Hair Follicle Immune Privilege in Autoimmune and Immune-Mediated Alopecias: Paths Toward Reestablishing Immune Tolerance

March 2026 in “ Frontiers in Medicine ”

Pedram Shafiei-Jahani, Xin Li, Amitis Akbari, Emily Haniff, Melissa Ziprick, Ryan Carlisle, Carolyn Goh, Vanessa Holland, Omid Akbari

TLDR Different types of alopecia cause hair loss due to immune system issues, with some allowing regrowth and others causing permanent loss.

The document discusses the breakdown of immune privilege in various forms of alopecia, leading to hair loss. Alopecia areata (AA) allows for hair regrowth after immune suppression due to preserved stem cells, while lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) result in permanent hair loss due to stem cell niche destruction. Discoid lupus erythematosus (DLE) involves immune-complex injury to the upper follicle, and central centrifugal cicatricial alopecia (CCCA) is linked to fibroblast activity and chronic stress. These conditions are categorized into four archetypes based on the location of immune privilege collapse and immune response characteristics. The Network Engineering for Site-Specific Tolerance (NEST) framework is used to classify these alopecias, highlighting the specific immune and stromal dynamics involved in each type.

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