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Canities subita: A reappraisal of evidence based on 196 case reports published in the medical literature



We have reviewed the medical literature on unusually rapid Canities of body hair to assess whether the reported clinical evidence can be explained with the current hypotheses of pathogenetic mechanisms. We screened the medical literature from 1800 onward, searching for as many case reports as possible. We assessed literature in Dutch, English, French, German, Italian and Spanish and included all cases, which contained an explicit mention or description of unusually rapid graying or whitening of hair. Case reports were classified into three categories: Cases are "authenticated" when the authors personally observed the rapid color change, "non-authenticated" when they saw the subject only after the alleged color change and "anecdotal" when authors were told about the case by a third party. In total, we found 196 cases of which 44 were authenticated. These studies reported the graying of human hair in the context of aging, somatic diseases, emotional trauma or stress and psychiatric disorders. Numerous cases involved not only scalp hair, but also beards, eyelashes and other body hair. Several authors stressed that there was no alopecia. Although plausible explanations exist to explain Canities subita occurring together with an effluvium, the observation of viable hair losing color along the axis within a timespan shorter than its growth rate remain as yet unexplained.
International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2 63
The process of graying or whitening hair is called Canities
and normally occurs as one of the signs of aging.
Pigment production by melanocytes in the hair matrix
area surrounding the dermal papilla is thought to cease
gradually, resulting in slow outgrowth of graying hair at the
pace of normal hair growth. Yet, not all hair bulbs decrease
pigment incorporation in the growing hair at the same
time – instead, single gray hairs start appearing interspersed
among the pigmented ones, colloquially called “salt and
pepper pattern”. As the differentiated hair shaft contains
no live cells, it is not thought to be able to undergo any
active changes. In contrast to this, unusually rapid loss of
hair color has been reported in the medical and non‑medical
literature. The prevailing theory states that apparent sudden
graying may occur because of a selective loss of pigmented
hairs due to alopecia areata diffusa.[1,2] However, along with
other authors, one of us (A. A. N.) observed the case of a
54‑year‑old woman whose hair had allegedly turned white
Address for correspondence:
Dr. Emily Williams Kelly,
Department of Psychiatry and
Neurobehavioral Sciences,
Division of Perceptual Studies,
University of Virginia Health
System, 210, 10th Street,
VA 22908, USA.
Canities Subita: A Reappraisal of
Evidence Based on 196 Case Reports
Published in the Medical Literature
Michael Nahm, Alexander A Navarini1, Emily Williams Kelly
Department of Psychiatry and Neurobehavioral Sciences, Division of Perceptual
Studies, University of Virginia Health System, Charlottesville, VA, USA,
1Dermatology, University Hospital of Zurich, Zurich, Switzerland
We have reviewed the medical literature on unusually rapid Canities of body hair to assess
whether the reported clinical evidence can be explained with the current hypotheses of
pathogenetic mechanisms. We screened the medical literature from 1800 onward, searching
for as many case reports as possible. We assessed literature in Dutch, English, French,
German, Italian and Spanish and included all cases, which contained an explicit mention
into three categories: Cases are “authenticated” when the authors personally observed the
rapid color change, “non-authenticated” when they saw the subject only after the alleged
color change and “anecdotal” when authors were told about the case by a third party. In
total, we found 196 cases of which 44 were authenticated. These studies reported the
graying of human hair in the context of aging, somatic diseases, emotional trauma or stress
and psychiatric disorders. Numerous cases involved not only scalp hair, but also beards,
eyelashes and other body hair. Several authors stressed that there was no alopecia. Although
plausible explanations exist to explain Canities subitaoccurringtogetherwithanefuvium,
the observation of viable hair losing color along the axis within a timespan shorter than its
growth rate remain as yet unexplained.
Key words: Alopecia areata diffusa, Canities subita, sudden hair blanching
within “a few weeks” without her having noticed the loss
of hair.[3] Because this patient’s observations may have been
incomplete, we decided to survey the medical literature on
unusually rapid whitening of hair, limiting our collection
to case reports published from 1800 to the present. We
assessed Dutch, English, French, German, Italian and
Spanish publications and included all cases containing an
explicit mention or description of unusually rapid graying
or whitening of hair. We found reports of 196 cases. Of
these, 44 were reported by physicians who saw their patients
before and after the color change, often witnessing the
graying process (authenticated cases) and we will focus our
presentation primarily on these rst‑hand accounts. Many
of these authors were renowned physicians of national and
international reputation. In addition, 82 cases were reported
by physicians who saw or treated the patients only after
the alleged sudden color change (non‑authenticated cases),
sometimes on the next day and 37 cases were merely reported
to the physicians (anecdotal cases). In the remaining 33 cases,
the precise circumstances of the observation were unclear.
