Inflammation For Androgenetic Alopecia--does The Pathology Of Biopsy???

[hairblues]

Can an Androgenetic Alopecia biopsy be false for AA

I present very much Androgenetic Alopecia both in appearance and also under inspection an physical exam...
Miniaturization
Hairs that shed have white bulbs
No exclamation point hairs (something for AA)
No round patches
Just defuse mainly on crown

Okay they finally did a biopsy and it came back as AA it was one sentence lymphocytes cells at hair follicle...

Im just curious can Androgenetic Alopecia that has inflammation also have these lymphocyte cells?

I know some of you complain about inflation etc. Is that same thing?

I need the science guys about hair loss--my dermatologist did a second biopsy but i have to wait a week.
My first biopsy literally had one sentence.
Im trying to go to Columbia University tomorrow to see Dr who supposedly is expert in Alopecia specifically. Ugh.

 

[cyrusthegreat@hotmail.com]

You may have AA and Androgenetic Alopecia occurring concomitantly. The BS thing with Androgenetic Alopecia is that its "diagnosis" is completely clinical. There is no blood test, no biopsy, no imaging to confirm or contradict its diagnosis. When hair loss doesn't fall into the very small bucket of known conditions, it's thrown into Androgenetic Alopecia. In your case, you have a potential real diagnosis for diffuse AA, but it comes after a diagnoses for Androgenetic Alopecia. What are you to believe?

If I were in your shoes, I would get a second opinion on the AA, which you are. If confirmed, i would get off any treatment you started for Androgenetic Alopecia and start one of the emerging or existing AA treatments. You should know in 6 months if its going in the right direction or not. The one thing about AA I know is that it progresses quite rapidly compared to Androgenetic Alopecia.

Have you visited any of the AA forums to see how others have maneuvered in your situation? I'm sure others with AA have similar stories.

 

[hairblues]

You may have AA and Androgenetic Alopecia occurring concomitantly. The BS thing with Androgenetic Alopecia is that its "diagnosis" is completely clinical. There is no blood test, no biopsy, no imaging to confirm or contradict its diagnosis. When hair loss doesn't fall into the very small bucket of known conditions, it's thrown into Androgenetic Alopecia. In your case, you have a potential real diagnosis for diffuse AA, but it comes after a diagnoses for Androgenetic Alopecia. What are you to believe?

If I were in your shoes, I would get a second opinion on the AA, which you are. If confirmed, i would get off any treatment you started for Androgenetic Alopecia and start one of the emerging or existing AA treatments. You should know in 6 months if its going in the right direction or not. The one thing about AA I know is that it progresses quite rapidly compared to Androgenetic Alopecia.

Have you visited any of the AA forums to see how others have maneuvered in your situation? I'm sure others with AA have similar stories.

Thats the mystery--Mine is NOT rapid at all..its slow like Androgenetic Alopecia

Its something (i think) called "Chronic DIfuse Alopecia Areta" I found it in a hair text book "Hair Growth and Disorders" I also saw it in another dermatology text book the other day. Its slow progressing and its defuse (somewhat at least mine is top of crown) and it presents like Androgenetic Alopecia. In the text book they suggest oral steroids for 4 weeks in one book the other suggest oral and injections of steroids...
Its extremely rare--only 2% of AA get defuse and of that the Chronic like i have is particularly rare according to text book.
They said its often misdiagnosed as Androgenetic Alopecia.
I read another paper by a pathologist named Kossard--he said that their may even be a sub sect of this that is about the stem cells and a lot of patients should be reexamined--lol this was 1999. So i dont know if he was taken seriously or not.
https://www.ncbi.nlm.nih.gov/pubmed/10027527

I mean i am lucky in one way that it presents so slowly and difuse--BUT i have joined several AA forums and so far no one except one Sweedish girl who is presenting as i am..She said they do not do steroid shots where she is she just did PRP and it did not work (shocking lol)

The problem with steroids from most of the women i talked to who did them--they work while your on them.
but its hit or miss when you go off if relapse immediately.

The other drugs--are super hard core they said a lot of Dr won't even prescribe them off label because side effects and Insurance won't pay for 'off' label uses...And they are extremely expensive.

Brots lotion seems to only be good for AA on children and young adults--Im 45 i dont know if this would work well for me.
None of the AA people have heard of Brotzu--i found that interesting.

