Benjamin Ungar, MD

HCPLive Five: Maui Derm NP+PA Summer 2026

, held in Colorado Springs from June 24 to 27, brought together leading dermatologists to address diagnostic and treatment updates across numerous 

, including eczematous dermatitis, rosacea, autoimmune blistering disease, hair loss, and pigmentation disorders. From IL-13 inhibitor response as a patch testing gatekeeper to the expanding oral JAK inhibitor pipeline in vitiligo, this year's sessions reflected how targeted therapies are reshaping diagnostic sequencing across dermatology subspecialties.

 Nickel and ammonium persulfate are the most missed patch test allergens

 Ocular involvement in up to 50% of patients

 Suspect pemphigoid in patients > 65 years with treatment-resistant pruritus

 3 oral JAK inhibitors FDA-approved for severe alopecia areata

 Vitiligo affects up to 1% of population, half before age 20 years

rounds up 5 key takeaways NPs and PAs can apply in practice.

Eczematous Dermatitis: IL-13 Inhibitor Response Guides Patch Testing Decisions

Matthew Zirwas, MD, of Bexley Dermatology, discussed how IL-13 inhibitor response now guides patch testing decisions in eczematous dermatitis. He starts with a detailed history of product and exposure changes, then trials dupilumab or lebrikizumab across 6 weeks and 3 doses before considering patch testing. Nonresponse or worsening signals likely contact dermatitis warranting testing.

Zirwas identified nickel and ammonium persulfate as the 2 most missed allergens, noting dietary nickel can drive systemic contact dermatitis and ammonium persulfate exposure often stems from hot tub chemicals, both frequently excluded from standard patch testing.

Rosacea Staging: From Pediatric Erythema to Phymatous Disease

Hilary Baldwin, MD, from Atantla Health, used a single composite patient to trace rosacea from pediatric erythema through adult flushing, papulopustular disease, and late-stage phymatous and ocular involvement, matching treatment to each stage. Pediatric rosacea, affecting 4% or fewer children, is often missed because red cheeks appear benign. Background erythema responds to alpha agonists, flushing requires oral carvedilol or botulinum toxin, and telangiectasias need energy-based treatment. Papulopustular disease is the most treatable, with ivermectin, topical minocycline, and newer sub-antimicrobial oral options like Emrosi. Ocular rosacea responds to tetracyclines and topical ivermectin.

Pemphigus, Pemphigoid: Diagnosing Atypical Blistering Disease Presentations

Donna Culton, MD, PhD, of UNC School of Medicine, addressed atypical presentations of autoimmune blistering diseases. Pemphigus often presents with chronic oral ulcers rather than classic flaccid blisters, while pemphigoid may have a prodromal phase resembling urticaria or eczematous dermatitis. Culton advised suspecting non-bullous pemphigoid in patients > 65 years with pruritic disease unresponsive to first-line treatment. She cautioned that serology can be falsely negative, particularly in anti-p200 pemphigoid, and that perilesional biopsy is essential for direct immunofluorescence. Following dupilumab's 2025 FDA approval for bullous pemphigoid, NPs and PAs can initiate treatment earlier, reserving referral for treatment failure or diagnostic uncertainty.

Hair Loss Treatment: JAK Inhibitors and Oral Minoxidil Reshape Care

Benjamin Ungar, MD, of Mount Sinai's Alopecia Center of Excellence, called JAK inhibitors the biggest advance in hair loss treatment over the past 2 years, reshaping care for alopecia areata and scarring alopecia. 3 oral JAK inhibitors, baricitinib, ritlecitinib, and deuruxolitinib, are FDA-approved for severe AA, and Ungar's long-term data show no meaningful increase in cardiovascular or thromboembolic risk despite class-wide boxed warnings. He favors oral JAK inhibitors as first-line systemic therapy over traditional immunosuppressants. Low-dose oral minoxidil is increasingly used across hair loss subtypes, with hypertrichosis as the most common side effect. Ungar views nutraceuticals as adjunctive, useful mainly for patients with underlying nutrient deficiencies.

