Histologic study of the regeneration of axillary hair after removal with subcutaneous tissue shaver

Morphological evaluation of polysaccharide content and collagen composition during cutaneous wound healing in the Sunda porcupine (Hystrix javanica)

Wound healing in the Sunda porcupine is believed to occur quickly, although the wound is large and severe. Wound enclosure involves many processes to restore the lost or damaged skin structure where conjugated polysaccharide-protein and collagen, as the main components deposited in wound tissue to restore it. The aim of this study was to evaluate alteration of polysaccharide contents and collagen in untreated full-thickness wound healing in the thoracodorsal and lumbosacral regions in the Sunda porcupines. Histological analysis was performed by periodic acid Schiff, alcian blue pH 2.5, picrosirius red staining method and Low Vacuum Scanning Electron Microscope (LV-SEM) imaging to obtain the fundamental data of healing process. Wound healing began with re-epithelization followed by progressive wound contraction with 4 overlapping stages in about 30–50 days until the wound closed (21–30 days in thoracodorsal and 30–50 days in lumbosacral). Neutral polysaccharide was more widely distributed compared to the acid polysaccharide in almost all stages of wound healing. The ratio of collagen I to III appeared to be higher in the thoracodorsal region than the lumbosacral region during healing process. LV-SEM imaging showed changes in connective tissue structure in the wound border and granulation tissue which appeared abundant and mixed of thin and thick fiber. In conclusion, cutaneous full thickness wound healing in the Sunda porcupine occurred faster in the thoracodorsal region, which might be correlated to the role of neutral polysaccharide and a high ratio of collagen I to III.

Relating Hair Growth Theory and Experimental Evidence to Practical Hair Transplantation

Hair transplantation methods as generally practiced utilize grafting of full follicles. Recent experimental evidence suggests that germinal cells responsible for follicular growth and differentiation may reside in specific localized areas within the follicle. This study was performed to relate experimental evidence to practical hair transplantation and to discuss results obtained from implantation of ½ follicular grafts. The study was done on four male patients with androgenetic alopecia who underwent transplantation with follicular half autografts. A total of 697 grafts of the upper ½ follicles and 694 grafts of lower ½ follicles were implanted. The results demonstrated that 50 hair shafts were produced from 697 upper ½ grafts, and 152 hair shafts from 694 lower ½ grafts. The conclusion is that the low percentage of terminal hair growth from ½ follicular grafts preclude this technique as an alternative method for cosmetic hair transplantation.

Management of Polycystic Ovary Syndrome

Polycystic ovary syndrome is a common endocrinological problem in women of reproductive age. Polycystic ovary syndrome is a heterogenous disorder and patients may attend different clinics depending on the main complaint. The exact pathophysiology of polycystic ovary syndrome remains obscure, although there have been insights that have thrown light on this condition. Consensus on the definition of the syndrome has only been recently achieved. The management of polycystic ovary syndrome poses a challenge to the physician as responses to the different treatment regimes have proved to be inconsistent. Diet and lifestyle advice, restoration of menstrual cycle regularity, treatment of hyperandrogenism, treatment of infertility and prevention of long-term consequences form the basis of polycystic ovary syndrome management. This review aims to provide the reader with the latest evidence in the treatment of polycystic ovary syndrome, as well as focus on some of the controversies surrounding its management.

Hair regeneration from transected follicles in duplicative surgery: rate of success and cell populations involved

BACKGROUND

The use of bisected hair follicles in hair transplantation has been previously reported, but the capacity of each half to regenerate the entire hair has not been clarified.

OBJECTIVE

To evaluate duplicative surgery rate of success and to analyze the cell populations involved in hair regeneration.

METHODS

We screened 28 patients undergoing duplicative surgery. Approximately 100 hair follicles from each patient were horizontally bisected and implanted. Upper and lower portions were stained for the known epithelial stem cell markers CD200, p63, beta1-integrin, CD34, and K19.

