Irreversible Hair Loss Research Articles

Upregulation of caveolae-associated structural proteins in the hair follicle bulge of lichen planopilaris and frontal fibrosing alopecia.

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary cicatricial alopecia that cause a major impact on quality of life due to irreversible hair loss and symptoms as itching, burning and pain. They are characterized by permanent loss of hair follicle stem cells (HFSCs) by pathomechanisms still poorly understood, resulting in poor efficacy of currently available treatments. Caveolae are flask-shaped lipid rafts invaginated within the plasma membrane of multiple cell types. Although their role in the HF physiology and pathophysiology is relatively unknown, we have previously demonstrated that the primary structural component of caveolae (caveolin-1 or Cav1) is upregulated in FFA. Thus, we propose to investigate the expression and localization of caveolae-associated structural proteins (Cav1, Cav2, and Cavin-1) and HFSCs (identified by K15) in both LPP and FFA. We analyzed 4 patients with LPP biopsied in affected and non-affected (NA) scalp, 4 patients with FFA biopsied in affected scalp and 4 healthy controls. Affected scalp of LPP and FFA demonstrated increased levels of Cav1 and Cavin-1 compared with HC and LPP-NA. Moreover, Cav1, Cav2 and Cavin1 all exhibit high colocalization with K15 and their expression appears to be negatively correlated, supporting the hypothesis that these proteins are important players in LPP/FFA and may serve as therapeutic targets in future treatments.

Platelet-rich plasma as a new and successful treatment for lichen planopilaris: A controlled blinded randomized clinical trial.

Lichen planopilaris (LPP) is one of the most common causes of scarring hair loss caused by immune-mediated inflammation resulting in atrophy and scaling. The key to preventing this irreversible hair loss is diagnosing and starting treatment at the earliest possible stage. As there is no definite cure for LPP, the therapy could be challenging. In the study, we conducted a single-blinded randomized clinical trial to evaluate the therapeutic effects, safety, and tolerability of platelet-rich plasma versus topical clobetasol in the treatment of LPP. A randomized single-blinded controlled clinical trial was conducted in 24 LPP patients referring to our dermatology clinic between August 2022 and March 2023. Patients in the control group were treated with topical clobetasol 0.05% applied at night, and patients in the case group, in addition to topical clobetasol, received three sessions of PRP injection monthly. Both groups were assessed 1, 2, and 6 months after the start of the study by the Lichen Planopilaris Activity Index (LPPAI), physician and patient satisfaction, tolerability, and recording adverse effects. The average age in the clobetasol and PRP groups was 43.75 ± 13.51 and 42.75 ± 9.67, respectively (p = 0.83). In terms of gender, all 12 cases (100%) in the clobetasol group and 9 cases (75%) in the PRP group were female (p = 0.21). Both PRP and topical clobetasol effectively reduced LPPAI in the first 2 months; however, after 6 months, the LPPAI significantly increased in the clobetasol group (p = 0.001). There were no significant differences in LPPAI between the two groups at the beginning of the study and after 1 month. However, the mean LPPAI score in the clobetasol group was significantly higher than in the PRP group at 2 and 6 months after the start of the study (p = 0.01). Patient satisfaction with treatment increased in both groups during follow-up sessions, but at the end of the follow-up period, it was significantly higher in the PRP group (p = 0.03). Finally, the study did not have any serious adverse effects, and the pain experienced during PRP injection was tolerable for the patients. Overall, treatment tolerability was excellent in both groups. Given the different efficacy profiles, PRP could be considered a new and effective choice for the treatment of LPP.

ATRICHIA WITH PAPULAR LESIONS : A CASE REPORT

Atrichia with papular lesions is a rare Autosomal recessive disorder characterized clinically by complete and irreversible hair loss shortly after birth, and is associated with the development of keratinfilled cysts all over the body. We present a 10 year old girl with extensive alopecia and papular lesions over scalp,upper limbs,lower limbs, abdomen and back . A clinical diagnosis of Atrichia with papular lesions was made after excluding Vit D dependent Rickets. An accurate diagnosis is important to prevent unnecessary treatment of APL with systemic steroids when misdiagnosed as alopecia universalis.

