title: Alopecia areata and affected skin CRH receptor upregulation induced by acute emotional stress.
abstract: BACKGROUND
  Recent evidence indicates that acute stress can precipitate a number of dermatological conditions, including alopecia areata. This effect may be mediated by corticotropin-releasing hormone (CRH) released locally in the skin from dorsal root ganglia or immune cells. CRH typically acts through activation of specific receptors that are either type 1 or types 2 alpha and 2 beta. CRH, or related peptides such as urocortin, could have proinflammatory effects directly or through activation of mast cells leading to destruction of the hair root.
  
  
  OBJECTIVE
  To investigate the expression of CRH receptors on the affected skin of patients who developed alopecia areata following acute emotional stress.
  
  
  METHODS
  Scalp skin biopsies were obtained from 1 normal volunteer and 3 patients after ring infiltration of the relevant site with lidocaine. The biopsies were frozen and were later processed for in situ hybridization for CRH receptors type 1 or types 2 alpha and 2 beta. Sections showing positive results were photographed.
  
  
  RESULTS
  The skin from the normal volunteer showed weak background expression of all three receptor types. However, skin from the affected sites of all 3 patients studied showed intense expression only on the type 2 beta receptor around the hair follicles.
  
  
  CONCLUSIONS
  Acute emotional stress may precipitate alopecia areata by activation of overexpressed type 2 beta CRH receptors around the hair follicles leading to intense local inflammation.
authors.affiliation: A. Syggros Hospital for Dermatologic Diseases, University of Athens School of Medicine, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Katsarou-Katsari
authors.forename: L K
authors.initials: LK
authors.lastname: Singh
authors.forename: T C
authors.initials: TC
authors.lastname: Theoharides
mesh_terms: D000328:Adult; D000506:Alopecia Areata / Q000209:etiology* / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D003346:Corticotropin-Releasing Hormone / Q000235:genetics*; D005260:Female; D005786:Gene Expression Regulation; D018859:Hair Follicle / Q000378:metabolism; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D012313:RNA / Q000235:genetics / Q000378:metabolism; D012867:Skin / Q000378:metabolism*; D013315:Stress, Psychological / Q000150:complications*; D015854:Up-Regulation
chemical_list: D012313:RNA; D003346:Corticotropin-Releasing Hormone