RESULTS

Similar percentages of hair regrowth after 12 months were observed when implanting the upper (72.7 +/- 0.4%) and lower (69.2 +/- 1.1%) portions. Expression of CD200, p63, and beta1-integrin was detected in both portions, whereas K19 and CD34 stained different cell populations in the upper and lower fragment, respectively.

CONCLUSION

Duplicative surgery might represent a successful alternative for hair transplantation, because both portions are capable of regenerating a healthy hair. Moreover, our results suggest the possible presence of stem cells in both halves of the follicle.

In Vivo Follicular Unit Multiplication: Is It Possible to Harvest an Unlimited Donor Supply?

BACKGROUND

Follicular unit extraction is a process of removing one follicular unit at a time from the donor region. The most important limitation of this surgical procedure is a high transection rate.

OBJECTIVE

In this clinical study, we have transplanted different parts of transected hair follicle by harvesting with the follicular unit extraction technique (FUE) in five male patients.

MATERIALS AND METHODS

In each patient, three boxes of 1 cm(2) are marked at both donor and recipient sites. The proximal one-third, one-half, and two-thirds of 15 hair follicles are extracted from each defined box and transplanted in recipient boxes. The density is determined at 12 months after the procedure.

RESULTS

A mean of 3 (range, 2-4) of the proximal one-third, 4.4 (range, 2-6) of the proximal one-half, and 6.2 (range, 5-8) of the proximal two-thirds of the transplanted follicles were observed as fully grown after 1 year. At the donor site, the regrowth rate was a mean of 12.6 (range, 10-14) of the proximal one-third, 10.2 (range, 8-13) of the proximal one-half, and 8 (range, 7-12) of the proximal two-thirds, respectively.

CONCLUSION

The survival rate of the transected hair follicles is directly related to the level of transection. Even the transected parts, however, can survive at the recipient site; the growth rate is not satisfactory and they are thinner than the original follicles. We therefore recommend that the surgeon not transplant the sectioned parts and be careful with the patients whose transection rate is high during FUE procedures.

Protection Against Chemotherapy-Induced Alopecia

PURPOSE

The goal is to provide an overview on the advances in protection against chemotherapy-induced alopecia (CIA).

MATERIALS AND METHODS

The four major parts of this review are (a) overview of the hair follicle biology, (b) characteristics of CIA, (c) state-of-the-art animal models of CIA, and (d) experimental approaches on protection against CIA.

RESULTS

The hair follicle represents an unintended target of cancer chemotherapy. CIA is a significant side effect that compromises the quality of life of patients. Overcoming CIA represents an area of unmet needs, especially for females and children. Significant progresses have been made in the last decade on the pathobiology of CIA. The pharmacological agents under evaluation include drug-specific antibodies, hair growth cycle modifiers, cytokines and growth factors, antioxidants, cell cycle or proliferation modifiers, and inhibitors of apoptosis. Their potential applications and limitations are discussed.

CONCLUSION

Multiple classes of agents with different action mechanisms have been evaluated in animal CIA models. Most of these protective agents have activity limited to a single chemotherapeutic agent. In comparison, calcitriol and cyclosporine A have broader spectrum of activity and can prevent against CIA by multiple chemotherapeutic agents. Among the three agents that have been evaluated in humans, AS101 and Minoxidil were able to reduce the severity or shorten the duration of CIA but could not prevent CIA.

Bulge cells of human hair follicles: segregation, cultivation and properties

The bulge region of hair follicle has been reported as a putative reservoir of hair follicle stem cell (HFSC) for years; however, few studies were done about the characteristics of bulge-originated cells in vitro up to now. In this experiment, the bulge cells isolated from human hair follicles by enzymatic digestion and microdissection were cultured and passaged, and the morphological and biological features of cultured bulge cells were investigated by microscopy and immunocytochemistry. The result showed that new-proliferated cells could be observed on the second day after inoculation, and the quantity of the cells with a greater proliferation potential, reached a peak at the 6th day and maintained this higher level for several days. The mitotic figures of bulge cells were seen and these cells showed undifferentiated morphologic features. The bulge cells strongly expressed K19 and beta1-integrin, which are the markers of HFSC, in a descensive way with the culture time. The result indicates that the cultured bulge cell from human hair follicle possesses the properties of primitive cells and supports the hypothesis that HFSC resides in the bulge area.

