This post is actually my comment to a blogpost featured on Alopecia World forum

"Normally, hair growth have three to four phases. The anagen (active growing phase), catagen ( involuting/ regressing phase) and telogen (arrested phase) and less notible exogen (shedding phase)UNDER NORMAL CIRCUMSTANCES. At any time most of the hair (about 90%) is in the anagen phase, a few % in catagen, and about 10% in telogen phase.The hair on our head have long anagen phase (several years) and short telogen phase ( a few months) while our eyebrows have shorter anagen phase (several months) and longer telogen phase (more than a few months). This explains why our hair in much longer and actively growing on our head while our eyebrows are shorter.Many studies have related alopecia areata with the hair growth phases/cycle. Many results suggest that the T-lymphocytes have held the hair follicle arrested for a much longer period (abnormal) in the telogen phase, as well as catagen phase (which then is related to exogen...when the hair shed).So basically, for people like me with alopecia universalis. I have about 80% of the hair on my scalp under abnormally long telogen phase or catagen phase while only a few dozen strands scattered across my head with normal hair growth phases. Thats why I still need to shave my head at least once every two days to keep my head clean.While we still couldn't predict our hair loss, we still know what is happening to our hair.You can check more information about what happened to our hair follicle as in alopecia areata at my blog @ http://joshuablogspace.blogspot.com/ and click onto the alopecia archive/label starting on February 17th ( a series of article about alopecia areata) which I have written a few months earlier.Hope you'll find it useful and informative.Take care.jt"

Joshua

Correlation between Alopecia areata & smoking?

This post is adapted from Alopecia World forum

and this is what I replied to the discussion:

"There is no scientific paper suggest that there is a significant correlation between smoking & alopecia areata yet, I am not aware of any test/ survey being done on the matter also.

1. It is widely accepted both by alopecia patients and scientists/ dermatologists that alopecia areata can be triggered by stress. Stress also comes in various form, physical/ physiological, psychological, pathological or any combinations of the mentioned..etc. Eventhough there is no scientific evidence on the connection between smoking & alopecia, I believe that smoking can be a predisposing factor to alopecia areata. (As per any foreign event/ particles in the body could induce an auto-immunity state). In short, smoking is a form of physical stress of the body indirectly and to the lungs directly.

2. Smoking as a mean to relax the mind and mental/emotional state, statement is valid & factual. One thing for sure, it is not relaxing to the lung and also the heart. While you're relaxing your mind and resting your brain at one time, at the same time you're also comprising the well being of the other vital organs of the body. Why don't you find other means to relax your mind without comprising the health of the other parts of your body. Just as much as you love your mental status/mind/brain, you must love your lungs and heart as well (in addition to the liver and kidney which made up the 5 vital organs of the body).

3. a little more fact about the lung, the lung surface are generally and mostly covered with thin pneumocytes type I (Lung cell type 1) which is responsible for gas exchange (Oxygen-Carbon dioxide exchange), oxygenated blood subsequently distributed by the heart to the entire body. Pneumocytes type II, on the other hand produce surfactant that provide integrity to the lung (thus preventing it from collapsing-atelectasis). Pneumocytes type I eventhough are plenty, their biological component is that it is higly susceptible to toxic insults/ infiltration and they do not regenerate/ or replicate, meaning these cells responsible for gas exchange does not regenerate after the cells die. The lack of cells for gas exchange, will result in lacking of oxygenation, and the tissues send signals to the body to increase breathing rate and heart rate, in order to restore the constant and adequate oxygenation to all body tissues. Well, it is true, some have smoke heavily for decades and yet still healthy, we must praise God that He had created reserve "lung tissues"- functional reserve to sustain our living, our lung's functional reserve is at least 50%-75%, meaning we can still live healthily with one side of the lung removed. So what, some may say, like my own grandfather, who smoked for over 70 years and he is now 97 years old.

I believe, those who smoke and still live long, could live even much longer if they didnt smoke.In conclusion (everyone at this time will say, Praise the Lord...lol). It doesnt matter much if smoking worsens alopecia areata or not, because it matters more that smoking actually add burden to the lung directly and the heart indirectly. Well, the lung and the heart are definitely more important than my hair.

Hair is just another ascessory tissues (play some role) to the skin, while the lung and the heart are major vital organs that sustain the quality of life and eventually life itself! Only if the heart and the lungs are visible on the outside of our body, the society then will pay a lot more attention to them!I dont mean to give you a lecture, I presume your occasional cigar would be more like a weekly habit rather than a daily habit.

I agree that smoking does add to the fact that can provide some form of calmness to the mind and relieve anxiety and ease emotional stress. My motto "I love my lung and my heart just as much as I love being calm to my mind", so I'll find another way to relax. If you're not thinking of quitting smoking, my next advice would be "Moderation is the key".

