Alopecia- absence or thinning of hair on the skin in places where it usually grows (usually on the scalp).
Code by international classification diseases ICD-10:
- Q84.0
Frequency. 50% of men by the age of 50 have clear signs of baldness according to male type. 37% of postmenopausal women report some signs of alopecia.
Predominant age: the frequency of androgenetic alopecia increases in proportion to age; ringworm of the scalp and traumatic alopecia occur more often in children.
Causes
Etiology. Mature hair loss: .. After childbirth as a consequence physiological changes body of a pregnant woman.. Medicines (oral contraceptives, anticoagulants, retinoids, b-blockers, antitumor drugs, interferon [IFN]) .. Stress (physical or mental) .. Endocrine pathology(hypo- or hyperthyroidism, hypopituitarism).. Nutritional factors (malnutrition, iron, zinc deficiency). Loss of growing hair: .. Mycosis fungoides .. X-ray therapy .. Medicines (antitumor drugs, allopurinol, bromocriptine) .. Poisoning (bismuth, arsenic, gold, boric acid, thallium). Cicatricial alopecia: .. Developmental anomalies and congenital defects .. Infections (leprosy, syphilis, herpetic infection, cutaneous leishmaniasis) .. Basal cell carcinoma.. Epidermal nevi.. Exposure to physical factors (acids and alkalis, extreme temperatures [burns, frostbite], radiation).. Cicatricial pemphigus.. Lichen planus.. Sarcoidosis. Androgenetic alopecia: .. Hyperplasia of the adrenal cortex.. Polycystic ovaries.. Ovarian hyperplasia.. Carcinoid.. Pituitary hyperplasia.. Drugs (testosterone, danazol, ACTH, anabolic steroids, progesterones). Alopecia areata. Etiological factors are unknown, autoimmune nature is possible; inherited forms are described. Traumatic alopecia: .. Trichotillomania (uncontrollable urge to pull out one's own hair)... Damage due to braiding or tightly tying bows. Dermatomycosis of the scalp: .. Fungi of the genus Microsporum .. Fungi of the genus Trichophyton.
Genetic aspects. There are at least 90 known inherited diseases and syndromes accompanied by alopecia. Congenital alopecia with keratosis of the palms and soles (104100, Â). Congenital total alopecia (*104130, Â): combined with giant pigmented nevi, periodontitis, seizures, lag in mental development. Alopecia areata (104000, Â) . Familial alopecia (anagen-telogen transformation, areas of baldness, 104110, Â). Total alopecia (203655, 8p12, HR gene, r). Various degrees of hypotrichosis, up to complete absence of hair, are characteristic of hereditary ectodermal dysplasia (see Ectodermal dysplasia).
Risk factors. Family history of baldness. Physical or mental stress. Pregnancy. Alopecia areata - Down syndrome, vitiligo, diabetes.
Types. Mature hair loss (telîgen effluvium) is diffuse hair loss, leading to a decrease in hair density, but not to complete baldness. Loss of growing hair (anàgen effluvium) - diffuse hair loss, incl. growing, with possible complete baldness. Scarring alopecia is the presence of shiny, smooth areas on the scalp that do not contain hair follicles. Androgenetic alopecia is hair loss that usually affects both sexes; possibly due to the effect of male sex hormones on the cells of the hair follicles. Alopecia areata (circular baldness) is acquired hair loss in the form of rounded lesions of varying sizes in certain areas of the scalp, eyebrows, and beard area, not accompanied by scarring. Traumatic alopecia is hair loss in certain areas of the skin due to chronic trauma, which in the early stages is not accompanied by scarring. Dermatomycosis of the scalp (tinea capitis) - the presence of limited foci with the absence of hair on the scalp, possibly combined with an inflammatory reaction; caused by a fungal infection.
Symptoms (signs)
Clinical picture. Hair loss. With dermatomycosis of the scalp - itching, flaking, inflammation. With dermatomycosis of the scalp and traumatic alopecia - hair breaking. With alopecia areata: sudden appearance on the scalp and face of several rounded areas of complete hair loss without any other changes; hair along the periphery of the lesions is easily pulled out; the lesions can grow, merge and lead to total baldness.
Diagnostics
Laboratory research. Function Research thyroid gland. Full analysis blood (to identify possible violations functions immune system) . Levels of unbound testosterone and dihydroepiandrosterone sulfate in women with androgenetic alopecia. Plasma ferritin concentration. Von Wasserman reaction to exclude syphilis. The number of T - and B - lymphocytes (sometimes reduced in patients with alopecia areata).