Controls of hair follicle cycling

Nearly 50 years ago, Chase published a review of hair cycling in which he detailed hair growth in the mouse and integrated hair biology with the biology of his day. In this review we have used Chase as our model and tried to put the adult hair follicle growth cycle in perspective. We have tried to sketch the adult hair follicle cycle, as we know it today and what needs to be known. Above all, we hope that this work will serve as an introduction to basic biologists who are looking for a defined biological system that illustrates many of the challenges of modern biology: cell differentiation, epithelial-mesenchymal interactions, stem cell biology, pattern formation, apoptosis, cell and organ growth cycles, and pigmentation. The most important theme in studying the cycling hair follicle is that the follicle is a regenerating system. By traversing the phases of the cycle (growth, regression, resting, shedding, then growth again), the follicle demonstrates the unusual ability to completely regenerate itself. The basis for this regeneration rests in the unique follicular epithelial and mesenchymal components and their interactions. Recently, some of the molecular signals making up these interactions have been defined. They involve gene families also found in other regenerating systems such as fibroblast growth factor, transforming growth factor-beta, Wnt pathway, Sonic hedgehog, neurotrophins, and homeobox. For the immediate future, our challenge is to define the molecular basis for hair follicle growth control, to regenerate a mature hair follicle in vitro from defined populations, and to offer real solutions to our patients' problems.

Role of hormones in pilosebaceous unit development

Androgens are required for sexual hair and sebaceous gland development. However, pilosebaceous unit (PSU) growth and differentiation require the interaction of androgen with numerous other biological factors. The pattern of PSU responsiveness to androgen is determined in the embryo. Hair follicle growth involves close reciprocal epithelial-stromal interactions that recapitulate ontogeny; these interactions are necessary for optimal hair growth in culture. Peroxisome proliferator-activated receptors (PPARs) and retinoids have recently been found to specifically affect sebaceous cell growth and differentiation. Many other hormones such as GH, insulin-like growth factors, insulin, glucocorticoids, estrogen, and thyroid hormone play important roles in PSU growth and development. The biological and endocrinological basis of PSU development and the hormonal treatment of the PSU disorders hirsutism, acne vulgaris, and pattern alopecia are reviewed. Improved understanding of the multiplicity of factors involved in normal PSU growth and differentiation will be necessary to provide optimal treatment approaches for these disorders.

Follicular bisection in hair transplantation surgery: an in vitro model

The aim of this study was to evaluate, in an in vitro model, the survival and growth rates of transversely sectioned human hair follicles to assess experimentally the soundness of this approach as a future possible method for "duplicating" available donor hair grafts in hair transplantation procedures. A total of 300 human anagen hair follicles was obtained from 10 healthy male patients. Follicles were thus randomly assigned to one of the following groups: group A (control; n = 100 follicles), cultured intact as dissected, and group B (experimental; n = 200 follicles), transversely transected, parallel to the epidermal surface and immediately below the bulge area, to obtain 200 lower-half follicles and 200 upper-half follicles. Isolated hair follicles from both groups were maintained in culture for 10 days. The length of each follicle was measured immediately following isolation and at the end of the 10-day culture period. No statistically significant differences were found between the growth rate of intact follicles (mean 10-day growth rate = 2.71 mm) and of lower-half follicles (mean 10-day growth-rate = 2.64 mm), whereas a statistically significant difference was found between the growth rate of follicles from the two above-mentioned groups and the growth rate of the "upper-half" follicles (mean 10-day growth rate = 1.07 mm). Histologic analysis demonstrated that both intact and lower-half follicles maintained a normal histologic appearance, whereas in upper-half follicle sections we invariably detected a region of intense cell proliferation, reminiscent of a regenerated follicular papilla, surrounding the lowermost part of the follicle. In our opinion, the reported in vitro survival rate of transected human hair follicles might represent an interesting starting point in striving to augment the number of donor hairs available during a hair transplantation procedure.

