The Arrector Pili Muscle and the Follicular Unit of the Scalp: A Microscopic Anatomy Study

Trichoscopic evaluation of dental pulp stem cell conditioned media for androgenic alopecia

BACKGROUND

Conditioned media (CM) derived from mesenchymal stem cells (MSC) is known to induce hair regrowth in androgenic alopecia.

OBJECTIVES

The objectives of the study were to assess the efficacy and safety of one type of MSC-CM, the CM derived from dental pulp stem cells obtained from human exfoliated deciduous teeth (SHED-CM) and to compare the efficacy of SHED-CM with and without dihydrotestosterone synthesis inhibitor (DHT-inhibitor).

METHODS

Eighty-eight male androgenic alopecia subjects with Hamilton-Norwood Classification (H-N C) I-VII were evaluated by trichoscopy to explore which trichoscopic factors statistically correlated with H-N C. After being screened, 33 subjects received six SHED-CM treatments at 1-month intervals. Clinical severity was assessed through global and trichoscopic images from baseline to 9th month.

RESULTS

SHED-CM was effective for 75% of subjects regardless of disease severity, concomitant DHT-inhibitor use, and age. Adverse effects including pain and small hemorrhages were transient and mild. We also found that clinical hair status evaluated by absolute values of three quantitative trichoscopic factors (maximum hair diameter, vellus hair rate, and multi-hair follicular unit rate) showed a good correlation with H-N C stages, and what is more-a scoring system of these three factors can be a possible predictor of SHED-CM efficacy.

CONCLUSIONS

We have shown that SHED-CM provides global and trichoscopic image improvement for androgenic alopecia, regardless of concomitant DHT-inhibitor use.

Magnetotrichography: Measuring the dc magnetic field produced by hair follicles

We here describe the dc magnetic field over the human head produced by healthy hair follicles when the scalp is lightly pressed. This phenomenon was briefly reported decades earlier, where a double-planar SQUID (Superconducting Quantum Interference Devices) gradiometer at a single location was used. We here perform a larger study, using the dcMEG containing 102 double-planar gradiometers covering the whole scalp. The field is displayed as an on-line arrow map over the head, showing the approximate flow of direct current (dc) in the scalp. Standard sets of five arrow maps per subject were measured, where the subject successively pressed parts of their head against the inside of the helmet. These maps were made for 15 normal subjects (5 females), and 2 with alopecia (non-functioning follicles). The directions of “pressed” generating arrows always followed the natural tilt of the follicles, verifying the follicles as generators, with a time constant of about one second. The maximum generator dipole strength was about 24 µA-cm. Scalp electric potentials corresponding to the magnetic signals were masked by much larger electrodermal potentials. Therefore, this magnetic method, called magnetotrichography, is unique in measuring this follicular electrical activity, with possible applications in studying baldness and hair diseases.

Stimulation of hair follicle stem cell proliferation through an IL-1 dependent activation of γδT-cells

The cutaneous wound-healing program is a product of a complex interplay among diverse cell types within the skin. One fundamental process that is mediated by these reciprocal interactions is the mobilization of local stem cell pools to promote tissue regeneration and repair. Using the ablation of epidermal caspase-8 as a model of wound healing in Mus musculus, we analyzed the signaling components responsible for epithelial stem cell proliferation. We found that IL-1α and IL-7 secreted from keratinocytes work in tandem to expand the activated population of resident epidermal γδT-cells. A downstream effect of activated γδT-cells is the preferential proliferation of hair follicle stem cells. By contrast, IL-1α-dependent stimulation of dermal fibroblasts optimally stimulates epidermal stem cell proliferation. These findings provide new mechanistic insights into the regulation and function of epidermal cell–immune cell interactions and into how components that are classically associated with inflammation can differentially influence distinct stem cell niches within a tissue.

The skin is a physical barrier that protects the body from the outside world. If the skin is injured, the body mounts a “wound healing” response to rapidly mend and restore this protective barrier. Wound healing is a complex process and relies on the different types of cells in the skin communicating with each other.

Stem cells provide tissues, like the skin, with new cells. Normally, stem cells are in a resting or inactive state. Yet, during wound healing, stem cells near the injured area are awakened and start producing more cells to repair the wound. Understanding how stem cells become activated in a wound has proved challenging because only a small number of cells near a damaged site will respond, and it is difficult to distinguish their response from that of other cells slightly further away.