Special studies. Hair pulling test: gently tugging (without force) on the hair shaft to remove it; positive (hair is easily removed) for alopecia areata. Microscopic examination of the hair shaft. Examination of areas of peeling using potassium hydroxide; positive for ringworm of the scalp. Application antifungal drugs can lead to false positive results. Examination of areas of peeling for the presence of fungi. A biopsy of the scalp with conventional microscopy and direct immunofluorescence study allows the diagnosis of dermatomycosis of the scalp, diffuse alopecia areata and cicatricial alopecia developed against the background of SLE, lichen planus and sarcoidosis.
Treatment
TREATMENT
Lead tactics. Mature hair loss. Hair loss maximum 3 months after the causative effect (drugs, stress, nutritional factors); Once the cause is eliminated, hair growth is quickly restored. Loss of growing hair. Hair loss begins a few days or weeks after the causative effect, hair growth is restored after the cause is eliminated. Scarring alopecia. The only one effective method treatment - surgical (skin flap transplantation or excision of scarring areas). Androgenic alopecia. After 12 months local application minoxidil, 39% of patients noted hair growth of varying severity. An alternative treatment method is surgery. Alopecia areata. Usually the disease goes away on its own within 3 years without treatment, but relapses often occur. Traumatic alopecia. Cure can occur only after hair pulling stops. Intervention from a psychologist or psychiatrist may be required. Successful treatment involves drug therapy, behavior correction and hypnosis. Dermatomycosis of the scalp: treatment is carried out for 6-8 weeks. Thorough hand washing and washing of hats and towels is necessary.
Drug therapy. Finasteride tablets. Good results have been obtained for various forms of alopecia. For androgenetic alopecia - minoxidil (2% r - r) for topical use. For alopecia areata... Sedatives, vitamins, irritating alcohol rubbing.. HA preparations for topical use.. B severe cases- photosensitizing drugs (beroxan) topically in combination with ultraviolet irradiation(Ural Federal District), GK inside. For dermatomycosis of the scalp - griseofulvin (adults 250-375 mg/day, children 5.5-7.3 mg/kg/day) or ketoconazole 200 mg 1 time/day for 6-8 weeks.
Surgery. Skin transplantation.
Course and prognosis. Mature and growing hair loss: Permanent baldness is rare. Scarring alopecia: Hair follicles are constantly damaged. Androgenetic alopecia: prognosis and course depend on treatment. Alopecia areata: spontaneous recovery is possible, but relapses are common; in the total form, hair is usually not restored. Traumatic alopecia: prognosis and course depend on the success of correction of the patient’s behavior. Ringworm of the scalp: usually completely resolved.
Synonyms. Atrichia. Atrichosis. Baldness. Baldness
ICD-10. L63 Alopecia areata. L64 Androgenic alopecia. L65 Other non-scarring hair loss. L66 Scarring alopecia. Q84.0 Congenital alopecia
In ICD-10, the disease in question is easily recognized by codes L63, L63.1, L63.2, and so on up to L64.9. Alopecia is a pathological hair loss followed by self-replacement of the site of hair loss with connective tissue.
Alopecia, according to the international directory of diseases, is divided into four main types based on the symptoms and appearance of the affected area of the hairline:
Types of baldness
Most common alopecia areata, the place of manifestation of which is the scalp. It is recognized by code L63.2 and does not affect the entire area of the integument, but a certain part of it, or focus. Moreover, it happens that several foci arise at once in different places. Gradually growing, bald spots can lead to complete baldness.
ICD-10 code L63.0 means total baldness. Symptoms of this pathology include an almost complete (94%) absence of hair on the head. The disease mainly affects the heads of men.
Alopecia areata has an index of international directory diseases L63.2. While in a state of disease, bald areas of a round, sometimes ring-shaped and nest-shaped form are observed on the patient’s head, hence the name of the pathology. Pattern baldness is inherited and usually affects the heads of middle-aged and older men and women.
L63.8 is an ICD-10 code for diffuse alopecia. Unlike previous types of baldness, this baldness spreads over the entire area of the scalp and represents hair thinning. The patient experiences a sharp decrease in the number of healthy hair follicles. The remaining hair becomes unable to cover the scalp 100%.
Due to the lack of hair in diffuse baldness, the patient's scalp is visible, which is usually observed in older people.
According to ICD-10, all types of baldness, including pattern baldness, can be treated with drugs that can act at the gene level. Basically, these are all kinds of corticosteroid drugs and photosensitizers. IN extreme cases Hair transplant can help.
Alopecia areata, unspecified
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Alopecia areata
Alopecia areata (syn. circular, or focal, alopecia, pelade) is characterized by the appearance of rounded foci of baldness.