Human hair follicle regeneration following amputation and grafting into the nude mouse

In this study we investigated the capacity of the human hair follicle to regenerate a fiber-forming bulb after its amputation. We removed the bases from terminal follicles from a variety of sites and transplanted the follicles onto athymic mice, either still attached to a skin graft or as subcutaneous implants of individual follicles. External hair growth was observed on the skin grafts, and histology of the follicles revealed restoration of dermal papillae and follicle bulb structures. This result suggests that the capacity of hair follicles to regenerate their lower structures after removal, which was first demonstrated on whisker follicles, may be a general phenomenon. It emphasizes the importance of specific cellular subpopulations within the follicle and the role of dermal-epidermal interactions in adult follicle activities.

Characterization of hair follicle bulge in human fetal skin: the human fetal bulge is a pool of undifferentiated keratinocytes

It has been suggested that the bulge of the hair follicle contains a pool of follicular stem cells that may serve as a target site of graft-versus-host disease and as a source of cells with carcinogenic potential. The bulge is prominent in the developing follicle although it is a subtle swelling in the adult follicle. In this paper, we studied the bulge in human fetal skin specimens. Ultrastructurally, the bulge cells, especially the interior cells, have abundant free ribosomes and glycogen particles, but almost no cytoplasmic organelles indicative of differentiation. Immunostaining with several specific anti-keratin antibodies demonstrated that the bulge cells express keratins of both stratified and simple epithelia. Melanocytes and Merkel cells, defined by immunohistochemical and ultrastructural criteria, are seen among bulge cells. Laser confocal microscopy revealed that primitive smooth muscle cells attached directly to the bulge initially at the mid-bulbous hair peg, the stage when the bulge is most prominent. K-laminin and type VII collagen are strongly expressed in the dermoepidermal junction of the bulge and between the matrix area of the bulb and the dermal papilla. Thus, the bulge of human hair follicle is not only an attachment site for arrector pili muscle, but also a pool of keratinocytes that are relatively undifferentiated.

Prevention and treatment of linear scar formation in the scalp: basic principles of the mechanism of scar formation

Linear scar formation in the scalp after suturing an incision has been considered unavoidable. It was not known why scars formed even if the hair bulb was left intact. The authors developed a subcutaneous tissue-shaving method for radical treatment of bromidrosis and studied the process of hair regeneration by using thick-tissue specimens. They suggest that stem cells (lower) are located not only in the lower end of the telogen hair follicles but also in the sebaceous isthmus at the secretory opening of the sebaceous gland (upper stem cells). They found that linear scars can be prevented and existing linear scars can be surgically treated by using a relaxed suture on a scalp incision to avoid excessive pressure on the upper stem cells.

Human scalp hair follicle development from birth to adulthood: statistical study with special regard to putative stem cells in the bulge and proliferating cells in the matrix

The depths of hair follicle compartments, and in particular of the bulge, the putative site of hair follicle stem cells, have not yet been determined in human scalp skin from infants, children or adolescents. This information is necessary in order to use the scalp safely as a donor site for skin grafts. We therefore investigated the development of the infundibulum, the bulge, Adamson's fringe, the B-fringe and the matrix by measuring the depths of these five follicular compartments in parietal scalp biopsy specimens from 100 patients ranging in age from 2 weeks to 21 years. The thickness of the epidermis and the dermis were also assessed. The correlations of these measurements with age were determined by regression analysis. The regression equation for the bulge was found to be b (microns) = 683.3 + 30.8y (r = 0.73; SEM = 145.5) where y is the age in years, and for the matrix it was m (microns) = 1616.2 + 90.4y (r = 0.76; SEM = 406.5); P < 0.0001 for the null hypothesis. The growth of the inferior portion below the bulge was not parallel but proportional to that of the superior portion. The relative position of the bulge in the dermis was stable, whereas the inferior portion moved progressively more deeply into the subcutis. These findings provide evidence for the postulated biologically advantageous localization of the bulge, and thus is a further argument in favour of the bulge as the site of follicular stem cells.

