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Shi Y, Wan S, Song X. Role of neurogenic inflammation in the pathogenesis of alopecia areata. J Dermatol 2024; 51:621-631. [PMID: 38605467 DOI: 10.1111/1346-8138.17227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
Alopecia areata refers to an autoimmune illness indicated by persistent inflammation. The key requirement for alopecia areata occurrence is the disruption of immune-privileged regions within the hair follicles. Recent research has indicated that neuropeptides play a role in the damage to hair follicles by triggering neurogenic inflammation, stimulating mast cells ambient the follicles, and promoting apoptotic processes in keratinocytes. However, the exact pathogenesis of alopecia areata requires further investigation. Recently, there has been an increasing focus on understanding the mechanisms of immune diseases resulting from the interplay between the nervous and the immune system. Neurogenic inflammation due to neuroimmune disorders of the skin system may disrupt the inflammatory microenvironment of the hair follicle, which plays a crucial part in the progression of alopecia areata.
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Affiliation(s)
- Yetan Shi
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Sheng Wan
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China
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2
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Kiselev A, Park S. Immune niches for hair follicle development and homeostasis. Front Physiol 2024; 15:1397067. [PMID: 38711955 PMCID: PMC11070776 DOI: 10.3389/fphys.2024.1397067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
The hair follicle is a dynamic mini-organ that has specialized cycles and architectures with diverse cell types to form hairs. Previous studies for several decades have investigated morphogenesis and signaling pathways during embryonic development and adult hair cycles in both mouse and human skin. In particular, hair follicle stem cells and mesenchymal niches received major attention as key players, and their roles and interactions were heavily revealed. Although resident and circulating immune cells affect cellular function and interactions in the skin, research on immune cells has mainly received attention on diseases rather than development or homeostasis. Recently, many studies have suggested the functional roles of diverse immune cells as a niche for hair follicles. Here, we will review recent findings about immune niches for hair follicles and provide insight into mechanisms of hair growth and diseases.
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Affiliation(s)
- Artem Kiselev
- Institute for Quantitative Health Science and Engineering (IQ), Michigan State University, East Lansing, MI, United States
- Division of Dermatology, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, United States
- Department of Pharmacology and Toxicology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Sangbum Park
- Institute for Quantitative Health Science and Engineering (IQ), Michigan State University, East Lansing, MI, United States
- Division of Dermatology, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, United States
- Department of Pharmacology and Toxicology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
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3
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Bertolini M, Gherardini J, Chéret J, Alam M, Sulk M, Botchkareva NV, Biro T, Funk W, Grieshaber F, Paus R. Mechanical epilation exerts complex biological effects on human hair follicles and perifollicular skin: An ex vivo study approach. Int J Cosmet Sci 2024; 46:175-198. [PMID: 37923568 DOI: 10.1111/ics.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Electrical epilation of unwanted hair is a widely used hair removal method, but it is largely unknown how this affects the biology of human hair follicles (HF) and perifollicular skin. Here, we have begun to explore how mechanical epilation changes selected key biological read-out parameters ex vivo within and around the pilosebaceous unit. METHODS Human full-thickness scalp skin samples were epilated ex vivo using an electro-mechanical device, organ-cultured for up to 6 days in serum-free, supplemented medium, and assessed at different time points by quantitative (immuno-)histomorphometry for selected relevant read-out parameters in epilated and sham-epilated control samples. RESULTS Epilation removed most of the hair shafts, often together with fragments of the outer and inner root sheath and hair matrix. This was associated with persistent focal thinning of the HF basal membrane, decreased melanin content of the residual HF epithelium, and increased HF keratinocyte apoptosis, including in the bulge, yet without affecting the number of cytokeratin 15+ HF epithelial stem cells. Sebocyte apoptosis in the peripheral zone was increased, albeit without visibly altering sebum production. Epilation transiently perturbed HF immune privilege, and increased the expression of ICAM-1 in the bulge and bulb mesenchyme, and the number of perifollicular MHC class II+ cells as well as mast cells around the distal epithelium and promoted mast cell degranulation around the suprabulbar and bulbar area. Moreover, compared to controls, several key players of neurogenic skin inflammation, itch, and/or thermosensation (TRPV1, TRPA1, NGF, and NKR1) were differentially expressed in post-epilation skin. CONCLUSION These data generated in denervated, organ-cultured human scalp skin demonstrate that epilation-induced mechanical HF trauma elicits surprisingly complex biological responses. These may contribute to the delayed re-growth of thinner and lighter hair shafts post-epilation and temporary post-epilation discomfort. Our findings also provide pointers regarding the development of topically applicable agents that minimize undesirable sequelae of epilation.
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Affiliation(s)
- Marta Bertolini
- Monasterium Laboratory Skin and Hair Research Solutions GmbH, Münster, Germany
| | - Jennifer Gherardini
- Monasterium Laboratory Skin and Hair Research Solutions GmbH, Münster, Germany
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jérémy Chéret
- Monasterium Laboratory Skin and Hair Research Solutions GmbH, Münster, Germany
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Majid Alam
- Department of Dermatology and Venereology, Qatar Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mathias Sulk
- Department of Dermatology, University of Münster, Münster, Germany
| | - Natalia V Botchkareva
- Department of Dermatology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tamas Biro
- Monasterium Laboratory Skin and Hair Research Solutions GmbH, Münster, Germany
| | - Wolfgang Funk
- Clinic for Plastic, Aesthetic and Reconstructive Surgery, Dr. Dr. med. Funk, Munich, Germany
| | | | - Ralf Paus
- Monasterium Laboratory Skin and Hair Research Solutions GmbH, Münster, Germany
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- CUTANEON - Skin & Hair Innovations, Hamburg, Germany
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4
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Paus R, Sevilla A, Grichnik JM. Human Hair Graying Revisited: Principles, Misconceptions, and Key Research Frontiers. J Invest Dermatol 2024; 144:474-491. [PMID: 38099887 DOI: 10.1016/j.jid.2023.09.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 02/25/2024]
Abstract
Hair graying holds psychosocial importance and serves as an excellent model for studying human pigmentation and aging in an accessible miniorgan. Current evidence suggests that graying results from an interindividually varying mixture of cumulative oxidative and DNA damage, excessive mTORC1 activity, melanocyte senescence, and inadequate production of pigmentation-promoting factors in the hair matrix. Various regulators modulate this process, including genetic factors (DNA repair defects and IRF4 sequence variation, peripheral clock genes, P-cadherin signaling, neuromediators, HGF, KIT ligand secretion, and autophagic flux. This leads to reduced MITF- and tyrosinase-controlled melanogenesis, defective melanosome transfer to precortical matrix keratinocytes, and eventual depletion of hair follicle (HF) pigmentary unit (HFPU) melanocytes and their local progenitors. Graying becomes irreversible only when bulge melanocyte stem cells are also depleted, occurring later in this process. Distinct pigmentary microenvironments are created as the HF cycles: early anagen is the most conducive phase for melanocytic reintegration and activation, and only during anagen can the phenotype of hair graying and repigmentation manifest, whereas the HFPU disassembles during catagen. The temporary reversibility of graying is highlighted by several drugs and hormones that induce repigmentation, indicating potential target pathways. We advise caution in directly applying mouse model concepts, define major open questions, and discuss future human antigraying strategies.
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Affiliation(s)
- Ralf Paus
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; CUTANEON - Skin & Hair Innovations, Hamburg, Germany; Monasterium Laboratory, Münster, Germany.
| | - Alec Sevilla
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Internal Medicine, Lakeland Regional Health, Lakeland, Florida, USA
| | - James M Grichnik
- Department of Dermatology & Cutaneous Surgery, University of South Florida, Tampa, Florida, USA
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5
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Zhang H, Wang M, Zhao X, Wang Y, Chen X, Su J. Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav Immun 2024; 116:286-302. [PMID: 38128623 DOI: 10.1016/j.bbi.2023.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Psychological stress is a crucial factor in the development of many skin diseases, and the stigma caused by skin disorders may further increase the psychological burden, forming a vicious cycle of psychological stress leading to skin diseases. Therefore, understanding the relationship between stress and skin diseases is necessary. The skin, as the vital interface with the external environment, possesses its own complex immune system, and the neuroendocrine system plays a central role in the stress response of the body. Stress-induced alterations in the immune system can also disrupt the delicate balance of immune cells and inflammatory mediators in the skin, leading to immune dysregulation and increased susceptibility to various skin diseases. Stress can also affect the skin barrier function, impair wound healing, and promote the release of pro-inflammatory cytokines, thereby exacerbating existing skin diseases such as psoriasis, atopic dermatitis, acne, and urticaria. In the present review, we explored the intricate relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective. We explored the occurrence and development of skin diseases in the context of stress, the stress models for skin diseases, the impact of stress on skin function and diseases, and relevant epidemiological studies and clinical trials. Understanding the relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective provides a comprehensive framework for targeted interventions and new insights into the diagnosis and treatment of skin diseases.
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Affiliation(s)
- Hanyi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Mi Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China; Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xue Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Yujie Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
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Dahabreh D, Jung S, Renert-Yuval Y, Bar J, Del Duca E, Guttman-Yassky E. Alopecia Areata: Current Treatments and New Directions. Am J Clin Dermatol 2023; 24:895-912. [PMID: 37606849 DOI: 10.1007/s40257-023-00808-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 08/23/2023]
Abstract
Alopecia areata is an autoimmune hair loss disease that is non-scarring and is characterized by chronic inflammation at the hair follicle level. Clinically, patients' presentation varies from patchy, circumscribed scalp involvement to total body and scalp hair loss. Current management is guided by the degree of scalp and body involvement, with topical and intralesional steroid injections as primarily first-line for mild cases and broad immunosuppressants as the mainstay for more severe cases. Until recently, the limited number of blinded, randomized, placebo-controlled clinical trials for this disease had made establishing an evidence-based treatment paradigm challenging. However, growing insights into the pathogenesis of alopecia areata through blood and tissue analysis of human lesions have identified several promising targets for therapy. T-helper (Th) 1/interferon skewing has traditionally been described as the driver of disease; however, recent investigations suggest activation of additional immune mediators, including the Th2 pathway, interleukin (IL)-9, IL-23, and IL-32, as contributors to alopecia areata pathogenesis. The landscape of alopecia areata treatment has the potential to be transformed, as several novel targeted drugs are currently undergoing clinical trials. Given the recent US FDA approval of baricitinib and ritlecitinib, Janus kinase (JAK) inhibitors are a promising drug class for treating severe alopecia areata cases. This article will review the efficacy, safety, and tolerability of current treatments for alopecia areata, and will provide an overview of the emerging therapies that are leading the revolution in the management of this challenging disease.