ICD-10 code
Causes and pathogenesis
Symptoms of alopecia areata
Symptoms of the disease begin with the sudden appearance of a round patch of baldness without subjective sensations; only some patients report paresthesia. The boundaries of the lesion are clear; the skin within its limits is not changed or slightly hyperemic, sometimes of a pasty consistency and gathers into folds more easily than healthy ones; mouth hair follicles saved. In the progressive stage, healthy-looking hair at the edges of the lesion is easily epilated (loose hair area); a pathognomonic sign is the appearance of hair in the form of exclamation marks. This is a club-shaped hair about 3 mm long, the distal end of which is split and thickened.
The first lesions often appear on the scalp. Possible hair loss in the beard area, hair loss on the torso, axillary and pubic areas. In many cases, eyebrows and eyelashes fall out. In 10-66% of patients, various dystrophies of the nail plates occur.
Alopecia - general information about etiopathogenesis and treatment
The constant increase in the number of people with excessive hair loss resulting from various types of baldness (alopecia), especially severe forms, is becoming an increasingly urgent problem in dermatology and aesthetic medicine. Alopecia in men, and even more so in women, very often leads to a decrease in quality of life and disruption of psychosocial adaptation. In most cases, this pathology is difficult to treat due to insufficient knowledge of its causes and mechanisms of development, the emergence of resistance to traditional methods treatment.
Alopecia - what is it, its types and causes
Alopecia is a pathological partial or complete loss of hair on the head, face and/or other areas of the body, which occurs as a result of damage to the hair follicles. There are many classifications of it, some of which are based on forms of baldness, others on the supposed causes and mechanism of development. Most of them are based on both, which does not make it easier to understand the disease and choose methods for its treatment.
But all classifications combine types of alopecia into two large groups:
Scarring alopecia
Causes of the disease
The final skin manifestations These diseases are the formation of scars and death of hair follicles in these areas.
Non-scarring alopecia
It accounts for 80 to 95% of all hair diseases. The etiopathogenesis of this group, unlike the previous one, remains poorly understood. It is most likely that different types of diseases in this group are based on different mechanisms, although the causes and triggering factors for almost all types are in most cases the same. All types of non-scarring baldness are united by the absence of previous skin lesions.
Causes of non-scarring alopecia
Classification of non-scarring alopecia
The classifications of non-scarring alopecia proposed today are unclear; they are based on mixed signs: both the main external clinical manifestations and causative factors. The most convenient classification seems to be the division into alopecia:
Diffuse alopecia
Diffuse alopecia can occur as a result of physiological hormonal changes in the body during puberty, pregnancy and breastfeeding, in menopause. In the first two cases, excessive hair loss is not considered pathological and is transient after stabilization hormonal levels. Under the influence of various provoking factors, it can be more or less pronounced.
Diffuse baldness is characterized by rapid hair loss of varying degrees uniform throughout the entire head. Losing all your hair is extremely rare. It is divided into:
Most often, diffuse baldness is provoked by stress, taking narcotic drugs, and some medicines And contraceptives, lack of microelements, especially with hidden iron deficiency in women with disorders menstrual cycle, as well as in people who have undergone gastrectomy due to poor absorption of iron due to a lack of vitamin B12.
Anagen baldness
Alopecia areata
Alopecia areata occurs with equal frequency in women and men. It accounts for about 5% of all patients with skin diseases. Single (initially) symmetrical foci of hair loss have a round or oval shape and appear more often in the occipital region. They tend to grow and merge, resulting in the formation of large areas of baldness, the edges of which reflect cyclicity. The course of alopecia areata is in most cases benign and occurs in three stages:
- Progressive, during which hair falls out not only at the site of the lesion, but also in the zone bordering it. This stage lasts from 4 months to six months.
- Stationary - cessation of formation and fusion of new foci of baldness.
- Regressive - restoration of normal hair growth.
- regional. in which lesions appear along the edges of the scalp, most often in the area of the back of the head and temples; a variation of this form is crown-shaped baldness;
- exposing. characterized by the formation of large lesions that cover the entire head, with preservation of hair in small areas;
- cutting hair- hair breaks off at the lesion site at a height of 1-1.5 cm; this variety is differentiated from a fungal infection (trichopytosis).
- benign, described above;
- malignant, which includes subtotal, total and universal forms.
Regional form of alopecia areata
Alopecia areata of the denuding type
There are also androgenic alopecia of the female and male type, associated with an imbalance of male and female sex hormones with normal levels in the blood. It is also possible to increase the content of androgens due to the presence of hormone-producing tumors, dysfunction of the hypothalamus, pituitary gland or adrenal cortex, a decrease in estrogen in diseases of the ovaries, thyroid gland, etc.
Depending on the area of damage and the nature of the course, the following forms of alopecia areata are distinguished:
The subtotal form is characterized by a slow progressive course. At the same time, the number of areas and their area not only gradually and slowly increases, but is also combined with loss of eyelashes and hair in the outer areas of the eyebrows.
