Early Stage Alopecia Areata Is Associated With Inflammation in the Upper Dermis and Damage to the Hair Follicle Infundibulum

    June 2013 in “ Australasian Journal of Dermatology ”
    Bin Zhou, Ying Zhang, Cai Zhang, Sillani Caulloo, Kevin J. McElwee, Yang Li, Xiaohong Chen, Man Yu, Jiong Yang, Wenna Chen, Xiangming Tang, Xingqi Zhang
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    TLDR Early stage bald spots are linked to skin inflammation and damage to the upper part of the hair follicle.
    The study examined 87 patients with early-stage alopecia areata (AA) and found that there was significant inflammation in the upper dermis and damage to the hair follicle infundibulum. Inflammation was characterized by T-lymphocytic invasion and regression of the lower follicle, with 13% of patients testing positive for anti-nuclear antibody (ANA), more commonly in women (21%) than in men (5%). Eosinophilic infiltration, which was present in 40% of patients, correlated with higher serum IgE levels and more severe perivascular lymphocytic inflammation. Mast cells were also found to be abundant in the upper dermis and correlated with eosinophil presence. The study concluded that the damage to the hair follicle infundibulum might be an important early change in AA, potentially caused by lymphocyte cell infiltration and suggesting that AA may involve damage to the upper hair follicle as well as the bulb, possibly involving hypersensitivity and autoimmunity.
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