Alopecia Areata Lesions Research Articles

Potential relationship between the canonical Wnt signalling pathway and expression of the vitamin D receptor in alopecia

Vitamin D receptor (VDR) is expressed in dermal papilla cells and in the epidermis of the hair follicle. Patients with alopecia areata (AA) and alopecia universalis (AU) have VDR mutations. We investigated expression of VDR in isolated hair follicles and epidermal keratinocytes from patients with AA or AU, and assessed changes in the expression of Wnt signalling regulation factors to determine the relationship between the occurrence of AA or AU and decreased expression of VDR. Immunohistochemistry was performed for canonical Wnt signalling molecules, VDR, and proliferation and differentiation markers in the skin tissue of patients with AA or AU. After VDR small interfering RNA or Dickkopf-1 (DKK1) treatment of follicle dermal papilla (DP) cells, expression of VDR and Wnt signalling molecules was determined. DKK1 was used to treated keratinocytes and DP cells in a transwell coculture system. Western blotting analysis was performed to assay for VDR and β-catenin. Expression of Wnt/β-catenin signals and VDR was decreased in AA or AU lesions compared with nonlesional skin. Inhibition of Wnt/β-catenin signals and VDR influenced differentiation and proliferation of epidermis and hair follicles. In the transwell coculture system, DKK1 reduced the expression of VDR and β-catenin in cells in a dose-dependent manner. This study demonstrates that the decreased expression of VDR in AA and AU lesions is related to decreased expression of Wnt/β-catenin signals, which inhibits proliferation and differentiation of hair follicles and epidermal cells.

Quantity and distribution of Langerhans cells and CD8 + T cells in lesions of alopecia areata

Objective To analyze the quantity and distribution of Langerhans cells in lesions of alopecia areata (AA),so as to investigate their role in the pathological process of AA as well as their relationship with T lymphocytes.Methods Tissue specimens were obtained from the scalp lesions of AA in 29 patients,including 16 in active phase and 13 in non-active phase.All the specimens were subjected to immunohistochemical staining for CD1a,and 17 specimens to immunohistochemical staining for CD4 and CD8.Fluorescence-based semi-quantitative reverse transcription (RT)-PCR was performed to determine the mRNA expressions of CD1a and granulocytemacrophage colony stimulating factor (GM-CSF) in the full-thickness skin specimens.Statistical analysis was done using Mann Whitney U test and Pearson correlation analysis.Results There was a significant increase in the quantity of CD1a+ Langerhans cells in the epidermis,perivascular and perifollicular areas in the upper and deep dermis of the AA patients compared with the healthy controls (Z =4.354,2.884,4.640,3.217,3.496,all P ＜ 0.01),and in the epidermis,perivascular and perifollicular areas in the deep dermis of AA patients in active phase compared with those in non-active phase (Z =2.457,2.130,1.954,P ＜ 0.05 or =0.05).The relative mRNA expression levels of CD1a and GM-CSF in the patients were similar to the healthy controls in the upper dermis,but significandy higher than the healthy controls in the deep dermis (Z =2.702,2.941,both P ＜ 0.01).A positive correlation was observed between the quantity of perivascular Langerhans cells in the upper dermis and that of perifollicular CD8+ T lymphocytes in the deep dermis in patients with AA (r =0.618,P ＜ 0.05) and in patients with active AA (r =0.795,P =0.01),but not in patients with inactive AA (r =0.304,P ＞ 0.05).Conclusions The number of Langerhans cells is elevated in patients with AA,especially in patients with active AA.The quantity of perivascular Langerhans cells in the upper dermis is positively correlated with that of perifollicular CD8 + T lymphocytes in the deep dermis of active AA lesions,hinting that Langerhans cells play an important role in the progression of AA. Key words: Alopecia areata; Langerhans cells; T-lymphocytes; CD1a protein

Association of HSPA1B SNP rs6457452 with Alopecia Areata in the Korean Population