 

[InBeforeTheCure]

T-lymphocyte infiltration is actually quite common in Androgenetic Alopecia. For example, This study found lymphocyte infiltration in many cases of female pattern hair loss:

BACKGROUND:
Female pattern hair loss affects many women; its pathogenetic basis has been held to be similar to men with common baldness.

OBJECTIVE:
The objective of this study was to determine the role of immunity and inflammation in androgenetic alopecia in women and modulate therapy according to inflammatory and immunoreactant profiles.

MATERIALS AND METHODS:
52 women with androgenetic alopecia (AA) underwent scalp biopsies for routine light microscopic assessment and direct immunofluroescent studies. In 18 patients, serologic assessment for antibodies to androgen receptor, estrogen receptor and cytokeratin 15 was conducted.

RESULTS:
A lymphocytic folliculitis targeting the bulge epithelium was observed in many cases. Thirty-three of 52 female patients had significant deposits of IgM within the epidermal basement membrane zone typically accompanied by components of complement activation. The severity of changes light microscopically were more apparent in the positive immunoreactant group. Biopsies from men with androgenetic alopecia showed a similar pattern of inflammation and immunoreactant deposition. Serologic assessment for antibodies to androgen receptor, estrogen receptor or cytokeratin 15 were negative. Combined modality therapy with minocycline and topical steroids along with red light produced consistent good results in the positive immunoreactant group compared to the negative immunoreactant group.

CONCLUSION:
A lymphocytic microfolliculitis targeting the bulge epithelium along with deposits of epithelial basement membrane zone immunoreactants are frequent findings in androgenetic alopecia and could point toward an immunologically driven trigger. Cases showing a positive immunoreactant profile respond well to combined modality therapy compared to those with a negative result.

Typically in Androgenetic Alopecia, when present, T-cell infiltration is around the bulge, while in AA it's around the bulb.

 

[hairblues]

@InBeforeTheCure

My biopsy just says "There are Lymphocytes at the base of the hair follicles in catagen"

I dont know the base is the bulb or bulge?

Can that technically be either as the 'base'?

 

[hairblues]

T-lymphocyte infiltration is actually quite common in Androgenetic Alopecia. For example, This study found lymphocyte infiltration in many cases of female pattern hair loss:



Typically in Androgenetic Alopecia, when present, T-cell infiltration is around the bulge, while in AA it's around the bulb.

So the inflammation of the cells--that is not automatically an autoimmune disease the way AA is?
Or is it a hybrid of AA--I read a study by a S. Kossard that talked about this https://www.ncbi.nlm.nih.gov/pubmed/10027527

 

[Armando Jose]

Im just curious can Androgenetic Alopecia that has inflammation also have these lymphocyte cells?

Br J Dermatol. 1992 Sep;127(3):239-46.
Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis.
Jaworsky C1, Kligman AM, Murphy GF.
Author information
Abstract
Hair-bearing, transitional, and alopecic scalp from three males and one female with progressive pattern alopecia were examined. Ultrastructural studies disclosed measurable thickening of the follicular adventitial sheaths of transitional and alopecic zones compared with those in the non-alopecic zones. This finding was associated with mast cell degranulation and fibroblast activation within the fibrous sheaths. Immunohistochemically, control biopsies were devoid of follicular inflammation (n = 3), while transitional regions consistently showed the presence of activated T-cell infiltrates about the lower portions of follicular infundibula. These infiltrates were associated with the induction of class II antigens on the endothelial linings of venules within follicular adventitia and with apparent hyperplasia of follicular dendritic cells displaying the CD1 epitope. Inflammatory cells infiltrated the region of the follicular bulge, the putative source of stem cells in cycling follicles. The data suggest that progressive fibrosis of the perifollicular sheath occurs in lesions of pattern alopecia, and may begin with T-cell infiltration of follicular stem cell epithelium. Injury to follicular stem cell epithelium and/or thickening of adventitial sheaths may impair normal pilar cycling and result in hair loss.

 

[cyrusthegreat@hotmail.com]

@hairblues how long have you been experiencing this kind of diffuse loss? Just curious.

 

[Dench57]

My scalp biopsy came back as "non-specific chronic perifolliculitis" which is just a fancy description for the inflammation around (peri) the hair follicle in Androgenetic Alopecia. As others said, T-lymphocyte infiltration is present in many Androgenetic Alopecia cases.

