Exploring the “brain-skin connection”: Leads and lessons from the hair follicle

Research into how the central nervous system (CNS) and the skin of mammals are physiologically connected and how this “brain-skin connection” may be therapeutically targeted in clinical medicine has witnessed a renaissance. A key element in this development has been the discovery that mammalian skin and its appendages, namely human scalp hair follicles (HFs), not only are important, long-underestimated target tissues for classical neurohormones, neurotrophins and neuropeptides, but also are eminent peripheral tissue sources for the production and/or release of these neuromediators. This essay summarizes the many different levels of biology at which human scalp HFs respond to and generate a striking variety of neurohormones, and portrays HFs as prototypic, cyclically remodelled miniorgans that utilize these neurohormones to autoregulate their growth, hair shaft production, rhythmic organ transformation, pigmentation, mitochondrial energy metabolism, and immune status. The essay also explores how preclinical research on human scalp HFs can be exploited to unveil and explore “novel” and clinically as yet untapped, but most likely ancestral functions of neurohormones within mammalian epithelial biology that still impact substantially on human skin physiology. Arguably, systematic investigation of the “brain-skin connection” is one of the most intriguing current research frontiers in investigative dermatology, not the least since it has reversed the traditional CNS focus in studying the interactions between two key organ systems by placing the skin epithelium on center stage.