The heat shock 70 kDa protein 1B (HSPA1B), which has been well-studied among the famous heat shock proteins HSPA1A/B/L, is related to autoimmune diseases, including Alopecia Areata (AA). In this study, the association of a 5’-untranslated region (5’UTR) SNP rs6457452 and a promoter SNP rs2763979 (‐1140C > T) of HSPA1B with AA was investigated in 236 controls and 228 AA patients. Statistical analyses using the multiple logistic models were done, according to the onset and the clinical features of AA, including the age of onset, family history, type of AA lesion, nail involvement and body hair involvement. The results showed that rs6457452 was associated with the onset of AA (p < 0.002). In the analysis of clinical features of AA, rs6457452 was weakly related to the age of onset (p ≤ 0.04) and that rs2763979 was only weakly related to the type of AA lesion (p = 0.041). In conclusion, we suggest that the 5’UTR SNP rs6457452 of HSPA1B may be associated with the onset of AA and the T allele of rs6457452 may confer the reduced susceptibility to AA in the Korean population.

Early stage alopecia areata is associated with inflammation in the upper dermis and damage to the hair follicle infundibulum

Alopecia areata (AA) is a non-scarring inflammatory hair loss disease. We investigated the early pathological changes of AA to identify possible factors participating in its pathogenesis. Clinical, laboratory and pathological features of 87 AA patients were investigated. Anti-nuclear antibody was found in 11 of 85 patients tested (13%), with a higher percentage in women (21%) than men (5%) (P = 0.026). In early AA lesions, inflammatory infiltration in the upper dermis and epithelial cell damage of the hair follicle infundibulum, just above the sebaceous gland, was observed. Liquefaction and disarrangement of peripheral infundibular epithelial cells coexisted with T-lymphocytic invasion and regression of the lower follicle. The latter findings positively correlated with the presence of eosinophils and perivascular mononuclear cell infiltration in the upper dermis. Eosinophilic infiltration was found in 35 patients (40%) and was positively correlated to elevated serum IgE levels (r = 0.21, P = 0.044), a more severe perivascular lymphocytic inflammation in the upper dermis (r = 0.24, P = 0.026), as well as a prominent swarm of bees-like peri-follicular infiltration (r = 0.41, P < 0.001). Mast cells were abundant in the upper dermis, especially around blood vessels, and positively correlated with eosinophil presence (r = 0.30, P = 0.027). Damage to the hair follicle infundibulum in the upper dermis might be an important component of early changes in AA lesions, possibly caused by lymphocyte cell infiltration in the same area. AA may involve damage of the upper hair follicle as well as the bulb, possibly involving hypersensitivity and autoimmunity.

Expression of filaggrin in alopecia areata lesions of patients

Objective To assess the relationship of filaggrin expression with atopic diathesis and disease severity in patients with alopecia areata (AA).Methods Thirty-seven patients with AA aged (26.3 ± 10.6) years were enrolled in this study.Atopic diseases were noted in 8 of these patients.Clinical data and laboratory test resuhs were reviewed.Immunohistochemical staining was performed to quantify the expression of filaggrin protein in scalp biopsy specimens from all of the 37 patients with AA and from 10 human controls,and fluorescence-based semiquantitative reverse transcription-PCR to detect the expression of filaggrin mRNA in scalp biopsy specimens from 22 patients with AA and 13 healthy controls.Data were statistically analyzed by Mann Whitney U test,chi-square test,and Spearman's rank correlation test.Results The expressions of filaggrin protein and mRNA were significantly lower in patients with AA than in the controls (P ＜ 0.05 or 0.01 ),and the decrease seemed more obvious in patients with large areas of lesions,long duration of disease,and nail abnormalities,but the degree of decrease was unrelated to the complication with atopic diseases.No significant differences were observed in sex ratio,age at onset,disease duration,area of hair loss,the prevalence of family history or incidence of nail abnormalities and increase in serum IgE and eosinophils,between patients with atopic diseases and those without.Conclusions The expressions of filaggrin protein and mRNA are decreased in patients with AA,suggesting that filaggrin may participate in the development of AA and is correlated with the severity of AA. Key words: Alopecia areata; Filaggrin; Immunity