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Nahm, et al.: Canities subita: Cases reported in the medical literature
64 International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2
Studies concerning color changes of single hairs due
to aging
When Neurologist Brown‑Séquard was 45 years of age,
he rst discovered white hairs in the anterior parts of
his beard and plucked them out.[4] After a few days, he
discovered new white hairs in his beard and plucked them
out. He repeated this procedure throughout the 5‑6 weeks,
always nding after 2‑5 days fully developed new white
hairs in his beard that had blanched on their entire length,
apparently overnight. Brown‑Séquard stressed that his
observations were beyond doubt. Around the same time,
Pincus presented the results of detailed investigations of
single hairs that women of different ages had lost.[5] After
microscopic analyses, Pincus stated that the graying of
hairs usually began at their base because pigments would
cease to be produced in the scalp and the hair would then
grow without pigmentation. However, he also found that
in the white sections of several hairs, their ne structure
was swollen and lled with air. Pincus concluded that
in these cases, the change of color had occurred in the
already existing and pigmented matter of the hairs by the
inclusion of air. Later, Naegeli studied the graying process
in women with a long black hair.[6] He observed that the
color change began both at the base and at the tips of the
hairs and that it would often progress fast, up to 1 cm in
2 days. Thus, entire hairs would be blanched within a few
weeks and often faster. Galewsky similarly stated that entire
hair shafts can gradually become white due to the aging.[7]
Ephraim questioned several hairdressers on this topic. They
held the opinion that pigmented hairs can become white
on their entire length.[8]
Cases reported in the context of intense pain or
somatic diseases
Like Brown‑Séquard, Anstie reported color changes in his
own hair.[9] Whenever he suffered severe neuralgia attacks,
a part of his right eyebrow and scalp hairs on the right side
of his head turned white. Yet, the original hair color was
always restored after a few days. Anstie stressed that there
was no alopecia and that he observed this phenomenon
in several of his patients as well. Similarly, Urbantschitsch
described a case in which, in addition to brittleness and
alopecia, many hairs turned white during severe attacks
of neuralgia.[10] In this case, the discoloration of hairs was
permanent. Raymond witnessed the rapid color change
in the hair of a 38‑year‑old woman together with his
colleague Vulpian, the discoverer of adrenalin.[11] Patient
suffered from extreme neuralgia and emotional anxiety. The
physicians observed that her hair changed its color almost
entirely within 5 h and they excluded the possibility that her
hairs had been dyed before. The process of decoloration
of hair continued during the following 2 days, after which
her hair started to fall out. Gowers reported the case of
a man who suffered a traumatic meningeal hemorrhage
over the left hemisphere.[12] During the 3 days, he lived
after the injury, the right half of his brown moustache
and beard became almost white. The scalp hair was not
affected. A similar non‑authenticated case was described
by Brissaud, who reported a perfect Hemicanities in a
63‑year‑old man, which had developed within 1 day after
a hemorrhage.[13] Perry related 2 other cases of this kind,
one involving a 12‑year‑old boy.[14] The Hemicanities in
the non‑authenticated case described by Loeb was said
to have followed a hemorrhage within 8 days.[15] Other
remarkable authenticated cases, in which rapid poliosis
was attributed to somatic causes include Dewees (during
parturition),[16] Compagne (during a severe fever in a
36‑year‑old woman),[17] Brée (coinciding with progressive
vitiligo in a 22‑year‑old man)[18] and Lieber (during several
cycles of menstruation in a 16‑year‑old teenager).[19]
A peculiar subset of 30 cases concerns the rapid whitening
of eyelashes [Table 1]. Eighteen of these were related to
severe pain in this region or to diseases of the eye. The
remaining cases were reported in the context of emotional
trauma (9 cases) or without discernible trigger (3 cases).
A classic case concerning eye diseases was reported by
Schenkl.[20] He reported that 5‑6 cilia had turned white
within 3 days in a 9‑year‑old boy whose left eye had been
enucleated. Schenkl had observed the wound closely and he
paid special attention to the lashes, many of which turned
toward the interior of the eye socket.
Cases reported in the context of emotional stress or
Of the 196 cases in our collection, 126 were attributed to
frightful or emotionally shattering experiences [Table 1].
For example, in March 1923, a 62‑year‑old widow was
injured and suffered extreme fright when she slipped
and fell.[21] She remained in the hospital for 3 months.
The woman had dark hair, which measured 80 cm at the
occipital region of her head. On the morning of the second
day in hospital, the basal areas of the hairs of the frontal
hemisphere of her head had turned white on a length of
1 cm. Initially, the hair of the occipital hemisphere of her
head showed no change. While the whitening progress on
her frontal hemisphere continued, but declined in velocity,
the 80 cm long hairs of the occipital skull hemisphere
Nahm, et al.: Canities subita: Cases reported in the medical literature
International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2 65
of his wife, just before he reached his 30th year.[26] Parry
reported the case of a 54‑year‑old man whose black hair
turned gray within half an hour during a frightening
military examination by his captors.[27] Perry saw a man
whose black hair turned gray 1 day after he was met with
a “terrible calamity.[14] Ferguson observed the graying of
a black‑haired acquaintance over 5 days when the latter
suffered from emotional distress.[28] Laumonier saw a
young mother appear with white hair at the funeral of her
12‑year‑old daughter, who had died from a u.[29] Gomer
observed sudden Canities in a soldier at the front.[30]
Cases reported in combination with alopecia
We have already mentioned cases, which involved unusual
Canities accompanied by alopecia.[10,11,21,23‑25] Similarly,
Groeger related a case, in which there was total whitening
of black scalp hair within 3 days, but in which alopecia
occurred only in the eyebrows and eyelashes.[31] It was
unclear whether the Groeger was a direct witness of these
changes. Ephraim described the case of a 63‑year‑old
patient whom he had seen the day after a fall and again
6 weeks later.[8] The man reported that he had noticed
hair loss 2 weeks after the accident and that he had turned
almost entirely white within the 3rd week. Initially, patient
had had only a few white hairs on top, with some graying
at his temples. Stankler and Bewsher reported analogous,
but non‑authenticated case of a 50‑year‑old patient.[32] His
wife, his medical practitioner and a neighbor who worked
at the hospital to which the man was referred, conrmed
began to show a different kind of color change. When
patient left the hospital after 90 days, these hairs consisted
of an irregular mixture of hairs that had remained dark
and that had blanched at different locations. Many of the
hairs had blanched only in their distal regions. On the
last examination of the woman, performed 92 days after
her release from the hospital, the basal whitening of her
frontal hair was 10 cm and the occipital area of her head
had turned entirely gray. Only a few weeks before, the
woman had rst noticed a loss of hair. She stated that
she never used hair dye and according to enquiries that
Sticker made among the people who knew her, she had
always had the long dark hair that she had at the time she
slipped. Similarly, Baelz has reported that the hair of a
female patient of his changed from dark to largely gray
within 6 months.[22] Irregular strands of white hairs were
mixed with darker hairs. The white hairs were blanched on
their entire length of about 25 cm. The color change began
after the woman was rescued from a shipwreck. Another
case, reported by Pöhlmann, involved a 34‑year‑old man
who was rescued with difculty after a mountaineering
accident.[23] He visited Pöhlmann because of frostbite on
his hands and feet. Pöhlmann observed that patches of
poliosis and alopecia areata developed during the course
of several weeks in the man’s beard and scalp hair. These
patches had begun to appear 3‑4 days after the accident.
