Chronic Telogen Effluvium And Female Pattern Hair Loss Are Separate And Distinct Forms Of Alopecia: A Histomorphometric And Immunohistochemical Analysis

Background Chronic telogen effluvium (CTE), a poorly understood condition, can be confused with or may be a prodrome to female pattern hair loss (FPHL). The pathogenesis of both is related to follicle cycle shortening and possibly to blood supply changes. Aim To analyze a number of histomorphometric and immunohistochemical findings through vascular endothelial growth factor (VEGF), Ki-67, and CD31 immunostaining in scalp biopsies of 20 patients with CTE, 17 patients with mild FPHL and 9 controls. Methods Ki-67 index and VEGF optical density were analyzed at the follicular outer sheath using ImageJ software. CD31 microvessel density was assessed by a Chalkley grid. Results Significant follicle miniaturization and higher density of nonanagen follicles were found in FPHL, compared with patients with CTE and controls. Ki-67+ index correlated positively with FPHL histological features. The FPHL group showed the highest VEGF optical density, followed by the CTE and control groups. No differences were found in CD31 microvessel density between the three groups. Conclusions Histomorphometric results establish CTE as a distinct disorder, separate from FPHL from its outset. Its pathogenic mechanisms are also distinct. These findings support the proposed mechanism of 'immediate telogen release' for CTE, leading to cycle synchronization. For FPHL, accelerated anagen follicular mitotic rates and, thus, higher Ki-67 and VEGF values, would leave less time for differentiation, resulting in hair miniaturization.398868873Whiting, D.A., Chronic telogen effluvium: Increased scalp hair shedding in middle-aged women (1996) J Am Acad Dermatol, 35, pp. 899-906Whiting, D.A., Chronic telogen effluvium (1996) Dermatol Clin, 14, pp. 723-731Gilmore, S., Sinclair, R., Chronic telogen effluvium is due to a reduction in the variance of anagen duration (2010) Australas J Dermatol, 51, pp. 163-167Rand, S., Chronic telogen effluvium: Potential complication for clinical trials in female andronegetic alopecia? (1997) J Am Acad Dermatol, 37, p. 1021Goldman, C.K., Tsai, J.C., Soroceanu, L., Gillespie, Y., Loss of vascular endothelial growth factor in human alopecia hair follicles (1995) J Invest Dermatol, 104, pp. 18-20SMecklenburg, L., Tobin, D.J., Muller-Rover, S., Active hair growth (anagen) is associated with angiogenesis (2000) J Invest Dermatol, 114, pp. 909-916Elston, D.M., Ferringer, T., Dalton, S., A comparison of vertical versus transverse sections in the evaluation of alopecia biopsy specimens (2005) J Am Acad Dermatol, 53, pp. 267-272Sinclair, R., Jolley, D., Mallari, R., Magee, J., The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women (2004) J Am Acad Dermatol, 51, pp. 189-199Sanchez-Elsner, T., Botella, L.M., Velasco, B., Endoglin expression is regulated by transcrptional cooperation between the hypoxia and transformin growth factor- beta pathways (2002) J Biol Chem, 277, pp. 43799-43808Vermeulen, P.B., Gasparini, G., Fox, S.B., Quantification of angiogenesis in solid human tumours: An international consensus on the methodology and criteria of evaluation (1996) Eur J Cancer, 32 A, pp. 2474-2484Rosner, B.A., (1995) Fundamentals of Biostatistics, p. 426. , 4th edn. Belmont: Duxbury PressBirch, M.P., Lalla, S.C., Messenger, A.G., Female pattern hair loss (2002) Clin Exp Dermatol, 27, pp. 383-388Sinclair, R.D., Dawber, R.P., Androgenetic alopecia in men and women (2001) Clin Dermatol, 19, pp. 167-178Trueb, R.M., Diffuse hair loss (2008) Hair Growth and Disorders, pp. 264-265. , (Blume-Peytavi U. Tosti A. Whiting D.A. Trueb R.M. eds). Berlin: Springer-VerlagHeadington, J.T., Telogen effluvium. New concepts and review (1993) Arch Dermatol, 12, pp. 356-363Piérard-Franchimont, C., Piérard, G.E., Teloptosis, a turning point in hair shedding biorhythms (2001) Dermatology, 203, pp. 115-117Olsen, E.A., Female pattern hair loss and its relationship to permanent/cicatricial alopecia: A new perspective (2005) J Investig Dermatol Symp Proc, 10, pp. 217-221Messenger, A.G., Sinclair, R., Follicular miniaturization in female pattern hair loss: Clinicopathological correlations (2006) Br J Dermatol, 155, pp. 926-930Rebora, A., Guarrera, M., Teloptosis and kenogen: Two new concepts in human trichology (2004) Arch Dermatol, 140, pp. 619-620Stenn, K.S., Fernandez, L.A., Tirrell, S.L., The angiogenic properties of the rat vibrissa hair follicle associate with the bulb (1988) J Invest Dermatol, 90, p. 40