Never too old to regenerate? Wound induced hair follicle neogenesis after secondary intention healing in a geriatric patient

https://doi.org/10.1016/j.jtv.2018.01.001Get rights and content

Highlights

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    Secondary intention healing of a large skin wound defect can result in minimal scar.

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    Hair regeneration has never been reported in human skin wound, especially in elderly patient.

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    This may be the first report on human hair neogenesis in elderly scalp after wound healing.

Abstract

Wound healing is a natural process to restore the structure and function of injured or diseased tissues. Repair of a skin wound usually leads to a scar while regeneration implies fully recovery of function and structure of the damaged tissue. Adult skin wound usually heals with scar while fetal skin heals scarless. Hair regeneration in elderly scalp wound has never been observed. We reported an 80-year-old patient with a large wound on the scalp after excision of a basal cell carcinoma healed by secondary intention wound healing. The patient's wound healed very well aesthetically. Interestingly, on approximate post wound day 180, a hair was observed to be growing towards the surface and eventually erupted in the center of the wound. The hair remained black at 42-month follow-up. This case demonstrated that neogenesis of hair is possible even in geriatric patient. To the best of our knowledge, this is the first report of hair regrow in human skin after wound healing.

Introduction

Wound repair is a self-preservation mechanism for species. Regeneration is the mechanism where a tissue or organ regains complete structure and function after injury. Ectodermal organ regeneration has been reported in mice and rabbits with large full-thickness dorsal wounds after healing with secondary intention [1], [2], [3]. The regenerated hair follicles occurred only in the center of the wound with re-epithelization in the wound margin. Furthermore, this wound induced hair follicle neogenesis (WIHN) becomes restricted with age, young mice regenerate much better than mature or geriatric mice. Cotsarelis' team discovered that fibroblast growth factor 9, initially secreted by γδ T cells, modulates WIHN after full-thickness skin wounding of adult mice. The authors hypothesized that humans do not regenerate hair after wounding due to limited quantities and no resident dermal γδ T cells [3]. In humans, there are anecdotal reports of digit regeneration after amputation of finger tips in young children. Illingworth reported excellent cosmetic and functional results in guillotine amputations of finger tips in young children with secondary intention healing [4]. However, hair regeneration has not been reported after full-thickness wound healing in human. Here, we report hair growth near the center of a large occipital healing wound, potential WIHN, in an 80-year-old gentleman. This regeneration occurred during secondary intension healing of a large full-thickness scalp wound due to surgical excision of a basal cell carcinoma. To the best of our knowledge, this may be the first case of hair neogenesis after wound healing in human.

Section snippets

Case report

An 80-year-old Taiwanese gentleman presented to the National Cheng Kung University Department of Dermatology outpatient clinic with a 5-year history of a growing mass on his occipital scalp (Fig. 1A). The patient has hypertension and diabetes which were under medical control. On examination, a 2.5 cm × 2.3 cm pigmented tumor with a rolling border was noted on the occipital scalp. The clinical diagnosis was basal cell carcinoma and was confirmed with histopathology. The submental and neck lymph

Discussion

This elderly man potentially demonstrated the first observation of follicular neogenesis in the center of a large healed scar in the geriatric population. Chuong proposed that wound repair and tissue regeneration are in competition [1]. If the wound is small, it heals with repair. If the wound is sufficiently large, it induces regeneration. The original description of WIHN by Breedis showed that delayed wound contraction was necessary for WIHN [5]. In fact, if normal contract occurred, then no

Conclusion

The present case shows the possibility of hair regeneration in humans, even in old age. More cases are needed to confirm this observation and for further study to elucidate the mechanism. If we can understand more of the underlying principles, we may gain new knowledge to develop novel strategies to treat hair related diseases or severe full-thickness injuries.

Statement of ethics

The authors have no ethical conflicts to disclose.

Disclosure statement

The authors declare no conflicts of interest.

Funding sources

The study is supported by the Ministry of Science and Technology of Taiwan (MOST103-2314-B-006-024) to Dr. TW Wong.

Conflicts of interest

None.

References (11)

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    Interestingly, despite being first recognized in rats, recent work by Guerrero-Juarez et al. suggests that it is not a common feature of laboratory strains of rats [13]. Although it has been reported in a few select cases, wounds in humans do not undergo large scale, clinically obvious, de novo hair regeneration [14–16]. The molecular mechanisms of WIHN were first described by Ito and Cotsarelis et al., who developed a reproducible mouse (Mus musculus) model for studying the process [2].

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1

Szu-Han Wang was a 5th grade medical student in the Department of Dermatology.

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