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• W2973292041 abstract "To the Editor: Pattern hair loss (PHL) is the most common type of hair loss: up to 62% of men younger than 55 years and up to 85% of men 60-69 years experience some form of PHL.1Lolli F. Pallotti F. Rossi A. et al.Androgenetic alopecia: a review.Endocrine. 2017; 57: 9-17Crossref PubMed Scopus (75) Google Scholar,2Severi G. Sinclair R. Hopper J.L. et al.Androgenetic alopecia in men aged 40-69 years: prevalence and risk factors.Br J Dermatol. 2003; 149: 1207-1213Crossref PubMed Scopus (115) Google Scholar In women, PHL is present in 25% by age 49 years, 41% by age 69 years, and more than 50% by 79 years.3Fabbrocini G. Cantelli M. Masarà A. Annunziata M.C. Marasca C. Cacciapuoti S. Female pattern hair loss: a clinical, pathophysiologic, and therapeutic review.Int J Women Dermatol. 2018; 4: 203-211Crossref PubMed Scopus (28) Google Scholar Activation of an inflammatory response toward the pilosebaceous unit may play a role in the development and progression of hair loss based on reports of perifollicular inflammation and fibrosis in histologic sections.4Mahé Y.F. Michelet J.F. Billoni N. et al.Androgenetic alopecia and microinflammation.Int J Dermatol. 2000; 39: 576-584Crossref PubMed Scopus (108) Google Scholar,5Whiting D.A. Chronic telogen effluvium: increased scalp hair shedding in middle-aged women.J Am Acad Dermatol. 1996; 35: 899-906Abstract Full Text PDF PubMed Scopus (185) Google Scholar Here, we sought to assess the location and degree of inflammation and fibrosis in a series of biopsy specimens from patients with PHL compared with control specimens. A series of 37 previously diagnosed PHL specimens and 45 scalp excisions were retrieved from the archives of the dermatopathology service of the University of California Irvine (Table I). We included all subsequent cases with at least 1 vertical section with the diagnosis of PHL, reviewing clinical information to confirm correlation. For control specimens, we reviewed either tips of scalp excisions or the section farthest from the lesion/scar. None showed features of pattern alopecia. We evaluated the presence or absence of perifollicular inflammation and fibrosis, its anatomic location (infundibular, isthmic, bulbar), and the degree of involvement (sparse, mild, moderate, severe). A single investigator (DME) rated each variable.Table IDemographicsCharacteristicsPatients with alopeciaControl individualsn%n%Sex Male6163271 Female31841329Age, y <3592449 35-7027732147 >70132044 Open table in a new tab Perifollicular lymphoid inflammation was found in 27 of 37 of PHL cases (73%), often in association with mild follicular spongiosis. The infiltrate was sparse in 2 cases (5.4%), mild in 21 (57%), and moderate in 4 (11%), and no inflammation was seen in 10 cases (27%). The infiltrate was present predominantly in the infundibulum in 26 cases (70%) and in the subinfundibulum approaching the isthmus in 1 case (3%). Control samples showed perifollicular inflammation in 38 cases (84% of the total number of control cases). The infiltrate was sparse in 4 cases (9%), mild in 30 (67%), and moderate in 4 (9%), and none was noted in 7 cases (16%). The infiltrate was found at the level of the infundibulum in all 38 cases (84% of the control cases) (Table II and Fig 1).Table IIInflammation and fibrosis in pattern hair loss and control biopsy specimensCriteriaAlopecia specimensControl specimensPn%n%Perifollicular inflammation.2023 Yes27733884 No1027715.6Location of the infiltrate.2201 Infundibular26703884 Sebaceous duct1300 None1027716Degree of inflammation.5676 Sparse25.449 Mild21573067 Moderate41149 None1027716Fibrosis.1241 Yes25683782 No1232818Location of the fibrosis.1241 Superficial25683782 None1232818Degree of fibrosis.1447 Mild24653271 Moderate13511 None1232818 Open table in a new tab Fibrosis was found in 25 PHL cases (68%): mild in 24 (65%) and moderate in 1 (3%). Fibrosis was peri-infundibular in all 25 cases. Within the control group, fibrosis was found in 37 cases (82.2%)—mild fibrosis was found in 32 cases (71.1%) and moderate in 5 (11.1%); it was superficially located in all 37 cases (Table I). We did not find any significant differences between the 2 groups (Table I), calling into question the role of inflammation and fibrosis in PHL. Whiting, in his series of 412 patients with AGA, found inflammation and fibrosis in 71.4% of patients with PHL.5Whiting D.A. Chronic telogen effluvium: increased scalp hair shedding in middle-aged women.J Am Acad Dermatol. 1996; 35: 899-906Abstract Full Text PDF PubMed Scopus (185) Google Scholar Similarly, we found inflammation and fibrosis in 73% and 68%, respectively, but found similar numbers in the control group and a larger percentage of cases with mild peri-infundibular fibrosis in the control group. When only moderate inflammation was considered, the PHL group had a higher number, but moderate inflammation was rare, and the difference did not reach statistical significance. Based on our findings, we suggest that inflammation and fibrosis may not play significant roles in the pathogenesis of PHL. Further studies with a larger population and age-matched controls are needed. Response to Letter to the EditorJournal of the American Academy of DermatologyPreview Full-Text PDF Pattern hair loss: Assessment of microinflammation in miniaturized and terminal hair follicles through horizontal histologic sectionsJournal of the American Academy of DermatologyVol. 83Issue 2PreviewTo the Editor: Pattern hair loss (PHL) evolves from progressive hair follicle miniaturization and the premature termination of the hair anagen phase. Its etiopathogenesis goes beyond the local activity of dihydrotestosterone, especially in women, in which the evidence of an androgen-dependent entity relies on scarce data.1 Full-Text PDF" @default.
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• W2973292041 title "Pattern hair loss: Assessment of inflammation and fibrosis on histologic sections" @default.
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