Now, Lee et al. overcome this hurdle by analyzing a genetically engineered mouse in which the entire skin displays a wound healing response, even without any injury or trauma. In these mice, most of the stem cells in the skin are awakened from their normal resting state and behave as if there is a wound to heal.

It turns out that a protein called interleukin-1, which is released from damaged skin cells known as keratinocytes, can activate two different groups of stem cells in the skin to help repair the injured tissue. One group lives in the hair follicle and is normally responsible for replacing the hair that falls from the body. Lee et al. found that when the skin is wounded interleukin-1 activates certain immune cells (called γδT-cells). These immune cells then awaken the resting stem cells in the hair follicle to multiply and travel to the wound site to repair the injury. The other group of stem cells resides in the outermost layer of the skin. Interleukin-1 can also activate so-called fibroblast cells, which then stimulate this second group of stem cells to divide and cover the open wound.

Quickly healing wounds has many health benefits such as preventing infection and shortening the time to recover from an injury. These new findings may help to repair injured skin in diseases such as diabetes, where wounds can take months to heal and often leads to permanent tissue damage. The next challenge is to identify the cues that instruct the stem cells to travel to the wound site and turn into the specific cells that are required to replace the damaged cells.

Platelet-rich plasma-an 'Elixir' for treatment of alopecia: personal experience on 117 patients with review of literature

Platelet-rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery and dermatology. PRP is a simple, cost-effective and feasible treatment option with high patient satisfaction for hair loss and can be regarded as a valuable adjuvant treatment modality for androgenic alopecia and other types of non-scarring alopecias. Authors have proposed a hair model termed "Golden anchorage with 'molecular locking' of ectodermal and mesenchymal components for survival and integrity of hair follicle (HF)" in this article. Golden anchorage comprises of bulge stem cells, ectodermal basement membrane and bulge portion of APM. PRP with its autologous supply of millions of growth factors works on 'Golden anchorage' along with keratinocytes (PDGF), dermal papilla (IGF and fibroblast growth factor), vasculature (VEGF and PDGF) and neural cells (Nerve Growth Factor) in a multipronged manner serving as an 'elixir' for hair growth and improving overall environment.

Destruction of the arrector pili muscle and fat infiltration in androgenic alopecia

BACKGROUND

Androgenic alopecia (AGA) is the most common hair loss condition in men and women. Hair loss is caused by follicle miniaturization, which is largely irreversible beyond a certain degree of follicular regression. In contrast, hair loss in telogen effluvium (TE) is readily reversible. The arrector pili muscle (APM) connects the follicle to the surrounding skin.

OBJECTIVES

To compare histopathological features of the APM in AGA and TE.

METHODS

Archival blocks of 4-mm scalp punch biopsies from eight patients with AGA and five with TE were obtained. New 4-mm biopsies from five normal cases were used as controls. Serial 7-μm sections were stained with a modified Masson's trichrome stain. 'Reconstruct' software was used to construct and evaluate three-dimensional images of the follicle and APM.

RESULTS

The APM degenerated and was replaced by adipose tissue in all AGA specimens. Remnants of the APM remained attached to the hair follicle. There was no fat in the normal skin specimens. Fat was seen in two of five TE specimens but could be attributed to these patients also showing evidence of AGA. Quantitative analysis showed that muscle volume decreased and fat volume increased significantly (P < 0·05) in AGA compared with controls.

CONCLUSIONS

APM degeneration and replacement with fat in AGA has not previously been described. The underlying mechanism remains to be determined. However, we speculate that this phenomenon might be related to depletion of stem or progenitor cells from the follicle mesenchyme, explaining why AGA is treatment resistant.

Beyond goosebumps: does the arrector pili muscle have a role in hair loss?

The arrector pili muscle (APM) consists of a small band of smooth muscle that connects the hair follicle to the connective tissue of the basement membrane. The APM mediates thermoregulation by contracting to increase air-trapping, but was thought to be vestigial in humans. The APM attaches proximally to the hair follicle at the bulge, a known stem cell niche. Recent studies have been directed toward this muscle's possible role in maintaining the follicular integrity and stability. This review summarizes APM anatomy and physiology and then discusses the relationship between the follicular unit and the APM. The potential role of the APM in hair loss disorders is also described, and a model explaining APM changes in hair loss is proposed.