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Affiliation(s)
- Dante Dahabreh
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
| | - Seungyeon Jung
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Jonathan Bar
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
| | - Ester Del Duca
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
| | - Emma Guttman-Yassky
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA.
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7
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Dettmer AM, Novak MA, Meyer JS. Are hair cortisol levels dependent on hair growth rate? A pilot study in rhesus macaques. Gen Comp Endocrinol 2023; 340:114308. [PMID: 37244411 PMCID: PMC10330586 DOI: 10.1016/j.ygcen.2023.114308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
Research incorporating the analysis of glucocorticoids, specifically cortisol, in hair samples has exploded over the past 10-15 years, yet factors contributing to the accumulation of cortisol in hair are not yet fully characterized. In particular, it is not clear whether cortisol accumulation in hair is dependent on hair growth rate, a possibility raised by prior rodent studies reporting glucocorticoid-mediated inhibition of hair growth. Using rhesus macaque monkeys (Macaca mulatta), an extensively studied nonhuman primate species, the present pilot study evaluated the hypothesis that hair cortisol accumulation is inversely related to hair growth rate (i.e., slower hair growth leading to elevated cortisol levels). Hair samples were collected from 19 adult female macaques and 17 infants (9 males) 3 months apart using a shave-reshave procedure from the same site below the posterior vertex of the scalp. The second hair samples were measured to the nearest millimeter (mm) for growth rate over the previous 3 months and assayed for hair cortisol concentrations (HCCs) using enzyme immunoassay. Because of the possibility of age-related differences in hair growth rate, correlational analyses were performed separately for adults and infants to determine whether HCC values were associated with growth rate in each age group. These analyses revealed that neither group displayed a significant correlation of HCCs with hair growth. The results additionally showed that overall, adults had a faster hair growth rate than infants and, as expected from previous studies, had lower HCCs than infants. Our results suggest that higher HCCs within the non-stress range do not result from cortisol-mediated inhibition of hair growth. Moreover, similarities between humans and macaque monkeys in both HPA axis regulation and hair growth rates argue that these findings are relevant for human hair cortisol studies. Extrapolation to other species in which the features of hair growth and the relevant regulatory mechanisms are less well understood should be done with caution.
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Affiliation(s)
- Amanda M Dettmer
- Yale Child Study Center, Yale School of Medicine, 230 S. Frontage Road, New Haven, CT 06519, USA.
| | - Melinda A Novak
- Department of Psychological & Brain Sciences, 135 Hicks Way, University of Massachusetts Amherst, Amherst, MA 01003, USA.
| | - Jerrold S Meyer
- Department of Psychological & Brain Sciences, 135 Hicks Way, University of Massachusetts Amherst, Amherst, MA 01003, USA.
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8
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Feng Z, Qin Y, Jiang G. Reversing Gray Hair: Inspiring the Development of New Therapies Through Research on Hair Pigmentation and Repigmentation Progress. Int J Biol Sci 2023; 19:4588-4607. [PMID: 37781032 PMCID: PMC10535703 DOI: 10.7150/ijbs.86911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/19/2023] [Indexed: 10/03/2023] Open
Abstract
Hair graying is a common and visible sign of aging resulting from decreased or absence of melanogenesis. Although it has been established that gray hair greatly impacts people's mental health and social life, there is no effective countermeasure other than hair dyes. It has long been thought that reversal of gray hair on a large scale is rare. However, a recent study reported that individual gray hair darkening is a common phenomenon, suggesting the possibility of large-scale reversal of gray hair. In this article, we summarize the regulation mechanism of melanogenesis and review existing cases of hair repigmentation caused by several factors, including monoclonal antibodies drugs, tyrosine kinase inhibitors (TKIs), immunomodulators, other drugs, micro-injury, and tumors, and speculate on the mechanisms behind them. This review offers some insights for further research into the modulation of melanogenesis and presents a novel perspective on the development of clinical therapies, with emphasis on topical treatments.
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Affiliation(s)
- Zhaorui Feng
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Dermatology, Xuzhou Medical University, Xuzhou, China
| | - Yi Qin
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Dermatology, Xuzhou Medical University, Xuzhou, China
| | - Guan Jiang
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Dermatology, Xuzhou Medical University, Xuzhou, China
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Umar S, Ton D, Carter MJ, Shitabata P. Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias. Clin Cosmet Investig Dermatol 2023; 16:2315-2327. [PMID: 37649568 PMCID: PMC10464825 DOI: 10.2147/ccid.s422310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
Purpose Small observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, we began routinely evaluating the entire scalp of patients with acne keloidalis nuchae (AKN), including trichoscopy-guided biopsies. Patients and Methods This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and December 2022. Primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones were clinically evaluated, and areas showing perifollicular erythema or scales/casts on trichoscopy were biopsied and histologically analyzed. Results Forty-one men with AKN, including 20 men of African descent, 17 Hispanic, and 4 European-descended Whites, were evaluated. All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. All patients showed histologic evidence of perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis (PIILIF), with 96% showing Vellus or miniaturized hair absence. PIILIF was often clinically mistaken for seborrheic dermatitis (44-51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis. Conclusion PIILIF may be a precursor to a wide spectrum of primary cicatricial alopecias, including AKN and folliculitis decalvans. This finding carries implications for the early diagnosis and management of AKN and other primary cicatricial alopecias.
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Affiliation(s)
- Sanusi Umar
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA
| | - Donna Ton
- Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA
| | | | - Paul Shitabata
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- Dermatopathology Institute, Torrance, CA, USA
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10
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Janket SJ, Fraser DD, Baird AE, Tamimi F, Sohaei D, Conte HA, Prassas I, Diamandis EP. Tachykinins and the potential causal factors for post-COVID-19 condition. THE LANCET. MICROBE 2023; 4:e642-e650. [PMID: 37327802 PMCID: PMC10263974 DOI: 10.1016/s2666-5247(23)00111-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 06/18/2023]
Abstract
The most prevalent symptoms of post-COVID-19 condition are pulmonary dysfunction, fatigue and muscle weakness, anxiety, anosmia, dysgeusia, headaches, difficulty in concentrating, sexual dysfunction, and digestive disturbances. Hence, neurological dysfunction and autonomic impairments predominate in post-COVID-19 condition. Tachykinins including the most studied substance P are neuropeptides expressed throughout the nervous and immune systems, and contribute to many physiopathological processes in the nervous, immune, gastrointestinal, respiratory, urogenital, and dermal systems and participate in inflammation, nociception, and cell proliferation. Substance P is a key molecule in neuroimmune crosstalk; immune cells near the peripheral nerve endings can send signals to the brain with cytokines, which highlights the important role of tachykinins in neuroimmune communication. We reviewed the evidence that relates the symptoms of post-COVID-19 condition to the functions of tachykinins and propose a putative pathogenic mechanism. The antagonism of tachykinins receptors can be a potential treatment target.
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Affiliation(s)
- Sok-Ja Janket
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Douglas D Fraser
- Paediatric Critical Care, Western University and Lawson Health Research Institute, London, ON, Canada
| | - Alison E Baird
- Department of Neurology, SUNY Health Sciences University, Brooklyn, NY, USA
| | - Faleh Tamimi
- College of Dental Medicine, Qatar University, Doha, Qatar
| | - Dorsa Sohaei
- McGill University School of Medicine, Montreal, QC, Canada
| | - Harry A Conte
- Department of Infectious Diseases, Johnson Memorial Hospital, Stafford Springs, CT, USA
| | - Ioannis Prassas
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
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11
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Ahn D, Kim H, Lee B, Hahm DH. Psychological Stress-Induced Pathogenesis of Alopecia Areata: Autoimmune and Apoptotic Pathways. Int J Mol Sci 2023; 24:11711. [PMID: 37511468 PMCID: PMC10380371 DOI: 10.3390/ijms241411711] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Alopecia areata (AA) is an autoimmune dermatological disease with multifactorial etiology and is characterized by reversible hair loss in patches. AA may be closely related to emotional stress and influenced by psychological factors as part of its pathophysiology; however, its etiology remains predominantly unknown. This review aimed to elucidate the association between AA occurrence and the neuropeptide substance P (SP) and corticotropin-releasing hormone (CRH), which are secreted during emotional stress, and have been understood to initiate and advance the etiopathogenesis of AA. Therefore, this review aimed to explain how SP and CRH initiate and contribute to the etiopathogenesis of AA. To assess the etiopathogenesis of AA, we conducted a literature search on PubMed and ClinicalTrials.gov. Overall, several authors described interactions between the hair follicles (HFs) and the stress-associated signaling substances, including SP and CRH, in the etiology of AA; this was attributed to the understanding in that AA can occur without the loss of HFs, similar to that observed in hereditary hair loss with age. Most studies demonstrated that the collapse of "immune privilege" plays a crucial role in the development and exacerbation of the AA; nonetheless, a few studies indicated that substances unrelated to autoimmunity may also cause apoptosis in keratocytes, leading to the development of AA. We investigated both the autoimmune and apoptotic pathways within the etiology of AA and assessed the potential interactions between the key substances of both pathways to evaluate potential therapeutic targets for the treatment of AA. Clinical trials of marketed/unreviewed intervention drugs for AA were also reviewed to determine their corresponding target pathways.
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Affiliation(s)
- Dongkyun Ahn
- Department of Medicine, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hyungjun Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Bombi Lee
- Center for Converging Humanities, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Dae-Hyun Hahm
- Department of Medicine, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
- Department of Physiology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
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12
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García A, Navarro MR, Ramirez A, Pino A, Navarro A, Moles I, Gallego E, Anitua E. Plasma Rich in Growth Factors as an Adjuvant Treatment for the Management of Frontal Fibrosing Alopecia: A Retrospective Observational Clinical Study. J Cutan Med Surg 2023; 27:340-349. [PMID: 37233603 DOI: 10.1177/12034754231177599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a scarring alopecia in which the exact etiopathogenesis has not been completely elucidated and the available treatments are not very effective. Plasma rich in growth factors (PRGF) has shown to induce folliculogenesis in hair loss related disorders. However, the scientific evidence when facing FFA is scarce. OBJECTIVES The aim of this study was to retrospectively analyze the adjuvant use of PRGF compared to the conventional treatment in the management of FFA. METHODS Participants with clinically diagnosed FFA who had been treated with either conventional therapy (Control Group) or conventional therapy combined with PRGF (PRGF Group) were identified from the center's medical records. The clinical assessment was based on the "Frontal Fibrosing Alopecia Severity Score" (FFASS), which was fulfilled during a period of two and 4 years. RESULTS This study included 118 patients with clinically diagnosed FFA (Control Group: 57 and PRGF Group: 61). No adverse effects related to the treatments were observed. Both treatments showed to halt the steady progression of hair loss compared to baseline. PRGF treatment also induced significant hair regrowth compared to the Control Group. The scalp inflammation was reduced in response to treatments. The FFASS score indicated that PRGF Group improved the symptoms and severity of FFA in a significant manner. CONCLUSIONS The adjuvant use of PRGF may exert long-term beneficial effects on hair loss reduction and might reduce the symptoms and severity of FFA.
