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Biomedicines
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Hair Pathology
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Hair Pathology

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 27113

Special Issue Editor

Dr. Mariya Miteva

E-Mail Website
Guest Editor
Department of Dermatology and Cutaneous Surgery, University of Miami L. Miller School of Medicine, Miami, FL, USA
Interests: hair follicle; hair loss; alopecia; hair pathology; dermatopathology; skin pathology; trichoscopy

Special Issue Information

Dear Colleagues,

The basics:

Hair pathology is an exciting subdivision of dermatopathology that is dedicated to diagnosing hair disorders (scarring and non-scarring alopecias) on histologic slides obtained from scalp biopsies. Scalp biopsy is the diagnostic standard for scarring alopecias. The goal is to perform a biopsy in very early cases with only subtle clinical and trichoscopic features in order to establish an early diagnosis. A scalp biopsy is also useful in diffuse non-scarring alopecia to assess follicular miniaturization based on follicular counts and ratios, and for detection of adjunct features with implication for the therapy such as the presence of peri-infundibular lymphohistiocytic infiltrate in some biopsies from androgenetic alopecia.

How is it done?

Hair pathologists are trained to evaluate the scalp biopsies through horizontal sections, a procedure first introduced by Headington in 1984. In no-scarring alopecias, one 4 mm punch biopsy from the parietal scalp will usually be processed for horizontal sections since vertical sections are not useful in no-scarring alopecias. If scarring alopecia is suspected, trichoscopy (hair and scalp dermoscopy) should be used to identify the most optimal site for the biopsy. Usually, a dermoscopy-guided 4 mm punch biopsy will be obtained and processed in horizontal sections to ascertain a larger area for evaluation and even diagnosis of focal disease (individually affected follicular units). If the working diagnosis is unclear, the clinician would sometimes obtain two biopsies—one for horizontal and one for vertical sections.

The “power” of hair pathology

Hair pathology is the ultimate tool in assembling the puzzle of the clinical and trichoscopic signs using follicular morphology. This allows for the most optimal diagnosis. By seeing the patient and performing a scalp biopsy, I am convinced that we achieve the most insight for designing the best possible treatment regimen. Hair pathology is also a crucial part of all breakthroughs in hair research as it provides the model to prove hypotheses generated ex vivo in the lab or in vivo in practice. I believe that there is an urgent demand for more morphological observations that can provide translational researchers with a rationale for experimental work toward curing alopecia.

This issue is dedicated to hair pathology and aims to take you on a journey in the fascinating world of hair morphology.

Prof. Dr. Mariya Miteva
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Biomedicines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hair follicle
  • scalp
  • alopecia
  • hair loss
  • pathology
  • histology
  • biopsy
  • horizontal sections
  • hair morphology
  • hair anatomy

Published Papers (5 papers)