Diagnostic delay, comorbid hidradenitis suppurativa and the prognostic value of bacterial culture in folliculitis decalvans: A cohort study.

Folliculitis decalvans (FD) is a type of primary neutrophilic cicatricial alopecia often leading to irreversible hair loss. Data on its epidemiology, clinical features, outcomes, and prognostic factors are limited. To evaluate a cohort of patients with FD and identify characteristics of severe disease and prognostic factors which impede remission. This retrospective cohort study included 192 patients diagnosed with FD and followed for at least six months at a tertiary center between 2010 and 2020. There was a diagnosticdelay averaging 22.2 (±29.7) months. Comorbid follicular occlusion disorders were common. Bacterial cultures were positive in 45.6% of the cases, with Staphylococcus (S.) aureus being the most common pathogen. Severe disease was associated with comorbid hidradenitis suppurativa and a positive bacterial culture, particularly S.aureus. 50.7% of patients experienced complete remission: 32% within the first six months of treatment and 18.7% later during follow-up. Relapses were frequent. Negative prognostic factors for achieving remission included younger age and a positive bacterial culture. There is a need for the education of dermatologists to reduce the diagnostic delay. Screening FD patients for comorbid hidradenitis suppurativa and obtaining bacterial cultures is important for treatment planning.

FEATURES OF THE COURSE OF LICHEN PLANOPILARIS IN MEN

Background. Lichen Planopilaris (LPP) is a variant of primary cicatricial alopecia with a lymphocytic inflammatory infiltrate that occurs at the level of the hair follicle funnel and destroys stem cells of the bulge zone. Timely diagnosis and determination of the correct treatment tactics allows to achieve stabilization of the process and minimize irreversible hair loss. The article presents clinical cases of Lichen Planopilaris in men, initially accompanied by misdiagnoses and lack of adequate therapy, which led to significant irreversible hair loss.

Congenital Atrichia: A Case Report

Introduction: Congenital Atrichia is a rare genetic condition in which all body hair may be absent. Congenital Atrichia is a rare genodermatoses is characterized by a mutation of the human hairless (HR) gene on chromosome 8p22. There is loss of scalp hair between, eyebrow, eyelash, and body hair may also be sparse or absent; patients may have a few pubic and axillary hairs. The condition may present in isolation or along with other defects. There are many forms of inherited alopecia (i.e., hair loss), which vary in age of onset, severity, and associated ectodermal abnormalities. Congenital alopecia universalis or congenital atrichia without associated ectodermal defects is a rare autosomal recessive disorder and is the only form of inherited alopecia for which the molecular basis is known. (2) Case Report: Here is a case report on a preterm neonate delivered via normal vaginal delivery in our hospital setup. Patient was on mechanical ventilator after birth. Patient gradually improved at it was noticed that there was total absence of hair on the body. Dermatology opinion was taken and after few investigations and genetic testing it was confirmed case of Congenital Atrichia due to mutation in chromosome no 8p22. Discussion: Congenital atrichia is a rare disease, causing irreversible alopecia which is inherited autosomal recessively. There is complete irreversible hair loss seen soon after birth. Situs inversus and mesocardia has also been reported to be associated with this disease. Conclusion: Congenital atrichias represent a large and heterogeneous group of inherited hair disorders. In this report, we describe a patient affected with alopecia universalis congenita Keywords: Congenital, atrichia, hairless gene, vitamin d deficiency

A multicenter descriptive analysis of 270 men with frontal fibrosing alopecia and lichen planopilaris in the United States