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Affiliation(s)
| | - M R Navarro
- Centro Dermatológico Estético, Alicante, Spain
| | - Ana Ramirez
- Centro Dermatológico Estético, Alicante, Spain
| | - Ander Pino
- BTI Biotechnology Institute, Vitoria, Spain
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13
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Lien KH, Ger TY, Chi CC. Association of Alopecia Areata with Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. Dermatology 2023; 239:523-532. [PMID: 37094565 PMCID: PMC10407832 DOI: 10.1159/000530784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/03/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Immune-mediated melanocyte-related pathogenesis in alopecia areata (AA) may cause sensorineural hearing loss (SNHL). However, the relation between AA and SNHL has been unclear. Therefore, we aimed to investigate this association between AA and SNHL. METHODS We performed a systematic review and searched MEDLINE and Embase on July 25, 2022, for cross-sectional, case-control, or cohort studies that examined the association of AA with SNHL. The Newcastle-Ottawa Scale was used to evaluate their risk of bias. A random-effects model meta-analysis was performed to obtain the mean differences in frequency-specific hearing thresholds between AA patients and age-matched healthy controls and the pooled odds ratio for SNHL in relation to AA. RESULTS We included 5 case-control studies and 1 cohort study, with none of them rated with high risk of biases. The meta-analysis showed AA patients had significantly higher mean differences in pure-tone hearing thresholds at 4,000 Hz and 12,000-12,500 Hz. The meta-analysis also found increased odds for SNHL among patients with AA (OR: 3.18; 95% CI: 2.06-4.89; I2 = 0%). CONCLUSIONS AA is associated with an increase of SNHL, especially at high frequencies. Otologic consultation may be indicated if AA patients present with hearing loss or tinnitus.
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Affiliation(s)
- Kuang-Hsu Lien
- Division of Otology, Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzong-Yun Ger
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Graduate Institute of Biomedical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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14
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Laufer Britva R, Keren A, Bertolini M, Ullmann Y, Paus R, Gilhar A. Involvement of ILC1-like innate lymphocytes in human autoimmunity, lessons from alopecia areata. eLife 2023; 12:80768. [PMID: 36930216 PMCID: PMC10023162 DOI: 10.7554/elife.80768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
Here, we have explored the involvement of innate lymphoid cells-type 1 (ILC1) in the pathogenesis of alopecia areata (AA), because we found them to be significantly increased around lesional and non-lesional HFs of AA patients. To further explore these unexpected findings, we first co-cultured autologous circulating ILC1-like cells (ILC1lc) with healthy, but stressed, organ-cultured human scalp hair follicles (HFs). ILClc induced all hallmarks of AA ex vivo: they significantly promoted premature, apoptosis-driven HF regression (catagen), HF cytotoxicity/dystrophy, and most important for AA pathogenesis, the collapse of the HFs physiological immune privilege. NKG2D-blocking or IFNγ-neutralizing antibodies antagonized this. In vivo, intradermal injection of autologous activated, NKG2D+/IFNγ-secreting ILC1lc into healthy human scalp skin xenotransplanted onto SCID/beige mice sufficed to rapidly induce characteristic AA lesions. This provides the first evidence that ILC1lc, which are positive for the ILC1 phenotype and negative for the classical NK markers, suffice to induce AA in previously healthy human HFs ex vivo and in vivo, and further questions the conventional wisdom that AA is always an autoantigen-dependent, CD8 +T cell-driven autoimmune disease.
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Affiliation(s)
- Rimma Laufer Britva
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion – Israel Institute of TechnologyHaifaIsrael
- Department of Dermatology, Rambam Health Care CampusHaifaIsrael
| | - Aviad Keren
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion – Israel Institute of TechnologyHaifaIsrael
| | | | - Yehuda Ullmann
- Department of Plastic Surgery, Rambam Medical CenterHaifaIsrael
| | - Ralf Paus
- Monasterium LaboratoryMünsterGermany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of MiamiMiamiUnited States
- CUTANEONHamburgGermany
| | - Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion – Israel Institute of TechnologyHaifaIsrael
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15
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Wang LH, Ma SH, Tai YH, Dai YX, Chang YT, Chen TJ, Chen MH. Increased Risk of Suicide Attempt in Patients with Alopecia Areata: A Nationwide Population-Based Cohort Study. Dermatology 2023; 239:712-719. [PMID: 36921592 DOI: 10.1159/000530076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND There is growing evidence that patients with alopecia areata (AA) have an increased risk of developing psychiatric comorbidities. However, the relationship between AA and suicidal behaviors remains unclear. OBJECTIVE The objective of this study was to investigate the association between AA and suicidal behaviors. METHODS Participants were recruited from the National Health Insurance Research Database in Taiwan, including 10,515 patients with AA and 10,5150 matched controls, to assess the risk of suicide attempts. A Cox regression model was used for all analyses. RESULTS Compared with the controls, an increased risk of suicide attempts was observed in patients with AA, with an adjusted hazard ratio of 6.28 (95% confidence interval, 4.47-8.81). Suicide risk remained significantly elevated in AA patients when stratified by underlying psychiatric disorders. The mean age of initial suicidal behaviors was also lower in patients with AA. CONCLUSIONS Patients with AA had a significantly higher incidence of suicidal attempts than controls, regardless of concurrent psychiatric illness. Further studies are needed to elucidate the pathophysiology of the association between AA and suicidality. In addition, dermatologists should be aware of the increased suicidality of patients with AA.
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Affiliation(s)
- Li-Hsin Wang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Hsiang Ma
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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16
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Paggioli I, Moss J. Alopecia Areata: Case report and review of pathophysiology and treatment with Jak inhibitors. J Autoimmun 2022; 133:102926. [PMID: 36335798 DOI: 10.1016/j.jaut.2022.102926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
Alopecia Areata (AA) is a T-cell mediated autoimmune attack on hair follicles resulting in rapidly developing areas of hair loss involving the scalp and beard that can progress to total scalp hair loss (alopecia totalis) and loss of eyebrows, eyelashes, and total body hair (alopecia universalis). Affected patients have high rates of psychological disorders and decreased quality of life. There are no FDA approved treatments, and the available treatments have a high failure rate. JAK inhibitors are remarkably effective in many autoimmune diseases including Alopecia Areata. Presented is a case report of successful treatment with tofacitinib, and a literature review of the pathophysiology of alopecia areata, the mechanism of action of JAK inhibitors, and the JAK inhibitors in phase 2 and 3 trials.
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Affiliation(s)
| | - Jeremy Moss
- Brookside Dermatology, 4639 Main Street, Bridgeport, CT, 06606, USA.
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17
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Rajput RJ. Influence of Nutrition, Food Supplements and Lifestyle in Hair Disorders. Indian Dermatol Online J 2022; 13:721-724. [PMID: 36386748 PMCID: PMC9650738 DOI: 10.4103/idoj.idoj_175_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
Genetic, androgenic, epigenetic, environmental, lifestyle, diet, and nutritional factors have influence over promoting or regulating inflammation, immunity, and genetic expression predisposing to hair loss. Oxidative stress is a major mediator for various mechanisms of hair loss, including the release of transforming growth factor-β ( TGF-β). Nutrients counter oxidative stress, repair cellular damage, support cellular functions, and restore hair growth. Nutrients can be synergistic or antagonistic. Covert subclinical nutritional deficiencies are common. Higher dose of nutrients does not mean higher efficiency but may reverse the benefits converting an antioxidant to become prooxidant. Nutrients do not work alone but are supported by accessory micronutrients which ensure biological utilization. Providing proper nutritional environment can neutralize free radicals and perpetuate active hair growth cycles.
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Affiliation(s)
- Rajendrasingh J. Rajput
- Hair Restore, 403 Esperanza, 198/45D, Linking Road Corner, Bandra West, Mumbai, Maharashtra, India,Address for correspondence: Dr. Rajendrasingh J. Rajput, Hair Restore, 403 Esperanza, 198/45D, Linking Road Corner, Bandra West, Mumbai - 400 050, Maharashtra, India. E-mail:
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18
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Miao YJ, Jing J, Du XF, Mao MQ, Yang XS, Lv ZF. Frontal fibrosing alopecia: A review of disease pathogenesis. Front Med (Lausanne) 2022; 9:911944. [PMID: 35957858 PMCID: PMC9357920 DOI: 10.3389/fmed.2022.911944] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Frontal fibrosing alopecia (FFA) is a primary patterned cicatricial alopecia that mostly affects postmenopausal women and causes frontotemporal hairline regression and eyebrow loss. Although the incidence of FFA has increased worldwide over the last decade, its etiology and pathology are still unclear. We cover the latest findings on its pathophysiology, including immunomodulation, neurogenic inflammation, and genetic regulation, to provide more alternatives for current clinical treatment. A persistent inflammatory response and immune privilege (IP) collapse develop and lead to epithelial hair follicle stem cells (eHFSCs) destruction and epithelial-mesenchymal transition (EMT) in the bulge area, which is the key process in FFA pathogenesis. Eventually, fibrous tissue replaces normal epithelial tissue and fills the entire hair follicle (HF). In addition, some familial reports and genome-wide association studies suggest a genetic susceptibility or epigenetic mechanism for the onset of FFA. The incidence of FFA increases sharply in postmenopausal women, and many FFA patients also suffer from female pattern hair loss in clinical observation, which suggests a potential association between FFA and steroid hormones. Sun exposure and topical allergens may also be triggers of FFA, but this conjecture has not been proven. More evidence and cohort studies are needed to help us understand the pathogenesis of this disease.