Steady and temporary expressions of smooth muscle actin in hair, vibrissa, arrector pili muscle, and other hair appendages of developing rats

The hair erection muscle, arrector pili, is a kind of smooth muscle located in the mammalian dermis. The immunohistochemical study using an antibody against smooth muscle alpha actin (SMA) showed that the arrector pili muscle develops approximately 1–2 weeks after birth in dorsal and ventral skin, but thereafter they degenerate. The arrector pili muscle was not detected in the mystacial pad during any stage of development, even in the neighboring pelage-type hair follicle. A strong signal of SMA in the skin was located in the dermal sheath as well as in some outer root sheath cells in the hair and vibrissal follicles. Positive areas in the dermal and outer root sheaths were restricted to a lower moiety, particularly areas of similar height, where keratinization of the hair shaft occurs. This rule is valid for both pelage hair follicles and vibrissal follicles. At medium heights of the follicle, SMA staining in the dermal sheath was patchy and distant from the boundary between dermis and epidermis. In contrast to SMA, vimentin was expressed over the entire height of the dermal sheath. Unlike the arrector pili muscle, the expression of SMA in the dermal sheath was observed during fetal, neonatal, and adult stages. The presence of actin-myosin and vimentin fibers in supporting cells is thought to be beneficial for the hair follicle to cope with the movement of the hair shaft, which may be caused by physical contacts with outside materials or by the contraction of internal muscles.

The ‘follicular trochanter’: an epithelial compartment of the human hair follicle bulge region in need of further characterization

Recent articles on hair follicle stem cells have summarized the current state of knowledge of what has been termed the hair follicle 'bulge'. During the course of immunohistological studies aimed at characterizing the expression of selected extracellular matrix proteins in the - as yet insufficiently characterized - niche of human bulge hair follicle stem cells, we have recently come across a largely forgotten, peculiar epithelial protrusion of the outer root sheath, which was visible in only a minority of all examined hair follicles. The morphology and immunoreactivity patterns of this structure, the 'follicular trochanter', are described herein.

A study of the secretion mechanism of the sebaceous gland using three-dimensional reconstruction to examine the morphological relationship between the sebaceous gland and the arrector pili muscle in the follicular unit

BACKGROUND

New models of the structural relationship between the arrector pili (AP) muscle and the sebaceous gland (SG) have been proposed recently.

OBJECTIVES

The purpose of the present study was to establish the actual morphological relationship between components of the follicular unit (FU) including the hair follicles, AP muscle and SG using 3D reconstruction of serially sectioned specimens so as to expand previous explanations of the secretory mechanism of the SG and to suggest other possible mechanisms based on newly proposed model.

METHODS

Scalp skin specimens were processed using routine histological procedures, with serially sectioned tissue slides being stained with Masson's trichrome. 'Reconstruct' software was used to align, assemble and reconstruct the sections, with observations of the 3D-reconstructed FU [including hair follicles (HFs), AP muscle and SG].

RESULTS

Fifty FUs were reconstructed. The AP muscle was curved and concave as it supported the basal portion of the sebaceous lobules in the perifolliculum. Sebaceous lobules were located between the AP muscle and HFs (angular area) and some sebaceous lobules located in the opposite (counter-angular) area.

CONCLUSIONS

We propose that the concave part of the AP muscle pushes up the basal portion of the sebaceous lobule between the HFs and AP muscle during AP muscle contraction and hair erection. In addition, the sebaceous lobule located at the counter-angular position is squeezed by the HF during AP muscle relaxation and hair repositioning. Combined with the previous mechanism of SG secretion, this newly established mechanism based on the 3D structure of the FU will improve our understanding of AP muscle function and SG secretion.

Characteristic features of Japanese women's hair with aging and with progressing hair loss

BACKGROUND

There have been few studies of the features of hair with aging and hair loss in Japanese women.

OBJECTIVE

Features of Japanese women's hair with aging and with progressing hair loss were investigated.

METHODS

Japanese women with hair loss (n=46) or with no or less hair loss (n=113), aged 14-68 years, were studied. Severity of hair loss was rated by visual comparison with six standard photographs. Hair density, hair growth rate, and hair diameter were analyzed by phototrichogram. Follicular units were deduced by a non-invasive method using tree-view analysis on scalp imaging.

