Aboul-Fettouh describes the protracted path many patients travel before receiving a correct AA diagnosis-often 6 to 12 months or longer-and explains the psychosocial weight that accumulates during that delay.

The Patient Journey to Diagnosis: Delays, Barriers, and the Psychosocial Toll

Patients with alopecia areata often endure a prolonged and frustrating diagnostic odyssey before they reach a dermatologist who can offer a definitive assessment and a structured therapeutic plan. In the most favorable scenario, a patient notices new hair loss, promptly seeks care, and is seen by a dermatologist who makes the correct diagnosis within weeks. This best-case trajectory, while achievable, is not the norm.

More commonly, patients spend months-and in many cases more than a year— attempting over-the-counter remedies marketed for hair loss, consulting generalist physicians who may not immediately recognize AA, and researching their symptoms online in a cycle that generates anxiety without generating answers. By the time many of these patients arrive at a dermatologist's office, they have already exhausted significant time, energy, and often money chasing treatments that were never suited to an autoimmune etiology.

The consequences of delayed diagnosis extend well beyond the scalp and carry meaningful clinical weight. Patients who have been symptomatic for 6 to 12 months or longer without a diagnosis have typically begun to restructure their lives around their hair loss: wearing hairpieces or head coverings as a daily necessity, declining social invitations that might involve scrutiny of their appearance, and experiencing escalating anxiety or depression that compounds the primary disease burden. The psychosocial impact of AA is not incidental or secondary—it constitutes a core, measurable dimension of the disease. Standardized instruments such as the Dermatology Life Quality Index (DLQI) consistently capture significant impairment in AA populations, and this impairment deepens with every additional month that an accurate diagnosis and effective treatment are deferred. Dermatologists who appreciate this trajectory are better equipped to meet newly referred patients with the urgency and empathy that their situation warrants.

In this segment, Nader Aboul-Fettouh, MD, double board-certified dermatologist and fellowship-trained Mohs Micrographic Surgeon and founder and managing director of Blue Ribbon Dermatology in the Dallas area, outlines the typical patient journey to an AA diagnosis, drawing on his clinical experience to describe the accumulating burden-practical, emotional, and social-that patients carry by the time they reach specialized dermatologic care. He emphasizes that even in an era of highly effective therapies, too many individuals are arriving later than is ideal and already struggling with significant, measurable quality-of-life impairment.

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Aboul-Fettouh clarifies the broad meaning of "alopecia" as a category, distinguishes alopecia areat as an autoimmune subtype, and addresses common patient misconceptions-including misplaced self-blame-that complicate early education and care.

Understanding Alopecia Areata: Terminology, Misconceptions, and Patient Education

The term "alopecia" describes hair loss broadly and serves as an umbrella for dozens of distinct conditions rather than a single diagnosis. Androgenetic alopecia, traction alopecia, telogen effluvium, and alopecia areata are all forms of alopecia, yet each has a fundamentally different etiology, prognosis, and therapeutic approach. This distinction matters enormously in clinical practice: a patient who reports "I have alopecia" has provided the dermatologist with a descriptive term, not a diagnosis. The specific subtype drives management decisions, patient education priorities, and realistic conversations about what treatment can and cannot accomplish. Among all subtypes, alopecia areata (AA) stands out as an autoimmune process in which the body's own immune cells target the hair follicle, producing characteristic bald patches, diffuse thinning, or, in its most severe forms, complete scalp or total body hair loss.

A particularly consequential and persistent misconception is the belief-common among newly diagnosed patients-that their own behavior triggered or worsened the disease.

Patients frequently wonder whether their diet, specific medications, an emotionally difficult period, or accumulated stress caused the follicular destruction they are experiencing. The reality is that AA reflects a combination of genetic predisposition and immune dysregulation; it is not caused or meaningfully worsened by anything the patient ate, took, or felt. Dermatologists managing AA must emphasize this point clearly and, often, repeatedly. Cultural stigmas surrounding visible hair loss can intensify self-blame and amplify the emotional burden of an already distressing diagnosis, making empathetic, corrective counseling an integral-not optional-component of every early clinical encounter. Patients who understand that they did not cause their disease are better positioned to engage with treatment and adhere to long-term therapy.

