Dr. Amy Spizuoco shares highlights from her lecture Alopecia Update: What You Should Know in 2025, at the 2nd Annual Elevate-Derm Alliance Summer Meeting at the Grand Hyatt Deer Valley in Park City, Utah.
In this video
Dr. Spizuoco starts every hair loss evaluation by sorting patients into scarring versus non-scarring alopecia, then narrowing down which specific version they have. From there she factors in the patient's age, sex, lifestyle, comorbidities, and any medications they're taking. On CCCA, she notes recent data supporting metformin — either topically alongside other oral medications, or dosed orally on its own if no other oral treatment is being used.
For androgenetic alopecia, she is clear that combinations work best and that "monotherapy is really not effective." She reaches for topicals ranging from minoxidil to compounded minoxidil with finasteride, spironolactone, or tretinoin; oral finasteride or minoxidil for men and oral spironolactone for women; plus PRP, which she calls "super safe and super effective." Throughout, she stresses keeping cost in mind, since polypharmacy and modalities like low-level laser therapy can add up quickly for patients.
- Classify hair loss first as scarring vs. non-scarring, then identify the specific subtype before choosing treatment.
- Weigh age, sex, lifestyle, comorbidities, and current medications in every treatment decision.
- For CCCA, consider metformin — topically in combination with other oral agents, or orally as monotherapy when no other oral treatment is used.
- For androgenetic alopecia, use combinations rather than monotherapy: topicals, oral finasteride/minoxidil for men, oral spironolactone for women, plus PRP.
- Factor in cost — polypharmacy and low-level laser therapy can be effective but expensive for patients.
