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A Very Rare Complication: New Hair Growth around Healing Wounds

ZY Sun, JS Diao, SZ Guo and GQ Yin Journal of International Medical Research 2009 37: 583 DOI: 10.1177/147323000903700236 The online version of this article can be found at: http://imr.sagepub.com/content/37/2/583

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The Journal of International Medical Research 2009; 37: 583 586 [first published online as 37(2) 9]

A Very Rare Complication: New Hair Growth Around Healing Wounds

ZY SUN1*, JS DIAO2*, SZ GUO2
AND

GQ YIN1

1Department of Plastic Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, China; 2Institute of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xian, China

We present the case of a patient in whom active new hair growth occurred around a wound after healing. This very rare phenomenon has not previously been reported in the literature. We postulate that, after the epidermis and hair follicles have been damaged by wounding, it is KEY WORDS: WOUND
REPAIR;

possible for them naturally to heal and repair if provided with an appropriate chemical and physical microenvironment. This hypothesis may inspire new thinking in the management of alopecia, tissue engineering and the regeneration of other organs. HAIR
FOLLICLES;

HAIR

GROWTH

Introduction
Active new hair growth around wounds is a very rare phenomenon and, as far as we are aware, there have been no previous published clinical reports on this. Although epidermis that is lost on injury can regenerate, the loss of adult hair follicles has, until now, been considered permanent.1,2 If, however, an appropriate chemical and physical microenvironment is provided after wounding it may be that hair follicles can develop anew.3,4 The case that we report of a man who requested medical attention for sudden increased hair growth around facial scar tissue after a boiling water scald injury to the area is, therefore, highly unusual and may inspire new thinking in the management of alopecia, tissue engineering and the regeneration of other organs.
*These authors contributed equally to this work.

Case report
A 25-year-old man requested medical attention for a sudden increase in hair growth on the left cheek (Fig. 1). The patient reported that he had scalded himself on the left cheek with boiling water 1 year previously, but then left the wound open while it was healing. Eight months later, he noticed hair growing around the scar tissue that grew faster than his moustache but caused no sensation. He shaved several times but the hair continued to grow. Histological analysis of the tissue around the wounds showed new hair follicle formation but no other distinct changes in the subcutaneous tissue (Fig. 2). The man had no history of endocrine disorders and an overall medical examination showed he was healthy.

Discussion
The phenomenon of active new hair growth

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ZY Sun, JS Diao, SZ Guo et al. New hair growth around healing wounds

FIGURE 1: The patient scalded himself on the left cheek with boiling water 1 year ago, then left the wound open while it healed and, 8 months later, noticed hair growing around the scar tissue on the left cheek (left), whereas the right side was normal (right)

20 m

50 m

FIGURE 2: Histology of punch biopsy around the wound showing new hair follicle formation (black arrows) but no other distinct changes in the subcutaneous tissue (haematoxylin and eosin staining)

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ZY Sun, JS Diao, SZ Guo et al. New hair growth around healing wounds
around wounds is very rare and no previous relevant clinical report has been published. We postulated that damaged epidermis and hair follicles in a wound can naturally heal and repair. The skins means of repairing the epidermis after injury resides in its stem cells which, in adults, occur in the basal layer of the epidermis and in the hair follicles.1 The main purposes of the stem cells are to maintain homeostasis of adult skin and hair follicles during cycling, and to participate in repair of the epidermis. Skin stem cells have sufficient proliferative capacity to replenish cells that are lost in tissue injury and to produce enough new epidermis to cover the wound surface.2 Epidermis that is lost on injury can regenerate, but the loss of adult hair follicles, which consist of at least 10 different epithelial and mesenchymal cell types, has been considered permanent.1,2 Ito et al.,3 however, reported that skin wounds can stimulate the formation of hair spontaneously as part of the normal healing process. They also indicated that the ability to regenerate new hair follicles during healing depends on the characteristics of the wound. It is not entirely surprising, therefore, that hair follicles can develop anew if an appropriate chemical and physical microenvironment is provided after wounding.4 After the skin has been wounded, various signalling systems coordinate the healing process and this provides a new microenvironment. The extrinsic signals received by the microenvironment and translated through transmembrane receptors are likely to couple with the intrinsic properties of epidermal stem cells to define their ability to undergo wound repair.2 Ito et al.3 also indicated that non-hair-follicle stem cells, when exposed to a new microenvironment (i.e. in response to wounding), not only can transform into wound epidermis but also into hair follicles. Whether epidermal or infundibular cells give rise to the new follicles awaits the identification of reliable markers for these areas,3 however, such cellular processes have been shown to occur under experimental conditions in healing skin wounds in mice.3 Nevertheless, the process of skin healing differs between humans and mice, and these experimental results need to be verified in humans. What is remarkable about the case we present here is that skin wounds stimulated the formation of hair spontaneously during the normal healing process in a human. We still know very little about the mechanisms and precise signalling pathways that are involved in mesenchymalepithelial interactions that lead cells to commit to differentiation into epidermal cells or hair follicles. A great deal of research has implicated various cell signalling pathways, including the Wnt, Bmp, sonic hedgehog (Shh), Notch, FGF (fibroblast growth factor) and TGF- (transforming growth factor ) pathways, in the tug of war between the fates of differentiation into epidermal cells and hair follicle cells.3,5 It is still not clear, however, whether these signalling pathways are involved in coordinating this central choice in skin development. A major therapeutic aim of stem cell research is to induce stem cells to differentiate into different cell types in the hope of eventually forming new organs as a means of treating diseases. Green6 harvested skin keratinocytes from the unaffected area of a burn patient, induced them to proliferate in culture and then grafted them back onto the burn to form a self-renewing skin; however, they did not form hair follicles. We believe that the regeneration of new hair follicles requires an appropriate, specific chemical and physical microenvironment and that the present case

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ZY Sun, JS Diao, SZ Guo et al. New hair growth around healing wounds
will inspire new thinking in the management of alopecia, tissue engineering and the regeneration of other organs. Fifth China Youth Award of Innovation in Science and Technology (to Dr Sun).

Acknowledgement
This study was supported by a grant of the

Conflicts of interest
The authors had no conflicts of interest to declare in relation to this article.

Received for publication 17 October 2008 Accepted subject to revision 24 October 2008 Revised accepted 5 February 2009 Copyright 2009 Field House Publishing
References 1 Taylor G, Lehrer MS, Jensen PJ, et al: Involvement of follicular stem cells in forming not only the follicle but also the epidermis. Cell 2000; 102: 451 461. 2 Fuchs E: Scratching the surface of skin development. Nature 2007; 445: 834 842. 3 Ito M, Yang Z, Andl T, et al: Wnt-dependent de novo hair follicle regeneration in adult mouse skin after wounding. Nature 2007; 447: 316 320. 4 Chuong CM: Regenerative biology: new hair from healing wounds. Nature 2007; 447: 265 266. 5 Fuchs E, Raghavan S: Getting under the skin of epidermal morphogenesis. Nat Rev Genet 2002; 3: 199 209. 6 Green H: Cultured cells for the treatment of disease. Sci Am 1991; 265: 96 102.

Authors address for correspondence Professor Guo-Qian Yin Department of Plastic Surgery, First Affiliated Hospital, Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi 530021, China. E-mail: yingq61@163.com

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