Endocrine effects on the skin - Pathology

()Map ENDOCRINE SYSTEM (Map)

The endocrine system typically has effects on the hair growth cycle so alopecia is a common finding. Many types of endocrine skin disease cause similar pathology.

The hair growth cycle

Hair follicles grow in repeated cycles in a mosiac pattern so that the whole hair coat isn't lost at one time.

• Anagen: Growth phase.
  The majority of hair follicles will be in this phase. The hair grows in length.
• Catagen: Transition phase.
  The dermal papilla is broken away and the follicle shrinks.
• Telogen: Resting phase.
  The hair doesn't grow but stays attached while the dermal papilla is resting.

After telogen the follicle re-enters anagen and the dermal papilla reattaches to the base of the follicle. If the old hair has not already epilated it will be pushed out by the new growing hair.

Pathogenesis

General skin changes seen with endocrine disease include:

• Hypotrichosis.
• Alopecia; usually bilaterally symmetric and non-pruritic.
• Pigment disturbance.
• Seborrhoea.

Histologically many of the follicles will be in telogen where the haircoat is easily epilated and then fails to regrow. This is why alopecia occurs over areas of friction (trunk face etc) while the legs and tail are spared. Follicular and epidermal atrophy may be evident along with atrophy of the adnexa E.g sebaceous atrophy.

Specific changes associated with disease:

Flame Follicles. Courtesy of A. Jefferies

• Hypothyroidism: Mucin within the dermis; myxoedema.
• Hyperadrenocorticism: Calcinosis cutis and dermal thinning.
• GH deficiency: Decreased dermal elastin and catagen follicles (Flame follicles).