Similarly, Bertrand in Bernard and Dubreuilh observed
the development of both poliosis and patches of alopecia
areata in patients after emotional strain.[24,25] Vogel stated
that his own hair turned white overnight after the death
Table1:Overviewofspecicfeaturesof196casesofunusuallyrapidcanities reported in the medical
literature from 1800 onward
Features of the cases Authenticated cases Non‑authenticated cases Anecdotal cases Unclear Sum
Total number of cases 44 82 37 33 196
Aected type of hair
Scalp hair 38 68 36 28 170
Eyebrows 3 15 1 3 22
Eyelashes 7 15 2 6 30
Beard 7 8 2 2 19
Other body hair 2 7 0 1 10
Apparent trigger of the onset of Canities
Aging, or no discernible trigger 513 1 2 21
Intense pain or somatic disease 12 19 4 4 39
Psychiatric disorder 6 3 1 0 10
Emotional stress 21 47 31 27 126
Associated specics
Alopecia 6 16 1 0 23
Poliosis 15 34 6 3 58
Vitiligo 2 7 0 0 9
Subject 4-18 years old 7 12 2 1 22
Nahm, et al.: Canities subita: Cases reported in the medical literature
66 International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2
that his hair had turned from black to white within 3 weeks
for unknown reasons. In addition to this progressive
Canities, alopecia was noted. A case reported by Hoff also
involved both alopecia and Canities.[33] Hoff, then director
of the Medical University Clinic in Frankfurt, examined
the patient 7 months after the reported color change of his
hair, but the case was well authenticated by direct witnesses,
among them Professor Walter Parissius, chief physician
of the Knappschafts‑Hospital in Essen, Germany, who
had referred the patient to Hoff. Patient, a 40‑year‑old
miner with dark blond hair, became ill, collapsed and was
visited by a physician. During the night, the man and his
wife noticed that when he ran his ngers through his hair,
much of his dark hair came out in tufts. The hairs that
remained on his head had turned white. His skin displayed
vitiligo universalis. The next day, he was admitted to the
Knappschafts‑Hospital. He remained hospitalized for
several days, during which time the whitening of other body
hair progressed. Within 3 days, his eyebrows and eyelashes
had turned white and after 10 days, the hair on his chest
and abdomen had whitened. His pubic hair had turned
completely white a few days later. Finally, about 1 month
after the onset of his disease, the axillary hairs had also
turned white. Moreover, the color of his irides had changed
from dark brown to a light blue. The miner was presented
at a dermatological convention on May 27, 1955 in Essen,
where Hoffmann met and talked with him as well.[34]
Hernández y Vázquez reported a similar non‑authenticated
case, in which a 52‑year‑old man developed total whitening
of all scalp, beard, axillary and pubic hair as well as alopecia,
within 2 days after a severe emotional afiction.[35] Two
other sources reported non‑authenticated cases, in which
alopecia occurred shortly after sudden whitening of scalp
hairs of their patients.[36,37]
In nine non‑authenticated reports, unusually rapid Canities
was attributed to alopecia alone. Their authors argued
that predominantly pigmented hairs were lost, but white
hair remained on the scalp.[2,38‑40] In this way, the false
impression that the hairs had turned white was created.
This process of whitening due to the rapid alopecia took
between 3 days and 3 weeks; in one case the process
took 3 months.[41] None of these cases was preceded by
sudden emotional strain; although, one patient reported
a distressing period of family trouble.[40] Thus, just as
there are case reports of rapid Canities without alopecia
and cases involving both rapid Canities and rapid alopecia,
there are cases of only rapid alopecia (areata diffusa) of
predominantly pigmented hairs. This nding highlights
the multifaceted phenomenology of disorders of the hair
and scalp as stressed by Dubreuilh.[25] Some physicians may
have failed to note that some of the “only alopecia” cases
might have involved unusual Canities as well. For example,
in one case patient’s scalp hair, measuring about 10 cm in
length, had whitened strikingly and progressively within
3 months, beginning on the crown of her head.[41] She had
reported loss of hairs, but the authors did not specify their
color. Still, they speculated that the progressive graying
resulted from the progressive, selective loss of pigmented
hairs. A hair count performed by the authors themselves;
however, showed that the average hair density was in fact
greater in the crown area, which displayed maximum
whitening, compared to the areas in which the hairs were
not yet affected by the progressive Canities and which
contained only “rare” gray hairs.
Cases reported in the context of psychiatric disorders
Rapid whitening of hair has also been reported in the
context of psychiatric disorders. As in some cases involving
intense periodic pain,[9,19] reversible color changes were
reported in this category. For example, Reinhard reported
a periodic change of hair color in a 13‑year‑old patient with
severe mental disabilities who also suffered from apparent
epileptic ts.[42] Her hair color changed repeatedly from a
yellowish blond to a reddish‑golden color and back again.
The reddish color lasted for 7 or 8 days, always correlating
with periods of mental agitation. There was no alopecia,
the possibility of hair dyes was excluded and several
caregivers and physicians witnessed these repeated color
changes. A similar case involved a 21‑year‑old woman
who suffered from schizophrenia.[43] During the phases
of intense emotional agitation, a 3 cm wide strand of her
blond hair turned white. It resumed its original color after
4 days, but it returned during four more attacks of mental
disturbance. Heinicke stressed that there was no alopecia.
Other well‑documented observations of hair color change
during psychotic ts were made by Mirto and Räuber.[44,45]
Lastly, the head and beard of an extremely frightful
34‑year‑old man who suffered from delirium tremens and
hallucinations had turned from blond to gray overnight
on the morning of the 4th day in hospital as noted by the
attending physicians and by other patients who had seen
him before.[46] Upon closer investigation, inclusions of
air were discovered in the blanched hair shafts that were
removable by incubation in water, ether or turpentine oil
with subsequent restoration of the original hair color.
In a survey of the medical literature about sudden or
unusually rapid whitening of fully developed hair shafts,
we found reports of 196 cases. The collection contains
Nahm, et al.: Canities subita: Cases reported in the medical literature
International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2 67
numerous apparently well‑authenticated case reports by
direct eyewitnesses. In only 6 of 44 authenticated and 16
of 82 non‑authenticated cases was alopecia reported to be
associated with the rapid color change. Thus, the selective
loss of pigmented hair by alopecia areata diffusa may not
explain all these cases. Several other hypotheses have been
put forward,[47‑49] most prominently inclusion of air in
hair shafts without pigment destruction.[46] Conspicuous
alterations of the internal ne structure of hair shafts,
usually associated with the inclusion of the air, have been
reported in 16 cases of this review. Such alterations were
not reported by others, but they did not have access to hair
from cases with rapid Canities.[49] However, air inclusions in
the hair cortex can denitely create a loss of color intensity
as is known from the disease pili annulati that produces dark
and bright stripes in the hair.[50] Interestingly, this process
is reversible as more distal pili annulati lose their bands
eventually, which is explained by the collapse of the air‑lled
cortex. However, whether the new air inclusions can be
created by internal processes in the fully differentiated hair
remains unclear and will be interesting to investigate. It
will be relatively easy to determine prospectively whether
the new cases of rapid Canities contain air inclusions in
the cortex and what physical inuences could lead to this
phenotype. This must be differentiated from air in the
medulla, which is a common phenomenon. Although no
conclusive proof exists that rapid Canities can occur without
concomitant alopecia areata diffusa, the sheer number of
authenticated cases suggesting this call for a more systematic
investigation of what factors may prompt loss of hair color.
