Dr. Thompson, among your publications, you recently had a peer-reviewed manuscript titled, “Absence of catagen/telogen phase and loss of cytokeratin 15 expression in hair follicles in lichen planopilaris (LPP).” Can you tell us in a simple manner, 1-2 sentences, what the take away would be for an average person if they are trying to better understand their biopsy results?
Lichen planopilaris (LPP), which causes permanent, scarring hair loss is increasing in frequency for unknown reasons. Our study, focused on the early destruction of the stem cell of the follicle, argues for early, aggressive treatment of LPP.
You look at CK15 as a marker of damage and discuss the effect on progression due to stem cell damage, can you tell us a little more about CK15 and stem cells in hair follicles in LPP?
The CK15 stem cell is the source of regrowth of a normal hair after it is shed during normal cycling. We demonstrate in this study that the CK15 stem cell is destroyed early in LPP. This early destruction of the CK15 stem cells explains the continued progression of LPP despite immunosuppressive treatment.
Do you think all LPP hair loss patients should get a biopsy?
Given the magnitude of a diagnosis of LPP with permanent hair loss and scarring, I do believe that the process should be documented with a single (4 millimeter punch) biopsy. Other disease processes can occasionally mimic LPP, and a biopsy rules out another disease process.
Approximately, how often do you do/see scalp biopsy on hair loss patients in general, and of LPP patients in particular?
We are a dermatopathology laboratory and do not see patients directly, but we receive three to five biopsies for hair loss a day, and LPP has become one of the most common diagnoses. Drs. Desai and Roberts from this study operate one of the busiest hair loss clinics on the West Coast, and they represent the source of most of our biopsies. The LPP study was conducted on patients entirely from their clinic, with hundreds of LPP diagnoses having been rendered on their patients alone.
What do you see as the most promising development in hair loss research in the next 5 years that will have practical/clinical application?
I am excited about the potential for engineered hair growth through the manipulation of either the cells of the follicular papilla (at the bottom of the hair) or the CK15 stem cells. The potential for growth of new, engineered hair would be of great value to patients with permanent hair loss.
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