The spectrum of histopathological lesions in scarring alopecia: a prospective study.

J Clin Diagn Res. 2013 Jul;7(7):1372-6. doi: 10.7860/JCDR/2013/5138.3131. Epub 2013 Jul 1.
The spectrum of histopathological lesions in scarring alopecia: a prospective study.
Kumar U M, Yelikar BR.

Associate Professor, Department of Pathology, Pratima Institute of Medical Sciences , Karimnagar, Andhra Pradesh, India .

Introduction: The aim of the article was to study the histopathological features of various lesions of Scarring Alopecia (SA) and to classify Primary SA on the basis of the predominant type of inflammatory cell component. Scarring or cicatricial alopecias are those that are produced as a result of the malformation, damage or destruction of the pilosebaceous follicles, which are replaced by cicatricial tissue, in such a way that they cannot again produce hair. Material and Methods: This prospective study included 32 biopsy - proven cases of SA, who had attended our hospital. Primary SA was classified according to the North American Hair Research Society. The informed consents of the subjects and the institutional ethical clearance was obtained for the study. The SPSS, version 14 software was used to analyse the data. Frequencies and percentages were used to describe the data. Results: During the study period, 32 cases of scarring alopecia were diagnosed, of which 24 were primary SA and 8 were secondary SA. Among the primary SA, there were 23 cases of lymphocyte associated primary scarring alopecias, of which, 19 of lupus erythematosus, 3 of lichen planopilaris (LPP) and one case of non specific SA. 1 case of neutrophil associated primary scarring (folliculitis decalvans) was also noted and among the secondary SA, there were 4 cases of morphea and 1 case each of lupus vulgaris, congenital absence of skin, burn and sarcoidosis. Conclusion: To conclude, histopathology is a dependable tool for identifying the underlying cause in scarring alopecia, which is helpful for an early diagnosis and treatment.

Full Study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749638/

What does this mean? Is it good news?

Its not necessarily good or bad. If you have scarring alopecia, there are improvements in the diagnostic tests that will tell you your specific pathology. I mean, to some extent the predominant forms of hairloss are like a spectrum, because there are scarring and autoimmune components even in classic MPB. So anything that helps us understand the pathological process of these other forms of loss will also help us understand MPB more concretely.

What is interesting was the high percentage of the SA cases that were related to straight autoimmune disorders. This continues to be the most puzzling aspect of hair loss, at least for me. What is the trigger? If other autoimmune situations are of any insight, then diet plays a huge role, rather the envrionment of the gut does in terms of permeability. Are there other triggers? Demodex mites or perhaps the bacteria they harbor, as is being realized with Rosacea? Could it be a combination situation where bacteria and/or fatty acids and/or excitatory amines are sensitizing the afferent neurons in the scalp, leading to recruiting immune cells where they aren't needed (neurogenic inflammation)? Its fascinating and infuriating. In fact, I think its plausible that the innervation of the scalp could be a huge contributor, and may be one of the reasons for degradation of the damage to arteries there.