Such an investigation may provide new insights into the
process of physiologic Canities.
We are indebted to Massimo Biondi, Renaud Evrard, Gerd
Hövelmann and Pascal Le Maléfan for their help in obtaining
copies of rare publications.
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How to cite this article: Nahm M, Navarini AA, Kelly EW.
Canities subita : A reappraisal of evidence based on 196
case reports published in the medical literature. Int J Trichol
Source of Support: Nil, Conict of Interest: None declared.
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... In this sudden greying process, a portion or the entirety of scalp or body hair "greys" over a period of weeks, days, or even hours (hence "overnight") (Shah et al., 2016). Closer inspection of the relevant case studies, many of which are now over 100 years old, reveals varying timeframes, rates and reversibility of greying, and describe how sudden onset may be associated not only with neuralgia, somatic disease or psychiatric disorders, but also stressful life events such as shipwrecking and loss of a spouse (Nahm et al., 2013). More recently, a case-control study showed that hair pigmentation is reduced by exam stress in healthy students . ...
... Interestingly, a subset of canities subita cases refer to greying of the entire HS occurring over a matter of days, faster than can be explained by mere cessation of melanin transfer. To account for rapid changes in distal HS coloration, it has been suggested that an appearance of pigment loss may occur by rapid and diffuse alopecia of pigmented hairs (alopecia areata incognita), leaving only white hairs intact (Nahm et al., 2013). However, this cannot be the case when alopecia is not observed, and hair density remains stable. ...
While popular belief harbors little doubt that perceived stress can cause hair loss and premature graying, the scientific evidence for this is arguably much thinner. Here, we investigate whether these phenomena are real, and show that the cyclic growth and pigmentation of the hair follicle (HF) provides a tractable model system for dissecting how perceived stress modulates aspects of human physiology. Local production of stress-associated neurohormones and neurotrophins coalesces with neurotransmitters and neuropeptides released from HF-associated sensory and autonomic nerve endings, forming a complex local stress-response system that regulates perifollicular neurogenic inflammation, interacts with the HF microbiome and controls mitochondrial function. This local system integrates into the central stress response systems, allowing the study of systemic stress responses affecting organ function by quantifying stress mediator content of hair. Focusing on selected mediators in this “brain-HF axis” under stress conditions, we distill general principles of HF dysfunction induced by perceived stress.
... However, its complexity has not allowed a concrete explanation to be found. Nahm et al. [9] reported a reappraisal of 196 cases of canities subita, of whom 44 cases were authenticated. Poliosis was the most frequent associated disease. ...
Full-text available
Canities subita has been considered by some authors an acute episode of diffuse alopecia areata in which the sudden whitening is caused by the preferential loss of pigmented hair in this immune-mediated disorder. Clinically, the “salt and pepper” pattern of hair color is the most frequent manifestation of canities subita. However, the exact physiopathology of canities subita is not completely understood. A 69-year-old Caucasian man was referred for the sudden and asymptomatic whitening of the hair on the scalp and eyebrows, without an associated hair loss. The trigger was the death of his brother. Hair whitening appeared 24 h after the event. He reported a history of alopecia areata in plaques on the scalp, with spontaneous complete resolution in 2006. The physical examination showed full whitening hair on the scalp and eyebrows. Eyelashes were not affected. The pull test was negative, and the patient denied a significant hair loss in the last days. The histopathological study showed several follicle-sebaceous structures in the anagen, and one of them (inset) with a transforming hair bulb. The anterior bulb was surrounded by a lymphocytic inflammatory infiltrate in an advanced stage of transformation to the catagen and incipient scar changes. Immunohistochemistry staining showed a positive anti-PD-L1 antibody expressed in the inflammatory infiltrate. Based on the clinical and histological findings, a diagnosis of canities subita was made. The histopathological study showed a positive staining for anti-PD-L1 antibodies, supporting the role of the immune system in the development of this phenomenon. The interaction between melanogenesis and the lymphocytes warrants further research.
... [23,50,88] There is even substantial evidence that the sudden whitening of hair after emotional trauma really does occur, although there is no conventional explanation for this rapid bleaching of hairs which are essentially dead matter. [50,89,90] It is likely that physical symptoms in somatic CORT are generated in a similar way, i.e. they might be induced in a non-material way via a mental or psychical impulse that doesn't even have to be conscious. The previously mentioned twin CORT of Indika and Kakshappa Ishwara is likewise a somatic case. ...
... There is no conclusive evidence that sudden bleaching can occur without concomitant diffuse AA, affecting pigmented hair and sparse gray hair. The number of authentic cases suggests a more systematic approach in investigating the factors that can cause sudden loss of hair pigmentation (Nahm 2013). ...
Full-text available
Alopecia areata (AA) has no definite cure, and several commonly used treatments require robust proof of effectiveness, efficiency, and security. This handbook provides the minimum and necessary knowledge about Evidence-Based Medicine and the dermatological disease known as AA. It also presents a broad systematic review of the medical literature on treatments (published randomized clinical trials) and analyzes each treatment’s effectiveness. Although not intended to replace specialized books, reading this manual can help decide the best (evidence-based) AA treatments (including variants AT - Alopecia Totalis and AU - Alopecia Universalis ) for Dermatology training and various specialties trained doctors.
... There is no conclusive evidence that sudden bleaching can occur without concomitant diffuse AA, affecting pigmented hair and sparse gray hair. The number of authentic cases suggests a more systematic approach in investigating the factors that can cause sudden loss of hair pigmentation (Nahm 2013). ...