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Affiliation(s)
- Yu-Jie Miao
- Department of Dermatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jing Jing
- Department of Dermatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Jing Jing,
| | - Xu-Feng Du
- Department of Dermatology, Wuxi People’s Hospital, Nanjing Medical University, Wuxi, China
| | - Mei-Qi Mao
- Department of Dermatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-Shuang Yang
- Department of Dermatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhong-Fa Lv
- Department of Dermatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Zhong-Fa Lv,
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19
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The impact of perceived stress on the hair follicle: Towards solving a psychoneuroendocrine and neuroimmunological puzzle. Front Neuroendocrinol 2022; 66:101008. [PMID: 35660551 DOI: 10.1016/j.yfrne.2022.101008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022]
Abstract
While popular belief harbors little doubt that perceived stress can cause hair loss and premature graying, the scientific evidence for this is arguably much thinner. Here, we investigate whether these phenomena are real, and show that the cyclic growth and pigmentation of the hair follicle (HF) provides a tractable model system for dissecting how perceived stress modulates aspects of human physiology. Local production of stress-associated neurohormones and neurotrophins coalesces with neurotransmitters and neuropeptides released from HF-associated sensory and autonomic nerve endings, forming a complex local stress-response system that regulates perifollicular neurogenic inflammation, interacts with the HF microbiome and controls mitochondrial function. This local system integrates into the central stress response systems, allowing the study of systemic stress responses affecting organ function by quantifying stress mediator content of hair. Focusing on selected mediators in this "brain-HF axis" under stress conditions, we distill general principles of HF dysfunction induced by perceived stress.
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20
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Peng J, Chen H, Zhang B. Nerve–stem cell crosstalk in skin regeneration and diseases. Trends Mol Med 2022; 28:583-595. [DOI: 10.1016/j.molmed.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
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21
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Senna MM, Peterson E, Jozic I, Chéret J, Paus R. Frontiers in Lichen Planopilaris and Frontal Fibrosing Alopecia Research: Pathobiology Progress and Translational Horizons. JID INNOVATIONS 2022; 2:100113. [PMID: 35521043 PMCID: PMC9062486 DOI: 10.1016/j.xjidi.2022.100113] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/06/2023] Open
Abstract
Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary, lymphocytic cicatricial hair loss disorders. These model epithelial stem cell (SC) diseases are thought to result from a CD8+ T-cell‒dominated immune attack on the hair follicle (HF) SC niche (bulge) after the latter has lost its immune privilege (IP) for as yet unknown reasons. This induces both apoptosis and pathological epithelial‒mesenchymal transition in epithelial SCs, thus depletes the bulge, causes fibrosis, and ultimately abrogates the HFs' capacity to regenerate. In this paper, we synthesize recent progress in LPP and FFA pathobiology research, integrate our limited current understanding of the roles that genetic, hormonal, environmental, and other factors may play, and define major open questions. We propose that LPP and FFA share a common initial pathobiology, which then bifurcates into two distinct clinical phenotypes, with macrophages possibly playing a key role in phenotype determination. As particularly promising translational research avenues toward direly needed progress in the management of these disfiguring, deeply distressful cicatricial alopecia variants, we advocate to focus on the development of bulge IP and epithelial SC protectants such as, for example, topically effective, HF‒penetrating and immunoinhibitory preparations that contain tacrolimus, peroxisome proliferator-activated receptor-γ, and/or CB1 agonists.
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Key Words
- 5ARI, 5α-reductase inhibitor
- AA, alopecia areata
- AGA, androgenetic alopecia
- CRH, corticotropin-releasing hormone
- EMT, epithelial‒mesenchymal transition
- FFA, frontal fibrosing alopecia
- HF, hair follicle
- IP, immune privilege
- K, keratin
- KC, keratinocyte
- LPP, lichen planopilaris
- MAC, macrophage
- MHC, major histocompatibility complex
- PCA, primary cicatricial alopecia
- PCP, personal care product
- PPAR-γ, peroxisome proliferator–activated receptor-γ
- SC, stem cell
- SP, substance P
- eHFSC, epithelial hair follicle stem cell
- α-MSH, α-melanocyte-stimulating hormone
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Affiliation(s)
- Maryanne Makredes Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Erik Peterson
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ivan Jozic
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jérémy Chéret
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.,Monasterium Laboratory, Münster, Germany.,CUTANEON, Hamburg, Germany
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22
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Datta D, Madke B, Das A. Skin as an endocrine organ: A narrative review. Indian J Dermatol Venereol Leprol 2022; 88:590-597. [PMID: 35389023 DOI: 10.25259/ijdvl_533_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/01/2021] [Indexed: 12/21/2022]
Abstract
Skin being the largest organ of the body, is equipped with numerous functional properties. Over the past few years, intricate research into the biology of skin has led to a gamut of discoveries. Skin is now regarded as one of the most vital endocrine organs. The skin contains equivalents of the hypothalamo-pituitary-adrenal axis, hypothalamo-pituitary-thyroid axis and the appendages produce multiple hormones such as Vitamin D, sex steroids, retinoids and opioids. In this article, we will explore the role of skin as a target and source of some of the hormones of the human body, and briefly touch on the clinical applications.
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Affiliation(s)
- Debatri Datta
- Oliva Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Bhushan Madke
- Department of Dermatology, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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23
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Shahidi-Dadras M, Asadi Kani Z, Dadkhahfar S, Zartab H, Rakhshan A. The presence of mast cells in lichen planopilaris and discoid lupus erythematosus of the scalp; a quantitative study. J Cutan Pathol 2022; 49:448-453. [PMID: 35103345 DOI: 10.1111/cup.14207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/04/2021] [Accepted: 01/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Histopathologic differentiation of Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) as the two common causes of primary cicatricial alopecias remains challenging. METHOD We performed a histopathologic study on a case series of LPP and DLE specimens to investigate the number, distribution, and morphology of mast cells as indices for differentiation of these two entities. H & E investigation and Giemsa staining for the detection of mast cells was performed. RESULT A total of 74 cases comprising 50 cases of LPP and 24 cases of DLE, were assessed. The mean mast cell count and percentage were significantly higher in LPP group (P <0.001). Mean degranulated mast cell count and the mean intact mast cell count were also significantly higher in LPP patients (P <0.001). Most of the specimens, 58 (78.4%), showed both perifollicular and perivascular distribution of mast cells without significant diffrence between two groups. The morphology of mast cells was predominantly round-oval in 85.5%, predominantly fusiform in 13.5% with more frequent fusiform morphology in DLE group. CONCLUSION The mast cell count detected by Giemsa staining could assist pathologists in distinguishing between LPP and DLE. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Zahra Asadi Kani
- Skin research center, Shahid Beheshti university of medical sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin research center, Shahid Beheshti university of medical sciences, Tehran, Iran
| | - Hamed Zartab
- Center for Research & Training in Skin Diseases & Leprosy, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Azadeh Rakhshan
- Skin research center, Shahid Beheshti university of medical sciences, Tehran, Iran.,Department of pathology, Shohada-e-Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Lintzeri DA, Constantinou A, Hillmann K, Ghoreschi K, Vogt A, Blume-Peytavi U. Alopecia areata – Aktuelles Verständnis und Management. J Dtsch Dermatol Ges 2022; 20:59-93. [PMID: 35040563 DOI: 10.1111/ddg.14689_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Dimitra Aikaterini Lintzeri
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Andria Constantinou
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Kathrin Hillmann
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Annika Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Ulrike Blume-Peytavi
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
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25
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Lintzeri DA, Constantinou A, Hillmann K, Ghoreschi K, Vogt A, Blume-Peytavi U. Alopecia areata - Current understanding and management. J Dtsch Dermatol Ges 2022; 20:59-90. [PMID: 35040577 DOI: 10.1111/ddg.14689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023]
Abstract
Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.
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Affiliation(s)
- Dimitra Aikaterini Lintzeri
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Andria Constantinou
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Annika Vogt
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
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Jung BH, Song SH, Yoon SJ, Koo JH, Yoo KY. The Effect of Botulinum Toxin on Hair Follicle Cell Regeneration Under Continuous Stress Conditions: a Pilot Animal Study. Neurotox Res 2022; 40:103-110. [PMID: 34997456 DOI: 10.1007/s12640-021-00453-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
We analyzed the effect of botulinum toxin (BTX) type A on the regeneration of hair follicle cells under continuous stress conditions. Thirty 6-week-old C57BL/6 mice were used, and hair loss was induced on their backs (10 control (CTL) mice, reared under normal conditions without stress; 10 mice, exposed to continuous stress (STRESS) by fixing in an enclosed space; 10 BTX + STRESS mice, injected subcutaneously with 1 IU of BTX (0.1 cc) where the hair follicles were removed under the same stress conditions). There was less hair growth in the STRESS and BTX + STRESS groups compared to that in the CTL group at 2 weeks. At 3 weeks, the telogen stage was mainly observed in the STRESS group whereas the anagen stage was observed in the CTL and BTX + STRESS groups. A substantial increase in terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells was observed in the STRESS group compared to that in the CTL and BTX + STRESS groups. Substance P (SP) immunoreactivity cell levels increased in the STRESS group at 2 and 3 weeks compared to those in the BTX + STRESS group. SP expression increased at 2 and 3 weeks in the STRESS group compared to that in the CTL and BTX + STRESS groups. A delay in the regeneration cycle of the hair follicle cells occurred when stress was applied, and an almost normal regeneration cycle occurred when BTX was injected subcutaneously. Therefore, BTX may be a positive indicator for hair loss treatment.
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Affiliation(s)
- Bo Hyun Jung
- Department of Oral Anatomy, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Sun Hong Song
- Department of Rehabilitation Medicine, College of Medicine, Gangneung Asan Hospital, University of Ulsan, Gangneung, Republic of Korea.
| | - Se Jin Yoon
- Danam Rehabilitation Clinics, Seoul, Republic of Korea
| | - Jung Hoi Koo
- Department of Rehabilitation Medicine, College of Medicine, Gangneung Asan Hospital, University of Ulsan, Gangneung, Republic of Korea
| | - Ki Yeon Yoo
- Department of Oral Anatomy, Gangneung-Wonju National University, Gangneung, Republic of Korea
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27
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Kim C, Shin JM, Kim D, Park S, Hong D, Jung KE, Kim CD, Seo YJ, Lee Y. Role of Substance P in Regulating Micro-Milieu of Inflammation in Alopecia Areata. Ann Dermatol 2022; 34:270-277. [PMID: 35948329 PMCID: PMC9365655 DOI: 10.5021/ad.21.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background Alopecia areata (AA) is an autoimmune disease characterized by chronic inflammation, the pathogenesis of which is unknown. Stress is believed to play a role; however, evidence remains insufficient. A recent study showed that substance P (SP) damaged hair follicles by causing neurogenic inflammation, activating perifollicular mast cells, and inducing keratinocyte apoptosis. Objective We aimed at studying the role of SP in AA pathogenesis. We investigated the SP levels in the lesional scalp tissues and serum. We also studied the effect of SP on the inflammatory response and hair growth in the outer root sheath (ORS) cells. Methods We compared the serum levels of SP in 58 AA patients and 28 healthy subjects. Then, we checked the expression of SP and SP receptor, neurokinin-1 receptor (NK-1R) in the scalps of AA patients and healthy controls using immunohistochemical staining. Finally, we analyzed the mRNA expression of inflammatory cytokines and hair growth-related factors in ORS cells. Results SP and NK-1R expression were markedly higher in the hair follicles and interfollicular epidermis of the scalp lesions of AA patients. However, there was no statistically significant difference in serum SP levels between controls and patients, regardless of the type of alopecia. SP significantly increased the mRNA expression of inflammatory cytokines and decreased hair growth-related growth factors in ORS cells, but the results were not dramatic. Conclusion SP triggered a localized micro-inflammation in lesional hair follicles, provoked an inflammatory response, and inhibited hair growth, thereby confirming the pathogenic role of SP in AA.
