Preservation of sebaceous glands and peroxisome proliferator-activated receptor gamma expression in central centrifugal cicatricial alopecia

To the Editor: Central centrifugal cicatricial alopecia (CCCA) is a primary (PCA) that occurs most commonly in black women.1Ogunleye T.A. McMichael A. Olsen E.A. alopecia.Dermatol Clin. 2014; 32: 173-181Abstract Full Text PDF PubMed Scopus (29) Google Scholar Little known about pathogenesis of CCCA, yet it remains common cause scarring hair loss this population.2Gathers R.C. Jankowski M. Eide Lim H.W. Hair grooming practices and central alopecia.J Am Acad Dermatol. 2009; 60: 574-578Abstract (45) Prominent destruction sebaceous glands characteristic feature PCAs; lichen planopilaris (LPP), prototypical PCA, has been attributed to decreased peroxisome proliferator-activated receptor gamma (PPARγ) expression.3Stenn K.S. Sundberg J.P. Sperling L.C. follicle biology, gland, alopecias.Arch 1999; 135: 973-974Crossref (47) Scholar, 4Karnik P. Tekeste Z. Mccormick T.S. et al.Hair stem cell-specific PPARgamma deletion causes Invest 129: 1243-1257Abstract (184) Thus far, there have no studies evaluating presence expression PPARγ CCCA. In study, we aim determine if are lost characterize CCCA using immunohistochemical staining. Approval for retrospective case series was obtained from Johns Hopkins Institutional Review Board. Seven patients with biopsy-proven seen our dermatologic clinics between September 2015 January 2017 were selected review. Six LPP 4 noncicatricial reviewed served as controls. All biopsy specimens before treatment stained hematoxylin–eosin. Entire tissue blocks each identify glands. Immunohistochemical stains performed on horizontal sections allow optimal visualization Mouse monoclonal antibody (sc-7273; Santa Cruz Biotechnology, Dallas, TX) diluted 1:200 Clinical staging based photographic scale developed by al,5Olsen Callender V. L. al.Central scalp African American women.Dermatol Ther. 2008; 21: 264-267Crossref (37) which stratifies individuals 0 (normal scalp) 5 (bald scalp). cases displayed preservation staining within (Table I). 6 LPP, complete absence or markedly diminished 2 diminished, only sole miniaturized gland noted Preservation observed 7 all preserved, intensity similar (Fig 1).Table ICharacteristics histologic findingsPatient no.DiagnosisAge, sexClinical stageSebaceous glandsPPARγ intensity1CCCA41, F1BPresentStrong2CCCA30, F2APresentStrong3CCCA56, F2BAbsentAbsent4CCCA38, F2BPresentStrong5CCCA51, F3BAbsentAbsent6CCCA56, F4BPresentStrong7CCCA61, F4BAbsentAbsent8LPP70, FN/APresentStrong9LPP67, FN/ADiminished∗One identified.Strong (in gland)10LPP61, FN/AAbsentAbsent11LPP68, FN/AAbsentAbsent12LPP40, gland)13LPP66, FN/AAbsentAbsent14TTA10, MN/APresentStrong/diffuse15TE15, FN/APresentStrong/diffuse16TE33, FN/APresentStrong/diffuse17AGA43, FN/APresentStrong/diffuseAGA, Androgenetic alopecia; F, female; planopilaris; M, male; N/A, not available; PPARγ, gamma; TE, telogen effluvium; TTA, temporal triangular alopecia.∗ One identified. Open table new tab AGA, alopecia. diffuse including 1 patient stage 4B disease. Of interest, remained constant observed, suggesting may serve marker Limitations study include use single center evaluation solely through immunohistochemistry. addition, because small number included, findings be generalizable We suggest that, unlike other PCAs, early key finding A future aimed at correlation disease progression response without warranted.