submission of a NIH K01 grant application in October 2012.
Dr. Sundberg's enthusiasm, commitment, guidance, and inspiration will always be a role model in my career. I am very grateful to AHRS for supporting this amazing mentorship experience. I believe the mentorship had opened opportunities of collaboration with Dr. Sundberg, but also with his colleague and another mentee, Dr. Annerose Berndt, at the University of Pittsburgh, on multiple on-going projects. Dr. Berndt was also a recipient of the North American Hair Research Society Mentorship Award for 2012 working with Dr. Sundberg.
Rayna M. Dyck, MD, Resident; Mentor: Wilma Bergfeld, MD, Cleveland Clinic, The use of intralesional steroids in folliculitis decalvans
This past year has certainly been a wonderful experience for me at Cleveland Clinic. As a resident in the research track, it has been helpful working with Dr. Bergfeld as she is passionate about research and has many contacts in the field of hair disorders. At national meetings she has taken the time to introduce me to others in hair research and dermatopathology. Currently we are working on a project looking at the use of intralesional kenalog in folliculitis decalvans. For my upcoming research year, we will be conducting a study on the use of botulinum toxin in androgenic alopecia. I am very excited to continue my work in hair research during residency and hope to continue this in my academic career.
Over the course of my residency, I have found I also have a strong interest in dermatopathology. As a dermatopathologist herself, Dr. Bergfeld has agreed to be my departmental mentor and has been extremely supportive in my pursuit of this subspecialty field. In fact, I have been awarded a 2012-2013 Mentorship Award from the American Society of Dermatopathology (ASDP) and my mentor for this award, Dr. Joan Guitart, is a former fellow of Dr. Bergfeld’s. He was more than happy to serve as my mentor upon her recommendation. I will be working with him for two weeks at Northwestern University on a project entitled, “Rationale for Reporting PAS for Onychomycosis.” This past October, I also presented a poster at the ASDP’s 48th Annual Meeting in Seattle, Washington entitled, “Eosinophils in the Dermal Infiltrate: Does This Rule Out Secondary Syphilis?” I will be working on a number of projects in the Department of Dermatopathology and in hair disorders here at Cleveland Clinic, and I must give credit to Dr. Bergfeld for helping me facilitate these opportunities. I have also applied for a 2012 AHRS Mentorship because my previous experience has been so valuable.
Lastly, over the past year I have become more involved in leadership at Cleveland Clinic and in the Cleveland community as a whole. I am currently in the process of being matched for a little sister in the Big Brothers/Big Sisters program here. I am also the resident representative on the Cleveland Clinic Policy Committee. In efforts to recruit minorities to Cleveland Clinic, I will represent our many residency programs at the Student National Medical Association’s Annual Education Conference in Atlanta, Georgia in April. Upon the recommendation of Dr. Bergfeld, I have been asked to join the Editorial Board for the Women’s Dermatologic Society, and I hope to be approved for this appointment during the AAD meeting in March. While I have made progress in research in the field of hair disorders, I have also made strides in leadership and service, which will certainly help me be well-rounded in my career. I am so grateful for this experience and hope to continue to work with AHRS throughout my career.
Ghada Abdulaziz Binsaif, MD, Dermatologist; Mentor: Amy McMichael, MD & Gil Yosipovitch, MD, Wake Forest University School of Medicine, Central Centrifugal Cicatricial Alopecia
I would like to thank you for involving me in the AHRS Mentorship Program. It was an amazing, useful and very productive experience. Words are not enough to describe how much skills and knowledge I gained from working with Drs. McMichael and Yosipovitch. We started with our project of assessing pain, thermal thresholds and neurogenic inflammation in CCCA patients. The unexpected results pushed us to extend our work to study the scalp of healthy subjects from various ethnic groups.
We presented part of our work in the Cicatricial Alopecia Symposium, Bethesda, Maryland, USA, Oct 2011. Under the title “Bin saif G, Mcmichael A, Yosipovitch G. Assessment of Itch, Thermal and Pain Thresholds, and Neurogenic Inflammation in Central Centrifugal Cicatricial Alopecia.” We also submitted the following abstract “Healthy scalp has reduced sensory thresholds to temperature, pain, itch and neurogenic inflammation response” to the Society of Investigative Dermatology annual meeting (2012). We are working now on writing two manuscripts that represent the results of our work, and they will be sent for publication soon.
