Academy HAIR Grants take off
AAD distributes another round of hair disorder research grants
Feature
By Matthew Walsh, Member Communications Specialist, October 1, 2022
Earlier this year, the AAD awarded seven Hair Loss and Alopecia Initiative in Research (HAIR) grants to dermatologists across the country to help fund their research of hair disorders that primarily impact patients with skin of color. Initially, a portion of the money used to fund the grants was earmarked for other purposes, but given the high quality of applications that were received, the Academy repurposed those funds to award four additional grants. Read more about the initial HAIR grant research projects.
The four newly selected awardees will use the grant money to help develop and carry out research strategies and learn important information about hair loss and alopecia. DermWorld interviewed each of the recipients to learn first-hand how they intend to use their HAIR grant to help further understanding and improve treatment of hair disorders.
Identifying biomarkers of therapeutic response and disease progression in central centrifugal cicatricial alopecia
Crystal Aguh, MD, is associate professor of dermatology and director of the ethnic skin program at Johns Hopkins School of Medicine.
DermWorld: Tell us why you chose to study this particular topic.
Dr. Aguh: Central centrifugal cicatricial alopecia (CCCA) is the most common form of scarring and permanent hair loss in Black women. The cause of this condition is currently unknown. Standard treatments include the use of topical steroid preparations in addition to intralesional steroid injections, which are often quite painful for patients. It is very important for us to understand whether these treatments are effective and, if possible, predict who will respond to treatments and who will not.
Tell us about your study/research design/methodology.
Dr. Aguh: We will begin by recruiting 60 patients with early or limited cases of the disease. Punch biopsies will be obtained from the diseased scalp, and patients will subsequently be treated with standard therapy, including topical high-potency corticosteroid preparations and serial steroid injections. After 18 months, patients will be assessed for the extent of disease progression. We will perform RNA sequencing analysis to identify genes that are associated with disease progression despite the use of standard therapy. We will also collect serum samples from participants to understand potential markers that may predict response to treatment.
What do you expect to find with your research?
Dr. Aguh: Preliminary studies from our group suggest that certain genes are associated with widespread disease, but it is unclear if these genes play a role in disease progression. We anticipate that these genes may also be associated with a lack of response to standard therapy.
How will your research address gaps in hair disorders research?
Dr. Aguh: Like many conditions that disproportionately impact Black patients, CCCA is largely understudied, especially when compared to other disorders of the scalp. We hope that through this study, we can identify ways to deliver better, more effective therapy to women affected by this condition.
Characterizing the immunophenotype, potential antigens and cognate T-cell receptors of central centrifugal cicatricial alopecia
Loren Krueger, MD, FAAD, is assistant professor of dermatology at Emory University School of Medicine in Atlanta.
DermWorld: Tell us why you chose to study this particular topic.
Dr. Krueger: CCCA is a devastating disorder. Aside from our understanding that it is a disorder that predominantly affects Black women and likely has dysregulation of fibroproliferation, there is much to be discovered. The role of immune dysregulation leading to inflammation has not yet been flushed out. Patients often grow discouraged and feel treatment options are limited.
Tell us about your study/research design/methodology.
Dr. Krueger: Our first aim is to immunophenotype CCCA lesions by characterizing adaptive and immune factors involved. We will do this using flow cytometry and immunohistochemistry/immunofluorescence. Second, we aim to identify candidate T-cell receptor antigens in CCCA by using the TetTCR-seq method. Cells will be tested against a library of randomly generated pMHC-tetramer library.
What do you expect to find with your research?
Dr. Krueger: We expect to better characterize the immune cells and mediators present in CCCA using flow cytometry and immunohistochemistry/immunofluorescence. We expect to find a predominance of pro-fibrotic CD4+Th2 T-cells. We also aim to identify any CCCA-inducing antigens and their reactive T-cell receptors. It is unclear whether there are direct antigens that may be identified. However, this study model may help us further identify direct antigens in other forms of hair loss as well.
How will your research address gaps in hair disorders research?
Dr. Krueger: CCCA impacts skin of color patients and can be detrimental to quality of life. The field currently accepts that there are likely genetic and environmental components leading to pro-fibrotic changes. However, we are not certain to what degree each contributes and how inflammation plays a role and can be mediated to prevent disease progression. Addressing this gap will allow us to develop more targeted treatments, preventing late-stage cicatricial alopecia. We will also be better empowered to counsel our patients on the role of hairstyling practices in this disorder if we understand how inflammation is contributing to it.
Academy Skin of Color Curriculum
As part of a continued effort to equip its members to provide the best possible care for the skin, hair, and nails of all patients, the AAD recently rolled out a new Skin of Color Curriculum. The curriculum will allow dermatologists to broaden the scope of their expertise to ensure that a diverse population of patients — who come from a wide spectrum of races, ethnicities, and skin colors — receive the best possible care.