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Affiliation(s)
- Changhyeon Kim
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jung-Min Shin
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Doyeon Kim
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Sanghyun Park
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Dongkyun Hong
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Kyung Eun Jung
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Chang-Deok Kim
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Young-Joon Seo
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Young Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
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28
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Fukuyama M, Ito T, Ohyama M. Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines. J Dermatol 2021; 49:19-36. [PMID: 34709679 DOI: 10.1111/1346-8138.16207] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022]
Abstract
Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence suggests that collapse of the HF immune privilege subsequent to triggering events, represented by viral infection, leads to autoimmune response in which autoreactive cytotoxic CD8+NKG2D+ T cells mainly target exposed HF autoantigens. AA had been recognized as type 1 inflammatory disease, but recent investigations have suggested some roles of type 2- and Th17-associated mediators in AA pathogenesis. The significance of psychological stress in AA pathogenesis is less emphasized nowadays, but psychological comorbidities, such as depression and anxiety, attract greater interest in AA management. In this regard, the disease severity may not solely be evaluated by the extent of hair loss. Use of trichoscopy markedly improved the resolution of the diagnosis and evaluation of the phase of AA, which is indispensable for the optimization of treatment. For the standardization of AA management, the establishment of guidelines/expert consensus is pivotal. Indeed, the Japanese Dermatological Association (JDA) and other societies and expert groups have published guidelines/expert consensus reports, which mostly recommend intralesional/topical corticosteroid administration and contact immunotherapy as first-line treatments, depending on the age, disease severity, and activity of AA. The uniqueness of the JDA guidelines can be found in their descriptions of intravenous corticosteroid pulse therapy, antihistamines, and other miscellaneous domestically conducted treatments. Considering the relatively high incidence of spontaneous regression in mild AA and its intractability in severe subsets, the importance of course observation is also noted. Evidenced-based medicine for AA is currently limited, however, novel therapeutic approaches, represented by JAK inhibitors, are on their way for clinical application. In this review, the latest understanding of the etiopathogenesis and pathophysiology, and update on therapeutic approaches with future perspectives are summarized for AA, following the current version of the JDA AA management guidelines.
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Affiliation(s)
- Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
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A Cell Membrane-Level Approach to Cicatricial Alopecia Management: Is Caveolin-1 a Viable Therapeutic Target in Frontal Fibrosing Alopecia? Biomedicines 2021; 9:biomedicines9050572. [PMID: 34069454 PMCID: PMC8159142 DOI: 10.3390/biomedicines9050572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Irreversible destruction of the hair follicle (HF) in primary cicatricial alopecia and its most common variant, frontal fibrosing alopecia (FFA), results from apoptosis and pathological epithelial-mesenchymal transition (EMT) of epithelial HF stem cells (eHFSCs), in conjunction with the collapse of bulge immune privilege (IP) and interferon-gamma-mediated chronic inflammation. The scaffolding protein caveolin-1 (Cav1) is a key component of specialized cell membrane microdomains (caveolae) that regulates multiple signaling events, and even though Cav1 is most prominently expressed in the bulge area of human scalp HFs, it has not been investigated in any cicatricial alopecia context. Interestingly, in mice, Cav1 is involved in the regulation of (1) key HF IP guardians (TGF-β and α-MSH signaling), (2) IP collapse inducers/markers (IFNγ, substance P and MICA), and (3) EMT. Therefore, we hypothesize that Cav1 may be an unrecognized, important player in the pathobiology of cicatricial alopecias, and particularly, in FFA, which is currently considered as the most common type of primary lymphocytic scarring alopecia in the world. We envision that localized therapeutic inhibition of Cav1 in management of FFA (by cholesterol depleting agents, i.e., cyclodextrins/statins), could inhibit and potentially reverse bulge IP collapse and pathological EMT. Moreover, manipulation of HF Cav1 expression/localization would not only be relevant for management of cicatricial alopecia, but FFA could also serve as a model disease for elucidating the role of Cav1 in other stem cell- and/or IP collapse-related pathologies.
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30
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Abstract
Hair loss affects millions of people worldwide and can have devastating effects on an individual's psychoemotional well-being. Today hair restoration technologies through hair transplantation have advanced with the use of robots and follicular unit extraction and grafting that it is possible to offer to patient's excellent clinical results. Adjuvant modalities such as platelet-rich plasma injections, lasers, and stem cells can further enhance the durability, health, and appearance of hair transplants.
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Affiliation(s)
- Neil Sadick
- Department of Dermatology, Weill Medical College of Cornell University, 1305 York Ave 9th Floor, New York, NY 10021, USA; Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA; Sadick Dermatology, 911 Park Avenue, New York, NY 10075, USA.
| | - Suleima Arruda
- Department of Dermatology, Weill Medical College of Cornell University, 1305 York Ave 9th Floor, New York, NY 10021, USA; Sadick Dermatology, 911 Park Avenue, New York, NY 10075, USA
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31
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Fischer TW, Bergmann A, Kruse N, Kleszczynski K, Skobowiat C, Slominski AT, Paus R. New effects of caffeine on corticotropin-releasing hormone (CRH)-induced stress along the intrafollicular classical hypothalamic-pituitary-adrenal (HPA) axis (CRH-R1/2, IP 3 -R, ACTH, MC-R2) and the neurogenic non-HPA axis (substance P, p75 NTR and TrkA) in ex vivo human male androgenetic scalp hair follicles. Br J Dermatol 2021; 184:96-110. [PMID: 32271938 PMCID: PMC7962141 DOI: 10.1111/bjd.19115] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Human hair is highly responsive to stress, and human scalp hair follicles (HFs) contain a peripheral neuroendocrine equivalent of the systemic hypothalamic-pituitary-adrenal (HPA) stress axis. Androgenetic alopecia (AGA) is supposed to be aggravated by stress. We used corticotropin-releasing hormone (CRH), which triggers the HPA axis, to induce a stress response in human ex vivo male AGA HFs. Caffeine is known to reverse testosterone-mediated hair growth inhibition in the same hair organ culture model. OBJECTIVES To investigate whether caffeine would antagonize CRH-mediated stress in these HFs. METHODS HFs from balding vertex area scalp biopsies of men affected by AGA were incubated with CRH (10-7 mol L-1 ) with or without caffeine (0·001% or 0·005%). RESULTS Compared to controls, CRH significantly enhanced the expression of catagen-inducing transforming growth factor-β2 (TGF-β2) (P < 0·001), CRH receptors 1 and 2 (CRH-R1/2) (P < 0·01), adrenocorticotropic hormone (ACTH) (P < 0·001) and melanocortin receptor 2 (MC-R2) (P < 0·001), and additional stress-associated parameters, substance P and p75 neurotrophin receptor (p75NTR ). CRH inhibited matrix keratinocyte proliferation and expression of anagen-promoting insulin-like growth factor-1 (IGF-1) and the pro-proliferative nerve growth factor receptor NGF-tyrosine kinase receptor A (TrkA). Caffeine significantly counteracted all described stress effects and additionally enhanced inositol trisphosphate receptor (IP3 -R), for the first time detected in human HFs. CONCLUSIONS These findings provide the first evidence in ex vivo human AGA HFs that the stress mediator CRH induces not only a complex intrafollicular HPA response, but also a non-HPA-related stress response. Moreover, we show that these effects can be effectively antagonized by caffeine. Thus, these data strongly support the hypothesis that stress can impair human hair physiology and induce hair loss, and that caffeine may effectively counteract stress-induced hair damage and possibly prevent stress-induced hair loss.
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Affiliation(s)
- T W Fischer
- Department of Dermatology, Allergology and Venerology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - A Bergmann
- Department of Dermatology, Allergology and Venerology, University of Lübeck, Lübeck, Germany
| | - N Kruse
- Department of Dermatology, Allergology and Venerology, University of Lübeck, Lübeck, Germany
| | - K Kleszczynski
- Department of Dermatology, Allergology and Venerology, University of Lübeck, Lübeck, Germany
| | - C Skobowiat
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - A T Slominski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- Comprehensive Cancer Center, Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- VA Medical Center, Birmingham, AL, 35294, USA
| | - R Paus
- Department of Dermatology, Allergology and Venerology, University of Lübeck, Lübeck, Germany
- Centre for Dermatology Research, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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32
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Gilhar A, Laufer Britva R, Keren A, Paus R. Mouse Models of Alopecia Areata: C3H/HeJ Mice Versus the Humanized AA Mouse Model. J Investig Dermatol Symp Proc 2020; 20:S11-S15. [PMID: 33099377 DOI: 10.1016/j.jisp.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The C3H/HeJ model has long dominated basic alopecia areata (AA) in vivo research and has been used as proof-of-principle that Jak inhibitors are suitable agents for AA management in vivo. However, its histologic features are not typical of human AA, and it is questionable whether it is sufficiently clinically predictive for evaluating the therapeutic effects of candidate AA agents. Instead, the humanized mouse model of AA has been used to functionally demonstrate the role of key immune cells in AA pathogenesis and to discover human-specific pharmacologic targets in AA management. Therefore, we advocate the use of both models in future preclinical AA research.