Role of androgens in the developmental biology of the pilosebaceous unit

The growth and development of pilosebaceous units in their characteristic pattern depends on the interaction of androgens and diverse biologic factors. Stromal-epithelial interactions are essential features. Considerable evidence suggests that androgens stimulate the growth of sensitive pilosebaceous units primarily by acting on specific stromal cells and that androgens and retinoic acid interact to regulate specific stages of sebocyte differentiation.

Cells within the bulge region of mouse hair follicle transiently proliferate during early anagen: heterogeneity and functional differences of various hair cycles

Based on cell kinetic, morphological and several biological considerations, we have recently proposed that hair follicle stem cells reside in the bulge area of the upper follicle. We predicted that during early anagen the normally slow-cycling bulge stem cells may be activated by the abutting dermal papilla cells to undergo transient proliferation giving rise to keratinocytes of the lower follicle. In the present work, we performed tritiated thymidine-labeling of DNA-synthesizing cells and colcemid-arrest of mitotic figures on the skins of 20-23 and 75-80 day old SENCAR mice, when the follicles entered the anagen phase of the 2nd and 3rd hair cycles. The results clearly indicate that the normally slow-cycling bulge cells indeed undergo transient proliferation during early anagen. Similar results were obtained when the telogen follicles are experimentally induced to enter the 3rd hair cycle by plucking and by topical applications of phorbol ester or tretinoin. These results support the notion that bulge cells are follicular stem cells, and that transient proliferation of these cells is a critical feature of early anagen. However, the long duration of the 2nd telogen (> 30 days in mouse) suggests that a new anagen phase does not automatically result from the physical proximity of dermal papilla to the bulge cells, and that another 'factor' is required for the initiation of the 3rd anagen. The tremendous difference in the durations of the first and second telogen (lasting for 2-3 days and > 50 days, respectively) suggests that follicles can exist in a non-cycling state that may be conceptually equivalent to the G0 state of the cell cycle. Our results also underscore the fact that the first hair cycle is distinct from all the subsequent hair cycles in their cellular origin and morphological sequence, and thus should be regarded as a neogenic event.

Hair melanins and hair color: ultrastructural and biochemical aspects

The color variants of mammalian hair, including spotting and albinism, are the result of melanocyte activity and have been shown to be determined by the action of multiple genes, some of which operate through the milieu in which the pigment cell resides; others appear to act intracellularly to control the type of melanogenesis. Although there has been much descriptive work on the mode of action of these genes, it has only been with the recent advances in the chemistry and molecular biology of melanin pigmentation that some progress is being made in understanding the nature and origin of hair color. It is the purpose of this article to provide an integrated overview of the major advances so made and to draw attention to certain peculiarities of the melanization processes of hair with respect to those underlying skin pigmentation. Key words: melanins, melanocytes, melanogenesis, hair.

Sex hormones and antiandrogens influence in vitro growth of dermal papilla cells and outer root sheath keratinocytes of human hair follicles