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Research

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10 pages, 15835 KiB  
Article
The Alopecia Areata Phenotype Is Induced by the Water Avoidance Stress Test In cchcr1-Deficient Mice
by Qiaofeng Zhao, Satoshi Koyama, Nagisa Yoshihara, Atsushi Takagi, Etsuko Komiyama, Akino Wada, Akira Oka and Shigaku Ikeda
Biomedicines 2021, 9(7), 840; https://doi.org/10.3390/biomedicines9070840 - 19 Jul 2021
Cited by 5 | Viewed by 2526
Abstract
We recently discovered a nonsynonymous variant in the coiled-coil alpha-helical rod protein 1 (CCHCR1) gene within the alopecia areata (AA) risk haplotype. We also reported that the engineered mice with this risk allele exhibited. To investigate more about the involvement of [...] Read more.
We recently discovered a nonsynonymous variant in the coiled-coil alpha-helical rod protein 1 (CCHCR1) gene within the alopecia areata (AA) risk haplotype. We also reported that the engineered mice with this risk allele exhibited. To investigate more about the involvement of the CCHCR1 gene in AA pathogenesis, we developed an AA model using C57BL/6N cchcr1 gene knockout mice. In this study, mice (6–8 weeks) were divided into two groups: cchcr1−/− mice and wild-type (WT) littermates. Both groups were subjected to a water avoidance stress (WAS) test. Eight weeks after the WAS test, 25% of cchcr1−/− mice exhibited non-inflammatory foci of alopecia on the dorsal skin. On the other hand, none of wild-type littermates cause hair loss. The foci resembled human AA in terms of gross morphology, trichoscopic findings and histological findings. Additionally, gene expression microarray analysis of cchcr1−/− mice revealed abnormalities of hair related genes compared to the control. Our results strongly suggest that CCHCR1 is associated with AA pathogenesis and that cchcr1−/− mice are a good model for investigating AA. Full article
(This article belongs to the Special Issue Hair Pathology)
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17 pages, 15422 KiB  
Article
Dysbiosis and Enhanced Beta-Defensin Production in Hair Follicles of Patients with Lichen Planopilaris and Frontal Fibrosing Alopecia
by Andria Constantinou, Katarzyna Polak-Witka, Marios Tomazou, Anastasis Oulas, Varvara Kanti, Rolf Schwarzer, Johannes Helmuth, Anke Edelmann, Ulrike Blume-Peytavi, George M. Spyrou and Annika Vogt
Biomedicines 2021, 9(3), 266; https://doi.org/10.3390/biomedicines9030266 - 07 Mar 2021
Cited by 7 | Viewed by 6606
Abstract
Despite their distinct clinical manifestation, frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) display similar histopathologic features. Aberrant innate immune responses to endogenous or exogenous triggers have been discussed as factors that could drive inflammatory cascades and the collapse of the stem cell [...] Read more.
Despite their distinct clinical manifestation, frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) display similar histopathologic features. Aberrant innate immune responses to endogenous or exogenous triggers have been discussed as factors that could drive inflammatory cascades and the collapse of the stem cell niche. In this exploratory study, we investigate the bacterial composition of scalp skin and plucked hair follicles (HF) of patients with FFA, LPP and alopecia areata circumscripta (AAc), as well as healthy individuals, in relation to cellular infiltrates and the expression of defense mediators. The most abundant genus in lesional and non-lesional HFs of LPP and FFA patients was Staphylococcus, while Lawsonella dominated in healthy individuals and in AAc patients. We observed statistically significant differences in the ratio of Firmicutes to Actinobacteria between healthy scalp, lesional, and non-lesional sites of FFA and LPP patients. This marked dysbiosis in FFA and LPP in compartments close to the bulge was associated with increased HβD1 and HβD2 expression along the HFs from lesional sites, while IL-17A was increased in lesional HF from AAc patients. The data encourage further studies on how exogenous factors and molecular interactions across the HF epithelium could contribute to disease onset and propagation. Full article
(This article belongs to the Special Issue Hair Pathology)
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Review