Full-text available
There is no definitive cure for AA (Alopecia areata), and several commonly used treatments require proof of effectiveness, efficiency, and security. This manual provides the reader with the minimum and necessary knowledge about Evidence-Based Medicine and the dermatological disease known as AA. It also presents a broad systematic review of the medical literature on treatments (published randomized clinical trials) and analyzes each treatment’s effectiveness. Although not intended to replace specialized books, reading this manual can help decide the best (evidence-based) treatment of AA (and its variants Alopecia Totalis – AT and Alopecia Universalis - AU) for Dermatology training and various specialties trained doctors.
... In other words, a hair strand could be white completely in a few weeks. [16] CAniTiES SuBiTA (MARiE AnToinETTE SyndRoME) ...
Full-text available
Marie Antoinette syndrome (Canities subita) can be defined by the sudden graying of a person's hair as a result of extreme stress, trauma or an illness. It was named after Marie Antoinette, the French queen whose hair turned white overnight until she was guillotined in 1793 during the French Revolution. Marie Antoinette, who was dethroned by the revolution, she knew that she would be executed by a guillotine, so her hair suddenly turned white while in prison due to excessive stress. Cases of sudden graying due to stress and trauma have been documented many times since over 200 years. These cases have been classified in terms of area affected, age, gender, cause of illness, and concomitant diseases, and were named Marie Antoinette syndrome for the first time in 2009. In Latin, it has been named Canities subita by using the words' ani (subita) and whitening (Canities). Although its molecular mechanism has not been clearly resolved, various hypotheses have been put forward by researchers. These are related to the rapid destruction of pigments in the hair, abnormalities that have occurred in the scalp, or the mechanisms of body defense cells that affect pigment oogenesis. Marie Antoinette syndrome, which is a very rapid whitening of hair, eyelashes, eyebrows or other body hair, can be triggered by bodily illnesses, severe psychological illnesses, emotional stress or severe trauma caused by an event. Nowadays, data on this disease are limited, and it is a subject open to research for the medical world.
... In light of these results, we next applied our HPP method to examine the possibility that psychological stress is associated with hair greying/reversal in humans. Anecdotal case reports and a recent pilot study suggest that psychological stress and other behavioral factors accelerate the hair greying process (Nahm et al., 2013;Peters et al., 2017), a notion supported by studies in mice demonstrating that adrenergic stimulation by norepinephrine signaling leads to melanocyte stem cell depletion in mice (Zhang et al., 2020). However, contrary to mice where this process appears to be irreversible at the single hair follicle level, our data demonstrates that human hair greying is, at least under In a 37-year-old Caucasian female, two bi-color HS collected 2 months apart aligned based on a growth rate of 1 cm/month undergoing reversal nearly simultaneously. ...
Full-text available
Background: Hair greying is a hallmark of aging generally believed to be irreversible and linked to psychological stress. Methods: Here, we develop an approach to profile hair pigmentation patterns (HPPs) along individual human hair shafts, producing quantifiable physical timescales of rapid greying transitions. Results: Using this method, we show white/grey hairs that naturally regain pigmentation across sex, ethnicities, ages, and body regions, thereby quantitatively defining the reversibility of greying in humans. Molecularly, grey hairs upregulate proteins related to energy metabolism, mitochondria, and antioxidant defenses. Combining HPP profiling and proteomics on single hairs, we also report hair greying and reversal that can occur in parallel with psychological stressors. To generalize these observations, we develop a computational simulation, which suggests a threshold-based mechanism for the temporary reversibility of greying. Conclusions: Overall, this new method to quantitatively map recent life history in HPPs provides an opportunity to longitudinally examine the influence of recent life exposures on human biology. Funding: This work was supported by the Wharton Fund and NIH grants GM119793, MH119336, and AG066828 (MP).
Full-text available
Hair greying (canities) is one of the earliest, most visible ageing-associated phenomena, whose modulation by genetic, psychoemotional, oxidative, senescence-associated, metabolic and nutritional factors has long attracted skin biologists, dermatologists, and industry. Greying is of profound psychological and commercial relevance in increasingly ageing populations. In addition, the onset and perpetuation of defective melanin production in the human anagen hair follicle pigmentary unit (HFPU) provides a superb model for interrogating the molecular mechanisms of ageing in a complex human mini-organ, and greying-associated defects in bulge melanocyte stem cells (MSCs) represent an intriguing system of neural crest-derived stem cell senescence. Here, we emphasize that human greying invariably begins with the gradual decline in melanogenesis, including reduced tyrosinase activity, defective melanosome transfer and apoptosis of HFPU melanocytes, and is thus a primary event of the anagen hair bulb, not the bulge. Eventually, the bulge MSC pool becomes depleted as well, at which stage greying becomes largely irreversible. There is still no universally accepted model of human hair greying, and the extent of genetic contributions to greying remains unclear. However, oxidative damage likely is a crucial driver of greying via its disruption of HFPU melanocyte survival, MSC maintenance, and of the enzymatic apparatus of melanogenesis itself. While neuroendocrine factors [e.g. alpha melanocyte-stimulating hormone (α-MSH), adrenocorticotropic hormone (ACTH), ß-endorphin, corticotropin-releasing hormone (CRH), thyrotropin-releasing hormone (TRH)], and micropthalmia-associated transcription factor (MITF) are well-known regulators of human hair follicle melanocytes and melanogenesis, how exactly these and other factors [e.g. thyroid hormones, hepatocyte growth factor (HGF), P-cadherin, peripheral clock activity] modulate greying requires more detailed study. Other important open questions include how HFPU melanocytes age intrinsically, how psychoemotional stress impacts this process, and how current insights into the gerontobiology of the human HFPU can best be translated into retardation or reversal of greying.
