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Dermatopathology: Practical & Conceptual April - June 1995
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Searching for Diogenes: Bulge-Activation Hypothesis Part II—The Bulge is Not a Bulge
Michael Radonich
Cosimo Misciali, MD
A. Bernard Ackerman, MD
Introduction
1876 Unna
1877 Schulin
1883 Unna
1892 Garcia
1904 Stöhr
1927 Felix Pinkus
1935 Zimmermann
1951 Hermann Pinkus
1958 Hermann Pinkus
1961 Sanderson & Thiede
1961 Sanderson
1964 Madsen
1964 Montagna
1984 Headington
1986 Mehregan
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 Headington
1993 Whiting
1993 Kobayashi, Rochat, Barrandon
1994 Rochat, Kobayashi, Barrandon
References
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1992 Jaworsky, Kligman, Murphy
Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis. Br J Dermatol. 1992;127:239-46.
Message
Permanent impairment of the follicular cycle in human androgenetic alopecia may be the result of an inflammatory process that resolves with fibrosis centered around follicular stem cells that reside in the lower part of the infundibulum.
Critique
This hypothesis for common baldness is based upon the assumption that follicular stem cells reside in the lower portion of the infundibulum, but the article by Cotsarelis, Sun, and Lavker (Cell 1990:61;1329-1337) cited in support of this idea places stem cells in "the bulge," i.e., the lower part of the isthmus, not in the infundibulum. There is no evidence that so-called follicular stem cells are housed in the infundibulum.
Common baldness is not an inflammatory process because it is devoid of inflammatory cells.
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