Hormonal
In long-standing extensive alopecia areata (EAA), T-cells in the scalp exhibit a state of partial tolerance characterized by reduced production of IL-2 and IFN-gamma, resulting in a paucity of inflammatory change and preventing follicle destruction.
For those with long-standing hair loss, the issue may not be active inflammation to be fought, but a specific immune tolerance where T-cells stop producing key growth signals (IL-2) and inflammatory markers (IFN-gamma). This suggests treatments might need to address this specific 'tolerance' state rather than just suppressing general inflammation.
The abnormalities in cytokine production may explain the relative paucity of inflammatory change observed in the clinical setting and suggest that T-cell responses in EAA scalp are tightly, albeit aberrantly, regulated via mechanisms of peripheral T-cell tolerance.
Why this rating
The study uses rigorous flow cytometry and immunohistochemistry on human biopsy samples with appropriate controls, though the sample size is small (n=12).
Source
Ginsenosides for the treatment of metabolic syndrome and cardiovascular diseases: Pharmacology and mechanisms
Wenxiang Fan et al. · Biomedicine & Pharmacotherapy · 2020
DOI 10.1016/j.biopha.2020.110915
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