In this segment of a video discussion on alopecia areata, Nader Aboul-Fettouh, MD, double board-certified dermatologist and fellowship-trained Mohs Micrographic Surgeon and founder and managing director of Blue Ribbon Dermatology in the Dallas area, explains the critical distinction between the generic term "alopecia" and the specific autoimmune entity "alopecia areata." He also describes how he approaches the patient who arrives at the dermatology office already burdened by unwarranted guilt about their condition, and why correcting that narrative early is foundational to the entire therapeutic relationship.

Distinguishing Functional Constipation From IBS-C and Embracing a Positive Diagnosis

Learn how Rome V criteria, predominant symptom drivers, and a positive diagnostic framework help clinicians distinguish functional constipation from pediatric IBS-C and move away from a diagnosis-of-exclusion mindset.

Pediatric functional constipation and irritable bowel syndrome with constipation (IBS-C) frequently present with overlapping symptoms, posing a diagnostic challenge for clinicians. In this discussion, pediatric gastroenterologist Julie Khlevner, MD, emphasizes that both conditions fall under the umbrella of disorders of gut–brain interaction and are best approached using symptom-based tools such as the Rome V criteria. She notes that Rome V provides a practical framework for parsing patterns of stooling, pain, and associated features, allowing clinicians to reach a confident, positive diagnosis rather than defaulting to an exclusionary label.

Khlevner explains that functional constipation is typically characterized by infrequent and/or painful defecation, fecal incontinence, passage of large-diameter stools, and fecal impaction. In contrast, IBS is driven primarily by abdominal pain that is often temporally related to defecation and associated with changes in stool form and frequency. Diagnostic uncertainty arises when children with significant constipation also report abdominal pain, bloating, and discomfort; fecal retention itself can generate visceral hypersensitivity that mimics IBS. She advises that IBS should be diagnosed when pain clearly remains the predominant, persistent symptom, even in the presence of constipation-related signs.

Historically, families often experienced IBS as a diagnosis of exclusion, conferred only after extensive testing failed to identify an “organic” cause, a process that could heighten anxiety and undermine confidence in the diagnosis. Khlevner describes how the Rome framework and a growing understanding of disorders of gut–brain interaction have enabled her to present IBS and functional constipation as legitimate biopsychosocial conditions diagnosed clinically when characteristic symptom patterns are present and alarm features are absent. She stresses that a positive diagnosis does not negate the need for careful history, physical examination, growth assessment, and selective testing, but it does shift the emphasis from “ruling everything out” to recognizing a well-described condition with known mechanisms and evidence-based management strategies.

Learn how Rome V criteria and gut–brain insights clarify pediatric constipation vs IBS-C, reducing unnecessary tests and guiding targeted pain care.

Robert Wallis, MD, is the chief scientific officer at the Aurum Institute and adjunct professor in the department of medicine at Vanderbilt University Medical Center.

2026 American Thoracic Society (ATS) International Conference

 in Orlando, Florida, investigator Robert Wallis, MD, the chief science officer at the Aurum Institute & professor of medicine at Vanderbilt University, presented preliminary findings from the PanTB-HM phase 2c trial, which evaluated 3 novel 4-month pan-TB regimens, each containing the investigational oxazolidinone sutezolid, against standard 6-month HRZE therapy in 378 adults across South Africa, Tanzania, and Mozambique.

Among participants with impaired baseline lung function (FEV1 ≤62%), recipients of the S1600BPN regimen—sutezolid 1600 mg, bedaquiline, pretomanid, and N-acetylcysteine (NAC)—demonstrated markedly superior FEV1 recovery compared with controls, a 10.6 percentage point difference at day 14 that was largely maintained through day 168. No typical oxazolidinone adverse events were observed across any experimental arm.

 sat down with Wallis during the meeting to discuss what these results may mean for clinicians managing TB-associated lung disease and the evolving role of sutezolid and NAC in next-generation TB regimens.

 Pulmonologists know that structural lung damage from TB can be permanent. Is the FEV1 recovery you're seeing reflecting true functional restoration, or is some of this early resolution of inflammation and consolidation? How do you interpret that distinction clinically?

We need to do that study [further]. The longest we have followed patients is about a year and a half, and the numbers get small as we go out that far. Lung damage after TB does seem permanent [in most patients].

There was one study, [conducted in] South Africa by Paul Wilcox [and] published in 1989, that called 80 individuals back to the TB clinic after [they had been] discharged [as] cured, and their lung function was impaired—[in some cases] up to 17 years [later] in proportion to how bad their x-ray was at the time of TB diagnosis and even in proportion to how much sputum they were producing at the time.