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Affiliation(s)
- Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Rimma Laufer Britva
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Aviad Keren
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ralf Paus
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Centre for Dermatology Research, University of Manchester, and NIHR Biomedical Research Centre, Manchester, United Kingdom; Monasterium Laboratory Skin & Hair Research Solutions GmbH, Muenster, Germany
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33
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O'Sullivan JDB, Nicu C, Picard M, Chéret J, Bedogni B, Tobin DJ, Paus R. The biology of human hair greying. Biol Rev Camb Philos Soc 2020; 96:107-128. [PMID: 32965076 DOI: 10.1111/brv.12648] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
Hair greying (canities) is one of the earliest, most visible ageing-associated phenomena, whose modulation by genetic, psychoemotional, oxidative, senescence-associated, metabolic and nutritional factors has long attracted skin biologists, dermatologists, and industry. Greying is of profound psychological and commercial relevance in increasingly ageing populations. In addition, the onset and perpetuation of defective melanin production in the human anagen hair follicle pigmentary unit (HFPU) provides a superb model for interrogating the molecular mechanisms of ageing in a complex human mini-organ, and greying-associated defects in bulge melanocyte stem cells (MSCs) represent an intriguing system of neural crest-derived stem cell senescence. Here, we emphasize that human greying invariably begins with the gradual decline in melanogenesis, including reduced tyrosinase activity, defective melanosome transfer and apoptosis of HFPU melanocytes, and is thus a primary event of the anagen hair bulb, not the bulge. Eventually, the bulge MSC pool becomes depleted as well, at which stage greying becomes largely irreversible. There is still no universally accepted model of human hair greying, and the extent of genetic contributions to greying remains unclear. However, oxidative damage likely is a crucial driver of greying via its disruption of HFPU melanocyte survival, MSC maintenance, and of the enzymatic apparatus of melanogenesis itself. While neuroendocrine factors [e.g. alpha melanocyte-stimulating hormone (α-MSH), adrenocorticotropic hormone (ACTH), ß-endorphin, corticotropin-releasing hormone (CRH), thyrotropin-releasing hormone (TRH)], and micropthalmia-associated transcription factor (MITF) are well-known regulators of human hair follicle melanocytes and melanogenesis, how exactly these and other factors [e.g. thyroid hormones, hepatocyte growth factor (HGF), P-cadherin, peripheral clock activity] modulate greying requires more detailed study. Other important open questions include how HFPU melanocytes age intrinsically, how psychoemotional stress impacts this process, and how current insights into the gerontobiology of the human HFPU can best be translated into retardation or reversal of greying.
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Affiliation(s)
- James D B O'Sullivan
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A
| | - Carina Nicu
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A
| | - Martin Picard
- Departments of Psychiatry and Neurology, Columbia University Irving Medical Center, 622 W 168th Street, PH1540N, New York, 10032, U.S.A
| | - Jérémy Chéret
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A
| | - Barbara Bedogni
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A
| | - Desmond J Tobin
- Charles Institute of Dermatology, University College Dublin, Dublin 4, Ireland
| | - Ralf Paus
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A.,Monasterium Laboratory, Skin & Hair Research Solutions GmbH, Münster, D-48149, Germany.,Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, M13 9PT, U.K
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34
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Bertolini M, McElwee K, Gilhar A, Bulfone‐Paus S, Paus R. Hair follicle immune privilege and its collapse in alopecia areata. Exp Dermatol 2020; 29:703-725. [DOI: 10.1111/exd.14155] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Kevin McElwee
- Monasterium Laboratory Münster Germany
- Centre for Skin Sciences University of Bradford Bradford UK
- Department of Dermatology and Skin Science University of British Columbia Vancouver British Columbia Canada
| | - Amos Gilhar
- Laboratory for Skin Research Rappaport Faculty of Medicine Technion‐Israel Institute of Technology Haifa Israel
| | - Silvia Bulfone‐Paus
- Monasterium Laboratory Münster Germany
- Centre for Dermatology Research University of Manchester and NIHR Manchester Biomedical Research Centre Manchester UK
| | - Ralf Paus
- Monasterium Laboratory Münster Germany
- Centre for Dermatology Research University of Manchester and NIHR Manchester Biomedical Research Centre Manchester UK
- Dr. Philip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
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35
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Del Duca E, Ruano Ruiz J, Pavel AB, Sanyal RD, Song T, Gay-Mimbrera J, Zhang N, Estrada YD, Peng X, Renert-Yuval Y, Phelps RG, Paus R, Krueger JG, Guttman-Yassky E. Frontal fibrosing alopecia shows robust T helper 1 and Janus kinase 3 skewing. Br J Dermatol 2020; 183:1083-1093. [PMID: 32215911 DOI: 10.1111/bjd.19040] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a scarring alopecia with unclear pathogenesis and a progressive course. The disease has a major impact on patients' quality of life and there is a lack of effective treatment to halt disease progression. METHODS We profiled lesional and nonlesional scalp biopsies collected in 2017 from patients with FFA (n = 12) compared with scalp biopsies from patients with alopecia areata (AA) (n = 8) and controls (n = 8) to evaluate gene and protein expression, including the primary outcome (CXCL9). We determined significant differences between biomarkers using a two-sided Student's t-test adjusting P-values by false discovery rate. RESULTS Significant increases were seen in CD8+ cytotoxic T cells, CD11c+ dendritic cells, CD103+ and CD69+ tissue-resident memory T cells in FFA and AA vs. control scalp (P < 0·05), with corresponding significantly upregulated granzyme B mRNA, particularly in FFA (P < 0·01). In AA, cellular infiltrates were primarily concentrated at the bulb, while in FFA these were mainly localized at the bulge. FFA demonstrated significant upregulation of T helper 1/intereferon (IFN) (IFN-γ, CXCL9/CXCL10), the Janus kinase/signal transducers and activators of transcription (JAK-STAT) pathway (STAT1, JAK3) and fibrosis-related products (vimentin, fibronectin; P < 0·05), with no concomitant downregulation of hair keratins and the T-regulatory marker, forkhead box P3, which were decreased in AA. The stem cell markers CD200 and K15 demonstrated significantly reduced expression only in FFA (P < 0·05). CONCLUSIONS These data suggest that follicular damage and loss of stem cells in FFA may be mediated through immune attack in the bulge region, with secondary fibrosis and reduced but still detectable stem cells. JAK/STAT-targeting treatments may be able to prevent permanent follicular destruction and fibrosis in early disease stages.
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Affiliation(s)
- E Del Duca
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - J Ruano Ruiz
- Department of Dermatology, University of Córdoba, Córdoba, Spain.,Immune-Mediated Inflammatory Skin Diseases Research Group, IMIBIC/Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - A B Pavel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R D Sanyal
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T Song
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Gay-Mimbrera
- Department of Dermatology, University of Córdoba, Córdoba, Spain.,Immune-Mediated Inflammatory Skin Diseases Research Group, IMIBIC/Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - N Zhang
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y D Estrada
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - X Peng
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - R G Phelps
- Department of Pathology, Division of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Paus
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Centre for Dermatology Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - J G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - E Guttman-Yassky
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH. Bidirectional association between alopecia areata and sleep disorders: a population-based cohort study in Taiwan. Sleep Med 2020; 75:112-116. [PMID: 32858349 DOI: 10.1016/j.sleep.2020.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The relationship between alopecia areata (AA) and sleep disorders remains uncertain. This study aims to investigate the bidirectional association between AA and sleep disorders. METHODS To assess the risk of developing sleep disorders, we recruited 5648 patients with AA and 22,592 matched controls from the National Health Insurance Research Database (NHIRD) in Taiwan. Similarly, risk of developing AA was assessed in 93,130 patients with sleep disorders (including 7310 patients with obstructive sleep apnea [OSA] and 85,820 patients with non-apnea insomnia) and 372,520 matched controls. Cox regression model was used for the analysis. RESULTS AA patients had a significantly increased risk of developing OSA (adjusted hazard ratio [aHR] 3.80; 95% confidence interval [CI] 2.53-5.71) and non-apnea insomnia (aHR 4.20; 95% CI 3.68-4.79). Conversely, presence of sleep disorders significantly increased the risk of AA development (aHR 4.70; 95% CI 3.99-5.54). Both OSA (aHR 3.89; 95% CI 2.46-6.16) and nonapnea insomnia (aHR 4.77; 95% CI 4.03-5.64) were associated an increased risk of developing AA. CONCLUSIONS Patients with AA have a higher risk of developing sleep disorders compared to controls, and vice versa. Further studies are needed to investigate the shared pathogenic mechanism underlying these two conditions.
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Affiliation(s)
- Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chiang Chen
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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Bedogni B, Paus R. Hair(y) Matters in Melanoma Biology. Trends Mol Med 2020; 26:441-449. [PMID: 32359476 DOI: 10.1016/j.molmed.2020.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/16/2019] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
Melanocyte stem cells (MeSCs), one candidate for the cellular origin of melanoma, reside in the bulge region of the hair follicle (HF), an immune-privileged tissue niche with impaired tumor immunosurveillance. Surprisingly, however, primary melanoma is only very rarely associated with HFs. Here, we explore the hypothesis that this profoundly immunoinhibitory signaling environment deprives both MeSCs and melanocytes of the anagen hair matrix of proinflammatory signals required for full oncogenic transformation. Understanding the cellular and molecular mechanisms for generating a putative antimelanoma tissue habitat, namely in the bulge, could help to recreate a similar melanoma-suppressive signaling environment in melanoma high-risk individuals. We further discuss how mimicking the bulge immune privilege may be an effective melanoma prevention strategy.
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Affiliation(s)
- Barbara Bedogni
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Ralf Paus
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Centre for Dermatology Research, University of Manchester, and NIHR Biomedical Research Centre, Manchester, UK; Monasterium Laboratory, Muenster, Germany.
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Carré J, Suzuki T, Paus R. Do hair follicles operate as primitive, multifocal kidney‐like excretory (mini‐) organs? Exp Dermatol 2020; 29:357-365. [DOI: 10.1111/exd.14076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Jean‐Luc Carré
- Département de Biochimie et Pharmaco‐Toxicologie Hôpital de la Cavale Blanche CHRU Brest France
- EA 4685 Laboratoire des Interactions Epithelium ‐ Neurones University of Brest Brest France
| | - Takahiro Suzuki
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
- Centre for Dermatology Research University of Manchester Manchester UK
- Monasterium Laboratory Münster Germany
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Toward Predicting the Spatio-Temporal Dynamics of Alopecia Areata Lesions Using Partial Differential Equation Analysis. Bull Math Biol 2020; 82:34. [PMID: 32095960 DOI: 10.1007/s11538-020-00707-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
Hair loss in the autoimmune disease, alopecia areata (AA), is characterized by the appearance of circularly spreading alopecic lesions in seemingly healthy skin. The distinct spatial patterns of AA lesions form because the immune system attacks hair follicle cells that are in the process of producing hair shaft, catapults the mini-organs that produce hair from a state of growth (anagen) into an apoptosis-driven regression state (catagen), and causes major hair follicle dystrophy along with rapid hair shaft shedding. In this paper, we develop a model of partial differential equations (PDEs) to describe the spatio-temporal dynamics of immune system components that clinical and experimental studies show are primarily involved in the disease development. Global linear stability analysis reveals there is a most unstable mode giving rise to a pattern. The most unstable mode indicates a spatial scale consistent with results of the humanized AA mouse model of Gilhar et al. (Autoimmun Rev 15(7):726-735, 2016) for experimentally induced AA lesions. Numerical simulations of the PDE system confirm our analytic findings and illustrate the formation of a pattern that is characteristic of the spatio-temporal AA dynamics. We apply marginal linear stability analysis to examine and predict the pattern propagation.