This experience provides me with skills in conducting simple basic science research in the field of hair, as well as skills in writing papers and presenting in conferences. I get very interested in the hair and scalp field, so I wrote (with Dr. Yosipovitch) a review article entitled “Itchy scalp, Scratching for an explanation” that was published in Exp Dermatology, Dec 2011. In addition, I am still working on a review article with Dr. McMichael on Neoxidil.
During the academic year 2010-11, I joined the international fellowship program in Wake Forest University under Drs. McMichael and Yosipovitch, and I was lucky to get the AHRS mentorship award. During which I believes that my hair clinical approach and research skills get polished. Now, I went back home to King Saud University, Riyadh, KSA. I opened a hair clinic and I am planning to be specialized in hair and scalp disorders in the clinical and the research sides. I am planning now for many hair researches and wishing to be able to participate with international hair research groups in future. Hope we could contribute to improve our understanding and our management skills of various hair disorders.
Sabina Anna Cieszynski, Medical Student; Mentor: Kimberly Salkey, MD, Eastern Virginia Medical School, Synthetic Hair is Associated with CCCA in Southeastern Virginia
The purpose of our study was to investigate whether there was an association between certain types of hair practices and central centrifugal cicatricial alopecia and whether the condition had a significant impact on patients’ lives. Two types of surveys were distributed to patients with CCCA, including the Hair Grooming Assessment Survey and the Dermatology Quality of Life Index, and results were analyzed.
We found that CCCA did have a moderate impact on the quality of life in these patients, comparable to other chronic skin conditions such as psoriasis and vitiligo. In addition, we found that there was an association between CCCA and glued in and sewn in weaves; however there was no clear indication that the use of this hair care practice preceded the onset of the condition. Currently we are in the process of submitting our results for publication and hope that these results will place us one step closer to finding the potential cause of this condition. Our results are similar to ones from various publications on this topic, indicating that weaves seem to be one of the main practices associated with CCCA.
Working with Dr. Kimberly Salkey was an extremely rewarding experience. As this was my first clinical study, I needed assistance in learning the steps of this process and she guided me through each of these steps with immense patience and encouragement. Prior to this experience, the process of running my own research project was somewhat foreign to me, however with Dr. Salkey’s enthusiasm, commitment, and guidance I am now much more comfortable with pursuing something like this on my own in the future.
Alde Carlo Patdu Gavino, MD, Resident, Mentor: David Whiting, MD, Baylor University Medical Center, Histopathology with clinical correlation
I spent 2 weeks (July 25 to August 5, 2011) with Dr. David Whiting at his Hair and Skin Research and Treatment Center in Dallas, TX. My experience was priceless, and I could not be more grateful to the North American Hair and Research Society for supporting my mentorship.
Dr. Whiting has a very busy Hair Clinic. I saw hair patients with him --- it was a good mix of follow-up and new patients --- and learned how he evaluated and managed alopecias. Dr. Whiting biopsied all of his new patients, and read those biopsies himself. This was a fantastic opportunity for me, especially because before dermatology residency, I completed a residency in anatomic and clinical pathology followed by a fellowship in dermatopathology. I had the opportunity to review all of the biopsies we did, do follicular counts on them, and formulate a diagnosis based on those counts. Dr. Whiting went over the biopsies with me after I had previewed them. The clinico-pathologic correlation was extremely educational. In addition to all that, Dr. Whiting was so generous with his time in that he sat down with me everyday and gave me a lecture using talks he had given at various local, national, and international meetings. What a privilege I had!
Incidentally, during my stay there, Dr. Whiting was working on a paper on Frontal Fibrosing Alopecia. I helped Dr. Whiting gather and organize some of the data needed to complete that paper. It was a great learning experience for me as well. Dr. Whiting had seen and continues to see a lot of patients with FFA, and I learned a lot about that disease during my time with him.
Lastly, I had the wonderful opportunity, pleasure, and honor to meet Dr. Whiting’s wife. Like Dr. Whiting, Mrs. Whiting was unbelievably kind and generous. The same is true for Dr. Whiting’s office staff.