You could plot a graph of FEV1 a decade later [against the] amount of [daily] sputum [volume] produced at the time of diagnosis, and they were very correlated. At a minimum, this is permanent damage, but we think it actually can be progressive in many patients because of impaired mucosal immunity and [recurrent] infections of many types: bacteria, fungal, and [viral].

 The lung function benefit appeared most pronounced in the S1600BPN arm—the one that includes NAC. How confident are you that NAC is doing meaningful work here?

I’m reasonably confident that the NAC was doing something. This is actually the second study that we have done [with NAC]. In the first study, it was added to standard TB treatment—HRZE—and we saw a similar benefit in terms of [FEV1] recovery. I think the majority of the [lung function] benefit…is probably attributable to NAC. I have to offer guarded advice to pulmonologists [about] how to use this information because of the findings [from] these two studies.

They are [small] phase 2 trials with some added long-term follow-up. In the first study that we did in Tanzania [n = 140; about 70 participants per arm], we had some indications that NAC might be interfering with the antimicrobial activity of the TB regimen. There were 2 [not statistically significant] relapses in the control arm and 5 relapses in the NAC arm. We saw a near-significant trend toward delayed culture conversion, [which had a hazard ratio of] 0.8, [but] the P-value was not less than .05—it was .08—[and] that’s a concern.

We also looked at the rate of change of [viable MTB] elimination of viable MTB [in] sputum [using] midget [time-to-positivity (TTP) in mycobacterial culture tubes]. This is an alternative way to measure colony counts. The clearance of colonies was slower [in the NAC arm], and this was highly statistically significant.

I say this because trying to understand the antimicrobial effects of NAC in TB is quite challenging. There have been a number of animal and in vitro studies that would suggest that NAC has direct antimicrobial activity against a wide range of organisms. [Studies] in guinea pigs and…mice that said colony counts in target organs go down, but when you start combining it with specific antimicrobial drugs, the picture gets very complicated. It seems to depend a lot on how you design the experiment, which drug you choose, how much of each drug you give, and what's the outcome measurement.

In some studies, it seemed like there might be a benefit. [In one study], the [NAC completely] took away the in vitro effect of isoniazid.

 Is there a broader message for pulmonologists about mucolytic or antioxidant adjuncts in TB treatment?

I am not an expert on this subject, but…the findings from these two studies…seem to indicate a detrimental effect when [NAC is combined with] standard TB treatment and [a possible] benefit when given with this new regimen. This difference needs to be explored further. Both [regimens] showed a benefit in lung function, but it's quite possible that only one of the regimens shows better antimicrobial activity.

 One of the concerns with oxazolidinones as a class is toxicity—myelosuppression, peripheral neuropathy. You saw no typical oxazolidinone SAEs here. How do you explain that?

[Across] the studies that I did at Pfizer and the [current studies], there are probably 5 or 6 clinical trials of sutezolid, and there are 3 in which the participants received doses in the range we're giving now—1200 or 1600 mg a day for more than a month, [in our case for] 4 months—[and we] saw none of the typical [lineazolid] adverse events. Those are peripheral neuropathy, anemia [or other] cytopenias, and an optic neuropathy.

We think that those [toxicities] occur due to off-target effects, [specifically] the inhibition of mitochondrial protein synthesis. It turns out that nerve cells and bone marrow cells are particularly sensitive to these unintended effects. We saw none of these [events] in 2 reasonably powered studies. [It is] very exciting to be able to advance a new oxazolidinone to be used worldwide for tuberculosis.

 How should clinicians think about sutezolid's safety profile relative to linezolid?

This problem with linezolid, [particularly its tendency to cause] anemia, is huge. Being able to put [rifampicin]-resistant TB patients on a BPAL [regimen] was a remarkable advance, but [linezolid] puts bedaquiline at risk because of the patients who end up having to have their treatment stopped, maybe a month or 2 months into treatment, because of severe anemia.

In most poor countries, what happens is they're given an iron supplement or they're given something else, and they're monitored, and finally the treatment is stopped, and then finally they're admitted to a hospital for transfusion, because in very few of these areas are there capabilities to do transfusions as outpatients—it can take a month [or] 2 months before patients can get back on to treatment. The problem is that the treatment is not really stopped because they have already received a month or 2 of bedaquiline.