 

[hairblues]

@hairblues how long have you been experiencing this kind of diffuse loss? Just curious.

I mean i had insanely dense hair in my 20s..I would say it slightly less dense in early 30s
Around 37 i saw first signs of widening part but not cosmetically a problem
around 43 i felt like it was too thin in middle part
Im now 45..i would say its been bothering me for 2 years on a cosmetic level.

I think i have 'chronic diffuse alopecia areta' and its very rare and i only found it in 2 dermatology text books.
Its slow moving and appears even with magnification to be Androgenetic Alopecia. (no cadaver hairs etc)

 

[hairblues]

Br J Dermatol. 1992 Sep;127(3):239-46.
Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis.
Jaworsky C1, Kligman AM, Murphy GF.
Author information
Abstract
Hair-bearing, transitional, and alopecic scalp from three males and one female with progressive pattern alopecia were examined. Ultrastructural studies disclosed measurable thickening of the follicular adventitial sheaths of transitional and alopecic zones compared with those in the non-alopecic zones. This finding was associated with mast cell degranulation and fibroblast activation within the fibrous sheaths. Immunohistochemically, control biopsies were devoid of follicular inflammation (n = 3), while transitional regions consistently showed the presence of activated T-cell infiltrates about the lower portions of follicular infundibula. These infiltrates were associated with the induction of class II antigens on the endothelial linings of venules within follicular adventitia and with apparent hyperplasia of follicular dendritic cells displaying the CD1 epitope. Inflammatory cells infiltrated the region of the follicular bulge, the putative source of stem cells in cycling follicles. The data suggest that progressive fibrosis of the perifollicular sheath occurs in lesions of pattern alopecia, and may begin with T-cell infiltration of follicular stem cell epithelium. Injury to follicular stem cell epithelium and/or thickening of adventitial sheaths may impair normal pilar cycling and result in hair loss.

If i have inflammation with lymphocytes but its Androgenetic Alopecia---do i treat it as i normally would Androgenetic Alopecia or do those treatments not work because of th lymphocytes?/

 

[Armando Jose]

If you cure the inflammatory infiltrates you'll have a better hair.

 

[hairblues]

My scalp biopsy came back as "non-specific chronic perifolliculitis" which is just a fancy description for the inflammation around (peri) the hair follicle in Androgenetic Alopecia. As others said, T-lymphocyte infiltration is present in many Androgenetic Alopecia cases.

@Armando Jose @Dench57

How do you treat your inflammation? Did dr give you anything additional to use?

 

[Armando Jose]

@Armando Jose @Dench57

How do you treat your inflammation? Did dr give you anything additional to use?

For you and anyone that could be interested
My lotion is this:

Jojoba esters (pure and cold pressed Jojoba oil), Limanthes alba (Limanthes oil), Borago officinalis (Borage oil), Rosa moschata (Rose Hip oil), Oenothera biennis (Oenothera oil), Persea gratísima (Avocado oil), Serenoa serrulata (Sabal serrulata oil), Butyruspermun parkii (Karite oil), Rosmarinun officinalis (Rosemary oil), Lavandula officinalis (Lavender oil), Melaleuca alternifolia (Tea tree oil), Origanum vulgaris ( Origanum oil), Thymus vulgaris (Thyme oil), Laurus nobilis (Bay oil), Anthemis nobilis (Chamomile oil), Ocimun basilicum (Basil oil), Salvia officinalis (Sage oil), Mentha piperita (Mint oil), Foeniculum vulgare (Fennel oil), Citrus limonun (Lemon oil), Carum petroselinum (Parsley oil), Eugenia caryophyllus (Clove oil).





* = recomended

Pure Jojoba Oil * Moreless 70-80%



Carrier olis: Moreless 7-15%, the sum of all CO’s

Borage oil *

Rose hip oil *

Oenothera oil

Avocado oil *



Essentials oils, no more than 5-6% The sum of alls EO’s

Serenoa repens oil

Butirospernum parkii butter

Rosmarinum officinalis oil *

Lavender oil *

Tea tree oil *

Origanum oil *

Thyme oil *

Bay oil

Chamomile oil

Basil oil

Sage oil *

Mint oil *

Fennel oil

Lemon oil

Parsley oil

Clove oil

 

[hairblues]

@Armando Jose Thank you that was very generous to share with us.