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Wang ECE, Higgins CA. Immune cell regulation of the hair cycle. Exp Dermatol 2020; 29:322-333. [PMID: 31903650 DOI: 10.1111/exd.14070] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/14/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022]
Abstract
The ability to manipulate the mammalian hair cycle will lead to novel therapies and strategies to combat all forms of alopecia. Thus, in addition to the epithelial-mesenchymal interactions in the hair follicle, niche and microenvironmental signals that accompany the phases of growth, regression and rest need to be scrutinized. Immune cells are well described in skin homeostasis and wound healing and have recently been shown to play an important role in the mammalian hair cycle. In this review, we will summarize our current knowledge of the role of immune cells in hair cycle control and discuss their relevance to human hair cycling disorders. Increased attention to this aspect of the hair cycle will provide new avenues to manipulate hair regeneration in humans and provide better insight into developing better ex vivo models of hair growth.
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Affiliation(s)
- Etienne C E Wang
- Skin Research Institute of Singapore (SRIS), National Skin Centre, Singapore, Singapore
| | - Claire A Higgins
- Department of Bioengineering, Imperial College London, London, UK
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Alcohol extract from Vernonia anthelmintica willd (L.) seed counteracts stress-induced murine hair follicle growth inhibition. Altern Ther Health Med 2019; 19:372. [PMID: 31847849 PMCID: PMC6918677 DOI: 10.1186/s12906-019-2744-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/04/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Vernonia anthelmintica (L.) willd is a traditional urgur herb in China for a long history. Its alcohol extract (AVE) has been proved to promote hair follicle growth in C57BL/6 mice. We conducted this study to investigate the hair-growth effects of AVE in stressed mice and its possible mechanism of action. METHODS The hair-follicle growth effects of AVE were examined by in vivo and in vitro study. We exposed C57BL/6 male mice to chronic restraint stress to induce murine hair follicle growth inhibition. The effects of AVE were examined by histological analysis, immunofluorescence for Ki67 and cytokeratin 19 immunoreactivity, western blot assay in tyrosinase and related proteins expressions and immunofluorescence for nerve fibers. In organ culture of mouse vibrissae follicles, we used substance P as a catagen-inducing factor of hair follicle growth, and measured the elongation of hair shafts and expression of neurokinin-1 receptor protein by application of AVE. RESULTS Our results showed that AVE counteract murine hair follicle growth inhibition caused by chronic restraint stress via inducing the conversion of telogen to anagen and inhibiting catagen premature, increasing bulb keratinocytes and bulge stem cells proliferation, promoting melanogenesis, and reducing the numbers of substance P and calcitonin gene-related peptide nerve fibers. Furthermore, AVE also counteracted murine hair follicle growth inhibition caused by substance P in organ culture. CONCLUSION These results suggest that AVE counteract stress-induced hair follicle growth inhibition in C57BL/6 mice in vivo and in vitro, and may be an effective new candidate for treatment of stress-induced hair loss.
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Gherardini J, Wegner J, Chéret J, Ghatak S, Lehmann J, Alam M, Jimenez F, Funk W, Böhm M, Botchkareva NV, Ward C, Paus R, Bertolini M. Transepidermal UV radiation of scalp skin ex vivo induces hair follicle damage that is alleviated by the topical treatment with caffeine. Int J Cosmet Sci 2019; 41:164-182. [PMID: 30746733 PMCID: PMC6850087 DOI: 10.1111/ics.12521] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/07/2019] [Indexed: 12/12/2022]
Abstract
Objectives Although the effect of ultraviolet radiation (UVR) on human skin has been extensively studied, very little is known on how UVR impacts on hair follicle (HF) homeostasis. Here, we investigated how solar spectrum UVR that hits the human skin surface impacts on HF biology, and whether any detrimental effects can be mitigated by a widely used cosmetic and nutraceutical ingredient, caffeine. Methods Human scalp skin with terminal HFs was irradiated transepidermally ex vivo using either 10 J/cm2UVA (340–440 nm) + 20 mJ/cm2UVB (290–320 nm) (low dose) or 50 J/cm2UVA + 50 mJ/cm2UVB (high dose) and organ‐cultured under serum‐free conditions for 1 or 3 days. 0.1% caffeine (5.15 mmol/L) was topically applied for 3 days prior to UV exposure with 40 J/cm2UVA + 40 mJ/cm2UVB and for 3 days after UVR. The effects on various toxicity and vitality read‐out parameters were measured in defined skin and HF compartments. Results Consistent with previous results, transepidermal UVR exerted skin cytotoxicity and epidermal damage. Treatment with high and/or low UVA+UVB doses also induced oxidative DNA damage and cytotoxicity in human HFs. In addition, it decreased proliferation and promoted apoptosis of HF outer root sheath (ORS) and hair matrix (HM) keratinocytes, stimulated catagen development, differentially regulated the expression of HF growth factors, and induced perifollicular mast cell degranulation. UVR‐mediated HF damage was more severe after irradiation with high UVR dose and reached also proximal HF compartments. The topical application of 0.1% caffeine did not induce skin or HF cytotoxicity and stimulated the expression of IGF‐1 in the proximal HF ORS. However, it promoted keratinocyte apoptosis in selected HF compartments. Moreover, caffeine provided protection towards UVR‐mediated HF cytotoxicity and dystrophy, keratinocyte apoptosis, and tendential up‐regulation of the catagen‐promoting growth factor. Conclusion Our study highlights the clinical relevance of our scalp UV irradiation ex vivo assay and provides the first evidence that transepidermal UV radiation negatively affects important human HF functions. This suggests that it is a sensible prophylactic strategy to integrate agents such as caffeine that can act as HF photoprotectants into sun‐protective cosmeceutical and nutraceutical formulations.
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Affiliation(s)
| | | | | | | | | | - Majid Alam
- Mediteknia Skin & Hair Lab, Universidad Fernando Pessoa Canarias, and Medical Pathology Group, IUIBS, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Francisco Jimenez
- Mediteknia Skin & Hair Lab, Universidad Fernando Pessoa Canarias, and Medical Pathology Group, IUIBS, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Wolfgang Funk
- Clinic for Plastic, Aesthetic and Reconstructive Surgery Dr. med. Funk, Munich, Germany
| | - Markus Böhm
- Department of Dermatology, University of Muenster, Muenster, Germany
| | | | - Chris Ward
- Monasterium Laboratory GmbH, Muenster, Germany
| | - Ralf Paus
- Centre for Dermatology Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Gupta AK, Carviel JL, Foley KA, Shear NH, Piraccini BM, Piguet V, Tosti A. Monotherapy for Alopecia Areata: A Systematic Review and Network Meta-Analysis. Skin Appendage Disord 2019; 5:331-337. [PMID: 31799258 PMCID: PMC6883433 DOI: 10.1159/000501940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/05/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There are many treatments available for alopecia areata; however, none are approved by the US Food and Drug Administration. Thus, there is clinician benefit in efficacy comparison. METHODS A network meta-analysis was used to create direct and indirect comparisons of alopecia areata studies in addition to an inconsistency analysis, risk of bias, and quality of evidence assessment. RESULTS For mild disease, intralesional corticosteroids were ranked the most likely to produce a response at 78.9% according to SUCRA (surface under the cumulative ranking curve) followed by topical corticosteroids (67.9%), prostaglandin analogs (67.1%), diphenylcyclopropenone (DPCP, 63.4%), topical minoxidil (61.2%), and squaric acid dibutylester (SADBE, 35.0%). In contrast, for moderate to severe disease (>50% scalp hair loss), DPCP was the top-ranked treatment (87.9%), followed by laser (77.9%), topical minoxidil (55.5%), topical corticosteroids (50.1%), SADBE (49.7%), and topical tofacitinib (47.6%). There were insufficient eligible trials to include oral tofacitinib in the network. CONCLUSION Statistically significant evidence is presented for the use of intralesional and topical corticosteroids for treatment of mild disease and DPCP, laser, SADBE, topical minoxidil and topical corticosteroids for moderate to severe disease. Further controlled trials are required to analyze the relative efficacy of oral tofacitinib.
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Affiliation(s)
- Aditya K. Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | | | | | - Neil H. Shear
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Antonella Tosti
- Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, USA
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Gilhar A, Laufer-Britva R, Keren A, Paus R. Frontiers in alopecia areata pathobiology research. J Allergy Clin Immunol 2019; 144:1478-1489. [PMID: 31606262 DOI: 10.1016/j.jaci.2019.08.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
This current review explores selected and as yet insufficiently investigated frontiers in current alopecia areata (AA) pathobiology research, with an emphasis on potential "new" players in AA pathobiology that deserve more systematic exploration and therapeutic targeting. Indeed, new evidence suggests that CD8+ T cells, which have long been thought to be the central players in AA pathobiology, are not the only drivers of disease. Instead, subsets of natural killer (NK) and so-called "unconventional" T cells (invariant NK T cells, γδ T cells, classic NK cells, and type 1 innate lymphoid cells), all of which can produce large amounts of IFN-γ, might also drive AA pathobiology independent of classical, autoantigen-dependent CD8+ T-cell functions. Another important new frontier is the role of regulatory lymphocyte subsets, such as regulatory T cells, γδ regulatory T cells, NKT10 cells, and perifollicular mast cells, in maintaining physiologic hair follicle immune privilege (IP); the extent to which these functions are defective in patients with AA; and how this IP-protective role could be restored therapeutically in patients with established AA. Broadening our AA research horizon along the lines suggested above promises not only to open the door to innovative and even more effective immunotherapy strategies for AA but will also likely be relevant for other autoimmune disorders in which pathobiology, ectopic MHC class I expression, and IP collapse play an important role.
