IL-17-positive mast cell infiltration in the lesional skin of lichen planopilaris: Possible role of mast cells in inducing inflammation and dermal fibrosis in cicatricial alopecia.

Lichen planopilaris (LPP) is a primary cicatricial alopecia characterized by the infiltration of lymphocytes in the upper portion of hair follicles. Inflammation around the bulge region of hair follicles induces destruction of hair follicle stem cells and tissue fibrosis, resulting in permanent hair loss. Treatment is still challenging, and the precise pathophysiology of this disorder is unknown. To clarify the pathogenesis of LPP, we performed histological and immunohistochemical analysis on specimens obtained from LPP patients. Formalin-fixed and paraffin-embedded samples were evaluated by staining with haematoxylin and eosin (HE), toluidine blue stain, immunohistochemistry and immunofluorescence. The immunohistochemical analysis demonstrated that CD4-positive T cells preferentially infiltrated into the follicular infundibulum in the LPP lesions. Toluidine blue stain detected a large number of mast cells in the inflammatory lesions of LPP. Interestingly, immunohistochemical analysis demonstrated that the mast cells harboured IL-17A- and IL-23-producing activity and expressed the IL-23 receptor. The number of IL-17A-positive mast cells was significantly higher in the LPP lesions than in normal scalp. Moreover, the IL-17 receptor was expressed exclusively in the follicular epithelial cells in the LPP lesions. These results suggested that mast cells infiltrating hair follicles might play a role in the pathogenesis of LPP via the IL-23/IL-17 axis.

Multivariate analysis of prognostic factors in patients with rapidly progressive alopecia areata.

BACKGROUND: Alopecia areata (AA) is a common acquired hair disorder showing variable hair loss. Although various prognostic factors have been reported, no evident factors for determining prognosis and appropriate treatment are known. OBJECTIVE: To identify prognostic factors in AA patients, especially those with positive results for the hair-pull test on the first visit or with a history of rapidly progressive AA (RPAA) within 6 months prior to the first visit. METHODS: One thousand thirty (1030) patients diagnosed with AA at Tokyo Medical University Hospital were retrospectively examined for 3 years, and their prognosis was assessed on the basis of various indices using multivariate analysis. RESULTS: Patients with regenerated vellus hairs showed a significantly higher improvement or cure rate regardless of severity. Early onset and lengthy duration were significantly associated with lower cure, and higher relapse, rates. RPAA patients tended to show a good prognosis regardless of the treatment employed. LIMITATIONS: The present study is retrospective, and treatment modalities were chosen according to clinical and social circumstances. CONCLUSION: RPAA patients tend to show a favorable prognosis regardless of treatment modality. Furthermore, the presence of regenerated vellus hairs may indicate a good prognosis.

Oral finasteride improved the quality of life of androgenetic alopecia patients.

Although androgenetic alopecia (AGA) is not a systemic disease, some patients suffer from anxiety about the progression of their condition. This study was conducted in order to ascertain whether treatment by oral finasteride can improve the quality of life (QOL) of these patients. Twenty-seven male AGA patients aged 19-76 years (average, 33.8) answered the Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI), WHO/QOL-26 and State-Trait Anxiety Inventory (STAI) questionnaires before and after the administration of finasteride (1 mg/day) for 6 months. Patients assessed by physicians as "excellent" or "good" were defined as "high responders"; those assessed as "moderate" or "no change" were "low responders". The changes in QOL before and after the treatment were statistically analyzed, and the improved value of each QOL index of the high responders and low responders from baseline were compared. There was a statistical difference in the VAS (P < 0.0001) and DLQI (P < 0.01) indices before and after the administration of finasteride. No significant changes occurred in the WHO/QOL-26 and STAI indices. Comparison of the high responders (11 cases) and low responders (16 cases) revealed no statistical difference in the improvement of VAS and DLQI scores. Oral finasteride improves the QOL of these patients, and VAS and DLQI are useful for the evaluation of patients' QOL because of the high sensitivity of these tests. However, oral finasteride did not alleviate the patients' anxiety nor did its efficacy correlate with the level of reported anxiety.