RESULTS

Hair loss in Japanese women is commonly characterized by a diffuse central pattern occurring after approximately 40 years of age. Hair density declines with age after the 40s. The reduction resulted from an increase in the number of one-haired follicular units and a reduction of three- and more-haired follicular units. Both the ratio and the growth rate of anagen hair also declined with age after the 40s. Mean hair diameter and the ratio of thick hairs increased with age from about 10 to 40 years, and decreased with progressing hair loss. There were few vellus-like hairs in women with hair loss, in comparison with male-pattern baldness.

CONCLUSION

In Japanese middle-aged women, hair density declined with age without the appearance of hair loss. Hair loss appeared after approximately 40 years of age. The major causes might be reduction of hair density and the ratio of thick hairs, but not an increase of vellus-like hairs.

A new model for the morphology of the arrector pili muscle in the follicular unit based on three-dimensional reconstruction

In the classic model of the arrector pili (AP) muscle, each hair follicle is independently associated with a single AP muscle. Recently, new models have been proposed based on interpretations of serial histological cross-sectional images. The purpose of this study was to confirm the morphology of the AP muscle in relation to the follicular unit (FU) using quantitative three-dimensional (3D) reconstruction of serially sectioned images. Skin samples were obtained from the parietal region of the scalp, and processed using routine histological procedures. The serially sectioned slides were stained with Masson's trichrome. All the hairs and hair follicles of the FU exhibited some degree of slanting, with the single AP muscle slanted in the same direction. The distal portion of the AP muscle was divided into branches, as in a bronchial tree. There was branching in the single AP muscle present in the FU, and it was inserted into all the hair follicles of the FU either tightly or loosely. We suggest that the classic anatomy of the AP muscle must be modified with this new model, now confirmed by computer-based 3D reconstruction.

Transfollicular drug delivery—Is it a reality?

Once regarded as merely evolutionary remnants, the hair follicles and sebaceous glands are increasingly recognised as potentially significant elements in the percutaneous drug delivery paradigm. Interest in pilosebaceous units has been directed towards their use as depots for localised therapy, particularly for the treatment of follicle-related disorders such as acne or the alopecias. Furthermore, considerable attention has also been focused on exploiting the follicles as transport shunts for systemic drug delivery. This paper reviews various key facets of this field including; relevant aspects of pilosebaceous anatomy and physiology, the design and efficacy of follicle-targeting formulations and the emergence of quantitative modeling systems. Several novel developments in this area promise to greatly expand our understanding of this field in the near future.

The contribution of the arrector pili muscle and sebaceous glands to the follicular unit structure

BACKGROUND

The evidence of hairs grouped into well-defined follicular units has given a new vision of hair anatomy and pathology. The sebaceous glands and the arrector pili muscle, as part of the pilosebaceous unit, should be viewed as important parts of this organized follicular unit structure.

OBJECTIVE

This study was performed to define the morphology and the relationships between the sebaceous glands, muscles, and follicles within the context of the follicular unit structure.

METHODS

This study analyzes horizontal, microscopic serial sections of large areas of normal human scalp skin stained with hematoxylin and eosin, Masson's trichrome, and desmin. The course of the arrector pili muscles from their superficial origins to their follicular attachments was followed in each section, which enabled us to match each muscle with its corresponding follicular unit.

RESULTS

Serial, horizontal sections show that, at the upper isthmus, the arrector pili muscle is arranged as a muscular unit structure at the periphery of each follicular unit. Then, at a lower level, the muscle divides and encircles the sebaceous gland, and penetrates between the sebaceous lobules towards the follicular attachment zone.

CONCLUSION

Microphotographic evaluation of large areas of scalp is important for assessing the anatomical relationships between the sebaceous glands, arrector pili muscles, and hair follicles as components of the follicular unit. We introduce the anatomical concept of a follicular unit served by a muscular unit, which can be identified in horizontal sections made at the upper level of the isthmus. This muscular unit results from the merging of the arrector pili muscles that originate from the hair follicles contained in that particular follicular unit. This anatomical disposition suggests that the arrector pili muscles could play an important role in the integrity of the follicular unit as well as in the secretion of the sebum contents.