Their tissues are saturated with bedaquiline, and so effectively they are continued on bedaquiline monotherapy during this [period], while the anemia due to linezolid is being sorted out. At least in my opinion, this is the key reason why there has been [such rapid] emergence of bedaquiline resistance as quickly as we have seen it.

Editor’s note: A relevant disclosure for Wallis includes Otsuka Pharmaceutical Development & Commercialization.

Wallis R, Mudzengi D, Mashatole S, et al. (

) Novel 4-month Pan-TB Regimens Promoting Recovery of Lung Function: Preliminary Findings of the PanTB-HM Phase 2c Trial. Poster presented at ATS 2026 on May 17.

Wallis R. Novel 4-Month Pan-TB Regimens Show Promise for Lung Function Recovery. HCPLive May 18, 2026. Accessed June 8, 2026. 

https://www.hcplive.com/view/4-month-pan-tb-regimens-promise-lung-function-recovery

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At ATS 2026, Robert Wallis, MD, discussed PanTB-HM findings on FEV1 recovery and NAC antimicrobial interactions.

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Sutezolid Shows Promise as Safer Oxazolidinone in Novel 4-Month TB Regimen

Henry Lim, MD, is the senior vice president of academic programs at Henry Ford Health. He previously served as chair of the department of dermatology.

Jane Yoo, MD, is an assistant clinical professor at the Icahn School of Medicine at Mount Sinai and is both a board certified dermatologist and dermatologic surgeon.

Jeanine Downie, MD, is a board-certified dermatologist, and founder of image Dermatology PC in Montclair, NJ.

Rebecca Vasquez, MD, is an associate professor of dermatology at UT Southwestern.

How Inclusive Messaging Could Improve Skin Cancer Prevention

 explored the importance of comprehensive photoprotection and culturally relevant public health messaging in reducing skin cancer risk among patients with skin of color. The discussion also highlighted emerging research areas that may help address persistent gaps in prevention and awareness.

Hosted by Rebecca Vasquez, MD, associate professor of dermatology at UT Southwestern Medical Center, the episode featured Jeanine Downie, MD, founder of Image Dermatology PC in Montclair, New Jersey; Henry Lim, MD, former chair of dermatology at Henry Ford Health; and Jane Yoo, MD, assistant clinical professor at the Icahn School of Medicine at Mount Sinai.

The conversation centered on the idea that sunscreen should be viewed as only one component of a broader photoprotection strategy. Lim emphasized that clinicians should continue encouraging patients to spend time outdoors because of the physical and psychological benefits associated with outdoor activity. However, he argued that sun safety must be approached as a “total package” rather than relying exclusively on sunscreen use.

According to Lim, effective photoprotection includes seeking shade when possible, wearing photoprotective clothing, utilizing wide-brimmed hats and sunglasses, and applying broad-spectrum sunscreen to exposed skin. He also stressed the importance of educating both clinicians and patients about visible light protection, particularly for individuals with darker skin tones who may be more susceptible to pigmentation disorders. Lim noted that tinted sunscreens currently represent one of the best available options for visible light protection in the United States.

The discussion then shifted toward public education and outreach. Downie argued that skin cancer prevention campaigns have historically failed to adequately represent diverse populations, contributing to the misconception that skin cancer primarily affects lighter-skinned individuals. She called for greater inclusion of skin of color models in educational materials, public service campaigns, and patient-facing resources.

Downie pointed to the death of Bob Marley from acral lentiginous melanoma as a frequently cited example in discussions of skin cancer among Black patients. However, she emphasized that public health messaging should not focus exclusively on uncommon presentations. Instead, she advocated for educating patients about both atypical and more common forms of skin cancer that can occur across all skin tones. Downie also stressed that awareness campaigns should illustrate the real-world consequences of delayed diagnosis, noting that greater visibility and representation remain critical to improving outcomes.

Referencing advocacy efforts discussed earlier in the episode, Lim highlighted continued public education as a major priority moving forward. He also outlined several research areas that may improve photoprotection in the future, including the development of newer ultraviolet filters capable of providing enhanced protection against longer-wave UVA radiation, which plays an important role in hyperpigmentation and photoaging.

Beyond sunscreen filters, Lim expressed optimism about emerging research into “biologic photoprotection.” These approaches include antioxidants and other ingredients designed to suppress UV-induced skin changes rather than simply blocking ultraviolet radiation. He noted that while only a limited number of such agents are currently supported by strong evidence, ongoing research into topical and oral photoprotective compounds may eventually expand the options available for skin cancer prevention and skin health, particularly among patients with skin of color.

