Does collapse of immune privilege in the hair-follicle bulge play a role in the pathogenesis of primary cicatricial alopecia?

Clin Exp Dermatol. 2009 Nov 3.
Does collapse of immune privilege in the hair-follicle bulge play a role in the pathogenesis of primary cicatricial alopecia?

Harries MJ, Meyer KC, Chaudhry IH, Griffiths CE, Paus R.

Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.

Summary Background. The hair-follicle bulge has recently been added to a growing list of human tissue compartments that exhibit a complex combination of immunosuppressive mechanisms, termed immune privilege (IP), which seem to restrict immune-mediated injury in specific locations. As epithelial hair-follicle stem cells (eHFSC) reside in the hair-follicle bulge region, it is conceivable that these IP mechanisms protect this vital compartment from immune-mediated damage, thereby ensuring the ongoing growth and cyclic regeneration of the hair follicle. Primary cicatricial alopecias (PCA) are a group of inflammatory hair disorders that result in hair-follicle destruction and permanent alopecia. Growing evidence suggests that eHFSC destruction is a key factor in the permanent follicle loss seen in these conditions. Aim. To explore the possible role of bulge IP collapse in PCA pathogenesis. Methods. We report three clinically distinct cases of PCA. Immunohistochemical analyses of paired biopsies from lesional and uninvolved scalp skin were compared using recognized markers of IP. Results. Immunohistochemical investigation found increased expression of major histocompatibility complex (MHC) classes I and II and of beta2-microglobulin in the bulge region of lesional follicles compared with uninvolved follicles in each case. Further, expression of the bulge marker keratin 15 was reduced in lesional skin in two of the cases. Conclusions. This small series represents our first preliminary attempts to ascertain whether bulge IP collapse may play a role in PCA pathogenesis. We present standard parameters relating to hair-follicle IP in the bulge region of three patients with distinct PCA variants, and show the presence of features consistent with bulge IP collapse in each case.

Autoimmun Rev. 2009 May;8(6):478-83.
Hair loss as a result of cutaneous autoimmunity: frontiers in the immunopathogenesis of primary cicatricial alopecia.

Harries MJ, Meyer KC, Paus R.

Dermatological Sciences, The University of Manchester, Manchester, UK.

Primary cicatricial alopecias (PCA) represent uncommon inflammatory disorders that result in permanent loss of scalp hair. Cutaneous autoimmunity, most prominently chronic cutaneous lupus erythematosus (CCLE), can result in this kind of scarring hair loss. The cosmetic disfigurement caused by PCA and the very unsatisfactory therapeutic options available to date all demand a better understanding of the obscure pathobiology of PCA so as to define new therapeutic targets and strategies. Hair follicle (HF) cycling and regeneration are abolished in PCA due to irreversible, epithelial hair follicle stem cell (eHFSC) damage, triggered by major, yet unclear pro-inflammatory events (e.g. type I interferon-associated cytotoxic inflammation, loss of HF immune privilege, loss of immunosuppressive "no danger" signals). Therefore, immuno-protection of eHFSC and restitution of their immune privilege are attractive future therapeutic strategies in PCA. Chronic cutaneous lupus erythematosus-associated PCA may serve as a model system for other diseases where epithelial stem cells undergo immuno-destruction.

From everything I have read about this, this condition seems to stem from consumption of wheat and gluten products. Many cases of lupus erythematosus is a direct result from wheat/gluten intake.

Thanks for posting this IH.

If you recall I had a scalp biopsy way back when my hair was first falling out in 2006 that diagnosed my hair loss as a combination of a scarring alopecia and male pattern hair loss. At that time I had a very pink scalp all the time. After finding you and using the topical and the regimen that symptom went away with time.

Clearly, something in the regimen has halted the loss from further affecting me, but I did lose a lot of hair diffusely down the center part and I do have one slick bald spot towards the front of my scalp behind my hairline. My hairline, by the way, has never been affected in any of this.

I've never had any regrowth in the areas of loss yet though. Once in awhile a hair will pop through but it doesn't stay for long in that slick area.

I haven't gone wheat/gluten free yet and my wife and I are planning to try it for a few weeks to see what kind of changes we see physically. It's just strange.

Could that intolerance to wheat and gluten develop later in life for me in my mid 30's? I mean, I was Mr. Wheat for most of my life. I never had white bread and even my pasta was whole wheat since I could find that type in the store.