Take care and God bless."

Joshua

Wouldn't the T-lymphocytes around the hair follicle die?

Hello,

I receive a question that what if the excessive T-lymphocytes around the hair follicles of a patient with Alopecia areata dies or will they live forever?

We're alive today because our body is alive, our tissues are alive and so does our cells (We're living organism because we're composed of living cells)

Yes, eventually all cells have to die however the life span of each type of cell varies. (Normally our red blood cells live about 120 days, they lost their membrane integrity due to wear and tear, and eventually destroyed by the spleen.)

T-lymphocytes also have its life-span. In human, the T-lymphocytes (Special/ specific Soldier) can survive between 3 to 6 months (The more wear and tear, the shorter the life-span) and B-Lymphocytes can survive between 1 to 2 months).

In my previous blog, I talked on the functions of T-lymphocytyes (the Cytotoxic and Helper cells), I was merely talking about effector Lymphocytes (Special/ specific Soldier). The second type of lymphocytes by function is memory Lymphocytes (Special/ specific Messenger). Memory lymphocytes stayed in the periphery tissues and blood circulation for an extended period, responding quicker upon the same specific exposure of antigen by providing instant information to the effector Lymphocytes (In this case, we're talking about the self-antigen of the hair-follicle).

Memory lymphocytes (T & B cells) live somewhere between 3 months to 5 years with 1% of the memory lymphocytes living up to 20 years (Vaccination that we get annually? or once every five years i.e. hepatitis A, B as booster?...much related to memory lymphocytes).

With the word memory alone, the dysfunctional T-lymphocytes found around the hair follicle or an Alopecia areata patient, kept on producing a specific dysfunctional response against the hair follicle.

Theoratically, (Memory Cells with the time element) we can now basically explain why some Alopecia areata patients:

1. Experience little regrowth but then fall off again...

2. Have a very long duration of disease...

3. Believed to be of genetic basis...

More details...(Wait for the next blog or post me a question)

Joshua

Should Alopecia areata patients strengthen their immune system?

Basically, the ultimate cure for Alopecia Areata would be to "tell" or "inform" the T-lymphocytes of our body (Specifically those who are targeting our hair follicles) that the "social security number" of hair follicle tissues are of our own body and NOT foreign.

So, should we strengthen our immune system?

Yes, the T-lymphocytes still plays a great role in our well being and defense mechanism against specific bacteria, viruses and prevent rapid proliferation of mutated cells (cancerous).

Therefore, systemic steroidal treatments are not encouraged to treat Alopecia Areata in long term, as it would "weaken" the ENTIRE Immune System. Its like, SHUTTING off the COUNTRY's entire police force because a few police made a mistake and arrested THE COUNTRY's own citizens as illegal immigrants.

Joshua

Alopecia Areata as Auto-immune disease

In my previous blogs, I talked about the immune system in relation to alopecia areata and then I talked about the normal functions of T-lymphocytes.

Why is Alopecia areata considered as an autoimmune disease?

Each different cells/tissue of the body has their own "social security number" / receptors (non antigenic) and the T-lymphocytes normally identify the "social security numbers" that does not belong to the normal tissues found in one own's body and attack them. For example, the immune system, including lymphocytes is triggered to attack the foreign infectious agents and abnormal proteins found in the normal body. (Different "social security numbers" of the various pathogenic bacteria, viruses...etc)

In Alopecia Areata, the T-lymphocytes somehow identify the specific "social security number" (self antigen) of the hair follicles as foreign infectious agents/ non self and could not distinguish it for being of the part of own body and start "arresting and attacking" the hair follicles....and now the person suffers from Alopecia Areata.

Medical definition for:

Antigen- Any substances which is capable, under appropriate conditions, of inducing a specific immune response..

Self antigen- Any constituents of body's own tissue capable of stimulating a specific immune response/ autoimmunity.

(Its like the police arrest you as for being an illegal immigrant when you're actually a citizen of the country)

Joshua

(For information on Alopecia & Support, pls visit AASC-i or join Alopecia Areata Support Community)

Understanding T-Cytotoxic & T-Helper Lymphocytes

Hello everyone,

From my previous blog (Explaining Alopecia Areata & Autoimmune Disease), I talked briefly about Alopecia Areata and then proceed to the discussion of the Immune System.

I have touched on the microscopic presence of T-Cytotoxic and T-Helper lymphocytes excessively on the hair follicles of a skin biopsy taken from a patient with Alopecia Areata.

Before I go on further to explain why Alopecia Areata is recognized to be an autoimmune condition. Let us watch the videos below to understand the normal function of T-Cytotoxic and T-Helper lymphocytes in our body's immune system.


