The autoimmune aspect of hair loss

Posted on February 8, 2011 by Dr. Jonathan

A fascinating study was just published in Medicinski arhiv (Medical Archives, Journal of the Academy of Medical Sciences of Bosnia and Herzegovina) that illuminates the type of autoimmune dysfunction involved in alopecia areata, a common cause of hair loss. The authors state:

“Alopecia areata (AA) is a heterogeneous disease characterized by nonscarring hair loss on the scalp or other parts of the body. A wide range of clinical presentations can occur-from a single patch of hair loss (alopecia unilocularis, AUl), multiple patches (alopecia multilocularis, AM) to complete loss of hair on the scalp (alopecia totalis, AT) or the entire body (alopecia universalis, AU). The cause of AA is unknown although most evidence supports the hypothesis that AA is a T-cell mediated autoimmune disease of the hair follicle and that cytokines play an important role.”

The authors set out to evaluate serum concentrations of interferon-gamma (IFN-g, a major proinflammatory cytokine) in 60 patients with AA in comparison to 20 healthy subjects. They also investigated for an association between IFN-g and the clinical type of AA and duration of the disease. What did their data show?

“The serum concentration of IFN-g in patients with AA was significantly higher than that in the control group. Significantly elevated serum IFN-g were noticed in patients with AU type, especially those suffering from AT, compared with both patients with AUI and patients with AM clinical type. There was no significant difference in serum IFN-g concentration between patients with AUI and AM group, as well as between patients with AT and AU. No correlations were found between duration of disease and the serum levels of IFN-g.”

This clearly shows the autoimmune basis of hair loss in general and the role of IFN-g in particular. Autoimmune conditions require a functional approach that uses up-to-date methods to objectively define the underlying causal factors such as IFN-g for treatments that are targeted, physiological and rational. The authors conclude:

“Our findings confirm previously published data that the Th1 type cytokine IFN-g is elevated in the serum of AA patients.“

Hair loss and autoimmunity

Posted on July 13, 2010 by Dr. Jonathan

Nature A paper just published in the prestigious journal Nature defines the type of autoimmune dysregulation that causes alopecia areata, a common type of hair loss, by determining the underlying genetic expression.

“Alopecia areata (AA) is among the most highly prevalent human autoimmune diseases, leading to disfiguring hair loss due to the collapse of immune privilege of the hair follicle and subsequent autoimmune attack. The genetic basis of AA is largely unknown.”

The authors undertook a search through the whole genome and identified 139 polymorphisms significantly associated with AA. They were able to:

“…show an association with genomic regions containing several genes controlling the activation and proliferation of regulatory T cells (Treg cells), cytotoxic T lymphocyte-associated antigen 4 (CTLA4), interleukin (IL)-2/IL-21, IL-2 receptor A (IL-2RA; CD25), etc…”

This is not only a reminder that hair loss can be autoimmune in nature, but that clinicians mustn’t be misled that an autoimmune disease is either an expression of innate immunity (Th1) or acquired immunity (Th2) but not both:

“This study provides evidence for the involvement of both innate and acquired immunity in the pathogenesis of AA. We have defined the genetic underpinnings of AA, placing it within the context of shared pathways among autoimmune diseases…”

This understanding is critical for the functional approach to managing these conditions.

Ladies, a surge of hair loss two times a year is normal

Posted on January 16, 2010 by Dr. Jonathan

Dermatology Are you sometimes worried about the amount of hair that you find in the shower drain? Of course excessive hair loss can be a result of a number of conditions including autoimmune disorders, hypothyroid, low iron, etc. We can be diagnose these with the right tests, but bear in mind that there are two seasonal spikes of hair loss that are normal. This recent paper in the journal Dermatology reports a study of 823 women in which “Analysis of trichograms demonstrated annual periodicity in the growth and shedding of hair, manifested by a maximal proportion of telogen hairs in summer. A second peak seems to exist, though it is less pronounced, in spring. The telogen rates were lowest in late winter.” [Trichograms are examinations of plucked hairs under the microscope. The telogen phase is the resting phase of the hair follicle during which hair is shed.] The authors conclude: “These results confirm the findings of former authors who have indicated seasonal changes in human hair growth, though this is the first study performed systematically in a representative number of women.”