Alopecia areata, new findings in histopathology and pathophysiology
Keywords:
alopecia, alopecia areata, nonscarring, pathologyAbstract
Alopecia areata is an organ-specific autoimmune disease thought to result from a collapse of the hair follicle immune privilege. It is a very common cause of nonscarring alopecia.
The histopathological features depend on the stage of the disease. Although a peribulbar lymphocytic infiltrate is the most frequent histological feature, this inflammatory infiltrate is not always visible. The frequency with which this and other histological changes are observed depends on the stage of the illness when the biopsy is performed. In the early stages of the disease the follicles show a variable inflammatory lymphocytic infiltrate in the peribulbar region. In the late stage, inflammation decreases and numerous miniaturized hair follicles and telogen follicles are present. In longstanding alopecia areata the majority of the hair follicles are in catagen and telogen.
Alopecia areata should be suspected when high percentages of miniaturized and telogen hairs are observed, even in the lack of a peribulbar lymphocytic infiltrate.
Author Biographies
Rodrigo Restrepo
Médico dermatopatólogo, Programa de Especialización en Dermatopatología, Facultad de Medicina, Universidad CES; instructor asociado de Patología y Dermatología, Universidad Pontificia Bolivariana; director, Laboratorio de Patología, Clínica Medellín, Medellín, Colombia
Lucía Mercedes Niño
Médica, residente de Patología, Universidad de Cartagena, Cartagena de Indias, Colombia
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3. Safavi KH, Muller SA, Suman VJ, Moshell AN, Melton LJ, 3rd. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. Mayo Clin Proc. 1995;70:628-33.
4. Price VH. Alopecia areata: Clinical aspects. J Invest Dermatol. 1991;96:68S.
5. Crowder JA, Frieden IJ, Price VH. Alopecia areata in infants and newborns. Pediatr Dermatol. 2002;19:155-8.
6. Bardazzi F, Neri I, Raone B, Patrizi A. Congenital alopecia areata: Another case. Dermatology. 1999;199:369.
7. Muñoz MA, Camacho FM. Sisaipho: A new form of presentation of alopecia areata. Arch Dermatol. 1996;132:1255-6.
8. Camacho F, García-Hernández M. Clinical evolution of alopecia areata with a male androgenetic alopecia pattern to sisaipho. Eur J Dermatol. 2000;10:133-4.
9. Goldsmith LA. Summary of the Third International Research Workshop on Alopecia Areata. J Investig Dermatol Symp Proc. 1999;4:200-1.
10. Ihm CW, Han JH. Diagnostic value of exclamation mark hairs. Dermatology. 1993;186:99-102.
11. Müller CSL, El Shabrawi-Caelen L. ‘Follicular Swiss cheese’ pattern –another histopathologic clue to alopecia areata. J Cutan Pathol. 2011;38:185-9.
12. Inui S, Nakajima T, Nakagawa K, Itami S. Clinical significance of dermoscopy in alopecia areata: Analysis of 300 cases. Int J Dermatol. 2008;47:688-93.
13. Rakowska A, Slowinska M, Kowalska-Oledzka E, Olszewska M, Czuwara J, Rudnicka L. Alopecia areata incognita: True or false? J Am Acad Dermatol. 2009;60:162-3.
14. Jelinek JE. Sudden whitening of the hair. Bull NY Acad Med. 1972;48:1003-13.
15. Navarini AA, Nobbe S, Trüeb RM. Marie Antoinette syndrome. Arch Dermatol. 2009;145:656.
16. Baden HP. Nail abnormalities associated with cutaneous diseases. In: Baden HP, editor. Diseases of the hair and nails. Chicago: Year Book Medical Publisher; 1987. p. 134-43.
17. Goh C, Finkel M, Christos PJ, Sinha AA. Profile of 513 patients with alopecia areata: Associations of disease subtypes with atopy, autoimmune disease and positive family history. J Eur Acad Dermatol Venereol. 2006;20:1055-60.
18. Kakourou T, Karachristou K, Chrousos G. A case series of alopecia areata in children: Impact of personal and family history of stress and autoimmunity. J Eur Acad Dermatol Venereol. 2007;21:356-9.