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17 pages, 5242 KiB  
Review
Scarring Alopecias: Pathology and an Update on Digital Developments
by Donna M. Cummins, Iskander H. Chaudhry and Matthew Harries
Biomedicines 2021, 9(12), 1755; https://doi.org/10.3390/biomedicines9121755 - 24 Nov 2021
Cited by 3 | Viewed by 4968
Abstract
Primary cicatricial alopecias (PCA) represent a challenging group of disorders that result in irreversible hair loss from the destruction and fibrosis of hair follicles. Scalp skin biopsies are considered essential in investigating these conditions. Unfortunately, the recognised complexity of histopathologic interpretation is compounded [...] Read more.
Primary cicatricial alopecias (PCA) represent a challenging group of disorders that result in irreversible hair loss from the destruction and fibrosis of hair follicles. Scalp skin biopsies are considered essential in investigating these conditions. Unfortunately, the recognised complexity of histopathologic interpretation is compounded by inadequate sampling and inappropriate laboratory processing. By sharing our successes in developing the communication pathway between the clinician, laboratory and histopathologist, we hope to mitigate some of the difficulties that can arise in managing these conditions. We provide insight from clinical and pathology practice into how diagnoses are derived and the key histological features observed across the most common PCAs seen in practice. Additionally, we highlight the opportunities that have emerged with advances in digital pathology and how these technologies may be used to develop clinicopathological relationships, improve working practices, enhance remote learning, reduce inefficiencies, optimise diagnostic yield, and harness the potential of artificial intelligence (AI). Full article
(This article belongs to the Special Issue Hair Pathology)
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19 pages, 2436 KiB  
Review
Design of In Vitro Hair Follicles for Different Applications in the Treatment of Alopecia—A Review
by Matej Žnidarič, Žan Michel Žurga and Uroš Maver
Biomedicines 2021, 9(4), 435; https://doi.org/10.3390/biomedicines9040435 - 16 Apr 2021
Cited by 12 | Viewed by 7726
Abstract
The hair research field has seen great improvement in recent decades, with in vitro hair follicle (HF) models being extensively developed. However, due to the cellular complexity and number of various molecular interactions that must be coordinated, a fully functional in vitro model [...] Read more.
The hair research field has seen great improvement in recent decades, with in vitro hair follicle (HF) models being extensively developed. However, due to the cellular complexity and number of various molecular interactions that must be coordinated, a fully functional in vitro model of HFs remains elusive. The most common bioengineering approach to grow HFs in vitro is to manipulate their features on cellular and molecular levels, with dermal papilla cells being the main focus. In this study, we focus on providing a better understanding of HFs in general and how they behave in vitro. The first part of the review presents skin morphology with an emphasis on HFs and hair loss. The remainder of the paper evaluates cells, materials, and methods of in vitro growth of HFs. Lastly, in vitro models and assays for evaluating the effects of active compounds on alopecia and hair growth are presented, with the final emphasis on applications of in vitro HFs in hair transplantation. Since the growth of in vitro HFs is a complicated procedure, there is still a great number of unanswered questions aimed at understanding the long-term cycling of HFs without losing inductivity. Incorporating other regions of HFs that lead to the successful formation of different hair classes remains a difficult challenge. Full article
(This article belongs to the Special Issue Hair Pathology)
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Other

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14 pages, 2738 KiB  
Hypothesis
A Cell Membrane-Level Approach to Cicatricial Alopecia Management: Is Caveolin-1 a Viable Therapeutic Target in Frontal Fibrosing Alopecia?
by Ivan Jozic, Jérémy Chéret, Beatriz Abdo Abujamra, Mariya Miteva, Jennifer Gherardini and Ralf Paus
Biomedicines 2021, 9(5), 572; https://doi.org/10.3390/biomedicines9050572 - 19 May 2021
Cited by 6 | Viewed by 3620
Abstract
Irreversible destruction of the hair follicle (HF) in primary cicatricial alopecia and its most common variant, frontal fibrosing alopecia (FFA), results from apoptosis and pathological epithelial-mesenchymal transition (EMT) of epithelial HF stem cells (eHFSCs), in conjunction with the collapse of bulge immune privilege [...] Read more.
Irreversible destruction of the hair follicle (HF) in primary cicatricial alopecia and its most common variant, frontal fibrosing alopecia (FFA), results from apoptosis and pathological epithelial-mesenchymal transition (EMT) of epithelial HF stem cells (eHFSCs), in conjunction with the collapse of bulge immune privilege (IP) and interferon-gamma-mediated chronic inflammation. The scaffolding protein caveolin-1 (Cav1) is a key component of specialized cell membrane microdomains (caveolae) that regulates multiple signaling events, and even though Cav1 is most prominently expressed in the bulge area of human scalp HFs, it has not been investigated in any cicatricial alopecia context. Interestingly, in mice, Cav1 is involved in the regulation of (1) key HF IP guardians (TGF-β and α-MSH signaling), (2) IP collapse inducers/markers (IFNγ, substance P and MICA), and (3) EMT. Therefore, we hypothesize that Cav1 may be an unrecognized, important player in the pathobiology of cicatricial alopecias, and particularly, in FFA, which is currently considered as the most common type of primary lymphocytic scarring alopecia in the world. We envision that localized therapeutic inhibition of Cav1 in management of FFA (by cholesterol depleting agents, i.e., cyclodextrins/statins), could inhibit and potentially reverse bulge IP collapse and pathological EMT. Moreover, manipulation of HF Cav1 expression/localization would not only be relevant for management of cicatricial alopecia, but FFA could also serve as a model disease for elucidating the role of Cav1 in other stem cell- and/or IP collapse-related pathologies. Full article
(This article belongs to the Special Issue Hair Pathology)
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