Perifollicular Inflammation and Fibrosis in Androgenetic Alopecia: Implications for Diagnosis and Treatment - A Comparative Histopathologic and Clinical Study with Normal-Appearing Scalp

January 2026 in “ DOAJ (DOAJ: Directory of Open Access Journals) ”

Umar S, Tan B.H., Shitabata PK

perifollicular inflammation fibrosis androgenetic alopecia AGA scarring alopecia immune inflammation hair follicles hormonal pathways inflammatory pathways biopsy hair loss baldness scalp inflammation

TLDR Early biopsy and targeting inflammation can improve treatment for hair loss in androgenetic alopecia.

This study investigates the presence of perifollicular inflammation and fibrosis (PIILIF) in androgenetic alopecia (AGA) patients, which may contribute to treatment resistance. In a cohort of 129 AGA patients, 81% exhibited PIILIF, particularly those aged 44 or older, with advanced hair loss, or with prior poor response to treatment. Histological analysis revealed immune inflammation around hair follicles, resembling early scarring alopecia. Patients receiving combination therapy targeting both hormonal and inflammatory pathways showed better outcomes, with 67% improving. The findings suggest that PIILIF is an under-recognized inflammatory endotype within AGA, and early biopsy can aid in diagnosis and treatment planning, potentially improving patient outcomes.

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