This chapter focuses on the microscopical examination of hair in the forensic domain. It discusses the relevant biological aspects of hair to provide the necessary background information upon which forensic hair examinations are based. The chapter introduces the methodologies and techniques used by forensic hair examiners. It describes the basic chemistry and basic histology of hairs. Each individual hair progresses through a regular and predictable cycle. This cycle is classically described as having three major phases: anagen, catagen, and telogen. While a variety of methods can be used, forceps and tape lifts are the two most commonly employed techniques for collecting hairs. Most forensic hair cases involve the examination of human hair. Historically, the emphasis has been placed on human hair comparisons. The chapter provides general guidelines for the comparison of hairs. Finally, the interpretation and significance of the results obtained through a microscopical hair examination are considered.
en Background Polyautoimmunity, the concurrent expression of two or more distinct autoimmune diseases (ADs) in a single individual, is a known phenomenon in humans and has been rarely reported in dogs. To the best of the authors’ knowledge, comorbid pemphigus foliaceus (PF) and generalized discoid lupus erythematosus (GDLE) has not been reported in dogs. Hypothesis/Objectives To describe the clinical, histological and immunological features and treatment outcome of two unrelated dogs with comorbid PF and GDLE. Animals One 10‐year‐old, spayed German shepherd dog and one 8‐year‐old, castrated American Staffordshire terrier presented for evaluation of a symmetrical, facial‐ and/or pedal‐dominant pustular dermatitis with concurrent, truncal scaly plaques. Methods For each dog, clinicopathological characterization included physical examination, lesion cytological evaluation, bacterial culture and sensitivity testing, skin histopathological investigation and direct and indirect immunofluorescence testing. Additional diagnostic imaging and haematological testing was performed to exclude extracutaneous disease. Results Both dogs exhibited lesions clinically and histologically compatible with PF and GDLE. Moreover, one dog exhibited generalized leucotrichia and chronic superficial keratitis. Remission was achieved with immunosuppressive dosages of prednisolone [high‐dose pulse (Case 1) or standard immunosuppressive dosage (Case 2)] and ciclosporin (5–6 mg/kg/day). Tissue‐bound antikeratinocyte immunoglobulin (Ig)G and IgM were detected in both dogs. A weak basement membrane zone deposit of C3 was seen in one dog. Circulating antikeratinocyte and anti‐desmocollin‐1 IgG were detected in one dog. Conclusions and clinical importance Cutaneous polyautoimmunity can occur in the dog. Depending on the specific disease combinations, overlapping clinical features may present diagnostic and/or therapeutic challenges. Moreover, these cases should be monitored for development of additional cutaneous or extra‐cutaneous AD(s). Résumé fr Contexte La poly‐auto‐immunité, l’expression concomitante de deux ou plus de maladies auto‐immunes (ADs) chez un même individu est un phénomène connu chez l’homme ; c’est rarement décrit chez le chien. A la connaissance des auteurs, l’association d’un pemphigus foliacé (PF) et d’un lupus érythémateux discoïde (GDLE) n’a pas été décrit chez le chien. Hypothèses/Objectifs Décrire les données clinques, histologiques et immunologiques ainsi que l’évolution de deux chiens non liés atteints de PF et GDLE. Sujets Une chienne berger allemand stérilisée de 10 ans et un american staffordshire terrier castré de 8 ans présentés en consultation pour une dermatite pustuleuse à dominante faciale/podale symétrique associée à des plaques squameuses tronculaires. Méthodes Pour chaque chien, un examen physique incluait une caractérisation clinicopathologique, une évaluation cytologique, une culture bactériologique et des tests de sensibilité, un examen histopathologique et des tests d’immunofluorescence directes et indirectes. Des test d’imagerie et hématologiques supplémentaires ont été réalisés pour exclure des maladies extra‐cutanées. Résultats Les deux chiens ont montré des lésions cliniques et histologiques compatibles avec PF et GDLE. En outre, un chien a montré une leucotrichie généralisée et une kératite superficielle chronique. Une rémission a été obtenue avec des doses immunosuppressives de prednisolone [doses élevées pulsées (Cas 1) ou dose immunosuppressive standard (Cas 2)] et ciclosporine (5–6 mg/kg/jour). Des immunoglobulines (Ig)M et IgG antikératinocytes ont été détectées chez les deux chiens. Un dépot faible de C3 au niveau de la membrane basale a été observé chez un chien. Les antikératinocytes circulants et IgG anti‐desmocolline 1 ont été détectés chez un chien. Conclusions et importance clinique La poly‐auto‐immunité cutanée peut se produite chez le chien. En fonction des combinaisons spécifiques des maladies, un recoupement des lésions cliniques peut représenter un défit diagnostic et/ou thérapeutique. En outre, ces cas devraient être suivis pour le développement d’autres atteintes cutanées ou extracutanées. Resumen es Introducción la poliautoinmunidad, la expresión conjunta de dos o más enfermedades autoinmunes (ADs) distintas en un solo individuo, es un fenómeno conocido en humanos; rara vez se ha reportado en perros. A entender de los autores, pénfigo foliáceo (PF) y lupus eritematoso discoide generalizado (GDLE) no se han reportado en perros en aparición conjunta. Hipótesis/Objetivos describir las características clínicas, histológicas e inmunológicas y el resultado del tratamiento de dos perros no relacionados con PF y GDLE de