Do Prolactin and its Receptor Play a Role in Alopecia Areata?

Prolactin: A Mammalian Stress Hormone and Its Role in Cutaneous Pathophysiology

The hormone prolactin (PRL) is best recognised for its indispensable role in mammalian biology, specifically the regulation of lactation. Bearing in mind that the mammary gland is a modified sweat gland, it is perhaps unsurprising to discover that PRL also plays a significant role in cutaneous biology and is implicated in the pathogenesis of a range of skin diseases, often those reportedly triggered and/or exacerbated by psychological stress. Given that PRL has been implicated in over 300 biological processes, spanning reproduction and hair growth and thermo- to immunoregulation, a comprehensive understanding of the relationship between PRL and the skin remains frustratingly elusive. In an historical curiosity, the first hint that PRL could affect skin biology came from the observation of seborrhoea in patients with post-encephalitic Parkinsonism as a result of another global pandemic, encephalitis lethargica, at the beginning of the last century. As PRL is now being postulated as a potential immunomodulator for COVID-19 infection, it is perhaps timeous to re-examine this pluripotent hormone with cytokine-like properties in the cutaneous context, drawing together our understanding of the role of PRL in skin disease to illustrate how targeting PRL-mediated signalling may represent a novel strategy to treat a range of skin diseases and hair disorders.

Evaluation of Follicular Unit Extraction Technique as a Method for Hair Restoration Problems

Context

Androgenetic alopecia, traction alopecia, and primary cicatricial alopecia can cause distressing scalp hair loss problems affecting a large number of both sexes. Follicular unit extraction (FUE) is one of the best ways to achieve improving conditions of those cases.

Aims

The aim of this study was to evaluate the FUE technique as a method for permanent hair restoration problems.

Settings and Design

Channels for the grafts were created through pieces of hand-cut razor blades.

Subjects and Methods

Twenty patients suffering from alopecia were eligible to participate in the study. They were subjected to FUE.

Results

On comparing different types of alopecia, we found that cicatricial alopecia was significantly more common among younger patients, unlike traction and traction types which were relatively more common among older patients (P = 0.043). There was no significant difference between alopecia types concerning the duration of operation. However, the number of implants was significantly higher among patients with androgenic alopecia when compared with cicatricial and traction subtypes (P < 0.001). Concerning patients' satisfaction, we found that there was no significant difference between alopecia types concerning patients, observers, or doctor satisfaction with an overall satisfaction rate ranging between 3.67 and 4.

Conclusions

Till now, there is no specific algorithm for treating patients with hair loss. However, there is a general preference of patients toward surgical options being less time-consuming and achieve better results. Whatever the cause is FUE showed good results concerning postpatients satisfaction concerning their appearance and visual age.

Hyperprolactinaemia

Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through “stalk effect”) are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.