White hair in alopecia areata: Clinical forms and proposed physiopathologic mechanisms

Asz-Sigall, Daniel; Ortega-Springall, María Fernanda; Smith-Pliego, Mariam; Rodríguez-Lobato, Erika; Martínez‐Velasco, María Abril; Arenas, Roberto; Vincenzi, Colombina; Tosti, Antonella

doi:10.1016/j.jaad.2018.12.047

Cited by 27 publications

(19 citation statements)

References 27 publications

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“…2,35 Pigmented HFs are preferentially lost in patients with active disease, whereas depigmented HFs tend to be spared, and hair regrowth frequently demonstrates white hair (poliosis). 1,2,36 Therefore it has long been suggested that melanogenesis-related peptides are key targets of an immunologic attack in patients with AA once an anagen HF has lost its protective IP. 35 Studies in various animal models support this concept.…”

Section: Autoantigens: the Search Continuesmentioning

confidence: 99%

Frontiers in alopecia areata pathobiology research

Gilhar

Laufer-Britva

Keren

et al. 2019

Journal of Allergy and Clinical Immunology

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This current review explores selected and as yet insufficiently investigated frontiers in current alopecia areata (AA) pathobiology research, with an emphasis on potential ''new'' players in AA pathobiology that deserve more systematic exploration and therapeutic targeting. Indeed, new evidence suggests that CD8 1 T cells, which have long been thought to be the central players in AA pathobiology, are not the only drivers of disease. Instead, subsets of natural killer (NK) and so-called ''unconventional'' T cells (invariant NK T cells, gd T cells, classic NK cells, and type 1 innate lymphoid cells), all of which can produce large amounts of IFN-g, might also drive AA pathobiology independent of classical, autoantigen-dependent CD8 1 T-cell functions. Another important new frontier is the role of regulatory lymphocyte subsets, such as regulatory T cells, gd regulatory T cells, NKT10 cells, and perifollicular mast cells, in maintaining physiologic hair follicle immune privilege (IP); the extent to which these functions are defective in patients with AA; and how this IP-protective role could be restored therapeutically in patients with established AA. Broadening our AA research horizon along the lines suggested above promises not only to open the door to innovative and even more effective immunotherapy strategies for AA but will also likely be relevant for other autoimmune disorders in which pathobiology, ectopic MHC class I expression, and IP collapse play an important role.

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Section: Autoantigens: the Search Continuesmentioning

confidence: 99%

Frontiers in alopecia areata pathobiology research

Gilhar

Laufer-Britva

Keren

et al. 2019

Journal of Allergy and Clinical Immunology

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“…They defined white hairs as a frequent sign and a well-known condition in the regrowing stage of AA. Also, it was suggested that the protection of white hairs by falling of black hairs caused patchy or diffuse hair whitening (21). In this study, white vellus hairs in the patient group (68.4%) were significantly (p=0.001) frequent.…”

Section: Discussionmentioning

confidence: 49%

“…Asz-Sigall et al defined clinical forms and possible pathophysiological mechanisms of white hairs in AA (21). They defined white hairs as a frequent sign and a well-known condition in the regrowing stage of AA.…”

Section: Discussionmentioning

confidence: 99%

The usefulness of dermoscopic findings in the clinical evaluation of bread alopecia areata

Köse¹

2019

Erciyes Med J

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The aim of this study is to investigate the usefulness of dermoscopic findings in the clinical evaluation of beard alopecia areata (BAA). Materials and Methods: A total of 38 patients who presented with BAA diagnosed via clinical evaluation and 38 adults who did not have BAA (control group) were included. Their age, skin phototype, localization, severity, scalp involvement, duration of the disease, laboratory findings, and concomitant disorders were noted. Clinical and dermoscopic photos were taken by videodermoscope and recorded. Dermoscopic findings were analyzed according to the checklist described in previous articles for scalp alopecia. Results: Clinical severity of alopecia areata was observed as 13 (34.2%) solitary lesions, 22 (57.9%) multiple lesions, and 3 (11.1%) cases of total beard loss. According to the follicular features, white vellus and tapering hairs were detected 26 (68.4%) and 8 (21.1%) in the patient group, respectively. The difference between white vellus (p=0.001) and tapering hairs (p=0.003) was significant between the patient and the control groups. Other follicular findings, such as yellow dots, black dots, black vellus hairs, broken hairs, hair diameter diversity, and gray-white dots, did not show a significant difference between the patient and control groups. None of the interfollicular findings were significantly different between the two groups. Conclusion: According to our study, a dermoscopic evaluation is useful in the clinical evaluation of BAA. Detection of the white vellus and tapering hairs may guide diagnosing of BAA.

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“…Canities subita has been considered by some authors an acute episode of diffuse alopecia areata in which the sudden whitening is caused by the preferential loss of pigmented hair in this immune-mediated disorder [2]. Clinically, the "salt and pepper" pattern of hair color is the most frequent manifestation of canities subita [3].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…The most famous historical report of sudden graying was Queen Marie Antoinette of France before her death in the guillotine. Some authors attributed this phenomenon to a diffuse alopecia areata [2], although the exact mechanism remains unclear. We describe a case of canities subita showing positive staining for anti-PD-L1 and discuss its potential implication in the pathogenesis of this entity.…”

Section: Introductionmentioning

confidence: 99%

Canities Subita after Extreme Trauma Showing Positive Staining for Anti-PD-L1 Antibodies: A New Clue into Etiopathogenesis?

Navarro‐Triviño

Ruiz‐Villaverde

Ramos-Pleguezuelos

et al. 2021

Skin Appendage Disord

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Canities subita has been considered by some authors an acute episode of diffuse alopecia areata in which the sudden whitening is caused by the preferential loss of pigmented hair in this immune-mediated disorder. Clinically, the “salt and pepper” pattern of hair color is the most frequent manifestation of canities subita. However, the exact physiopathology of canities subita is not completely understood. A 69-year-old Caucasian man was referred for the sudden and asymptomatic whitening of the hair on the scalp and eyebrows, without an associated hair loss. The trigger was the death of his brother. Hair whitening appeared 24 h after the event. He reported a history of alopecia areata in plaques on the scalp, with spontaneous complete resolution in 2006. The physical examination showed full whitening hair on the scalp and eyebrows. Eyelashes were not affected. The pull test was negative, and the patient denied a significant hair loss in the last days. The histopathological study showed several follicle-sebaceous structures in the anagen, and one of them (inset) with a transforming hair bulb. The anterior bulb was surrounded by a lymphocytic inflammatory infiltrate in an advanced stage of transformation to the catagen and incipient scar changes. Immunohistochemistry staining showed a positive anti-PD-L1 antibody expressed in the inflammatory infiltrate. Based on the clinical and histological findings, a diagnosis of canities subita was made. The histopathological study showed a positive staining for anti-PD-L1 antibodies, supporting the role of the immune system in the development of this phenomenon. The interaction between melanogenesis and the lymphocytes warrants further research.

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White hair in alopecia areata: Clinical forms and proposed physiopathologic mechanisms

Cited by 27 publications

References 27 publications

Frontiers in alopecia areata pathobiology research

Frontiers in alopecia areata pathobiology research

The usefulness of dermoscopic findings in the clinical evaluation of bread alopecia areata

Canities Subita after Extreme Trauma Showing Positive Staining for Anti-PD-L1 Antibodies: A New Clue into Etiopathogenesis?

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