In summary, I had the most pleasant and most valuable learning experience with Dr. Whiting. My time with him solidified my desire and plan to carve a niche in hair diseases and alopecias. Dr. Whiting will always be an inspiration and role model to me, and I thank him and the North American Hair and Research Society for helping me find my niche in dermatology and dermatopathology.
Natasha Atanaskova Mesinkovska, MD, PhD, Resident, Mentor: Wilma Bergfeld, MD, Cleveland Clinic, Lichen Plano Pilaris: Therapy with Pioglitazone
Where do I begin to tell you about the amazing and prolific year that I had working with Dr. Bergfeld? For all of you who know her, you are well aware that she is an exemplary mentor, smart, fair and imaginative. Dr. Bergfeld possesses an amazing gift to teach her mentees while making them feel that they are the ones who are changing the future, as she only gently points the way. In these times full of limitations, with Dr. Bergfeld I discovered the world where hard work still obtains unlimited possibilities.
Here is what may seem like an uncreative task list, but one completed with tremendous effort and love on my part:
- We started off the year by looking at the Cleveland Clinic experience with alopecia and by creating the alopecia database. This was a project that was in the works for some time, but had never really gained momentum. We successfully qualified and organized over 800 patients, with many more to be entered. This database has offered us a wealth of knowledge, and is yet to provide much needed information on patients with alopecia.
- The first scientific project focused on identifying stem cell markers in scarring and non-scarring alopecia, done in collaboration with the excellent Dr. Klaus Sellheyer. This work was chosen for an oral presentation at two meetings: the American Society of Dermatopathology in Seattle, WA, and the NIH Cicatricial alopecia conference, in Bethesda, MD. The completed study was subsequently published in the British Journal of Dermatology, 2011.
- We completed a study focusing on the levels of Vitamin D in patients with alopecia. This project was also chosen for a poster and oral presentation at the NIH Cicatricial conference, October 2011 in Bethesda, MD. The first draft of the paper was revised and resubmitted for publication.In addition, I will be presenting a talk on the role of Vitamin D in alopecia at the upcoming AAD meeting, 2012 San Diego, CA.
- We compiled our experience with Lichen Planopilaris and Pioglitazone and presented this work at the NIH Cicatricial conference, October 2011 in Bethesda, MD. Some aspects of the work were included in Cleveland clinic yearly outcomes book and we are preparing this to be published in a peer reviewed journal.
- My current project is focused on devising a protocol for alopecia areata clinical trials for the NAAF,under the guidance of Dr. Bergfeld, and in collaboration with Dr. Shapiro. This project has taken a lot of effort but finally coming to fruition.
We were jovially discussing with Dr. Bergfeld, that I have too much work to send this AHRS summary back on time. That is her gentle way of nudging me to get it done.
With immense gratitude to the AHRS for making all of this possible: the $500 grant has supported my inkling to grow into a strong interest and possible career path. For this alone, I will be eternally indebted.
I look forward to returning this favor to future generations of residents.
Mariya Miteva, Associate Scientist, Mentor: Leonard Sperling, MD, Uniformed Services University, Hair pathology
I consider my visit with Dr. Sperling as one of my best academic experiences. My area of interest is hair pathology and therefore for me to be able sit at microscope with Dr. Sperling who is a leading expert in this field was a terrific opportunity.
I combined my mentorship visit in Bethesda with attending the Cicatricial Alopecia Symposium which was held there in October. My visit with Dr. Sperling consisted of 4 days. At the beginning I had the chance to take several self-assessment tests in hair pathology which I liked very much. I found that particularly useful as I had time to think over the cases, then we discussed the answers and I was able to ask questions. Every day I spent time at the microscope reviewing Dr. Sperling’s collection of hair specimens which we discussed afterwards during our sessions at the microscope. In these sessions I extended significantly my knowledge on hair pathology, particularly the assessment of horizontal sections and we exchanged ideas about future common projects. In fact, we are currently working on two scientific publications on hair pathology which will appear in the near future.
Dr. Sperling included me also in the routine evaluation of hair biopsies which I found very exciting part of the mentorship. I also attended the dermatopathology sign out of the most difficult cases of the week where I was able to meet and interact with other nice colleagues.
