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Dermatopathology: Practical & Conceptual April - June 1995
Searching for Diogenes: Bulge-Activation Hypothesis Part II—The Bulge is Not a Bulge
Cosimo Misciali, MD
A. Bernard Ackerman, MD
1927 Felix Pinkus
1951 Hermann Pinkus
1958 Hermann Pinkus
1961 Sanderson & Thiede
1987 Headington & Astle
1990 Leshin & White
1990 Cotsarelis, Sun, Lavker
1991 Sun, Cotsarelis, Lavker
1991 Lavker, Cotsarelis, Wei, Sun
1991 Lane, Wilson, Hughes, Leigh
1992 Jaworsky, Kligman, Murphy
1993 Yang, Lavker, Sun
1993 Lavker, Miller, Wilson, Costarelis, Wei, Yang, Sun
1993 Kobayashi, Rochat, Barrandon
1994 Rochat, Kobayashi, Barrandon
Über einige Formverhältnisse der Haarfollikel des Menschen. Zeitschrift f mikr-anat. Forschung. 1935;38:503-53 (
Fig. 8 [Fig. 16] Bulge area of a coarse hair follicle from the labium majora of a 75-year-old woman. Hair thickness 72.5
m. Rests of inner root sheath. Multiple tubular appendages with and without concentric layered, bright anuclear content. (Reproduced with permission.)
Fig. 9 [Fig. 17] Bulge area of a hair follicle from the parotid area of a 32-year-old woman. Spiral structure of the outer root sheath. Bair thickness 28 p.m. Arrector fibers radiate arch-like into the hair follicle. Traction on them appears to have coursed the spiral structure. Leitz, binoc. Obj: 5, Ok.3. (Reproduced with permission.)
Protuberances of "the bulge" take two forms, one a solid cone and the other a pedunculated "bubble" within which are very thin, anuclear, concentric layers.
The persistence of protuberances of "the bulge" indicates that they serve a purpose, which could be production of a hormone.
Zimmermann noted, correctly, solid protuberant structures of bulges, but those described by him as "bubbles" are not truly bulges. Those cystic outpouchings derive not only from the isthmus, but also episodically from the upper part of the stem. Furthermore, unlike bulges that are invariable components of all normal follicles, both vellus and terminal ones, "bubbles" seem to arise only on terminal follicles and then very uncommonly. The tiny "cysts" house corneocytes that are arrayed concentrically in delicate, laminated fashion. What these "bubbles" represent has yet to be determined, but they are not conventional bulges.
Zimmermann offered no evidence to support his speculation that "the bulge" manufactures hormones. In our view, bulges serve only as attachment sites for the muscle of hair erection.
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