To learn more about SOCS’s programs and initiatives, visit 

Editor’s note: This episode was summarized with the help of AI tools.

Disclosures: Lim reported research funding to his institution from Incyte, L'Oréal, Pfizer, and PCORI; consulting relationships with ISDIN, Beiersdorf, Ferndale, L'Oréal, Eli Lilly, Zerigo Health, Skinosive, Kenvue, Cantabria Labs, and NAOS; and speaking engagements for La Roche-Posay, Cantabria Labs, Pierre Fabre, NAOS, Uriage, Pfizer, and ISDIN. Downie reported consulting, research, and/or speaking relationships with Johnson & Johnson, Allergan, SkinMedica, Merz, Pfizer, Galderma, Lifes2Good, Perigee Medical, Nutrafol, Valeant, Intendis (Bayer), BTL, Restorsea, Procter & Gamble, Theraplex, ThermiRF, Revance, Neothetics, Evidera, Alphaeon, Ranbaxy, Fibrocell, BioPharmX, and Exeltis, and is a shareholder in RegimenMD. Yoo reported serving as a consultant for Amorepacific US Inc. Vasquez reported no relevant disclosures.

Chao LX, Sheu SL, Kundu RV, et al. Identifying gaps in consumer knowledge about sunscreen. J Am Acad Dermatol. 2017 Dec;77(6):1172-1173.e2. 

Vasquez R, Lim H, Yoo J, Downie J. Skin of Color Savvy: The Sunscreen Gap—Cancer Prevention in Skin of Color. HCPLive. May 26, 2026. Accessed June 8, 2026. 

https://www.hcplive.com/view/skin-of-color-savvy-sunscreen-gap-cancer-prevention-skin-color

This segment of the latest Skin of Color Savvy episode highlights clinician viewpoints surrounding sun protection and skin cancer.

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Diana Isaacs, PharmD, is an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic.

Ketan Dhatariya, MD, PhD, MS, joins the show to discuss how therapies for diabetes have evolved in the UK in comparison to the US.

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Phase 4 PASSAGE data from ATS 2026 show tezepelumab reduced exacerbation rates across a diverse real-world cohort, including smokers, adolescents, and patients with comorbid COPD.

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Tezepelumab Reduces Severe Asthma Exacerbations by 70% in Phase 4 PASSAGE

Abigail Brooks is a strategic content lead overseeing 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

twiist improved time in range by 16 percentage points and reduced HbA1c by 0.7 points over 13 weeks in insulin-treated adults with type 2 diabetes, with no severe hypoglycemia events.

twiist AID System Improves HbA1c, Time in Range in Insulin-Treated Type 2 Diabetes

Dr. Kiera Booth, MD, is a board-certified dermatologist practicing at Premier Dermatology & Cosmetic Surgery in the Newark and Middletown, Deleware areas.

This Q&A interview highlights key takeaways regarding hidradenitis suppurativa, raising awareness for HS Awareness week, and the current treatment landscape.

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Q&A: How Does the Current HS Landscape Look? With Kiera Booth, MD

In the phase 2 SLIMMER-UP-SWITCH trial, ecnoglutide delivered greater weight loss and waist circumference reduction than semaglutide at 20 weeks in adults with obesity in China.

Ecnoglutide Delivers 35% Greater Weight Loss Than Semaglutide in Head-to-Head Trial

Trang Ly, PhD, MBBS, joins the show to discuss Insulet’s recent advancements in automated insulin delivery and the trajectory of the Omnipod platform.

Diabetes Dialogue: Omnipod and AID Advancements at Insulet, With Trang Ly, PhD, MBBS

DKA remains a growing challenge in diabetes care, with new data highlighting missed diagnoses, rising admissions, and higher costs.

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Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

A new substudy of VESALIUS-CV presented at ADA 2026 has confirmed that evolocumab’s cardioprotective effects extend to patients at risk from diabetes.

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The Patient Journey to Diagnosis: Delays, Barriers, and the Psychosocial Toll

Understanding Alopecia Areata: Terminology, Misconceptions, and Patient Education

Distinguishing Functional Constipation From IBS-C and Embracing a Positive Diagnosis

Sutezolid Shows Promise as Safer Oxazolidinone in Novel 4-Month TB Regimen

How Inclusive Messaging Could Improve Skin Cancer Prevention