Circumscribed alopecia areata incognita

The characteristic lesion of alopecia areata is a smooth bald patch on the scalp. When there is no bald surface it is called alopecia areata incognita. To date, all cases of alopecia areata reported as so-called 'incognito' have shown a diffuse involvement of the scalp as in acute telogen effluvium. Recently, we have observed two patients who showed localised hair thinning of the scalp without bald spots. Histopathologically, the lesions were typical of alopecia areata with peribulbar lymphocytic infiltrates. The response to corticosteroid treatment and its clinical course were also compatible with alopecia areata.

In vivo imaging of alopecia areata with confocal laser scanning microscopy

Objective To assess the microscopic features of alopecia areata (AA) by using in vivo confocal laser scanning microscopy (CLSM).Methods Between January 2010 and May 2011,26 male and 20 female patients diagnosed with AA were enrolled in this study.AA lesions and perilesional normal skin were examined by means of in vivo CLSM.Tissue specimens were obtained from the lesions and perilesional normal skin of 10 out of the 46 patients and subjected to routine histopathologic examination.Results The number of hair follicles per unit area (cm2) was decreased in lesions of progressive AA and resting AA compared with normal perilesional skin (134.856 ± 18.301 and 147.159 ± 17.536 vs.301.613 ± 35.317,both P ＜ 0.05).Although the quantity of hair follicles increased in lesions of recovery AA ((227.778 ± 16.861 )/cm2),but was still less than that in the normal perilesional skin (P ＜ 0.05).There was a lack of hair shaft in follicles,as well as an inflammatory infiltration in hair follicles,around hair follicles and capillaries in superficial dermis in lesions of progressive AA.The inflammatory infiltration was attenuated in lesions of resting AA.In lesions of recovery AA,the infiltration was further attenuated with an apparent growth of lanugos and terminal hairs.Conclusions As far as AA lesions are concerned,CLSM images are consistent with histopathological findings.CLSM may serve as a promising tool for monitoring efficacy and predicting prognosis based on hair growth cycle,hair follicle number,and inflammatory infiltration degree. Key words: Microscopy, confocal; Alopecia areata

Hair shaft abnormalities in alopecia areata evaluated by optical coherence tomography

Optical coherence tomography (OCT) is able to provide highly reproducible measurements of hair shaft thickness, including hair shaft diameter, cross-sectional surface area and hair shape, similar to histology but in vivo. Variations in the caliber of hair shafts have been described in patchy hair loss like alopecia areata (AA) using electron microscopy. The aim of this study was to evaluate whether OCT is useful for the evaluation of hair shaft abnormalities in AA. The measurements were performed on patients with AA (n=9), aged 2-66 years. Fifty hairs from the border of an alopecic area and 50 hairs from an unaffected area without hair loss were examined using the OCT technique. The hair parameters were characterized by the cross-section (CS) and the form factor. The ratio of the maximal and minimal diameters of the hair at a fixed measuring distance from the scalp surface determined the form factor (d(max)/d(min)). In all cases, the CS of hairs from an AA patch was significantly lower compared with hairs of an unaffected area. However, the form factor did not indicate any disturbances in hair growth. The results demonstrate that structural abnormalities of hair shafts are found in active lesions of AA, but not in clinically unaffected hairs. The OCT technique is a promising method to gain more insight into the pathogenesis of AA in a non-invasive way.