Read more from Susan C. Taylor, MD, FAAD, and Daniela Kroshinsky, MD, MPH, FAAD, and visit the AAD Learning Center to utilize the curriculum.
Scalp cooling for chemotherapy-induced alopecia in patients of color: A clinical and mechanistic study
Beth McLellan, MD, FAAD, is chief of the division of dermatology at Albert Einstein College of Medicine in New York.
DermWorld: Tell us why you chose to study this particular topic.
Dr. McLellan: I specialize in supportive oncodermatology and see many of my patients suffering with chemotherapy-induced alopecia. This is detrimental to patients during treatment and in some cases can persist years after therapy in cancer survivors. Scalp cooling is currently the best option to prevent chemotherapy-induced hair loss. However, due to high out-of-pocket costs to patients and lack of data showing efficacy in patients with textured hair, it has not been an option for many of the patients I care for in the Bronx. I chose to study scalp cooling to create access for my patients who have otherwise not had the option for hair preservation during cancer therapy, and show that scalp cooling can be effective in patients with textured hair types by adjusting hair-preparation techniques.
Tell us about your study/research design/methodology.
Dr. McLellan: We will recruit patients with types 3 or 4 hair undergoing taxane-based chemotherapy for breast, lung, or gynecologic cancers and enroll them in one of two arms according to a patient-preference design:
scalp cooling with hair prepped with coating of water and conditioner emulsion then styled in loose braids or twists.
control arm with no scalp cooling.
We will measure hair follicle density and patient quality of life. We will also use plucked hairs for transcriptome profiling to identify predictive markers for scalp cooling success as well as predictors for persistent alopecia.
What do you expect to find with your research?
Dr. McLellan: We expect to find that through adjusting hair-preparation techniques to work with textured hair types, we can demonstrate efficacy of scalp cooling for prevention of chemotherapy-induced alopecia in cancer patients with types 3 and 4 hair. Through our hair follicle transcriptome investigation, we also hope to identify biomarkers that could help identify patients at risk of persistent hair loss and potential therapeutic targets for future studies.
How will your research address gaps in hair disorders research?
Dr. McLellan: Minority patients have been underrepresented in prior scalp-cooling research. Additionally, fear of hair loss can lead patients to decline chemotherapy, which can exacerbate already existing disparities in cancer-related mortality. We hope that showing scalp cooling can be efficacious in patients with textured hair types will bring us one step closer to equality in cancer care.
A multi-omics evaluation of the heterogeneity and pathogenesis of central centrifugal cicatricial alopecia
Arash Mostaghimi, MD, MPA, MPH, FAAD, is assistant professor of dermatology, director of the inpatient dermatology consult service, and co-director of the Complex Medical Dermatology Fellowship at Brigham & Women’s Hospital.
DermWorld: Tell us why you chose to study this particular topic.
Dr. Mostaghimi: CCCA is an incredibly challenging disease for patients. Although we’ve made some advances in determining the genetics of the disease, our overall understanding of CCCA is limited, and our treatment options are inadequate. Our research is inspired by all the patients who have asked, ‘Why isn’t anybody doing research on this?’ This project, which we are doing in collaboration with the George Church lab at Harvard Medical School, will use advanced techniques to provide insights into the pathophysiology of CCCA. We hope that this research will be the first step toward identifying potential targets for new therapies.
Tell us about your study/research design/methodology.
Dr. Mostaghimi: Our study uses a combination of two distinct approaches to compare lesional (CCCA-affected) scalp tissue to matched, unaffected tissue in patients with CCCA. We will first perform a whole-genome analysis of these samples and use machine-learning techniques to identify genetic variants of interest by comparing patients with CCCA with existing data from healthy patients and from patients with other forms of hair loss. Next, we will perform a multi-omics analysis that integrates genomic, transcriptomic, and proteomic data to compare differences between affected and unaffected scalp skin samples within patients.
What do you expect to find with your research?
Dr. Mostaghimi: Our hope is that this research both confirms prior research on genetic variations among patients with CCCA and identifies new genes of interest. Similarly, we hope the multi-omics approach helps translate those genetic variations into a greater understanding of the molecular and inflammatory mechanisms underlying CCCA. These results will serve as the foundation for additional investigation.
How will your research address gaps in hair disorders research?
Dr. Mostaghimi: Patients with CCCA and their treating physicians share a common set of questions. They want to know:
Why is this disease occurring?
What can we do to make it better?
This research will hopefully help answer these questions and put us toward the path for identifying novel treatments for this overlooked illness.