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Affiliation(s)
- Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | | | - Aviad Keren
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ralf Paus
- Dr Philipp Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Fla; Dermatology Research Centre, University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
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Effects of the selective TrkA agonist gambogic amide on pigmentation and growth of human hair follicles in vitro. PLoS One 2019; 14:e0221757. [PMID: 31465471 PMCID: PMC6715186 DOI: 10.1371/journal.pone.0221757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/14/2019] [Indexed: 12/20/2022] Open
Abstract
The human hair follicle is a neuroendocrine mini-organ that can be used to study aging processes in vitro. Neurotrophins maintain homeostasis in hair biology via the Trk-family of receptors. TrkA, the high affinity receptor for nerve growth factor (NGF), is expressed in hair follicle melanocytes and keratinocytes, where it regulates proliferation, differentiation and apoptosis and may thereby play a role in hair pigmentation and growth. We investigated TrkA expression during the human hair cycle and the effects of a selective high affinity TrkA agonist, Gambogic Amide, on hair pigmentation and hair growth in human hair follicles in vitro. In human scalp skin, TrkA expression was strongest in proliferating melanocytes re-establishing the pigmentary unit in the hair bulb during the early hair growth phase, anagen. During high anagen and in the de-composing pigmentary-unit of the regression phase, catagen, bulb-melanocytes lost TrkA expression and only undifferentiated outer root sheath melanocytes maintained it. In cultured human anagen hair follicles, Gambogic Amide was able to prevent gradual pigment loss, while it stimulated hair shaft elongation. This was achieved by increased melanocyte activation, migration and dendricity, highlighted by distinct c-KIT-expression in melanocyte sub-populations. Our results suggest that Gambogic Amide can maintain hair follicle pigmentation by acting on undifferentiated melanocytes residing in the outer root sheath and making them migrate to establish the pigmentary-unit. This suggests that the selective TrkA agonist Gambogic Amide acts as an anti-hair greying and hair growth promoting molecule in vitro.
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Leon A, Rosen JD, Hashimoto T, Fostini AC, Paus R, Yosipovitch G. Itching for an answer: A review of potential mechanisms of scalp itch in psoriasis. Exp Dermatol 2019; 28:1397-1404. [DOI: 10.1111/exd.13947] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Argentina Leon
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery Miami Itch Center Miller School of Medicine Miami Florida
| | - Jordan D. Rosen
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery Miami Itch Center Miller School of Medicine Miami Florida
| | - Takashi Hashimoto
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery Miami Itch Center Miller School of Medicine Miami Florida
| | - Anna C. Fostini
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery Miami Itch Center Miller School of Medicine Miami Florida
| | - Ralf Paus
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery Miami Itch Center Miller School of Medicine Miami Florida
| | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery Miami Itch Center Miller School of Medicine Miami Florida
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47
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Richmond JM, Strassner JP, Essien KI, Harris JE. T-cell positioning by chemokines in autoimmune skin diseases. Immunol Rev 2019; 289:186-204. [PMID: 30977191 PMCID: PMC6553463 DOI: 10.1111/imr.12762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022]
Abstract
Autoimmune skin diseases are complex processes in which autoreactive cells must navigate through the skin tissue to find their targets. Regulatory T cells in the skin help to mitigate autoimmune inflammation and may in fact be responsible for the patchy nature of these conditions. In this review, we will discuss chemokines that are important for global recruitment of T cell populations to the skin during disease, as well as signals that fine-tune their localization and function. We will describe prototypical disease responses and chemokine families that mediate these responses. Lastly, we will include an overview of chemokine-targeting drugs that have been tested as new treatment strategies for autoimmune skin diseases.
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Affiliation(s)
- Jillian M Richmond
- Department of Dermatology, UMass Medical School, Worcester, Massachusetts
| | - James P Strassner
- Department of Dermatology, UMass Medical School, Worcester, Massachusetts
| | - Kingsley I Essien
- Department of Dermatology, UMass Medical School, Worcester, Massachusetts
| | - John E Harris
- Department of Dermatology, UMass Medical School, Worcester, Massachusetts
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48
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Tavakolpour S, Mahmoudi H, Abedini R, Kamyab Hesari K, Kiani A, Daneshpazhooh M. Frontal fibrosing alopecia: An update on the hypothesis of pathogenesis and treatment. Int J Womens Dermatol 2019; 5:116-123. [PMID: 30997385 PMCID: PMC6451751 DOI: 10.1016/j.ijwd.2018.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/12/2018] [Accepted: 11/07/2018] [Indexed: 01/10/2023] Open
Abstract
Frontal fibrosing alopecia (FFA) is a relatively new scarring alopecia that is considered a variant of lichen planopilaris (LPP) with no recognized promising treatments. In this study, we tried to clarify the underlying signaling pathways and their roles in the pathogenesis and progression of FFA. Because of several differences in clinical manifestations, response to treatments, and pathological findings, these two conditions could be differentiated from each other. Taking into account the already discussed signaling pathways and involved players such as T cells, mast cells, and sebaceous glands, different possible therapeutic options could be suggested. In addition to treatments supported by clinical evidence, such as 5 alpha-reductase inhibitors, topical calcineurin inhibitors, hydroxychloroquine, peroxisome proliferator-activated receptor gamma agonists, and oral retinoid agents, various other treatment strategies and drugs, such as phototherapy, Janus kinase inhibitors, dehydroepiandrosterone, sirolimus, cetirizine, and rituximab, could be suggested to mitigate disease progression. Of course, such lines of treatment need further evaluation in clinical trials.
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Affiliation(s)
- Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - HamidReza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedini
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Kamyab Hesari
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Kiani
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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49
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Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: A multifactorial autoimmune condition. J Autoimmun 2018; 98:74-85. [PMID: 30558963 DOI: 10.1016/j.jaut.2018.12.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
Alopecia areata is an autoimmune disease that results in non-scarring hair loss, and it is clinically characterised by small patches of baldness on the scalp and/or around the body. It can later progress to total loss of scalp hair (Alopecia totalis) and/or total loss of all body hair (Alopecia universalis). The rapid rate of hair loss and disfiguration caused by the condition causes anxiety on patients and increases the risks of developing psychological and psychiatric complications. Hair loss in alopecia areata is caused by lymphocytic infiltrations around the hair follicles and IFN-γ. IgG antibodies against the hair follicle cells are also found in alopecia areata sufferers. In addition, the disease coexists with other autoimmune disorders and can come secondary to infections or inflammation. However, despite the growing knowledge about alopecia areata, the aetiology and pathophysiology of disease are not well defined. In this review we discuss various genetic and environmental factors that cause autoimmunity and describe the immune mechanisms that lead to hair loss in alopecia areata patients.
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Affiliation(s)
- Teontor Simakou
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, 1 High Street, Paisley, PA1 2BE, UK
| | - John P Butcher
- Department of Life Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - Stuart Reid
- SUPA, Department of Biomedical Engineering, University of Strathclyde, UK
| | - Fiona L Henriquez
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, 1 High Street, Paisley, PA1 2BE, UK.
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Hamed FN, McDonagh AJG, Almaghrabi S, Bakri Y, Messenger AG, Tazi-Ahnini R. Epigallocatechin-3 Gallate Inhibits STAT-1/JAK2/IRF-1/HLA-DR/HLA-B and Reduces CD8 MKG2D Lymphocytes of Alopecia Areata Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122882. [PMID: 30558329 PMCID: PMC6313664 DOI: 10.3390/ijerph15122882] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alopecia areata (AA) is associated with Interferon- γ (IFN-γ) mediated T-lymphocyte dysfunction and increased circulating Interleukine-17 (IL-17) levels. Epigallocatechin-3-gallate (EGCG) specifically inhibits IFN-γ pathways and unlike Janus Kinase 1 and 2 (JAK1/JAK2) inhibitors (tofacitinib, ruxolitinib), EGCG is safer, more cost-effective, and is a topically active agent. Our objective is to test the mode of action of EGCG in vitro and ex vivo using HaCat, Jurkat cell lines, and peripheral blood mononuclear cells (PBMCs) of AA patients and healthy controls (HCs), respectively. METHODS distribution of T helper cells (Th1, Th17), and cytotoxic cells (CD8) in PBMCs isolated from 30 AA patients and 30 HCs was investigated by flowcytomterty. In vitro treatment of HaCat and Jurkat cells with 40 μm EGCG for 48 h was performed to measure the level of phosphorylation of signal transducer and activator of transcription protein STAT1, and replicated in ex vivo model using PBMCs of AA patients. RESULTS Interestingly, 40 μm EGCG is capable of completely inhibiting phosphorylation of STAT1 after 48 h in HaCat and Jurkat cells and ex vivo in PBMCs of AA patients. Based on QPCR data, the action of EGCG on p-STAT1 seems to be mediated via downregulation of the expression of JAK2 but not JAK1 leading to the inhibition of human leukocyte antigens (HLA-DR and HLA-B) expression probably via IRF-1. On the other hand, AA patients have significantly increased levels of Th1, Th17, and CD8 cells and the production of IFN-γ and IL-17 by PBMCs in AA patients was significantly higher compared to HC; p = 0.008 and p = 0.006, respectively. Total numbers of CD8+ cells were not significantly different between treated and untreated samples. However, CD8+ cells with positive Natural killer group 2 member D (NKG2D) transmembrane receptor (CD8+ NKG2D+ subset) was significantly reduced when PBMCs were treated with 20 μm EGCG for 48 h. CONCLUSION These results suggest that EGCG has a synergistic action that inhibits expression of HLA-DR and HLA-B molecules via the IFN-γ pathway to maintain immune privilege in HF; also it reduces CD8+ NKG2D+ subset.
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Affiliation(s)
- Fatma N Hamed
- Department of Infection, Immunity and Cardiovascular disease, The Medical School, University of Sheffield, Sheffield S10 2RX, UK.
| | - Andrew J G McDonagh
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Sarah Almaghrabi
- Department of Infection, Immunity and Cardiovascular disease, The Medical School, University of Sheffield, Sheffield S10 2RX, UK.
| | - Youssef Bakri
- Laboratoire de Biologie de Pathologies Humaines, Faculté des Sciences, Université Mohammed V Rabat, Rabat B.P:8007.N.U, Morocco.
| | - Andrew G Messenger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Rachid Tazi-Ahnini
- Department of Infection, Immunity and Cardiovascular disease, The Medical School, University of Sheffield, Sheffield S10 2RX, UK.
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