Dermoscopic features of alopecia areata and their correlation with clinicopathological manifestations

Objective To observe the microstructural changes in lesions of alopecia areata (AA) with dermoscopy and to evaluate their correlation with clinicopathological manifestations. Methods The area of alopecia of 62 patients with AA and 44 patients with other types of hair loss were observed by using a noncontact polarized dermoscope (Dermlite, USA). Clinical data on and laboratory findings from these patients were collected. Pathological examination was carried out with scalp biopsy specimens from the alopecia area of 15 AA patients. Results Characteristic dermoscopic signs of AA included yellow dots, black dots, broken hairs, exclamation mark hairs, short vellus hair and newly-grown short hairs. Among these signs, yellow dots showed the highest prevalence (83.9%). Exclamation mark hairs, black dots and broken hairs were rather specific signs for AA, and the prevalence of the three signs was positively correlated with disease activity and positivity rate of hair-pull test. A positive correlation was also noted between the prevalence of elevated thyroid peroxidase antibody levels and positivity rate of hair-pull test (r = 0.269, P ＜ 0.05 ) as well as prevalence of broken hairs (r = 0.445, P ＜ 0.05), and between the prevalence of yellow dots and that of keratinous plug in follicular orifice. There was a negative correlation between the prevalence of newly-grown short hairs and perifollicular mast cell infiltration and between the prevalence of black dots and the anagen/catagen ratio. Conclusions Yellow dots can serve as a preliminary screening marker for AA. Exclamation mark hairs, black dots and broken hairs are highly sensitive for the confirmation of diagnosis of AA, and often predict progressive AA.Dermoscopic signs are well correlated to the histopathology features of AA, and may be useful for the evaluation of disease severity and guidance on the treatment of AA. Key words: Alopecia areata; Dermoscopy; Pathologic processes

Involvement of the bulge region with decreased expression of hair follicle stem cell markers in senile female cases of alopecia areata

Alopecia areata (AA) is a common hair loss disorder characterized by cellular autoimmune reaction predominantly involving the bulbar portion of anagen hair follicles. In most cases of AA, the bulge stem cell area remains intact. Recently, a couple of molecules, such as keratin15 (K15) and CD200, have been identified as biomarkers of human bulge cells. Of note, an immunosuppressive molecule, CD200 is speculated to provide an immune privilege for bulge stem cells. To investigate expression levels of stem cell markers, especially CD200, in two senile female cases of AA with unusual lymphocytic cell infiltrates surrounding both the bulge and the bulbar regions. Then, compare them with those in common AA cases without the bulge involvement. Transverse sections containing the bulge levels were prepared from unaffected and affected lesions, respectively, from each AA group and immunohistochemical investigation using anti-K15 and CD200 antibodies was performed. Importantly, an approach to detect CD200 in paraffin sections was newly developed. Immunoreactivities of individual antibodies were compared between corresponding lesions in each patient group. In unaffected bulge lesions, K15 immunoreactivity was not different between bulge-involving AA and common AA groups, whilst that of CD200 was decreased in the former group. Both K15 and CD200 immunoreactivities were decreased in affected bulge lesions of bulge-involving AA compared to the bulge of common AA cases. Selective downregulation of CD200 in the bulge area could contribute to the collapse of immune privilege with resultant unusual bulge involvement in a subset of AA.

Coexistence of giant blue nevus of the scalp with hair loss and alopecia areata

A 43-year-old Japanese man presented with a 13-year history of a grayish macule measuring 7 cm in diameter with sparse hairs on the vertex. Histopathological examination demonstrated two types of melanocytes, spindle-shaped and ovoid cells, with abundant melanin aggregated around the upper part of the pilosebaceous apparatus. Fibrous, thick collagen bundles were also seen surrounding the upper part of the small hair follicles. There was no infiltration of melanocytes or lymphocytes in the lower dermis or adipose tissue. Based on these findings, a diagnosis of blue nevus, cellular type, was made. Giant cellular blue nevi on the scalp are rare, and 11 cases reported in the published work have shown characteristic features such as hair loss and cranial invasion of nevus cells. It should be noted that melanocytes of giant blue nevi have a high potential to damage other organs such as underlying bone and hair follicles. The patient also showed a typical lesion of alopecia areata on the left temporal which was successfully treated with topical corticosteroid.

