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Senna MM, Peterson E, Jozic I, Chéret J, Paus R. Frontiers in Lichen Planopilaris and Frontal Fibrosing Alopecia Research: Pathobiology Progress and Translational Horizons. JID Innov 2022; 2:100113. [PMID: 35521043 PMCID: PMC9062486 DOI: 10.1016/j.xjidi.2022.100113] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/06/2023] Open
Abstract
Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary, lymphocytic cicatricial hair loss disorders. These model epithelial stem cell (SC) diseases are thought to result from a CD8+ T-cell‒dominated immune attack on the hair follicle (HF) SC niche (bulge) after the latter has lost its immune privilege (IP) for as yet unknown reasons. This induces both apoptosis and pathological epithelial‒mesenchymal transition in epithelial SCs, thus depletes the bulge, causes fibrosis, and ultimately abrogates the HFs' capacity to regenerate. In this paper, we synthesize recent progress in LPP and FFA pathobiology research, integrate our limited current understanding of the roles that genetic, hormonal, environmental, and other factors may play, and define major open questions. We propose that LPP and FFA share a common initial pathobiology, which then bifurcates into two distinct clinical phenotypes, with macrophages possibly playing a key role in phenotype determination. As particularly promising translational research avenues toward direly needed progress in the management of these disfiguring, deeply distressful cicatricial alopecia variants, we advocate to focus on the development of bulge IP and epithelial SC protectants such as, for example, topically effective, HF‒penetrating and immunoinhibitory preparations that contain tacrolimus, peroxisome proliferator-activated receptor-γ, and/or CB1 agonists.
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Key Words
- 5ARI, 5α-reductase inhibitor
- AA, alopecia areata
- AGA, androgenetic alopecia
- CRH, corticotropin-releasing hormone
- EMT, epithelial‒mesenchymal transition
- FFA, frontal fibrosing alopecia
- HF, hair follicle
- IP, immune privilege
- K, keratin
- KC, keratinocyte
- LPP, lichen planopilaris
- MAC, macrophage
- MHC, major histocompatibility complex
- PCA, primary cicatricial alopecia
- PCP, personal care product
- PPAR-γ, peroxisome proliferator–activated receptor-γ
- SC, stem cell
- SP, substance P
- eHFSC, epithelial hair follicle stem cell
- α-MSH, α-melanocyte-stimulating hormone
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Affiliation(s)
- Maryanne Makredes Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Erik Peterson
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ivan Jozic
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jérémy Chéret
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.,Monasterium Laboratory, Münster, Germany.,CUTANEON, Hamburg, Germany
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Du X, Li Y, Zhu Q, Zhu J, Xu W, Li Z, Elston DM. Focal and diffuse fibrosing alopecias: Classical lichen planopilaris, frontal fibrosing alopecia, fibrosing alopecia with a pattern distribution, cicatricial pattern hair loss, and lichen planopilaris diffuse pattern. JAAD Case Rep 2020; 6:403-10. [PMID: 32382630 DOI: 10.1016/j.jdcr.2020.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Affiliation(s)
- Maryam Shayesteh Alam
- Correspondence to: Maryam Shayesteh Alam, MD, FRCPC, FAAD, SimcoDerm Medical and Surgical Dermatology Centre, 105-5 Quarry Ridge Road, Barrie, ON L4M7G1, Canada.
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Affiliation(s)
- Xufeng Du
- Department of Dermatology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Zhongming Li
- Department of Dermatology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Qilin Zhu
- Department of Dermatology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Wengrong Xu
- Department of Dermatology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Yuqian Li
- Department of Dermatology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Jing Zhu
- Department of Dermatology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Dirk M Elston
- Department of Dermatology and Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
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Affiliation(s)
- Anna L Cogen
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vishwas Parekh
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Tara Gangadhar
- Department of Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jules B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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