Vitiligo, Melasma: Pigmentation Treatment Pipeline Advances

George Martin, MD, of the Dermatology and Laser Center of Maui, reviewed advances in vitiligo and melasma treatment. Topical ruxolitinib remains the only FDA-approved topical vitiligo therapy, showing durable, increasing repigmentation through 2 to 3 years of treatment, though extensive disease above 50% body surface area requires additional systemic therapy. Oral JAK inhibitors, including povorcitinib, ritlecitinib, and upadacitinib, are advancing in additional late-stage trials and are expected to replace pulse-dose dexamethasone for widespread active disease.

For melasma, Martin emphasized combining lightening topicals with procedural treatment, noting current sunscreens inadequately block visible light despite its role in pigmentation.

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5 dermatology takeaways from Maui Derm NP+PA Summer 2026, covering eczematous dermatitis, rosacea, blistering disease, hair loss, and pigmentation disorders.

Early Signs of Scarring Alopecia, Pipeline Outlook, With Bejamin Ungar, MD

Early Clinical Clues of Scarring Alopecia

Itching, stinging, burning, tenderness, or pain alongside hair loss should raise early suspicion for scarring alopecia, according to Benjamin Ungar, MD, director of the Alopecia Center of Excellence at the Kimberly and Eric J. Waldman department of dermatology at Mount Sinai. Ungar addressed early diagnostic clues, pipeline therapies, and practical takeaways during his session, "Hair Update 2026," at Maui Derm NP+PA Summer 2026 in Colorado Springs.

“Now, it’s often the case that people may have symptoms for other conditions affecting a scalp, like seborrheic dermatitis, but that should at least prompt careful evaluation for the potential for scarring alopecia,” Ungar told 

Trichoscopy can help identify early or mild disease before a biopsy is pursued, he said. Signs such as erythema and perifollicular scaling on trichoscopy are not diagnostic on their own but can warrant closer workup, including biopsy in many cases.

Evidence-based treatments for scarring alopecia remain limited, and Ungar said there is still substantial work needed to establish reliable options. He pointed to early and small clinical studies suggesting that topical and oral JAK inhibitors may help patients with scarring alopecia, a population that currently has no FDA-approved therapies.

 Ungar called this the area of hair loss research he is most excited to watch, given the unmet need.

Promising JAK inhibitors for scarring alopecia include oral options like tofacitinib, baricitinib, and upadacitinib, which are especially useful for lichen planopilaris and frontal fibrosing alopecia.

 Topical options like tofacitinib and ruxolitinib can be safer choices for localized conditions. The dual TYK2/JAK1 inhibitor brepocitinib is also promising for lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia.

2 Takeaways: Oral Minoxidil for Alopecia and Managing Patient Expectations on JAK Inhibitor Regrowth

Asked for a single practical change clinicians could bring back to the clinic, Ungar said the complexity of hair loss makes it difficult to choose just 1, so he offered 2 instead. The first is broader use of low-dose oral minoxidil, which he uses as both monotherapy and as an adjunctive treatment, particularly in inflammatory alopecia.

The second is setting patient expectations around treatment timelines. Ungar said hair regrowth can take a long time even with well-established, evidence-based treatments such as JAK inhibitors for alopecia areata.

“Making sure that patients understand that it takes time can be extremely beneficial in achieving good outcomes,” Ungar said. “If patients’ expectations are not set on the timeframe, then they may stop therapy early. They may be very concerned that it's not working. The last thing we want to do is have a patient stop before it starts working, when really all it would take is giving it a little more time. So be patient with treatments and give it time to really assess if it's effective.”

Read the first part of our interview with Ungar on the emergence of JAK inhibitors for alopecia areata and scarring alopecia here: 

JAK Inhibitors, Oral Minoxidil Reshape Hair Loss Care

Ungar B. Hair Update 2026. Presented at: Maui Derm NP+PA Summer 2026; 2026.

Green L, Guttman E, Lebwohl, et al. Exploring novel management options for alopecia areata.

. Published on March 3, 2026. Accessed July 10, 2026. 

https://www.ajmc.com/view/exploring-novel-management-options-for-alopecia-areata

Martin A, Sharma D, Su M, Kreytak C, Senna MM. A review of Janus kinase inhibitor use in scarring alopecia. 

