Autoimmunity: Alopecia Areata Maria Hordinsky, Marna Ericson  Journal of Investigative Dermatology Symposium Proceedings  Volume 9, Issue 1, Pages 73-78 (January 2004) DOI: 10.1111/j.1087-0024.2004.00835.x Copyright © 2004 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Alopecia areata. Left: Patchy disease activity consistent with the diagnosis of alopecia areata. Right: Extensive scalp hair loss characteristic of alopecia totalis. Figure 2, Figure 3, Figure 4. Miniaturized scalp hair follicles in 4-mm scalp biopsy specimens taken from patients with extensive alopecia areata of greater than two years' duration. Images depict nerves (PGP 9.5) and neuropeptide, substance p (SP), or calcitonin gene–related peptide (CGRP) expression before and after a 21-day treatment period with capsaicin. Each image is a projection of multiple optical sections captured with a laser scanning confocal microscope (MRC-1000 Confocal Imaging System, Bio-Rad, Hercules, CA). Journal of Investigative Dermatology Symposium Proceedings 2004 9, 73-78DOI: (10.1111/j.1087-0024.2004.00835.x) Copyright © 2004 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Pre-treatment—PGP 9.5 and CGRP expression. (a) PGP 9.5-positive subepidermal nerves extend from this plexus into the epidermis, and perifollicular nerves are present in a basket-weave pattern. (b) CGRP-positive nerves can be found in the subepidermal nerve plexus and epidermis and as a network of nerves around a miniaturized hair follicle. (c) Colocalization of PGP 9.5 (green) and CGRP (red) in several subepidermal and perifollicular nerves is present. Each picture is a projection of 36 optical sections taken at 2-micron intervals. Scale bar=100 microns. Journal of Investigative Dermatology Symposium Proceedings 2004 9, 73-78DOI: (10.1111/j.1087-0024.2004.00835.x) Copyright © 2004 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Pre-treatment—PGP9.5 and SP expression. (a) PGP 9.5-positive epidermal and perifollicular nerves, as well nerves highlighting eccrine glands and the arrector pili muscle, are seen. (b) SP staining nerves and globule-like extra neuronal structures are present in the dermis. (c) Colocalization of PGP 9.5 (green) and SP (red) reveals some SP-containing nerve fibers throughout the scalp skin, but the majority of expression is within the vasculature (data not shown). Each picture is a projection of 46 optical sections taken at 1-micron intervals. Scale bar=100 microns. Journal of Investigative Dermatology Symposium Proceedings 2004 9, 73-78DOI: (10.1111/j.1087-0024.2004.00835.x) Copyright © 2004 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Post-treatment—PGP9.5 and SP expression. (a) PGP 9.5-positive nerves are less prominent in the epidermis; the subepidermal plexus appears intact. The perifollicular nerve network is dominated by the PGP-positive staining nerve stockade surrounding a miniaturized follicle. (b) SP expression is significant in the area of the stockade, and there is significantly less SP expression elsewhere. (c) Colocalization of PGP 9.5 (green) and SP (red) demonstrate that the expression of PGP 9.5 is separate from SP expression in the stockade region. Each picture is a projection of 45 optical sections taken at 1-micron intervals. Scale bar=100 microns. Journal of Investigative Dermatology Symposium Proceedings 2004 9, 73-78DOI: (10.1111/j.1087-0024.2004.00835.x) Copyright © 2004 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 Flow diagram of the Alopecia Areata Registry. Journal of Investigative Dermatology Symposium Proceedings 2004 9, 73-78DOI: (10.1111/j.1087-0024.2004.00835.x) Copyright © 2004 The Society for Investigative Dermatology, Inc Terms and Conditions