To the Editor: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are forms of primary lymphocytic cicatricial alopecia characterized by inflammation and fibrosis of the follicular unit causing irreversible hair loss if untreated. 1 Sundberg J.P. Hordinsky M.K. Bergfeld W. et al. Cicatricial Alopecia Research Foundation meeting, May 2016: progress towards the diagnosis, treatment and cure of primary cicatricial alopecias. Exp Dermatol. 2018; 27: 302-310https://doi.org/10.1111/exd.13495 Crossref PubMed Scopus (17) Google Scholar Epidemiologic studies of LPP/FFA are lacking but it is thought that the incidence is increasing globally. 2 Tosti A. Bergfeld W.F. Christiano A.M. et al. Response from the American Hair Research Society to “sunscreen and frontal fibrosing alopecia: a review“. J Am Acad Dermatol. 2020; 82: 729-730https://doi.org/10.1016/j.jaad.2019.10.032 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Men with LPP/FFA are increasingly reported in the literature, challenging the paradigm that LPP/FFA is a disease of postmenopausal women. 3 Doche I. Nico M.M.S. Gerlero P. et al. Clinical features and sex hormone profile in male patients with frontal fibrosing alopecia: a multicenter retrospective study with 33 patients. J Am Acad Dermatol. 2021; 86: 1176-1178https://doi.org/10.1016/j.jaad.2021.04.076 Abstract Full Text Full Text PDF Scopus (3) Google Scholar ,4 Lobato-Berezo A. Iglesias-Sancho M. Rodríguez-Lomba E. et al. Frontal fibrosing alopecia in men: a multicenter study of 39 patients. J Am Acad Dermatol. 2021; 86: 481-484https://doi.org/10.1016/j.jaad.2021.09.033 Abstract Full Text Full Text PDF Scopus (1) Google Scholar This multicenter descriptive study is the first to characterize LPP/FFA among men in the United States.

Primary cicatricial alopecias are characterized by dysregulation of shared gene expression pathways.

The primary forms of cicatricial (scarring) alopecia (PCA) are a group of inflammatory, irreversible hair loss disorders characterized by immune cell infiltrates targeting hair follicles (HFs). Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and centrifugal cicatricial alopecia (CCCA) are among the main subtypes of PCAs. The pathogenesis of the different types of PCAs are poorly understood, and current treatment regimens yield inconsistent and unsatisfactory results. We performed high-throughput RNA-sequencing on scalp biopsies of a large cohort PCA patients to develop gene expression-based signatures, trained into machine-learning-based predictive models and pathways associated with dysregulated gene expression. We performed morphological and cytokine analysis to define the immune cell populations found in PCA subtypes. We identified a common PCA gene signature that was shared between LPP, FFA, and CCCA, which revealed a significant over-representation of mast cell (MC) genes, as well as downregulation of cholesterogenic pathways and upregulation of fibrosis and immune signaling genes. Immunohistological analyses revealed an increased presence of MCs in PCAs lesions. Our gene expression analyses revealed common pathways associated with PCAs, with a strong association with MCs. The indistinguishable differences in gene expression profiles and immune cell signatures between LPP, FFA, and CCCA suggest that similar treatment regimens may be effective in treating these irreversible forms of hair loss.

A prospective pilot study of narrowband UV-B treatment of lichen planopilaris

A prospective pilot study of narrowband UV-B treatment of lichen planopilaris

Scarring Alopecias: Pathology and an Update on Digital Developments.

Primary cicatricial alopecias (PCA) represent a challenging group of disorders that result in irreversible hair loss from the destruction and fibrosis of hair follicles. Scalp skin biopsies are considered essential in investigating these conditions. Unfortunately, the recognised complexity of histopathologic interpretation is compounded by inadequate sampling and inappropriate laboratory processing. By sharing our successes in developing the communication pathway between the clinician, laboratory and histopathologist, we hope to mitigate some of the difficulties that can arise in managing these conditions. We provide insight from clinical and pathology practice into how diagnoses are derived and the key histological features observed across the most common PCAs seen in practice. Additionally, we highlight the opportunities that have emerged with advances in digital pathology and how these technologies may be used to develop clinicopathological relationships, improve working practices, enhance remote learning, reduce inefficiencies, optimise diagnostic yield, and harness the potential of artificial intelligence (AI).