At Maui Derm NP+PA Summer 2026, Benjamin Ungar, MD, discussed early clues for scarring alopecia, pipeline JAK inhibitors, and setting patient expectations.

Benjamin Ungar, MD, director of the Alopecia Center of Excellence at the Kimberly and Eric J. Waldman department of dermatology at Mount Sinai, said the emergence of Janus kinase (JAK) inhibitors has been the single biggest advance in 

treatment over the past 2 years, reshaping care for both alopecia areata (AA) and scarring alopecia.

Ungar discussed the shift during his session, “Hair Update 2026,” at the Maui Derm NP+PA Summer 2026 conference in Colorodo Springs.

Currently, 3 oral JAK inhibitors are approved in the US for severe AA: baricitinib (Olumiant), ritlecitinib (Litfulo), and deuruxolitinib (Leqselvi).

 Ungar noted that newer anti-inflammatory approaches, including topical and off-label oral JAK inhibitors, are also beginning to move the needle on scarring alopecia, a historically difficult subtype to treat.

Ungar has published research characterizing the long-term safety of JAK inhibitors in AA, an important consideration given that treatment is typically ongoing rather than time limited. His findings, along with data from other groups, suggest that JAK inhibitor use in AA does not meaningfully increase the risk of major adverse cardiovascular events (MACE) or thromboembolic events beyond background population rates, even over several years of follow-up.

All 3 approved agents carry a US Food & Drug Administration (FDA) boxed warning for class-wide risks, including serious infection, malignancy, MACE, and thrombosis, based largely on post-marketing data from rheumatoid arthritis populations treated with a different JAK inhibitor.

 Ungar's data adds to a growing body of AA-specific evidence that has not shown new or unexpected safety signals to date.

Low-dose oral minoxidil (LDOM) has become an increasingly common option across hair loss subtypes, according to Ungar. He uses it as monotherapy in some patients and in combination with other treatments in others, applying it broadly to androgenetic alopecia and telogen effluvium alike.

Dosing typically starts at 1.25 mg for women and 2.5 mg for men, with titration upward as tolerated, Ungar said. Cardiovascular effects such as hypotension and tachycardia, along with rare pericardial effusion, remain the primary safety concerns, though Ungar noted that large-scale clinical experience has shown these events to be uncommon and that LDOM is generally well-tolerated.

The most frequent adverse effect is hypertrichosis, which Ungar counsels patients to expect before starting treatment. In his experience, most patients who develop unwanted hair growth still choose to continue therapy because of the benefit to scalp hair.

Direct-to-consumer marketing of hair growth nutraceuticals continues to expand, but Ungar said evidence should guide how clinicians position these products. Some formulations have data supporting benefit, particularly in patients with underlying nutrient deficiencies or insufficiencies that can affect the hair cycle. Ungar generally views nutraceuticals as adjunctive rather than core therapy, noting that aside from cost, there is typically little downside to their use alongside evidence-based treatment.

Ungar said severity remains the primary driver of treatment selection in AA. Mild disease is generally managed with intralesional steroid injections, while severe disease warrants systemic therapy. Moderate disease occupies a gray zone in which injections alone may be insufficient.

“Once someone is determined to be a candidate for systemic treatment, in most cases, oral JAK inhibitors are the first-line treatment,” Ungar said. “I think that we as a field should be shifting away from more traditional immunosuppressants like systemic steroids… and really should be using oral JAK inhibitors to treat patients who are systemic candidates because of the higher degree of efficacy and overall better safety profile.”

Ungar B. Hair Update 2026. Presented at Maui Derm NP+PA Summer 2026 in Colorado Springs.

FDA-approved JAK inhibitors. National Alopecia Areata Foundation. Accessed July 8, 2026. 

https://www.naaf.org/navigation-toolkit/fda-approved-jak-inhibitors/

Green L, Guttman E, Lebwohl M, et al. Exploring novel management options for alopecia areata

Published on March 3, 2026. Accessed July 8, 2026. 

At Maui Derm NP+PA Summer 2026, Benjamin Ungar, MD, detailed how JAK inhibitors and oral minoxidil are reshaping hair loss treatment strategy.

Benjamin Ungar, MD

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