Treatment of alopecia areata with 308‐nm excimer lamp

Alopecia areata is considered to be a T-cell mediated autoimmune disorder. The 308-nm excimer lamp is thought to be capable of inducing T-cell apoptosis in vitro, suggesting that the lamp might be effective for the treatment of alopecia areata. We examined the effectiveness of the 308-nm excimer lamp for the treatment of alopecia areata. We recruited three patients with single alopecia areata lesions that were resistant to conventional treatment. The lesions were exposed to a 308-nm excimer lamp at 2-weekly intervals. Hair regrowth was observed in all three patients after approximately 10 treatment sessions. Our study showed that exposure to the 308-nm excimer lamp effectively induced hair regrowth in solitary alopecia areata lesions. Apart from erythema, there were no significant adverse effects. Therefore, we suggest that it may be considered as a treatment modality for recalcitrant alopecia areata.

An implication for post-transcriptional control: Reciprocal changes of melanocortin receptor type 2 mRNA and protein expression in alopecia areata

Alopecia areata (AA) is a hair follicle-specific autoimmune disease that is inherited genetically but triggered environmentally. Stress response is believed to play a role in the pathogenesis of AA. The hypothalamic-pituitary-adrenal axis (HPA axis), known as the stress axis, plays a cardinal role in the stress response. Growing evidence demonstrates that stress responses are under the control of both the central and peripheral nervous systems. Skin and hair follicles display peripheral HPA axis-like signaling systems. Some studies have revealed that a modified HPA axis, which is characterized by enhanced CRH/CRHR and insufficient glucocorticoid, is involved in the pathology of AA, suggesting that the paradoxical expression differs from that of normal control and should be further examined. Because adrenocorticotropic hormone (ACTH) is an intermediary in the HPA axis, MC2R, which specifically binds ACTH, may be important in the stress response of skin. Therefore, we investigated the gene and protein expression of MC2R in AA lesions and tried to elucidate the connection between HPA axis regulation, MC2R and AA. Reciprocal changes in MC2R mRNA and proteins in human AA were observed in our study; while mRNA levels were higher in lesions from AA patients compared with scalp tissues from normal controls, protein levels of MC2R were lower. The paradoxical expression of MC2R gene and protein levels coincided with evidence that over-responsive HPA activity coexists with a deficient HPA response in AA. We hypothesized that the HPA axis response in human AA may be the following: stressors first activate excess CRH/CRHR to produce increased ACTH, which up-regulates the expression of MC2R mRNA, but the stress response cannot create sufficient cortisol when the binding of ACTH/MC2R is deficient due to decreased MC2R protein. This hypothesis rationally clarifies the changed HPA axis in human AA and highlights the importance of MC2R in the pathogenesis of AA. The inconsistent expression of protein and mRNA implicates post-transcriptional control of human MC2R gene expression as found in murine MC2R gene.

Melanocortin receptor type 2 (MC2R, ACTH receptor) expression in patients with alopecia areata

Human skin expresses elements of the hypothalamo-pituitary-adrenal (HPA) axis that function as a local stress response system. Because adrenocorticotropic hormone (ACTH) is an intermediate in the HPA axis from corticotropin-releasing hormone (CRH) signal to cortisol secretion, MC2R that binds only ACTH may be important in the stress response of skin. We investigated the local expression of MC2R by immunohistochemistry to identify the role of ACTH/MC2R in stress-associated alopecia areata (AA). MC2R appeared to be highly compartmentalized in scalp skin including the epidermal cells of hair follicles and epidermis, sebaceous and eccrine glands, as well as dermal fibroblasts. The expression of MC2R was lower in AA lesions than in normal scalp tissue in almost all scalp skin cells, especially in epithelial cells. These findings demonstrate that MC2R expression is aberrant in AA and suggest a deficit in ACTH/MC2R activity may play an important role in the pathophysiology of AA.