International E conference on Current Research Perspectives in Clinical Sciences

In humans, hair is an essential indicator of individual self-image, identity, ethnicity, and health. Loss of hair from any part of the body for any reason is called alopecia. There are several conditions ranging from thinning hair to complete baldness. Alopecia is of two kinds, scarring alopecia and non-scarring alopecia. The scarring alopecia is divided into three types depending on the presence of inflammatory cells like lymphocytic, neutrophilic, and mixed. Scarring alopecias are typically caused by inflammation that destroys the hair follicle leading to irreversible hair loss. While the etiology and pathogenesis of PCA remain unclear, it is currently considered as an inflammatory disorder.

597 Incidence of cicatricial alopecia among new alopecia patients undergoing platelet rich plasma

Platelet rich plasma (PRP) is an effective treatment for pattern hair loss (PHL). However, there is little evidence for PRP as a treatment of cicatricial alopecia (CA). PRP is expensive and carries inherent procedural risk. A thorough history and exam can exclude inflammatory causes of alopecia and optimize patient outcomes. High patient demand for PRP coupled with lenient procedural regulations open the possibility for inadequately trained personnel to miss a diagnosis of CA in patients presenting for PRP. We examined the incidence of new CA diagnosis among our PRP patients to evaluate this potential risk. A retrospective review of new patients presenting for PRP between August 2019 and December 2020 was performed. A total of 82 patients (45 female) with a mean age of 44.5 were included. 76.8% were undergoing alopecia treatment for presumed pattern hair loss at the time of presentation, most were PRP naïve (92.7%) and had never underwent scalp biopsy (91.5%). On clinical and trichoscopic exam, 12 (14.6%) were noted to have mild to moderate perifollicular scale, erythema, or both, 2 of whom had known biopsy proven CA. A scalp biopsy was recommended to 10 (12.2%) patients due to signs of inflammation and 2 (2.4%) declined biopsy due to personal preference. Of the 8 (9.8%) that underwent scalp biopsy, 5 (62.5%) were diagnosed with CA and the remaining 3 (37.5%) were PHL. We report 6.1% of new patients presenting to our clinic for PRP had undiagnosed CA. CAs can present similarly to PHL and early treatment is critical to limit irreversible hair loss. PRP is not an effective monotherapy for CA, is costly, and carries procedural risk. Trichoscopic and clinical evaluation by a trained dermatologist before PRP therapy can help to optimize treatment outcomes by correctly identifying CA when present. This study highlights the potential risk that non-trained personnel providing PRP may pose to patient safety.

Quality of life and mental health status in patients with lichen planopilaris based on Dermatology Life Quality Index and General Health Questionnaire-28 questionnaires.

BackgroundLichen planopilaris (LPP) is a relatively uncommon inflammatory skin condition that causes permanent hair loss. Irreversible hair loss can have a significant psychosocial and psychological impact on patients’ lives. Limited studies have assessed the psychological status of patients suffering from LPP, and to our knowledge, none have evaluated patients with LPP as a separate group in this regard.ObjectiveThis study aimed to assess the quality of life (QoL) and general health of patients with LPP using the Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire-28 (GHQ-28), respectively.MethodsOur study employed a cross-sectional design. In total, 41 patients with LPP attending the follow-up skin clinic at the Razi Hospital in Tehran, Iran were asked to complete the DLQI and GHQ-28. Furthermore, selected demographic information was obtained from patients to evaluate their association with general health and QoL.ResultsForty-one patients (14 men and 27 women) with a mean age of 44.02 ± 10.8 years completed both questionnaires. QoL was affected moderately to extremely in 70.7% of patients. Also, 26 patients (63.4%) were at risk for psychological disorders. Lower QoL was reported by patients age <45 years (p < .05). Both QoL and general health had a negative relation with the disease activity index (p < .05), but were not affected by sex, marital status, education level, treatment type, presence of mucous lesions, and disease duration.ConclusionLPP significantly affects patients’ QoL and general health. Dermatologists should address these issues in patients with LPP alongside treating physical symptoms.