19. Wang SJ, Shohat T, Vadheim C, Shellow W, Edwards J, Rotter JI. Increased risk for type I (insulin-dependent) diabetes in relatives of patients with alopecia areata (AA). Am J Med Genet. 1994;51:234-9.
20. Adams BB, Lucky AW. Colocalization of alopecia areata and vitiligo. Pediatr Dermatol. 1999;16:364-6.
21. Werth VP, White WL, Sánchez MR, Franks AG. Incidence of alopecia areata in lupus erythematosus. Arch Dermatol. 1992;128:368-71.
22. Hordinsky M, Ericson M. Autoimmunity: Alopecia areata. J Investig Dermatol Symp Proc. 2004;9:73-8.
23. Dhar S, Dhar S. Colocalization of alopecia areata and lichen planus. Pediatr Dermatol. 1996;13:258-9.
24. Schepis C, Barone C, Siragusa M, Pettinato R, Romano C. An updated survey on skin conditions in Down syndrome. Dermatology. 2002;205:234-8.
25. Fessatou S, Kostaki M, Karpathios T. Coeliac disease and alopecia areata in childhood. J Paediatr Child Health. 2003;39:152-4.
26. Agesta N, Zabala R, Díaz-Pérez JL. Alopecia areata during interferon alpha-2b/ribavirin therapy. Dermatology. 2002;205:300-1.
27. Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2000;42:66-70.
28. MacDonald Hull SP, Wood ML, Hutchinson PE, Sladden M, Messenger AG. Guidelines for the management of alopecia areata. Br J Dermatol. 2003;149:692-9.
29. Shapiro J, Madani S. Alopecia areata: Diagnosis and management. Int J Dermatol. 1999;38(Suppl.1):19-24.
30. Tosti A, Bellavista S, Iorizzo M. Alopecia areata: A long term followup study of 191 patients. J Am Acad Dermatol. 2006;55:438-41.
31. Kalish RS, Gilhar A. Alopecia areata: Autoimmunity –the evidence is compelling. J Investig Dermatol Symp Proc. 2003;8:164-7.
32. Price VH. Plenary workshop on alopecia areata. J Invest Dermatol Symp Proc. 2005;10:280-5.
33. Kos L, Conlon J. An update on alopecia areata. Curr Opin Pediatr. 2009;21:475-80.
34. Tobin DJ, Orentreich N, Fenton DA, Bystryn JC. Antibodies to hair follicles in alopecia areata. J Invest Dermatol. 1994;102:721-4.
35. Gilhar A, Landau M, Assy B, Ullmann Y, Shalaginov R, Serafimovich S, et al. Transfer of alopecia areata in the human scalp graft/Prkdc(scid) (SCID) mouse system is characterized by a TH1 response. Clin Immunol. 2003;106:181-7.
36. Billingham RE, Silvers WK. A biologist’s reflections on dermatology. J Invest Dermatol. 1971;57:227-40.
37. Paus R, Slominski A, Czarnetzki BM. Is alopecia areata an autoimmune-response against melanogenesis-related proteins, exposed by abnormal MHC class I expression in the anagen hair bulb? Yale J Biol Med. 1994;66:541-54.
38. Ito T, Meyer KC, Ito N, Paus R. Immune privilege and the skin. Curr Dir Autoimmun. 2008;10:27-52.
39. Harrist TJ, Ruiter DJ, Mihm MC, Bhan AK. Distribution of major histocompatibility antigens in normal skin. Br J Dermatol. 1983;109:623-33.
40. Paus R, van der Veen C, Eichmüller S, Kopp T, Hagen E, MüllerRöver S, et al. Generation and cyclic remodeling of the hair follicle immune system in mice. J Invest Dermatol. 1998;111:7-18.
41. Paus R, Nickoloff BJ, Ito TA. “Hairy” privilege. Trends Immunol. 2005;26:32-40.
42. Ito T, Saathoff M, Nickoloff BJ, Takigawa M, Paus R. Novel aspects of hair follicle immune privilege and their relevance to alopecia areata. J Invest Dermatol. 2005;124(Suppl.):A103.