Anagen hair bulb papillae, interfollicular dermal fibroblasts, and interfollicular keratinocytes isolated from fronto-parietal scalp biopsies as well as outer root sheath keratinocytes from plucked anagen hairs were separately grown in subculture for 14 d. The effect of different concentrations (2.4 nM-17.3 microM) of testosterone, dihydrotestosterone, and the antiandrogens cyproterone acetate or 17 alpha-propylmesterolone on growth behavior of the mesenchymal and epithelial cell types of the hair follicle were comparatively studied by means of growth curves, cell doubling times, and 3H-thymidine incorporation. For control, all cell lines were subcultured in hormone-free medium. Testosterone and dihydrotestosterone (345 nM) significantly reduced proliferation of papilla cells compared with dermal fibroblasts (p < 0.01) and outer root sheath keratinocytes compared with interfollicular keratinocytes (p < 0.01), as well as compared with cells cultured in control medium. Low concentrations of 17 beta-estradiol were ineffective, whereas doses of 180 nM 17 beta-estradiol increased the growth velocities of all cell types, especially of papilla cells, compared with dermal fibroblasts. Low doses of either cyproterone acetate (24 nM) or 17 alpha-propylmesterolone (29 nM) induced a growth enhancement, especially of papilla cells and outer root sheath keratinocytes, whereas high doses of cyproterone (1.20 microM) and 17 alpha-propylmesterolone (1.45 microM) had opposite effects. These changes were significant between papilla cells and dermal fibroblasts as well as between outer root sheath keratinocytes and interfollicular keratinocytes. Applying increasing doses of androgens to cyproterone acetate (24 nM)- or 17 alpha-propylmesterolone (29 nM)-containing media neutralized the growth-stimulating effect of antiandrogens, particularly in papilla cells and outer root sheath keratinocytes. However, minor differences between testosterone and dihydrotestosterone effects on cell growth were found. The data clearly demonstrate that the changes of in vitro growth of hair follicle cells depend on the concentrations of androgens and antiandrogens, as higher doses of both antiandrogens tested retarded the cell proliferation similar to testosterone or dihydrotestosterone. The papilla cells and outer root sheath keratinocytes reacted more sensitively to the hormones tested, thereby confirming the concept of a distinct androgen sensitivity of these specialized hair follicle cells.

Skin-specific expression of a truncated E1a oncoprotein binding to p105-Rb leads to abnormal hair follicle maturation without increased epidermal proliferation

In cultured cells, mutants of the Adenovirus E1a oncoprotein which bind to a reduced set of cellular proteins, including p105-Rb, p107, and p60-cyclin A, are transformation defective but can still interfere with exogenous growth inhibitory and differentiating signals, such as those triggered by TGF-beta. We have tested the ability of one such mutant, NTdl646, to interfere with keratinocyte growth and differentiation in vivo, in the skin of transgenic mice. Keratinocyte-specific expression of the transgene was achieved by using a keratin 5 promoter. Two independent lines of transgenic mice were obtained which expressed E1a specifically in their skin and exhibited an aberrant hair coat phenotype with striking regional variations. Affected hair shafts were short and crooked and hair follicles exhibited a dystrophic or absent inner root sheath. Interfollicular epidermis was normal, but its hyperplastic response to acute treatment with TPA (12-O-tetradecanoylphorbol-13-acetate) was significantly reduced. Primary keratinocytes derived from these animals were partially resistant to the effects of TPA and TGF-beta. The rate of spontaneous or chemically induced skin tumors in the transgenic mice was not increased. Thus, expression of a transgene which interferes with known negative growth regulatory proteins causes profound disturbances of keratinocyte maturation into a highly organized structure such as the hair follicle but does not lead to increased and/or neoplastic proliferation.

Label-retaining cells reside in the bulge area of pilosebaceous unit: implications for follicular stem cells, hair cycle, and skin carcinogenesis

Inconsistent with the view that hair follicle stem cells reside in the matrix area of the hair bulb, we found that label-retaining cells exist exclusively in the bulge area of the mouse hair follicle. The bulge consists of a subpopulation of outer root sheath cells located in the midportion of the follicle at the arrector pili muscle attachment site. Keratinocytes in the bulge area are relatively undifferentiated ultrastructurally. They are normally slow cycling, but can be stimulated to proliferate transiently by TPA. Located in a well-protected and nourished environment, these cells mark the lower end of the "permanent" portion of the follicle. Our findings, plus a reevaluation of the literature, suggest that follicular stem cells reside in the bulge region, instead of the lower bulb. This new view provides insights into hair cycle control and the possible involvement of hair follicle stem cells in skin carcinogenesis.

