Students of alopecia areata (AA) face confusion in the understanding of the follicular status of the lesion. This confusion partly is related to varing histopathological descriptions given by different authors. In an attempt to clarify these varing descriptions, we made our own observations on 45 scalp biopsies from the patients with AA. The lesions were devided into four groups by the duration of the alopecia. The results were as in the following. Initial stage (within 2 weeks after the onset, 5 cases) showed mostly the catagen stage of terminal hair follicles and pigmentary incontinence in all cases. Only 2 cases (40%) showed significant cellular infiltrate. Progressive stage (between 2 weeks and several months after onset, 11 cases) showed catagen follicles of terminal hair with the development of miniature follicles among them. Pigmentary incontinence and inflammatory cell infiltrate were seen in 9 cases (82%) and 8 cases (73%) respectively. In established stage (26 cases), miniature follicles were predominant with pigmentary incontinence (73%: 19 cases) and cellular infiltrate (69%: 18 cases). In recovery stage, there were normal anagen follicles with absent or decreased inflammatory cells and pigmentary incontinence. A proposal that hair follicles better be designated not only with their stages but also with their types is presented.
Alopecia Areata* ; Alopecia* ; Biopsy ; Hair ; Hair Follicle ; Humans ; Scalp

BACKGROUND: Apoptosis protease activating factor-1 (Apaf-1), caspase-9, Bcl-2, p53, and survivin are important factors in the pathway of apoptosis, but their clinicopathologic significance remains unclear in human cutaneous melanoma. We investigated the expression of these proteins and their clinical value in human cutaneous melanocytic lesions. METHODS: We performed an immunohistochemical analysis to examine the expression and distribution of Apaf-1, caspase-9, Bcl-2, p53, and survivin in 36 cases of malignant melanoma (22 cases of primary melanoma and 14 cases of metastatic melanoma) and 41 cases of melanocytic nevus. RESULTS: The expression of p53 was significantly higher in malignant melanoma than in melanocytic nevus (p<0.01), however the expressions of Apaf-1 and caspase-9 were significantly lower in malignant melanoma compared with melanocytic nevus (p<0.01 and p=0.027, respectively). Also, there was a significant difference for Bcl-2 staining between primary melanomas and metastatic lesions (p=0.004). Nuclear staining for survivin were absent in nevus, but were positive in 14 of 36 melanomas (p<0.01). CONCLUSIONS: The altered expression of Apaf-1, caspase-9, p53, and survivin are considered to be related to malignant progression in human cutaneous melanocytic lesions. Loss of Bcl-2 can be considered as a prognostic marker of malignant melanomas.
Apoptosis ; Caspase 9 ; Humans ; Melanoma ; Nevus ; Nevus, Pigmented ; Proteins