Using biopsies to study the differences between two hair loss disorders: lichen planopilaris and frontal fibrosing alopecia

British Journal of DermatologyVolume 183, Issue 3 p. e77-e77 Plain Language SummaryFree Access Using biopsies to study the differences between two hair loss disorders: lichen planopilaris and frontal fibrosing alopecia First published: 02 September 2020 https://doi.org/10.1111/bjd.19363AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are two uncommon disorders that both cause permanent, scarring alopecia (hair loss) and inflammation of the hair follicles. LPP affects both sexes and typically causes patchy alopecia over the central scalp, whereas FFA generally affects women and causes the hairline at the front of the scalp to recede. It can also cause eyebrow and body hair loss. Despite these distinct phenotypes (physical characteristics), FFA has traditionally been regarded as a variant of LPP. The authors sought to distinguish the two conditions using a wide array of markers for different cell types around the hair follicles. Markers are substances in the body, such as certain proteins, which act as signs to show, for example, the presence of certain cells or inflammation. The authors took skin punch biopsies (a type of tissue sample) from affected areas of scalp in patients with a diagnosis of LPP or FFA, and from healthy controls (people without LPP or FFA). In this study, the authors present a detailed, systematic analysis of a range of key inflammatory cell markers in LPP, FFA and controls. There were many similarities in the numbers and type of inflammatory cells in the two conditions. The study focussed on the different types of cells called macrophages seen in LPP and FFA. Broadly, these cells can be divided into two types, M1 cells, associated with inflammation and cell death, and M2 cells, involved in tissue repair. The two conditions differed in that more markers for M2 cells were seen in LPP in comparison to FFA. The authors hope that therapies directed against specific macrophage cell types may be developed in the future, preventing irreversible hair loss. Linked Article: Harries et al. Br J Dermatol 2020; 183:537–547. Volume183, Issue3September 2020Pages e77-e77 RelatedInformation

599 PPARg signaling modulation protects from hair follicle bulge stem cell damage and cyclophosphamide-induced hair follicle cytotoxicity

In oncology, permanent chemotherapy-induced alopecia (pCIA) remains an unfulfilled clinical need. Irreversible hair loss may result from permanent damage of hair follicle bulge epithelial stem cells (HFeSCs), some of which may undergo epithelial-mesenchymal transition (EMT). To prove our hypothesis, we treated ex vivo full-length HFs with 4HC, a cyclophosphamide metabolite 4HC, which routinely induces reversible CIA and sometimes pCIA. PPARγ signaling is known to have a protective role in eSCs biology. Therefore, we additionally tested whether NAC-GED-0507-Levo (NACGED), a PPARγ modulator, may protect HFs from 4HC-induced damage. Ex vivo, treatment with 4HC (3μM, 30μM) induced HF cytotoxicity and promoted dystrophic catagen development. Moreover, 4HC caused reduction of CK15+ bulge cells number, mainly by inducing apoptosis. Interestingly, 4HC also induced EMT in the bulge epithelium, as indicated by decreased E-cadherin expression, upregulation of fibronectin and appearance of vimentin+ intra-bulge cells. HFs pretreatment with 0.01-1mM NACGED before addition of 4HC provided relative protection from induction of cytotoxicity without preventing catagen development. Finally, NACGED treatment also antagonized CIA-induced intra-bulge EMT by counteracting both E-cadherin expression reduction and increased vimentin+ cells number. Our data suggest that pCIA irreversibility may indeed result from apoptosis and/or EMT-mediated destruction of CK15+bulge eSCs. Modulation of PPARγ signaling could provide an effective strategy for managing permanent hair loss in chemotherapy-treated cancer patients.

A Case of Folliculitis Decalvans With Concomitant Acne Keloidalis Nuchae, Androgenic Alopecia, and Profound Postinflammatory Hyperpigmentation

ABSTRACT Folliculitis decalvans is a cicatricial alopecia of the parietal scalp and vertex characterized by erythematous, scarred, confluent patches of alopecia with scattered peripheral pustules and scale. It is most common among middle-aged men and is frequently associated with acne keloidalis nuchae. The pathogenesis of folliculitis decalvans is not completely understood, but it likely involves an inappropriate inflammatory response to components of Staphylococcus aureus. Folliculitis decalvans is a chronic disease characterized by periods of remission and exacerbation. Patients with long-standing, undertreated disease can experience severe hair loss and postinflammatory hyperpigmentation. Treatment is focused on reducing inflammation and bacterial load using oral antibiotic therapy. Early recognition and treatment is paramount to alleviate symptoms and limit irreversible hair loss.

