Meet the Board: Benjamin Ungar, MD

Born and raised in New York City, Benjamin Ungar, MD, considers himself a “lifer” at the Icahn School of Medicine at Mount Sinai.

“I went to medical school at Mount Sinai and did my residency there, and now I’m a faculty member,” Ungar told Healio. “I was actually born at Mount Sinai as well.”

Ungar is assistant professor of dermatology and director of the Rosacea & Seborrheic Dermatitis Clinic and the Alopecia Center of Excellence at Mount Sinai, in addition to being a member of the Healio Allergy/Asthma Peer Perspective Board.

Healio spoke with Ungar about how his career began, his research breakthroughs and what is next in dermatology treatment.

Healio: How did you come to pursue dermatology as your specialty?

Ungar: Although dermatology wasn’t the primary specialty on my radar when I entered medical school, as I was exploring different specialties, I came to increasingly realize that it is a great fit for me in terms of the kinds of diseases we treat, the broad range of different patients who suffer from skin conditions and the plentiful and available research opportunities. Many different aspects of dermatology came together as really a great fit for me.

Healio: Do you have a particular area of dermatology that you enjoy the most?

Ungar: Broadly speaking, my clinical and research focus specialization is in inflammatory skin diseases, as well as how the immunology of the skin relates to the systemic components of the diseases that we study. My research has focused thus far mostly on atopic dermatitis and alopecia areata, and I have been expanding my efforts into a few other diseases such as seborrheic dermatitis.

Three of the studies I’ve participated in have been particularly interesting and exciting to me. First, we published the first study of biomarkers in using dupilumab (Regeneron Pharmaceuticals/Sanofi-Aventis) to treat moderate-to-severe AD. That was very significant because it greatly improved our understanding of the disease process in atopic dermatitis how biomarkers in skin and blood were modulated by a very effective targeted treatment.

The second study that I was fortunate to be involved in was a profiling study of scalp tissues in alopecia areata where we initially characterized the inflammation seen in the disease and first pointed to type 2 inflammation playing a role in its disease process.

We’re beginning to recognize that alopecia areata, for many people, may be a part of the atopic spectrum of diseases. It’s an area of ongoing research that we’re very excited about and interested in, identifying those patients and coming up with treatments targeting that type 2 inflammation in alopecia areata.

The third study looked at patients with moderate to severe AD in regard to cardiovascular inflammation. We assessed these patients using PET/MRI, which can measure active cardiovascular inflammation, and we found that it was elevated in these patients. It really highlighted and hammered home the point that AD, and likely other inflammatory skin diseases, have systemic inflammation that can impact the whole body.

Healio: What challenges do you face regularly in practice that keep you up at night?

Ungar: The field of dermatology has made tremendous advances in the last several years in treating many inflammatory skin diseases. Unfortunately, however, there is still a large, unmet need for safe and effective treatments for many conditions. There are numerous research efforts to improve our treatment options, but we’re still not there yet.

For many conditions, we have one or more really good treatments, which is sufficient to treat many people, but it’s not the case for everyone. There still is a non-negligible subset of patients who come in, and we don’t yet have the treatments that are safe and effective to really help them improve their skin conditions. From my perspective as a physician-scientist involved in the research and trying to get to the point where we have these treatments, I’d say that’s certainly one of the big obstacles that exists now.

Healio: What do you like to do outside of clinical practice?

Ungar: That’s a great question. My answer is going to be a little cliché, but I enjoy reading and watching TV. I tend to lean toward science fiction. I also enjoy going out to dinner and seeing friends, and on occasion, I enjoy a good board game night. It’s kind of a classic, but Settlers of Catan is one of my favorites t’s a great game.

Healio: What would you say has been the most exciting development in dermatology over the last decade?

Ungar: I don’t know if I’m able to pinpoint one development per se, because there have so many incredible advances that have each have left their mark in different ways. The development of a number of targeted and other systemic treatments for otherwise very difficult-to-treat inflammatory skin diseases has been tremendous. If you look at where things are now compared with a decade ago, the treatment arsenal that we have now would have been unrecognizable at that time, including biologics, JAK inhibitors, other oral small molecules, and others.

Healio: What advances are you most looking forward to over the next 10 years?

Ungar: I think over the next 10 years — and this may not sound exciting on paper, but it is so important — we’ll see advances in new biologics, new immunomodulatory treatments and new oral medications. Perhaps also importantly, we will make strides toward developing a precision medicine approach, because in treating patients, we recognize that most of these inflammatory skin diseases are very heterogeneous in terms of the way they present and in their underlying immunology. So, each person will ultimately require a different approach to identifying the right treatment for that person. I’m certainly looking forward to the field making significant strides in developing approaches that will allow us to identify the right treatment for the right patient from the get-go in the next decade.

References:

• Guttman-Yassky E, et al. J Allergy Clin Immunol. 2018;doi:10.1016/j.jaci.2018.08.022.
• Suárez-Farias M, et al. J Allergy Clin Immunol. 2015;doi:10.1016/j.jaci.2015.06.032.
• Ungar B, et al. J Allergy Clin Immunol Pract. 2020;doi:10.1016/j.jaip.2020.07.018.

For more information:

Benjamin Ungar, MD, can be reached at benjiungar@gmail.com.