0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.204.217.249. Please contact the publisher to request reinstatement.
Research Letters |

Scalp Psoriasis: A Paradigm of “Switch-On” Mechanism to Anagen Hair Growth? FREE

Sami Sawan, MD; Vincent Descamps, MD, PhD
Arch Dermatol. 2008;144(8):1064-1066. doi:10.1001/archdermatol.2008.2.
Text Size: A A A
Published online

Psoriasis is characterized by an increase of epidermal proliferation. The consequence of psoriasis on hair growth is not well known. It was previously suggested that both psoriatic epidermal lesions and anagen hair growth shared the same “switch-on” mechanism based on the comparison of the Koebner phenomenon and wound-induced hair growth.1 We provide new data to support this hypothesis.

We studied 7 consecutive patients (including the patient in the index case) with sharply demarcated, chronic, untreated psoriatic plaques on their scalps (Table). The index case involved a 41-year-old man with androgenetic alopecia and a history of flares of cutaneous psoriasis who decided to shave his scalp completely. After shaving, he developed psoriatic plaques on his scalp, and when his hair started to grow back, he noticed that the hair appeared to be denser in the areas affected by the psoriatic plaques than in other areas of the scalp. He had 1 plaque in the occipital region (Figure 1) and 2 plaques in the vertex region (Figure 2).

Place holder to copy figure label and caption
Figure 1.

Index case (case 1). Increased density of hair in psoriatic plaque.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Index case (case 1). Increased density of hair in psoriatic plaque.

Graphic Jump Location
Table Graphic Jump LocationTable. Clinical Characteristics in 7 Cases of Psoriasis

The 6 cases other than the index case were studied with videomicroscopic analysis. The psoriatic areas of the scalp (Figure 3, A) were compared with adjacent nonaffected areas (Figure 3, B). Videomicroscopic analysis demonstrated that the denser appearance of the plaques was attributable to a higher hair count, not to the length of the hair, which was always the same in both the normal areas and the areas with the psoriatic plaques.

Place holder to copy figure label and caption
Figure 3.

Videomicrosopic images showing psoriatic scalp areas (A) and adjacent normal areas (B) in cases 2 through 7.

Graphic Jump Location

We report an increased density of hair in psoriatic plaques. Psoriasis- and wound-induced hair growth may share the same switch-on mechanism. In 1956, Argyris2 reported that wounding of the skin induced hair growth. Recently, Osaka et al3 demonstrated the critical involvement of macrophages in wound-induced hair growth in a model of mice. Apoptosis signal-regulating kinase 1 (ASK1) is a member of the mitogen-activated protein kinase family that is required for the recruitment and activation of macrophages. Wound-induced hair regrowth is impaired in ASK1-deficient mice. It activates both c-Jun NH2-terminal kinase and p38 mitogen-activated protein kinase pathways in response to inflammatory cytokine and physical stress. Transplantation of cytokine-activated bone marrow–derived macrophages also strongly induces hair growth in both ASK1-deficient and wild-type mice. Interestingly, recent studies provide support for a major contribution of monocytes and macrophages in psoriasis initiation. Marble et al4 demonstrated an increase of macrophages and dermal dendritic cells in prepsoriatic skin.

The role of psoriasis in hair growth induction is further supported by the recent finding of an increased level of nuclear β-catenin in the suprabasal psoriatic epidermis compared with uninvolved or normal skin.5 β-Catenin is known to control the hair cycle, and its expression is correlated with the induction of the anagen phase and the differentiation of stem cells. The ability to induce growth of new hair follicles by transiently activating β-catenin signaling in adult mouse epidermis is additional corroborating evidence.6

In conclusion, we suggest that scalp psoriasis may be caused by an increase in the recruitment of stem cells, resulting in a switch-on entry in the anagen phase. As compared with wound-induced hair growth, monocytes and macrophages could have a key role in this cascade of events in psoriasis by upregulation of the Wnt/β-catenin pathway.

Correspondence: Dr Descamps, Department of Dermatology, Bichat-Claude Bernard Hospital, Paris 7 University, Assistance Publique des Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France (vincent.descamps@bch.aphp.fr).

Author Contributions: Dr Descamps had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Descamps. Acquisition of data: Sawan and Descamps. Analysis and interpretation of data: Descamps. Drafting of the manuscript: Descamps. Critical revision of the manuscript for important content: Sawan and Descamps. Administrative, technical, or material support: Sawan and Descamps. Study supervision: Descamps.

Financial Disclosure: None reported.

Paus  RLink  RE The psoriatic epidermal lesion and anagen hair growth may share the same “switch-on” mechanism. Yale J Biol Med 1988;61 (5) 467- 476
PubMed
Argyris  TS The effect of wounds on adjacent growing or resting hair follicles in mice. AMA Arch Pathol 1956;61 (1) 31- 36
PubMed
Osaka  NTakahashi  TMurakami  S  et al.  ASK1-dependent recruitment and activation of macrophages induce hair growth in skin wounds. J Cell Biol 2007;176 (7) 903- 909
PubMed
Marble  DJGordon  KBNickoloff  BJ Targeting TNF alpha rapidly reduces density of dendritic cells and macrophages in psoriatic plaques with restoration of epidermal keratinocyte differentiation. J Dermatol Sci 2007;48 (2) 87- 101
PubMed
Hampton  PJRoss  OKReynolds  NJ Increased nuclear beta-catenin in suprabasal involved psoriatic epidermis. Br J Dermatol 2007;157 (6) 1168- 1177
PubMed
Lo Celso  CProwse  DMWatt  FM Transient activation of beta-catenin signalling in adult mouse epidermis is sufficient to induce new hair follicles but continuous activation is required to maintain hair follicle tumours. Development 2004;131 (8) 1787- 1799
PubMed

Figures

Place holder to copy figure label and caption
Figure 1.

Index case (case 1). Increased density of hair in psoriatic plaque.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Index case (case 1). Increased density of hair in psoriatic plaque.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Videomicrosopic images showing psoriatic scalp areas (A) and adjacent normal areas (B) in cases 2 through 7.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable. Clinical Characteristics in 7 Cases of Psoriasis

References

Paus  RLink  RE The psoriatic epidermal lesion and anagen hair growth may share the same “switch-on” mechanism. Yale J Biol Med 1988;61 (5) 467- 476
PubMed
Argyris  TS The effect of wounds on adjacent growing or resting hair follicles in mice. AMA Arch Pathol 1956;61 (1) 31- 36
PubMed
Osaka  NTakahashi  TMurakami  S  et al.  ASK1-dependent recruitment and activation of macrophages induce hair growth in skin wounds. J Cell Biol 2007;176 (7) 903- 909
PubMed
Marble  DJGordon  KBNickoloff  BJ Targeting TNF alpha rapidly reduces density of dendritic cells and macrophages in psoriatic plaques with restoration of epidermal keratinocyte differentiation. J Dermatol Sci 2007;48 (2) 87- 101
PubMed
Hampton  PJRoss  OKReynolds  NJ Increased nuclear beta-catenin in suprabasal involved psoriatic epidermis. Br J Dermatol 2007;157 (6) 1168- 1177
PubMed
Lo Celso  CProwse  DMWatt  FM Transient activation of beta-catenin signalling in adult mouse epidermis is sufficient to induce new hair follicles but continuous activation is required to maintain hair follicle tumours. Development 2004;131 (8) 1787- 1799
PubMed

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Teratogen update: methotrexate. Birth Defects Res A Clin Mol Teratol 2012;94(4):187-207.