Besides all the time that he dedicated to me at the microscope, Dr. Sperling also gave me great hospitality as we went for nice afternoon walks between the microscope sessions and dinners at the end of the day. In this time we were able to talk about future projects and exchange ideas in an informal way.
In conclusion, I would to thank the AHRS for this unique opportunity.
I am sure this mentorship established the basis of new productive future collaboration with big impact on hair pathology.
Peggy Suejin Myung, MD, PhD, Resident, Mentor: Mayumi Ito, PhD, New York University School of Medicine, The regulation of Wnt signaling in hair follicle melanocyte stem cells by epithelial and dermal cells
During my mentorship training under Dr. Mayumi Ito at New York University, we examined hair follicle regeneration in adult mouse skin using two models: 1) the adult hair cycle and 2) wound-induced hair follicle neogenesis.
We approached an important question: How do hair follicles activate Wnt/β-catenin signaling to initiate adult hair follicle regeneration? Virtually all hair biologists recognize that Wnt/β-catenin signaling is critical for hair follicle regeneration, but the cellular source of Wnt ligands that activate Wnt/β-catenin signaling during hair regeneration is unknown. Several Wnt ligands are expressed redundantly in the hair follicle epithelium and dermal papilla, making it difficult to experimentally address this question in vivo. We took advantage of the recently characterized Wntless protein that is required for secretion of Wnt ligands by Wnt-producing cells. We generated mice that allowed us to genetically delete the Wntless gene specifically in hair follicle stem cells during telogen phase. We discovered that Wnt ligand secretion by the follicular epithelium is absolutely required for anagen and that Wntless-depleted hair follicles show a profound hair cycle arrest at telogen or early anagen. Furthermore, we show that epithelial Wnts are necessary for the dual activation of Wnt/β-catenin signaling in hair follicle stem cells and dermal papilla cells, and epithelial Wnt ligands are required for hair follicle stem cell proliferation but not their maintenance. Finally, epidermal Wnt ligands are critical for de novo hair follicle regeneration following wound healing in adult mice.
This study demonstrated the requirement for epithelial Wnt ligand secretion in directing early events in hair regeneration. This study also highlights Wntless as an effective tool to inhibit Wnt signaling in the hair follicle independently of downstream Wnt signaling transducers, which have both Wnt-dependent and Wnt-independent functions. We predict that this study will provide new insight into the cell-cell interactions that promote the coordinated growth of different cell types during adult hair/tissue regeneration and will be signifcant to hair biologists, clinical dermatologists and tissue engineers. This work has been submitted recently to the Journal of Investigative Dermatology for publication and will be presented orally at the 2012 annual Society of Investigational Dermatology meeting.
More importantly, this hands-on experience with Dr. Ito and her lab gave me a new appreciation and excitement for studying hair follicle biology and the experimental approaches available to address questions, including their limitations. Dr. Ito’s astute and prolific expertise in hair biology, as well as her sincere and contagious enthusiasm for teaching and engaging students, gave me the unique opportunity to learn hair morphology throughout the hair cycle as well as during adult hair neogenesis. As a future dermatopathologist, this experience gave me a new appreciation of the histological and biochemical changes that occur throughout the hair cycle and how this relates to human hair diseases. I am eager to incorporate basic science research with my upcoming dermatopathology fellowship training at Yale and hope to continue my interests in hair regeneration there. I am looking forward to continuing scientific collaborations with Dr. Ito during my fellowship and know that we will maintain a friendship throughout my career. Put simply, she is one of the best mentors I have ever met and has the unique ability to give a sense of ownership, dedication, and discovery to her trainees.
Sophia Rangwala, Researcher, Mentor: Madeleine Duvic, MD, University of Texas M.D. Anderson Cancer Center, Alopecial areata, T cell disease
In January 2011, I was awarded a AHRS grant to support my mentorship with Dr. Madeleine Duvic at the University of Texas M.D. Anderson Cancer Center. I participated in her cutaneous lymphoma clinic twice weekly and helped manage many patients who had debilitating diseases associated with hair loss, such as folliculotropic mycosis fungoides and cutaneous B cell lymphoma of the scalp. Outside of clinic, I was involved in translational research that determined the biologic mechanisms of response of various therapeutics found to be effective in cutaneous T-cell lymphoma patients, including histone deacetylase inhibitors, pralatrexate, and bexarotene. The findings of this research have implications for hair loss associated with T cell lymphomas of the scalp. While at MD Anderson, I also helped prepare a case series entitled “Antinuclear antibody seropositivity in male patients with cutaneous B-cell lymphoma of the scalp” and a review entitled “Alopecia: a review of laser and light approaches.” Both manuscripts are currently submitted for publication.
