Abnormal inner root sheath of the hair follicle in the loose anagen hair syndrome: An ultrastructural study Paradi Mirmirani, MD, Hideo Uno, MD, PhD,

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Abnormal inner root sheath of the hair follicle in the loose anagen hair syndrome: An ultrastructural study Paradi Mirmirani, MD, Hideo Uno, MD, PhD, Vera H. Price, MD Journal of the American Academy of Dermatology Volume 64, Issue 1, Pages 129-134 (January 2011) DOI: 10.1016/j.jaad.2010.01.026 Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Photomicrograph of lower portion of anagen follicle from the scalp of a healthy individual showing the orderly arrangement and keratinization of Henle cells (arrow), Huxley cells (x), and hair cuticle cells (arrowhead). ORS, Outer root sheath; H: hair cortex; DP, dermal papilla. (Original magnification: ×63;.) [Courtesy of Drs Uno and Montagna, 1988] Journal of the American Academy of Dermatology 2011 64, 129-134DOI: (10.1016/j.jaad.2010.01.026) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Lower portion of an anagen follicle from a patient showing the irregularly thickened and tortuous appearance of a keratinized Henle cell strand (arrow), vacuolar swelling of Huxley cell (x), and irregular keratinization of hair cuticle cells (arrowhead). (Original magnification: ×63.) Journal of the American Academy of Dermatology 2011 64, 129-134DOI: (10.1016/j.jaad.2010.01.026) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Ultrastructure of inner root sheath of an anagen follicle in normal scalp showing prekeratinized and keratinized Henle cells (HL), Huxley cells (HX), inner cuticle (IC), and hair cortical cuticle cells (CC). A prekeratinized Henle cell contains large trichohyaline granules and many bundles of filaments running parallel to the longitudinal axis; the filaments' contact with keratinized Henle cells consist of densely arranged long filaments. Huxley cells contain trichohyaline granules and few filament bundles. Cuticle cells are arranged in an orderly fashion. (Original magnification: ×7000.) (Courtesy of Dr K. Hashimoto, 1976.) Journal of the American Academy of Dermatology 2011 64, 129-134DOI: (10.1016/j.jaad.2010.01.026) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 Ultrastructure of inner root sheath in anagen follicle of patient showing dyskeratotic change and disconnection of Henle cell (HL), poor orientation of filaments and vacuoles in Huxley (HX) and inner cells (IC). (Original magnification: ×6650.) Journal of the American Academy of Dermatology 2011 64, 129-134DOI: (10.1016/j.jaad.2010.01.026) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Ultrastructure of upper bulb of anagen follicle of a patient showing marked intercellular edema (arrow) and loose connection of Huxley cells (HX) throughout nonkeratinized layer and edematous separation between Huxley cells and inner cuticle cell (IC) layers. Henle cells (HL) show irregular swelling and uneven filamentous arrangement. (Original magnification: ×8000.) Journal of the American Academy of Dermatology 2011 64, 129-134DOI: (10.1016/j.jaad.2010.01.026) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions