Perifollicular Inflammation and Fibrosis in Androgenetic Alopecia: Implications for Diagnosis and Treatment - A Comparative Histopathologic and Clinical Study with Normal-Appearing Scalp - PubMed
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- Androgenetic alopecia (AGA) may involve perifollicular inflammation and fibrosis (PIILIF), resembling early primary cicatricial alopecia (PCA).
- PIILIF was found in 81% of patients, especially those aged 44+, with advanced thinning (Norwood stage ≥5), or poor treatment response.
- Histology revealed CD117+ mast cells, CD4-predominant lymphocytes, and fibrosis in the infundibulo-isthmic unit.
- Combination therapy targeting androgenic and inflammatory pathways (e.g., DHT blockers, tetracyclines, topical calcineurin inhibitors) improved outcomes in 67% of patients.
- Early biopsy and targeted therapy may enhance diagnosis and treatment, particularly in resistant or unclear cases.
- PIILIF represents an under-recognized inflammatory endotype in AGA, potentially explaining treatment resistance.