In addition to these projects, I helped obtain buccal DNA samples for the National Alopecia Areata Registry from patients who had declined phlebotomy and determined the best protocol to extract the buccal DNA. Buccal samples gathered from clinic and the 2011 National Alopecia Areata Conference will be used for a future genome-wide association study on alopecia areata.
During my experience, I observed how debilitating hair disease can be, read over the current literature, and finally, participated in research that has the potential to reverse hair-affecting conditions. This mentorship has reinforced my interest in serving and improving the lives of those with hair disease as a future medical dermatologist.
Patricia Ting, Resident, Mentor: Vera Price, MD, University of California San Francisco, Hair disorders
I completed a 2 week mentorship in March 2010 with Dr. Vera Price in San Francisco. This mentorship experience was generously supported by the AHRS.
The experience was both delightful and memorable. On the first day, I arrived at the UCSF Dermatology Department bright and early at 7:15am. The walk to the clinic was a little shorter than I had anticipated. I was greeted by welcoming support staff. When I returned from Starbucks, I was greeted by a smiling Dr. Price. I was fortunate to have had the opportunity to meet her in New Orleans just one month earlier since she graciously invited me to her UCSF Hair Fellow’s breakfast at the American Academy Meeting. Dr. Price immediately began to get me organized by directing me to a bookshelf of reference books, website resources, patient information handouts and a clinic schedule. As I began to peruse through some of her books, I quickly realized how vast hair disorders can actually be, clearly not reflected in the 25 pages dedicated to hair in our beloved Bolognia textbook.
During the time I spent with Dr. Price, I learned how to take a proper history and perform through hair examinations. The clinics were filled with patients with androgenetic alopecia as well as uncommon and rare forms of cicatricial alopecias, alopecia areata, etc. I can recall a number of teary eyed patients, upset from the cosmetic disfigurement caused from their hair loss. The patience, understanding and reassurance Dr. Price demonstrated to these patients was very special to observe. Dr. Price also provided these patients with useful resources and support groups to help them cope with their hair disorders.
Furthermore, Dr. Price also taught me how to make and interpret hair mounts. This was something I had never done before! She gave me access to her collection of hair samples collected over the years of rare hair disorders such as trichorexhis nodosa, spun glass hair, monilethrix, pili bifurcate, etc. It was immensely educational to look through seemingly endless envelopes of hair samples and practice making hair mounts of them.
In sum, I accumulated a lot of knowledge and practical skills in the two short weeks I spent with Dr. Price in San Francisco. She is a very skilled and knowledgeable clinician and researcher, a wonderful mentor and a lovely person to work with. I certainly wish I could have had the opportunity to work with her longer! This mentorship experience has certainly made me more interested in possibly pursuing a hair fellowship. I am very thankful to AHRS for supporting this amazing mentorship experience.
Vasanop Vachiramon, Dermatologist, Mentor: Amy McMichael, MD, Wake Forest University School of Medicine, Hair and pigmentary disorders, laser hair removal
I would like to express my sincere gratitude to both North American Hair Research Society and to Dr. McMichael for an exceptional mentorship experience at the Department of Dermatology, Wake Forest University School of Medicine. Dr. McMichael and the entire Department of Dermatology at Wake Forest University were very gracious hosts and incredibly welcoming.
