Management of Primary Cicatricial Alopecias: Options for Treatment

M.J. Harries; R.D. Sinclair; S. MacDonald-Hull; D.A. Whiting; C.E.M. Griffiths; R. Paus

Disclosures

The British Journal of Dermatology. 2008;159(1):1-22. 

In This Article

Pathophysiology

The pathogenesis of PCAs is currently unknown. Their occurrence, however, invariably implies exhaustion of the regenerative potential of the hair follicle due to an inflammation-based loss of epithelial hair follicle stem cells in the follicle's bulge region. How and why these stem cells are targeted and destroyed are essentially unknown.[3,6,7,12] However, the observation that complete disappearance of pilosebaceous units can be induced in genetically engineered mutant mice by targeting keratin 15-expressing epithelial progenitor cells in the hair follicle's ORS,[13] in the absence of any signs of fibrotic skin changes, suggests that the deletion of epithelial stem cells alone does not suffice to produce the full spectrum of PCA, namely the characteristic scarring. In any case, the cicatricial alopecia phenotype represents the final common pathway for a number of different disease processes, of which hair follicle epithelial stem cell deletion represents a crucial, but not the only important pathogenesis event.

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