T-Cytotoxic (Lymphocytes)
*Note: Antigens are proteins that are able to produce an immune response (E.g. proteins of bacteria, viruses)

-function to eliminate antigens by releasing cytoxic properties/substances.

T-Helper (Lymphocytes)

-function to eliminate antigens by signalling other immune cells.

Thats all for today, I shall talk about Alopecia Areata as an Autoimmune Disease at a later date. (I shall continue our discussion in about a week from now)

At the end of this series of blog, if the people who read and learned about Alopecia areata still behaved rudely and even jeer at people suffering from Alopecia areata. I shall make an official declaration on this kind of people.

As for the rest, thank you very much for your support, patience and interest in Alopecia areata.

Joshua

Explaning Alopecia areata & Autoimmune disease.

I would like to begin my first official blog by posting a subject that is not life-threatening but life-altering. The subject is Alopecia Areata (Widely believed to be an autoimmune disease).

As an Alopecia areata patient, I have been laughed, stared, commented rudely and even be labelled as a member of the skinhead gang in the public multiple times. I've even heard from the public calling women with alopecia totalis, alopecia universalis, crazy womens, Alopecia universalis patients as freaks who shaved their eyebrows and pulled off their eyelashes.

Children are being laughed and jeered as baldy, alien or even hairless monsters! Enough is enough! If we are not bound by the Rule of Law but rather the Law of the jungle, I would have given a smack or two slaps on the faces on people who laughed at children with Alopecia areata.

• So, to whoever (on condition that you're civilized, with brains in the body, I don't care where your brains is, as long as you have one in your body) want or have showed rudeness, ignorance to children and women with alopecia especially and also to my fellow brothers. You are welcome to read my blog.

To those who live with Alopecia areata or live with/know someone you loved with Alopecia areata, you are most welcome to read my blog.

• First of all, Immune system and Autoimmune system does not exist separately. The term "Autoimmune System" does not even exist whether in scientific or medical definition. There is only Immune system and Autoimmune disease/condition (One of many ways the immune system can breakdown).

• However, "Autoimmune disorder, Autoimmune conditions, Autoimmune diseases" are often used interchangeably and Autoimmune disorder/conditions/diseases is merely the failure of the body Immune system to recognize one own self (cells and tissues) and therefore "attack" (produce an immune response against) the host's (e.g human) own cells and tissues that makes up the normal structure of the physical body.

• Let us not discuss in depth into scientific terms but rather an explanation based on basic science.

The immune system in general, works in two general pathways:

1. Non-specific immunity (innate pathway)- eg. the physical barrier of skin, acid in the stomach, phagocytics cells in blood that eats up bacteria in general...etc
2. Specific immunity (pathway)

Alopecia areata falls into the minor malfunction of the Specific immunity (pathway).Under Specific Immunity, it further subdivides into two components:

1. Passive immunity- (e.g transfer of antibodies from mother's milk to baby)
   and Alopecia Areata (Autoimmnue condition) is narrowed down to the minor malfunction of the Active immunity.
2. Active immunity- response upon stimulation (e.g vaccination, exposure of disease, infection)

Under Active immunity, it further divides into two categories:

1. Humoral immunity ( produced by B-lymphocytes)- e.g production of antibodies like Immunoglobulins, IgM, IgG, IgE...etc.
2. Cell-mediated immunity (T-lymphocytes)

* Another type of lymphocytes besides B and T-lymphocytes is Natural Killer Cells (NK) which is part of the Non-specific (Innate pathway) immune system.

and the identified culprit (agreed by most) for Alopecia areata is the T-lymphocyte cells (T-Cytotoxic cells which destroys cells) and (T-Helper cell which tells the other white blood cells to destroy cells and enhance the B-lymphocytes to produce antibodies specifically)

Under the microscope: a skin biopsy of a patient with Alopecia Areata shows

• Extensive T-Cytotoxic and T-Helper cells are present surrounding the hair follicles, "attacking" them, so in laymen term the hair follicle is "under siege". Hence, the hair follicle cannot produce any hair, and the nutrients supplied for hair growth is BLOCKED by these T-lymphocytes cells and their allies.

So, above the surface of the skin, no hair is present (Alopecia= a clinical symptom of absence of hair on skin where they normally are/ should be).

Why is Alopecia Areata often starts as circular patches extending outwardly? What's wrong with the presence lymphocytes around the hair follicle and why Autoimmune disease?

I will discuss that in my next blog. Thank you for reading.

Joshua

p/s: You may want to visit Alopecia Areata Support Community or read about Alopecia Areata at AASC-i if you find my blog interesting.