A clinico-epidemiological study of scalp hair loss in children (0–18 years) in Kota Region, South-East Rajasthan

Background:Currently, the studies related to hair loss in children showed the variable prevalence of different clinical patterns and causes of scalp hair loss, that had regional variation.Aims:The aim of this study is to evaluate the epidemiology and clinical pattern of scalp hair loss in children (0–18 years age group).Materials and Methods:A total of 300 children presenting with scalp hair loss were studied during a period of 1 year from April 2015 to March 2016. The results were recorded and analyzed.Results:The most common disorder found in this study was tinea capitis seen in 166 (55.33%) cases followed by alopecia areata, seborrheic dermatitis, pediculosis with secondary infection. Other uncommon causes were lichen planopilaris, tractional alopecia, telogen effluvium, nevus sebaceous, occipital neonatal alopecia, ectodermal dysplasia, scalp psoriasis, trichotillomania, and alopecia due to nutritional deficiency. Several other rare causes were identified in this study.Conclusion:This study showed that hair loss in children in our region is not an uncommon problem and results from a variety of causes. Early diagnosis and treatment are needed to prevent further hair loss and to avoid irreversible hair loss and scarring alopecia. As has been observed in this study, hair problem may be due to important nutritional deficiency. We should be aware of such presentation. These may be a clue to the diagnosis of systemic illness.

SnapshotDx Quiz: December 2018

SnapshotDx Quiz: December 2018

Severe Infliximab-Induced Alopecia and Scalp Psoriasis in a Woman with Crohn's Disease: Dramatic Improvement after Drug Discontinuation and Treatment with Adjuvant Systemic and Topical Therapies.

Scalp psoriasis with alopecia is a rare cutaneous reaction to tumor necrosis factor alpha antagonists. This reaction often reverses with discontinuation of the offending drug and initiation of topical treatments; however, irreversible hair loss may occur if a scarring alopecia develops. We describe a woman with Crohn’s disease who developed scalp psoriasis and alopecia secondary to infliximab. She had a remarkable recovery after discontinuation of infliximab and treatment with oral minocycline and topical therapy: mineral oil under occlusion, betamethasone lotion, and sequential coal tar, salicylic acid, and ketoconazole shampoos each day. The patient’s alopecia completely resolved within 4 months of initiating this treatment regimen. In summary, early diagnosis of alopecia secondary to tumor necrosis factor alpha antagonist therapy is crucial in preventing diffuse alopecia and scalp psoriasis. In addition to discontinuing the offending agent, initiating aggressive adjuvant treatment with an oral antibiotic, topical therapies, or both, should be considered to reverse tumor necrosis factor alpha antagonist-induced alopecia and/or scalp psoriasis.

Central centrifugal cicatricial alopecia: challenges and solutions.

Central centrifugal cicatricial alopecia (CCCA) is the most common scarring alopecia among African American women. Data about epidemiology, etiology, genetic inheritance, and management are scarce and come from individual reports or small series. CCCA has been associated with hot combing and traumatic hair styling for years; however, studies fail to confirm it as the sole etiologic factor. It has been shown in a small series that CCCA can be inherited in an autosomal dominant fashion, with a partial penetrance and a strong modifying effect of hairstyling and sex. CCCA presents clinically as a central area of progressive irreversible hair loss that expands to the periphery. A patchy form has also been described. Dermoscopy is helpful to identify the optimal site for the biopsy, which establishes the diagnosis. Well-designed randomized controlled trials are needed to discover the optimal management. At this point, patients are advised to avoid traction and chemical treatments; topical and intralesional steroids, calcineurin inhibitors, and minoxidil can be helpful in halting the progression.