aparición conjunta. Animales un perro pastor alemán castrado de 10 años de edad y un American Staffordshire terrier castrado de 8 años de edad presentados para evaluación de una dermatitis predominantemente pustular simétrica, facial y/o podal y placas escamosas truncales concomitantes. Métodos en cada perro, la caracterización clínico‐patológica incluyó examen físico, evaluación citológica de la lesión, cultivo bacteriano y pruebas de sensibilidad, investigación histopatológica de la piel y pruebas de inmunofluorescencia directa e indirecta. Se realizó un diagnóstico por imagen adicional y una investigación hematológica para excluir enfermedades extracutáneas. Resultados Ambos perros exhibieron lesiones clínicamente e histológicamente compatibles con PF y GDLE. Además, un perro presentó leucotrichia generalizada y queratitis superficial crónica. La remisión se logró con dosis inmunosupresoras de prednisolona [pulso de dosis alta (caso 1) o dosis inmunosupresora estándar (caso 2)] y ciclosporina (5–6 mg/kg /día). Se detectaron inmunoglobulinas (Ig) G e IgM antiqueratinocitos unidas a tejidos en ambos perros. Se observó un depósito débil de C3 en la membrana basal epidermal en un perro. Se detectaron IgG antiqueratinocitos y anti‐desmocollin‐1 circulantes en un perro. Conclusiones e importancia clínica la poliautoinmunidad cutánea puede ocurrir en el perro. Dependiendo de las combinaciones de enfermedades específicas, las características clínicas superpuestas pueden presentar dificultades diagnósticas y/o terapéuticas. Además, estos casos deben ser controlados por el posible desarrollo de AD(s) cutáneas o extracutáneas adicionales. Zusammenfassung de Hintergrund Die Polyautoimmunität, der momentane Ausdruck für zwei oder mehr unterschiedliche Autoimmunerkrankungen (ADs) in einem einzigen Individuum ist ein bekanntes Phänomen beim Menschen; es wird bei Hunden nur selten beschrieben. Nach bestem Wissen der Autoren, wurde bisher eine Komorbidität von Pemphigus foliaceus (PF) und generalisiertem discoiden Lupus Erythematosus (GDLE) bei Hunden nicht beschrieben. Hypothese/Ziele Die Beschreibung der klinischen, histologischen und immunologischen Merkmale und Behandlungserfolge zweier nicht verwandter Hunde mit Komorbidität von PF und GDLE. Tiere Eine 10 Jahre alte kastrierte Deutsche Schäferhündin und ein 8 Jahre alter kastrierter American Staffordshire Terrier wurden zur Evaluierung einer symmetrischen, Gesichts und/oder die Füsse‐dominierender pustulöser Dermatitis mit gleichzeitigen schuppigen Plaques am Rumpf vorgestellt. Methoden Für jeden Hund beinhaltete die klinisch‐pathologische Charakterisierung eine physische Untersuchung, eine zytologische Evaluierung der Läsionen, eine Bakterienkultur und Antibiogramm, eine histopathologische Untersuchung der Haut und direkte und indirekte Immunfluoreszenz. Zusätzliche Bildgebende Diagnostik und hämatologische Untersuchungen wurden durchgeführt, um Erkrankungen, die nicht mit der Haut im Zusammenhang standen, auszuschließen. Ergebnisse Beide Hunde zeigten Hautveränderungen, die klinisch und histologisch mit PF und GDLE vergleichbar waren. Zusätzlich zeigte ein Hund eine generalisierte Leukotrichie und eine chronische superfizielle Keratitis. Eine Remission wurde mit immunsuppressiven Dosen von Prednisolon [hochdosierte Pulstherapie (Fall 1) oder eine Standard immunsuppressive Dosis (Fall 2)] und Ciclosporin (5‐6 mg/kg/Tag) erzielt. An Gewebe gebundene Antikeratinozyten Immunglobulin (Ig) G und IgM wurden bei beiden Hunden gefunden. Eine schwache Ablagerung in der Basalmembran von C3 wurde bei einem Hund gefunden. Bei einem Hund wurden zirkulierende Antikeratinozyten und Anti‐Desmocollin‐1 IgG festgestellt. Schlussfolgerungen und klinische Bedeutung Eine kutane Polyautoimmunität kann beim Hund auftreten. Abhängig von den spezifischen Krankheitskombinationen, könnten überlappende klinische Merkmale diagnostische und/oder therapeutische Herausforderungen darstellen. Darüber hinaus sollten diese Erkrankungen auf die Entwicklung zusätzlicher kutaner oder extra‐kutaner AD(s) untersucht werden. 要約 ja 背景 単一個体における2つ以上の異なる自己免疫疾患(AD)を同時発現する多発性自己免疫性疾患は、人医療においては既知の現象である。犬ではほとんど報告されていない。著者の知る限り、落葉性天疱瘡(PF)および全身性円板状エリテマトーデス(GDLE)を併発した犬は報告されていない。 仮説/目的 本研究の目的は、PFとGDLEが併発した血縁のない2頭の犬の臨床的、組織学的、免疫学的特徴と治療成績を説明することであった。 供試動物 1頭の10歳避妊雌ジャーマン・シェパード・ドッグおよび1頭の8歳去勢雄アメリカン・スタッフォードシャー・テリアが、左右対称性の顔面および/または肢を主要病変とする膿疱性皮膚炎と同時発生した体幹の鱗状局面の評価のため来院した。 方法 各犬の臨床病理学的特性の評価には、身体検査、病変細胞学的評価、細菌培養および薬剤感受性検査、皮膚組織病理学的検査、直接および間接免疫蛍光検査を含んだ。皮膚以外の疾患を除外するため、追加画像診断および血液学的調査を実施した。 結果 どちらの犬においても、PFおよびGDLEと臨床的および組織学的に適合した病変を示した。さらに、1頭の犬は、全身性白毛症および慢性表在性角膜炎を呈した。免疫抑制量のプレドニゾロン[高用量パルス(症例1)または標準免疫抑制量(症例2)]およびシクロス ポリン(5‐6 mg / kg /日)によって寛解に至った。組織結合抗ケラチノサイト免疫グロブリン(Ig)GおよびIgMがどちらの犬でも検出された。 C3の基底膜領域における弱い沈着が1頭の犬に認められた。循環抗角化細胞および抗デスモコリン‐1 IgGが1頭の犬で検出された。 結論と臨床的重要性 犬では皮膚自己免疫疾患が起こる。特定の疾患の組み合わせに応じて、重複する臨床的特徴は診断および/または治療上の課題が認められる場合がある。さらに、本症例は皮膚または皮膚以外のADの追加の発生を監視する必要がある。 摘要 zh 背景 多发性自身免疫是已知的人类疾病,一个病患同时表现两种或两种以上不同的自体免疫病 (ADs);在犬鲜有报道。据作者所知,尚未有过关于犬并发落叶型天疱疮 (PF) 和全身性盘状红斑狼疮 (GDLE) 的报告 。 假设/目的 描述两只无血缘关系、并发PF和GDLE的犬,报告其临床、组织学和免疫学特征以及治疗效果。 动物 一只10岁切除卵巢的德国牧羊犬和一只8岁去势的美国斯塔福德郡㹴犬,评估其对称性面部和/或爪部脓疱性皮炎,以及并发的躯干鳞屑性斑块。 方法 对于每只犬,临床病理学表征包括体格检查、病变细胞学评估、细菌培养和药敏试验、皮肤组织病理学研究以及直接和间接免疫荧光试验。另外进行影像学诊断和血液学检查,以排除皮肤系统外疾病。 结果 两只犬均表现出与PF和GDLE临床和组织学相符的病变。此外,一只犬表现出全身性白毛病和慢性浅表性角膜炎。使用免疫抑制剂量的泼尼松龙 [高剂量脉冲(病例 1),或标准免疫抑制剂量(病例 2)] 和环孢素(5‐6 mg/kg/天)达到缓解。在两只犬身上均检测到组织结合的抗角质细胞免疫球蛋白 (Ig) G 和 IgM。在一只犬身上观察到C3的弱基底膜带沉积。在一只犬身上检测到循环抗角质细胞和抗桥粒糖蛋白‐1 IgG。 结论和临床重要性 皮肤多发性自体免疫可发生在犬身上。根据特定的疾病组合、重叠的临床特征可能带来诊断和/或治疗挑战。此外,应监测这些病例是否发生其他皮肤或皮肤系统外ADs。 