Evaluation of Perifollicular Inflammation of Donor Area during Hair Transplantation in Androgenetic Alopecia and its Comparison with Controls.

Int J Trichology. 2013 Apr;5(2):73-6. doi: 10.4103/0974-7753.122963.
Evaluation of Perifollicular Inflammation of Donor Area during Hair Transplantation in Androgenetic Alopecia and its Comparison with Controls.
Nirmal B1, Somiah S1, Sacchidanand SA1, Biligi DS2, Palo S2.

BACKGROUND:
Mild perifollicular inflammation is seen in both androgenetic alopecia (AGA) cases and normal controls, whereas moderate or dense inflammation with concentric layers of collagen, is seen in AGA cases but only in very few normal controls, and may lessen the response to topical minoxidil. Moderate or dense lymphocytic inflammation and perifollicular fibrosis have poor hair growth following transplantation.
AIM:
The purpose of the study is to evaluate the perifollicular lymphocytic inflammation and fibrosis in AGA patients during follicular unit hair transplantation (FUT) and its comparison in normal controls.
MATERIALS AND METHODS:
A total of 21 male patients with AGA and 7 matched controls participated in the study. Histopathological analysis of biopsy specimens from donor strip of patients during the hair transplantation and two 4 mm punch biopsies on controls were performed. Morphometric analysis was performed and perifollicular fibrosis was scored based on the width of the condensed collagen at the lower infundibulum and isthmus from 0 to 3. Perifollicular infiltrate was also scored 0-3 and a total score of 3 or more out of 6 was considered significant.
RESULTS:
Nearly 76% of AGA patients had perifollicular fibrosis more than 50 μm at ×200 magnification. Almost 33.33% patients had moderate/dense perifollicular lymphocytic infiltrate whereas none of the controls had it. Total score in AGA cases was significantly higher than controls (P = 0.012) using Chi-square test. Out of 21 patients, 13 had a score of 3 or more and were followed-up with monthly treatment with intralesional steroids using a dermaroller.
CONCLUSION:
Histopathological evaluation of the donor area is a must during hair transplantation to evaluate the extent of perifollicular inflammation and achieve better results by following it up with treatment directed to decrease the inflammation.
KEYWORDS:
Fibrosis, hair transplantation, inflammation

Thanks Caustic.

Is it the fibrosis (a result of chronic inflammation) that causes the miniaturization of hair?

What are yout thoughts on dermatolling or wounding?

Yes, chronic inflammation can lead to fibrosis.

I posted a study on dermarolling recently that shows more promise.

It should work given enough time and if a natural topical is used, can probably enahance the process.
Internals such as marine oils (krill oil) are important because PGD2 can inhibit wounding healing.

CS,

I'm wondering in light of the inflammatory infiltrate, does something like dermarolling worsen the problem? It seems like introducing a wound to the region would cause more collagen deposition and worsen our problem? Or does the wounding cause a different response?

Wounding healing improves a fibrotic environment.

For example, hair growth is encouraged by inducement of VEGF, which is initiated by forms
of wound healing. In turn, MMP-2 will degrade the altered collagen to make room for the growth of these
blood vessels of a new capillary network to begin.

Wounding healing stimulates activity in the stem cells that produce hairs. Or to put it another way, progenitor cells within hair follicles induce a new epithelialization of wounds. This causes changes in hair cycling (towards anagen).

CS - I'm wondering what you might recommend as a topical. I've been derma-rolling 1x week with a 1.0mm roller and I'm seeing some very interesting results. They are coming slow, but without a doubt they are coming. This is without a topical. I'd love to throw a topical into this.

CS, thanks for your answer.

Could we expect this principle to work with other areas of the skin besides the hair follicle...such as scars/stretch marks? Would creating the wound response there restructure all of the cross-linked collagen?

Sorry for all the questions...it just seems so counter-intuitive. With a scar, there was already a wound to begin with right, so mimicking another wound is supposed to help correct? Or perhaps by making a series of small wounds the body isn't overwhelmed like it is with a larger wound, the immune system can clean up and the collagen can be replaced in proper fashion.

hadrion wrote:CS - I'm wondering what you might recommend as a topical. I've been derma-rolling 1x week with a 1.0mm roller and I'm seeing some very interesting results. They are coming slow, but without a doubt they are coming. This is without a topical. I'd love to throw a topical into this.

Yes, there are many potential topical options. Some of them are not easily obtainable, because they are not yet commercially available, however there are many that are. I think I've posted nearly 50 of them over the years. I suppose which of them would work the best would be a good question. Only wish I knew the answer. There is Rejuveplex which contains a variety of them combined together.

In a wound healing environment is prime for regrowth since it will further augment wnt proteins, integrins, reduce inflammation.  As you mentioned, even without a topical results are promising.

AS54 - I've seen results/research of this type for facial scars, so I would imagine it would also work on other parts of the body. The remodeling process (collagen remodeling as it is called) works by embolizing (dissolving the scar tissue) and then rebuilding the collagen tissue (de novo).