Dermal-epidermal interactions

The dermal papilla is established as a permanent and stable population of specialized fibroblasts that first appear as a cellular aggregate that interacts with the epidermis to ensure follicle development. Our experimental findings strongly suggest that thereafter the papilla, in association with the confluent lower dermal sheath, continues to interact with the follicular epidermis with the papilla cells, which retain their aggregative property, undergoing cyclic changes in size and synthetic activities in phase with the hair cycle. In these activities, the lower follicle dermis appears to act as a functional unit that retains key embryonic characteristics throughout the lifetime of the follicle, re-enacting its inductive influence over follicular epidermis to regulate the profound morphogenetic changes that occur during successive hair cycles and to determine the physical characteristics of the fibers produced. While epidermal mitotic inhibitors have been suggested as a controlling mechanism in the hair cycle, we have argued that the papilla provides potent factors that stimulate epidermal proliferation in the hair germ to initiate, and then sustain, anagen and also follicle morphogenesis. Our recent findings with cocultures of dermal papilla and epidermal cells, which demonstrated that papilla cells enhance epidermal cell attachment and proliferative activity, reinforces this supposition. Thus, it may prove that the intrinsically determined aspect of the hair cycle reflects and is dependent on an intrapapillary cycle of events. Furthermore, we have suggested that at another level of interaction the dermal component of the follicle may mediate the influence of systemic factors, which are known to modify this innately programmed pattern of follicle behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Pilosebaceous physiology in relation to hirsutism and acne

PSAs, with few exceptions, consist of a piliary and a sebaceous component. In androgen-sensitive areas, each has the capacity to develop into either a terminal hair follicle or a sebaceous follicle depending upon its location. Without androgen, there is no development of the sexual hair follicle or sebaceous gland. Androgens appear to promote sexual hair growth by recruiting a population of PSAs that have preset genetic sensitivity to initiate the production of terminal hairs. The site of action of androgens within the PSA is unclear. There are indications that androgens may act at more than one site in a system that requires two-way reciprocal interaction between dermal and epithelial cells for the generation of hair growth. Growth hormone appears to exert an important synergism with androgen in affecting the PSA, seemingly through the mediation of insulin-like growth factors. Hirsutism is due to an increased density of growing terminal hairs. The majority of cases of moderately severe hirsutism in women are due to hyperandrogenaemia, as are half the cases of mild hirsutism and about one-quarter of the cases of mild acne vulgaris. We advocate reserving the term idiopathic hirsutism or idiopathic acne for those patients in whom excessive growth of terminal hair or acne is not explained by androgen excess. We believe that highly variable sensitivity to androgen within the population explains both idiopathic hirsutism and cryptic hyperandrogenaemia; that is, these disorders lie at opposite ends of the normal spectrum of sensitivity to androgen. The biological basis for the variations in responsiveness of PSAs to androgens is unknown. The regression of hirsutism induced by antiandrogen treatment is characterized by the growth of hairs that are more vellus in character, i.e. smaller and less medullated.

Studies of androgen metabolism and action in cultured hair and skin cells

In order to study the mechanism of action of androgen on pubic and scalp hair, we established these and skin epithelial cells in culture. Because 5 alpha-reductase has been suspected of playing a role in hair growth, we tested the possibility that these cells differ in their pattern of androgen metabolism. Furthermore, we tested the hypothesis that androgen exerts its distinctive effects on these hairs by differentially regulating keratin or DNA synthesis. Anagen hairs of men and women were plucked from the pubis or scalp vertex and were studied using an epithelial cell culture technique. DHT formation from [3H]T cultured skin cells increased in the following order: epidermal less than scalp less than pubic less than fibroblasts = 0.8:2.8:8.1:71%/mg DNA/min, respectively. Androstanediols were minor [3H]DHT metabolites of all these skin cell types. The only feature that distinguished among the cultured epithelial cells was the ratio of apparent 5 alpha-reductase (5 alpha-R) to 17 beta-hydroxysteroid dehydrogenase (17 beta-HSD) activity: this was significantly greater (P less than 0.05) in cultured pubic hair cells than in scalp hair or epidermal cells. Cultured scalp and pubic hair cells resembled freshly plucked hair follicle cells in their keratin pattern. 46, 50, 56 and 58 kdalton bands constituted 99% of the total keratins. This keratin pattern and the polygonal cell shape were also similar to that of cultured epidermal cells. However, this keratin pattern was distinctly different from that of hair shafts which have 53 and 63 kdalton keratins. Dihydrotestosterone did not affect the keratin pattern, pattern of incorporation of [35S]cysteine or [35S]methionine, or rates of protein synthesis or cell proliferation in cultured hair cells. Although the higher apparent 5 alpha-R/17 beta-HSD ratio of cultured pubic than of scalp hairs is compatible with modulation of hair development by androgen, these studies militate against the possibility that androgens directly affect hair cell proliferation or protein synthesis in pubic or scalp hair.