Resumo pt Contexto A poliautoimunidade, expressão simultânea de duas ou mais doenças autoimunes (DAs) distintas em um único indivíduo, é um fenômeno conhecido em humanos; este raramente é relatado em cães. De acordo com o conhecimento dos autores, ainda não há relatos em cães de pênfigo foliáceo (PF) e o lúpus eritematoso discóide generalizado (GDLE) em comorbidade. Hipótese/Objetivos Descrever as características clínicas, histológicas e imunológicas e o resultado do tratamento de dois cães não relacionados com PF e GDLE em comorbidade. Animais Um cão pastor alemão de 10 anos, castrado e um American Staffordshire terrier castrado de 8 anos de idade foram apresentados para avaliação de uma dermatite pustular simétrica, predominantemente facial e/ou a podal com placas descamativas concomitantes no dorso. Métodos Para cada cão, a caracterização clínico‐patológica incluiu exame físico, avaliação citológica lesional, cultura bacteriana e teste de sensibilidade, investigação histopatológica da pele e teste direto e indireto de imunofluorescência. Diagnóstico por imagem adicional e investigação hematológica foram realizadas para excluir doença extracutânea. Resultados Ambos os cães apresentaram lesões clinica e histologicamente compatíveis com PF e GDLE. Além disso, um cão exibiu leucotriquia generalizada e ceratite superficial crônica. A remissão foi alcançada com dosagens imunossupressoras de prednisolona [pulso de alta dose (Caso 1) ou dosagem imunossupressora padrão (Caso 2)] e ciclosporina (5–6 mg / kg / dia). Detectou‐se a presença de imunoglobulina (Ig) anti‐queratinócito G e a IgM ligadas ao tecido em ambos os cães. Um depósito fraco de C3 na zona da membrana basal foi observado em um cão. Anticorpos IgG anti‐queratinócitos e anti‐desmocolina‐1 circulantes foram detectados em um cão. Conclusões e importância clínica A poliautoimunidade cutânea pode ocorrer no cão. Dependendo das combinações específicas de doenças, as características clínicas sobrepostas podem apresentar desafios diagnósticos e/ou terapêuticos. Além disso, esses casos devem ser monitorados quanto ao desenvolvimento de Das cutâneas ou extra‐cutâneas adicionais.
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Sudden hair whitening (canities) was first reported centuries ago. Although a rare event, it has affected well-known historical figures, including Sir Thomas Moore and Queen Marie Antoinette of France. Early reports are substantiated by more recent cases in the scientific literature. Often, there is association with psychological stress; in the two historical cases above, the condition is thought to have been a reaction to the sentence of execution. In this paper, we examine some case histories of those afflicted throughout history and discuss hypotheses to explain the phenomenon.
Die als Alopecia areata bezeichnete Alopekieform stellt ein selbstndiges, durch einen charakteristischen Symptomenkomplex von allen anderen Alopekien leicht unterscheidbares Krankheitsbild dar.Die meisten Flle von Areata knnen klinisch nicht anders als durch die Annahme einer bertragung eines noch unbekannten Kontagiums erklrt werden. Ab und zu kommen jedoch auch Flle von traumatischer und neurotischer Alopekie zur Beobachtung, bei denen eine Infektion auszuschlieen ist, und welche wir doch klinisch von dem Krankheitsbild einer typischen Areata zu unterscheiden nicht im stande sind. Endlich knnen ganz vereinzelt auch toxische Ursachen eine der Areata sehr hnliche Alopekie hervorrufen.Diese klinischen und die experimentellen Erfahrungen verbieten uns, weiter an einer einheitlichen tiologie der Alopecia areata festzuhalten.Da eine prinzipielle Trennung verschiedener Formen von Alopecia areata nach dem klinischen Bilde nicht durchgefhrt werden kann, aber unter demselben klinischen Bild Affektionen ganz verschiedener tiologie verlaufen, sind wir gentigt, die Alopecia areata als einen Symptomenkomplex aufzufassen, der durch von einander verschiedene Noxen (Infektion, Innervationsstrung, Intoxikation) in gleicher Weise hervorgerufen werden kann.
A case is reported of a patient whose hair suddenly appeared to have turned white. As the disease progressed, he developed patches of complete hair loss, which established the diagnosis of alopecia areata.
Figure.A, Singular patch of alopecia areata on the left parietal side (X) of the patient's scalp. B, Total canities. The time lapse between A and B was 6 months (normal photodocumentationinterval).Marie Antoinette syndrome designates the condition in which scalp hair suddenly turns white. The name alludes to the unhappy Queen Marie Antoinette of France (1755-1793), whose hair allegedly turned white the night before her last walk to the guillotine during the French Revolution. She was 38 years old when she died. Although the actual incidence is rare, this stigmatizing phenomenon, which has captured storytellers' imagination like few other afflictions, occurs to protagonists as a sign of grave sorrow in religious texts as early as the Talmud. History also records that the hair of the English martyr Sir Thomas More (1478-1535) turned white overnight in the Tower of London before his execution. More modern accounts refer to the turning white of hair in survivors of bomb attacks during World War II. In 1957, an American dermatologist witnessed a 63-year-old man's hair turn white over several weeks after he had fallen down some stairs. The patient noticed loss of hair but no bald patches and 17 months later had extensive vitiligo.1 The term canities subita has also been used for this disorder.2- 3 Today, the syndrome is interpreted as an acute episode of diffuse alopecia areata in which the very sudden “overnight” graying is caused by the preferential loss of pigmented hair in this supposedly immune-mediated disorder.4 This observation has led some experts to hypothesize that the autoimmune target in alopecia areata may be related to the melanin pigment system.5