Hair Loss

Eur J Dermatol.1999;9:111

Pronounced perifollicular lymphocytic infiltrates in alopecia areata are associated with poor treatment response to diphencyprone.
Freyschmidt-Paul P, et al

Some authors have reported that severe destruction of follicular structures and even scarring patterns occur in those patients with hair loss due to alopecia areata (AA) who fail to respond with regrowth to treatment with contact sensitizers, such as diphencyprone (DCP). Other studies, however, gave contradictory results. Therefore, we re-examined histopathological changes in scalp samples obtained from 85 patients with severe hair loss before initiation of DCP treatment (40 responders and 45 non-responders in terms of hair regrowth). The following parameters were evaluated: i) perifollicular lymphocytic infiltration; ii) perifollicular fibrosis, and iii) miniaturized hair follicles. No difference between responders and non-responders could be observed in the degree of miniaturization of hair follicles and proliferation of perifollicular fibrous tissue. In neither group was there any evidence of scarring or severe follicular destruction. 18 non-responders who did not regrow hair but only 6 responders to hair loss treatment showed a very dense perifollicular lymphocytic infiltration. In contrast, a particularly scarce infiltrate was seen in 9 non-regrowers and in 19 responders. We conclude that non-responders tend to have pronounced inflammatory reactions with dense perifollicular lymphocytic infiltrates.