Meniere's disease triggered by alopecia areata

A 38-year-old female presented to the Otorhinolaryngology Clinic of Cumhuriyet University Hospital with recurrent fluctuating sensorineural hearing loss, aural pressure, episodic vertigo and tinnitus with duration of 4 years. Personal history revealed that an attack of Meniere's disease occurred 3-4 weeks later from an alopecia lesion emerged. She told that it was fourth sequential episodes of two diseases that she was experiencing within the last four years. Ear, nose and throat examination was normal. Pure tone audiometry showed sensorineural low frequency hearing loss (LFHL). The level of hearing loss was assessed by four frequency pure-tone averages (PTA) ranging from 500 to 3000 Hz. Speech discrimination scores were normal left ear, but right ear that was decreased (% 80). The clinical findings were consistent with the diagnosis of Meniere’s disease. In dermatologic examination there was an alopecia areata lesion in 3 cm diameter on the parietal region of the head (Figure 1). This patient's alopecia areata lesion was seen the last five years. Ig E levels of the subjects were normal, and there was no personal and family history of atopic or allergic diseases.

Type 1 interferon signature in the scalp lesions of alopecia areata

Autoimmune attack of the bulbar region of anagen phase hair follicles by CD8+ T cells and Th1 cytokines has been proposed to result in hair loss in alopecia areata (AA). The initiating stimuli are unknown. As interferon-alpha therapy may trigger AA, we propose that type 1 interferons are involved in the induction of disease. To compare lesional scalp from patients with AA with scalp lesions of cutaneous diseases associated with local type 1 interferon-related protein expression. Lesional scalp of patients with AA, discoid lupus erythematosus, lichen planopilaris and androgenetic alopecia was examined by immunohistochemistry for expression of the type 1 interferon-inducible myxovirus protein A (MxA), the chemokine receptor CXCR3, and the cytotoxic proteins granzyme B (GrB) and T-cell intracytoplasmic antigen 1 (TiA-1). MxA was expressed in the intradermal and subcutaneous compartments of the hair follicle including sebaceous glands in inflammatory AA similar to lesions of cicatricial alopecia (discoid lupus erythematosus, lichen planopilaris) but not in the epidermal compartment of AA, and not at all in noninflammatory AA or androgenetic alopecia. The location of CXCR3-expressing cells correlated with MxA expression. The inflammatory cells around the hair follicle in AA included a lower number of GrB+ and TiA-1+ cells compared with cicatricial alopecia and demonstrated predominant TiA-1+ expression. We demonstrate the expression of type 1 interferon-related proteins in the inflammatory lesions of AA. The distribution pattern of the interferon signature and cytotoxicity-associated proteins in AA differs from cicatricial alopecia.

308‐nm Excimer Laser for the Treatment of Alopecia Areata in Children

Alopecia areata (AA) is a common skin disease which is characterized by nonscarring localized or diffused hair loss. In this study we assessed the efficacy of 308-nm Excimer laser in the treatment of alopecia areata in children. A total of 9 children with 30 recalcitrant patches alopecia areata and two children with alopecia areata totalis were enrolled in this study which included seven male and four female patients, aged between 4 and 14 years and the durations of their disease were between 7 and 25 months. All of these patients had more than one lesion of alopecia areata and at least one of them was left as a control for comparison. The lesions were treated with the 308-nm Excimer laser twice a week for a period of 12 weeks. Regrowth of hair was observed in 18 (60%) alopecia patches in the scalp, while there was no response in the control patches and over the extremities. Only four patients with scalp lesions showed a recurrence of alopecia after 6 months post laser therapy. So, 308-nm Excimer laser is considered an effective safe therapeutic option for patchy alopecia areata in children.