43. Waldmann H. Immunology: Protection and privilege. Nature. 2006;442:987-8.
44. McElwee KJ, Yu M, Park SW, Ross EK, Finner A, Shapiro J. What can we learn from animal models of Alopecia areata? Dermatology. 2005;211:47-53.
45. Gilhar A, Paus R, Kalish RS. Lymphocytes, neuropeptides, and genes involved in alopecia areata. J Clin Invest. 2007;117:2019-27.
46. Gilhar A, Landau M, Assy B, Shalaginov R, Serafimovich S, Kalish RS. Mediation of alopecia areata by cooperation between CD4+ and CD8+ T lymphocytes: Transfer to human scalp explants on Prkdc(scid) mice. Arch Dermatol. 2002;138:916-22.
47. Gilhar A, Landau M, Assy B, Shalaginov R, Serafimovich S, Kalish RS. Melanocyte-associated T cell epitopes can function as autoantigens for transfer of alopecia areata to human scalp explants on Prkdc(scid) mice. J Invest Dermatol. 2001;117:1357-62.
48. McElwee KJ, Boggess D, King LE Jr, Sundberg JP. Experimental induction of alopecia areata-like hair loss in C3H/HeJ mice using full-thickness skin grafts. J Invest Dermatol. 1998;111:797-803.
49. Ito T, Ito N, Saatoff M, Hashizume H, Fukamizu H, Nickoloff BJ, et al. Maintenance of hair follicle immune privilege is linked to prevention of NK cell attack. J Invest Dermatol. 2008;128:1196-206.
50. McElwee KJ, Freyschmidt-Paul P, Sundberg JP, Hoffmann R. The pathogenesis of alopecia areata in rodent models. J Investig Dermatol Symp Proc. 2003;8:6-11.
51. McDonagh AJ, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002;27:405-9.
52. Martinez-Mir A, Zlotogorski A, Gordon D, Petukhova L, Mo J, Gilliam TC, et al. Genomewide scan for linkage reveals evidence of several susceptibility loci for alopecia areata. Am J Hum Genet. 2007;80:316-28.
53. McElwee K, Freyschmidt-Paul P, Ziegler A, Happle R, Hoffmann R. Genetic susceptibility and severity of alopecia areata in human and animal models. Eur J Dermatol. 2001;11:11-6.
54. Marques Da Costa C, Dupont E, van der Cruys M, Andrien M, Hidajat M, Song M, et al. Earlier occurrence of severe alopecia areata in HLA-DRB1*11- positive patients. Dermatology. 2006;213:12-4.
55. Barahmani N, de Andrade M, Slusser JP, Wei Q, Hordinsky M, Price VH, et al. Human leukocyte antigen class II alleles are associated with risk of alopecia areata. J Invest Dermatol. 2008;128:240-3.
56. Duvic M, Norris D, Christiano A, Hordinsky M, Price V. Alopecia areata registry: An overview. J Investig Dermatol Symp Proc. 2003;8:219-21.
57. Mitchell MK, Gregersen PK, Johnson S, Parsons R, Vlahov D. The New York Cancer Project: Rationale, organization, design, and baseline characteristics. J Urban Health. 2004;81:301-10.
58. Petukhova L, Duvic M, Hordinsky M, Norris D, Price V, Shimomura Y, et al. Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature. 2010;466:113-7.
59. van der Steen P, Boezeman J, Duller P, Happle R. Can alopecia areata be triggered by emotional stress? An uncontrolled evaluation of 178 patients with extensive hair loss. Acta Derm Venereol. 1992;72:279-80.
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How to Cite
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Restrepo R, Niño LM. Alopecia areata, new findings in histopathology and pathophysiology. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Feb. 18 [cited 2024 Jul. 3];20(1):41-53. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/209
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2019-02-18
How to Cite
1.
Restrepo R, Niño LM. Alopecia areata, new findings in histopathology and pathophysiology. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Feb. 18 [cited 2024 Jul. 3];20(1):41-53. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/209
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