The sad thing is how doctors treat this disease. The list of medications in their playbook are truly horrific. You're lucky if you just get off with steroid foam and/or injections. Some of the other internals they are prescribing are life takers and in most cases don't even work.

They have to figure this out and find a cure for this since I have personally seen it affects a lot more women than the data is letting on. It's a lot more common than you think. I can't imagine being a woman and going through what the full blown version of a scarring alopecia would be like.

hadrion - In my early days I never thought of myself as wheat/gluten sensitive, but I have noticed that when I eat a heavy load of wheat products, my skin tends to suffer, usually within a few days. I bought some wheat germ oil (Now brand) last year and I had what I thought was the unthinkable happen to me. The food sat in my stomach for hours on end, I never experienced heart burn before at least not like this. I didn't realize it was the wheat germ oil until my third try and that was it.

Food allergies for whatever reason occur with age, so it seems. I haven't a clue exactly why they occur outside of lactose intolerance.

Here is a product that helps with gluten digestion. I think this would be useful because it's incredibly difficult to avoid wheat/gluten entirely. Sourdough bread is a great substitute for wheat if you're into bread or sandwiches.

http://www.iherb.com/Now-Foods-Gluten-Digest-60-Vcaps/12364?at=0

@ hadrion, what's your current regime? Your hair struture sounds EXACTLY like mine, balding wise.

Thanks for the link to the supplement. I'm going to give it a try and I'll report back with any feedback.

I was just talking about this with my wife and she said considering I've had weight issues and skin issues most of my life, I very well could have had this allergy all this time and not known.

I've pretty much given bread up but I do get sourdough whenever I get the chance. Still, it's next to impossible to avoid wheat/gluten although I will say this -- I shop at Trader Joe's a lot and I recently saw thaty have brown rice gluten free tortilla if you want to make a wrap or breakfast burrito. They also now are selling a gluten free pancake/waffle mix there.

Dave228 wrote:@ hadrion, what's your current regime? Your hair struture sounds EXACTLY like mine, balding wise.

Dave,

I take a lot of stuff. I went mostly for the anti-inflammatory type supplement since I had heavy inflammation.

I take almost everything on on the Immortal Hair "My Regimen" page. All of the top 6 and all of the "Ancillary/Supplemental" supplements with the exception of "Chasteberry". From the "Helpful when eating civilized food" section I only take NAC.

On top of that, I supplement with iodine.

I also take 1g or Cayenne caps per day.

I take 3000mg of Vitamin C each day with 3000mg of Lysine and 1500mg of Proline (this is something called the Pauling Protocol which is used to prevent heart disease).

I also take 50mg of Ubuqinol which is a form of CoQ10. each day.

I also take Niacinamide 500mg 1x per day.

Hadrion did you ever have a dandruff problem? I feel I have excessive amounts even for a normal person.

Dave228 wrote:Hadrion did you ever have a dandruff problem? I feel I have excessive amounts even for a normal person.

I never had dandruff until I started losing my hair rapidly and then I suddenly had a major dandruff problem. Major. Never saw anything like it in my life. It was horrible.

In the beginning Head & Shoulders and Nizoral helped with that, but I started using IH's topical on his page and that knocked that issue out. Haven't had that problem since then and I've stopped using the topical every day. I use it when I feel itchy or inflamed.

Sourdough bread still contains gluten unless you make it yourself with a special recipe.

JHarsh80 wrote:Sourdough bread still contains gluten unless you make it yourself with a special recipe.

Exactly. I've read the ingredients on many sourdough and see wheat flour listed at the top.

The reason sourdough is less evil than typical wheat/gluten breads is because of its lactic acid content.

I just wrote about his in my daily topic: Here's the meat of the article.

"According to the researchers in Lund, Sweden, sourdough bread is safe. Unlike standard wheat bread, It has been observed that bread containing lactic acid produced during the sourdough fermentation or added directly, has the ability to lower glucose and insulin responses after meals in humans.

The mechanisms for a lowered glucose response to bread containing lactic acid were found to be that the inclusion of lactic acid in bread reduces the rate of starch digestion by creating interactions between the gluten and starch."

Thank you CS for this info.

I love sour dough! at least now i know there is a bread i can eat when i crave.

i literally try to stay away from bread, pasta...i have to eat some rice at times but less than 2 oz.