Immunoreactivity of corticotropin‐releasing hormone, adrenocorticotropic hormone and α‐melanocyte‐stimulating hormone in alopecia areata

Abstract: Psychological factors are believed to play a role in the pathogenesis of alopecia areata (AA), a frequently encountered hair disorder. In our study, statistically significant elevation of psychological stress was felt by AA patients prior hair loss compared with control, which was strongly believed contributory to hair loss (t‐test, P &lt; 0.01). The corticotropin‐releasing hormone (CRH) and proopiomelanocortin (POMC) mRNA have been identified in the basal layer of the epidermis and pilosebaceous units of the normal scalp. And with the recent discovery of melanocytes and dermal fibroblasts capable of corticosterone production, the presence of a local stress response system resembling the hypothalamic–pituitary–adrenal (HPA) axis has been suggested. The local stress response system is involved in regulation of the normal hair cycle, but its precise role in AA is unknown. The influence of a local HPA axis or rather, CRH–POMC axis in AA was investigated by analysing immunohistochemically the expression levels of CRH and POMC peptides, including the adrenocorticotropic hormone (ACTH) and α‐melanocyte‐stimulating hormone (α‐MSH), in a number of AA lesions and normal scalp (as control). The epidermis and pilosebaceous units of normal scalp stained weakly with CRH, ACTH and α‐MSH, whereas those from the affected sites of the AA group showed intense expression of the peptides (chi‐square test, P &lt; 0.01). The meaning of this enhanced expression and their role in the pathogenesis of AA should be further evaluated in future.

Immunoreactivity of corticotropin-releasing hormone, adrenocorticotropic hormone andα-melanocyte-stimulating hormone in alopecia areata

Abstract: Psychological factors are believed to play a role in the pathogenesis of alopecia areata (AA), a frequently encountered hair disorder. In our study, statistically significant elevation of psychological stress was felt by AA patients prior hair loss compared with control, which was strongly believed contributory to hair loss (t-test, P < 0.01). The corticotropin-releasing hormone (CRH) and proopiomelanocortin (POMC) mRNA have been identified in the basal layer of the epidermis and pilosebaceous units of the normal scalp. And with the recent discovery of melanocytes and dermal fibroblasts capable of corticosterone production, the presence of a local stress response system resembling the hypothalamic–pituitary–adrenal (HPA) axis has been suggested. The local stress response system is involved in regulation of the normal hair cycle, but its precise role in AA is unknown. The influence of a local HPA axis or rather, CRH–POMC axis in AA was investigated by analysing immunohistochemically the expression levels of CRH and POMC peptides, including the adrenocorticotropic hormone (ACTH) and α-melanocyte-stimulating hormone (α-MSH), in a number of AA lesions and normal scalp (as control). The epidermis and pilosebaceous units of normal scalp stained weakly with CRH, ACTH and α-MSH, whereas those from the affected sites of the AA group showed intense expression of the peptides (chi-square test, P < 0.01). The meaning of this enhanced expression and their role in the pathogenesis of AA should be further evaluated in future.

Immunoreactivity of corticotropin-releasing hormone, adrenocorticotropic hormone andα-melanocyte-stimulating hormone in alopecia areata

Psychological factors are believed to play a role in the pathogenesis of alopecia areata (AA), a frequently encountered hair disorder. In our study, statistically significant elevation of psychological stress was felt by AA patients prior hair loss compared with control, which was strongly believed contributory to hair loss (t-test, P < 0.01). The corticotropin-releasing hormone (CRH) and proopiomelanocortin (POMC) mRNA have been identified in the basal layer of the epidermis and pilosebaceous units of the normal scalp. And with the recent discovery of melanocytes and dermal fibroblasts capable of corticosterone production, the presence of a local stress response system resembling the hypothalamic-pituitary-adrenal (HPA) axis has been suggested. The local stress response system is involved in regulation of the normal hair cycle, but its precise role in AA is unknown. The influence of a local HPA axis or rather, CRH-POMC axis in AA was investigated by analysing immunohistochemically the expression levels of CRH and POMC peptides, including the adrenocorticotropic hormone (ACTH) and alpha-melanocyte-stimulating hormone (alpha-MSH), in a number of AA lesions and normal scalp (as control). The epidermis and pilosebaceous units of normal scalp stained weakly with CRH, ACTH and alpha-MSH, whereas those from the affected sites of the AA group showed intense expression of the peptides (chi-square test, P < 0.01). The meaning of this enhanced expression and their role in the pathogenesis of AA should be further evaluated in future.