I spent time in Dr. McMichael’s hair clinic, general dermatology clinics, and laser clinic. One of the reasons I was so interested in spending time in her hair clinics was her interest in patients with hair and scalp disorders. Dr. McMicahel is the quintessential academic dermatologist and such a great teacher. Every case provided an interesting teaching point. The patients in Dr. McMichael’s hair clinic provided me unique opportunities to hone my clinical skills in this field. I had a chance to see many patients who had hair and scalp disorders in her clinic. These include central centrifugal cicatricial alopecia, lichen planopilaris, folliculitis decalvans, androgenetic alopecia, alopecia areata, and alopecia universalis. Seeing a high volume of these patients helped me recognize patterns of presentation for these disorders as well as subtle variations in disease manifestations. These patients provided even further teaching opportunities for Dr. McMichael who seems to truly enjoy teaching. I didn’t just benefit, though, from learning about patients’ conditions, it was also Dr. McMichael’s approach to patient education that was also very beneficial. All patients walk out the door with a handout about hair and skin care and usually one about their specific diagnosis, which is something I definitely plan to bring back to my home institution.
Another clinical interest of Dr. McMichael is laser hair removal and I had a chance to see many patients who had unwanted hair in her laser clinic. We also conducted two clinical researches and published during my visit. The first one is entitled “Patient knowledge and attitudes on laser hair removal: a survey in people of color” and was published in Journal of Cosmetic Dermatology and the second one is entitled “Patient satisfaction and complications following laser hair removal in ethnic skin” and was accepted for publication in Journal of Drugs in Dermatology.
During my visit at the Department of Dermatology, Wake Forest University School of Medicine, I was also able to attend the clinico-pathological conferences, grand rounds, and many lecture series for resident education. They were all of high quality and informative. Many of the faculty members are recognized experts in the topics they presented, and it was an enormous privilege to hear them speak. When Dr. McMichael wasn’t in her clinic, she graciously had talked with other attendings to ensure if it was okay for me to spend time with them and so I got to spend time with Dr. Yosipovitch and Dr. Jorizzo in their clinic. Both of them were also an excellent teacher.
Again, I want to thank everyone at the AHRS for giving me this amazing opportunity to spend time with Dr. McMichael and the rest of the dermatologists at the Department of Dermatology, Wake Forest University School of Medicine. I will take whatever I have learned and bring it back to my home institution in Thailand to teach medical students and residents. I would highly recommend this experience to others interested in hair and scalp disorders. Thank you again to both the AHRS and Dr. McMichael for making all of this possible.
Renee Beach, MD, Resident, University of Ottawa; Mentor: Nonhlanhla Khumalo, MD, Groote Schuur Hospital, Cape Town, South Africa, Cytokine profiles in Afro-textured hair, pediatric dermatology, adult academic dermatology
I embarked on a four-week elective at the University of Cape Town’s (UCT) Groote Schuur hospital (GSH) under the tutelage of Dr. Nonhlanhla Khumalo (January 24, 2010 – February 19, 2010).
My daily schedule consisted of 8 am teaching sessions where the UCT registrars prepared for their upcoming exams, followed by clinic at the GSH (adult general dermatology), the Red Cross Children’s Hospital (pediatric general dermatology), or the Hair Disorders clinic at the GSH. In the afternoons, I completed a research study with Dr. Khumalo that focused on women with afro-textured hair. In the evenings, I took the research study samples of sebum to the lab and prepared them for extraction.
The research study is entitled “ICANAR - Inflammatory cytokines in afro-textured natural and relaxed hair”, and the main question asks whether or not there is a difference in the cytokine profile obtained from the scalp sebum of women who chemically process their hair compared to women who do not. Sub group analyses will examine whether or not there is any difference between types of chemical processing used on the hair (e.g. sodium hydroxide vs. guanidine preparations). The study will analyze sebum samples in women with afro-textured hair before and after shampoo/conditioner and before and after chemical processing. I obtained and prepared 525 sebum samples from the research participants over a total of 110 patient visits. Currently, we are awaiting the cytokine kit arrival so that the samples can be analyzed.
Clinic experiences at the hospitals in Cape Town were high-yield. There was a fantastic diversity of skin types and pigment complexions. I became more and more comfortable with subtle morphological differences found in non-Caucasian type skin. There were several conditions I encountered that I had not seen in a North American setting such as pellagra, measles, diphtheria, oral Kaposi’s sarcoma, papular pruritic eruption (PPE) of HIV, atopic dermatitis with post-inflammatory depigmentation in Fitzpatrick type V skin.
I had an unforgettably positive experience. I would like to thank Dr. Khumalo for her consistent teaching, mentorship and warmth. I’d also like to thank the North American Hair Research Society for providing the grant that helped to make the elective financially possible.