Electrosurgery using insulated needles: epilation

This paper deals mainly with histologic findings and clinical aspects of epilation using insulated needles. Patients were checked for hair regrowth after "thermolysis" epilation--a cycle of three to four treatments at roughly 3-month intervals, within an observation period of 2 1/2 years. The results for 39 patients, compiled 6 months to 1 year after the final epilations, showed almost no or extremely reduced hair regrowth with almost no scarring.

Electrolysis and thermolysis for permanent hair removal

The historical, legal, and theoretical aspects and clinical technics of both electrolysis and thermolysis are critically reviewed. The pitfalls of electronic tweezers and the dangers of self-electrolysis are discussed. Complications of electrolysis and thermolysis and the pathophysiology of hair regrowth are presented. In the United States, the lack of uniform training requirements and standards for electrologists may pose an unrecognized risk to public health. It is suggested that more responsible state legislation be enacted in order to decrease the present potential threat to the public health and safety.

Three-dimensional hair follicular differentiation of a trichilemmoma cell line in vitro

A cell line was established in vitro from a benign hair follicular tumor of human trichilemmoma. Individual and organized cellular differentiation of this cell line was studied. When these cells were cultured for a long time (more than 3 weeks) without subculture, they started to pile up spontaneously. A part of the pile became indented and simultaneously the opposite side of the indentation budded out. The bud slowly elongated 2 to 3 mm in length in 8 to 12 weeks in culture. Light and electron microscopy revealed the internal structure of piles and elongated buds to be a three-dimensional hair follicular structure. The cells in the outermost layer were least mature. These were cuboid in shape and contained glycogen. The cells in the middle layer were more differentiated with a decreased amount of glycogen and an increased number of tonofilaments and desmosomes. The cells in the innermost layer were most differentiated. Cells were flat in shape and highly convoluted. The cell membrane was thickened as observed in cornified cells in vivo. These organized differentiations were also confirmed by histochemical and immunocytochemical studies; using a fluorescent thiol reagent, N-(7-dimethylamino-4-methylcoumarinyl)-maleimide method, free sulfhydryl groups were detected but disulfide bonds were absent in the early cell culture. Disulfide bonds increased slowly and accumulated in the innermost layer of piles. Accumulation of keratin substances, detected by indirect immunofluorescence method using anti-human keratin antibody, was also observed specifically in the piles. These results suggest that an established cell line of human trichilemmoma spontaneously produced, without stromal influence, hair follicular structures as well as individual cell differentiations in vitro as do trichilemmal (hair follicular) cells in vivo.

Clinical observations on the development and eventual character of hair in the axillae of human beings

The authors examined clinically growth and patterns of axillary hair of Japanese males and females of various ages with a specific interest in the differences between vellus and coarse hairs. One notable finding was that in the axillae of children, vellus hairs are equidistant and solitary, whereas the coarse hairs that replace them emerge during puberty as solitary hairs and in bundles or groups. A statistical summary and speculation as to why growth of vellus hair and growth of coarse hair differ are the substance of this report.

Regeneration of axillary hairs after plucking

Studies on the regeneration of axillary hairs after plucking are described. Regeneration of axillary hairs after plucking was recognized as originating in a special region of the upper isthmus of the hair apparatus, from which point solid pegs of epithelial cells grow downward and form inner root sheaths. New hairs form in their centers. At this stage, the lower parts of the hair follicles descend while the new hairs grow from the centers of the pegs by vigorous mitosis of germinal cells. Eventually, the epithelial cells wrap around masses of mesenchymal cells and form new bulbs from which hair shafts grow upward. The new matrices acquire new complements of functioning melanocytes.