During her session, “Pathophysiology of AA & Role of Various Immune Pathways in the Disease,” presented at the Mount Sinai Winter Symposium, Emma Guttman-Yassky, MD, PhD, discussed how alopecia areata (AA) is more complicated than previously thought, and how there are multiple clinical phenotypes with immune abnormalities. Certain patients with an allergic background, such as atopic dermatitis (AD) or asthma, have tendencies to exhibit type 2 immunity. The understanding of these differences and immune responses toward AA may influence the response to treatment.

Dr Guttman-Yassky shared her journey into AA, coming from the world of AD. She noted that many of her patients with AD also had AA. She mentioned how this led to a deeper dive into research surrounding AA, particularly around comorbidity with allergies, AD, and asthma.

Her research involving patient studies has found that the scalp profile of patients with AA is quite similar to patients with AD in terms of type 2 immunity. Essentially, the chronicity of AA is associated with type 1 immunity, whereas the severity of the disease is associated with type 2 immunity.

Dr Guttman-Yassky also advised on how to manage patients' concerns and expectations about the disease, acknowledging the journey as more of a marathon than a speedy treatment process. “It is important to consider the patient's whole health status, not just solely focusing on AA,” she said. “For instance, a patient with AD, asthma, and AA might be considered for different treatment than a patient with only AA.”

Reference
Guttman-Yassky E. Pathophysiology of AA & role of various immune pathways in the disease. Presented at: 26^th Annual Mount Sinai Symposium; November 30-December 3, 2023; New York, NY.