Total - within 3 months all the hair on the head and face falls out. If the hair is restored, then this process lasts for years and occurs in the reverse order: eyelashes, eyebrows, face. The hair on the head is the last to grow.
At universal form hair is lost not only on the face and head, but on the entire body and limbs.
Subtotal alopecia
Total form of alopecia
Androgenetic alopecia
It accounts for 90% of all causes of alopecia in men and women. This type of baldness is considered by most authors to be independent, although external manifestations is mainly diffuse in nature and is often combined with oily seborrhea. The disease is associated with a hereditarily transmitted autosomal dominant gene, the function of which is realized, presumably, through mechanisms affecting the action of enzymes in the hair follicles and papillae. These mechanisms lead to increased transformation of testosterone into a more active form, and in women - into estrone. Therefore, the types of baldness in men and women may differ.
ALOPECIA
ALOPECIA (synonyms: calvities. baldness, baldness) - complete or partial loss or thinning of hair, often on the head, less often on other parts of the body.
Alopecia is classified as a polyetiological disease with polypathogenetic mechanisms. Functional disorders of the nervous system play a certain role in the development of baldness. endocrine diseases, outbreaks chronic infection, changes in immune status, genetic factors, peripheral vascular system And cerebral vessels, imbalance of microelements, changes in the rheological properties of blood, etc. Normally, a person loses up to 100 hairs every day, the loss of more hair is pathological and leads to the development of baldness.
- total (complete absence of hair)
- diffuse (sharp hair thinning)
- focal (lack of hair in limited areas)
- genetic predisposition, since in 10-25% the pathology is familial;
- acute viral infection;
- the presence of foci of chronic infection in the body - rhinosinusitis, tonsillitis, dental caries and others;
- stressful conditions;
- dysfunction endocrine organs: such patients often exhibit deviations from normal function adrenal cortex, thyroid gland, hypothalamus or pituitary gland;
- disorders of the function of the autonomic nervous system, leading to disruption of microcirculation in the form of pronounced spasm of precapillaries and arterioles, a decrease in the number of functioning capillaries, increased blood viscosity, and a slowdown in the speed of blood flow; The more pronounced such disorders are, the more severe the course.
- local . which is characterized by isolated round or oval patches of hair loss;
- ribbon-like (ophiasis of Celsus) . characterized by an unfavorable course; the focus of baldness spreads from the occipital to the temporal region in the form of a ribbon;
- subtotal . characterized by the fusion of small foci with the formation of large areas of damage;
- total . in which there is no hair on the entire head, eyelashes and eyebrows completely fall out;
- universal - lack of hair on the entire surface of the body; this form can last continuously for decades, when, after the elimination of old lesions, new ones arise or after periods of remission, relapses occur; usually repeated exacerbations occur in milder forms;
- alopecia areata . accompanied by nail damage - the most severe form of the process.
- Progressive or active stage. The skin in the affected areas becomes swollen and hyperemic (red), and has an inflamed appearance. The patient is bothered by itching, tingling and burning. Characteristic is the presence of broken hair and the so-called “loose hair” zone at the borders of the bald area. It has a width of approximately 3 mm to 1 cm. By lightly pulling the hair in this area, it is painlessly and quite easily removed. The bulbous ends of the hair shafts are dystrophic and have the appearance of a “dangling rope.”
- Subacute or stationary stage. It is characterized by minor or no inflammation, pale skin at the site of the lesion and the absence of a “loose hair” area.
- Regression stage. in which the gradual growth of pigmented terminal hair and the growth of vellus light hair (vellus) begins, gradually thickening over time and acquiring pigmentation.
- Providing psychological assistance, explaining the reasons for the difficulty of individual selection of drugs and methods, the duration of the disease and the possibility of self-healing. It is necessary to explain that the effect of treatment in each area occurs no earlier than 3 months after its occurrence. There are also cases where, with the cessation of effective treatment, baldness returns.
- Application medications, contributing to the correction of disorders in the body and the treatment of concomitant diseases that were identified during a full examination. These include:
- Various creams, ointments, lotions, and tinctures are used externally. They contain heparin, which reduces blood clots in small vessels, verapamil, blocks calcium channels of cells that are involved in the regeneration and function of keratinocytes. Irritant (irritating) drugs are also prescribed to help improve microcirculation - bodyaga, croton oil, tincture (10%) of red pepper, juices of garlic, onion and black radish, 20% solution of turpentine in castor oil.
In severe and persistent forms, persons over 14 years of age are prescribed ointments with a high content of the most active hormonal (glucocorticoid) drugs, as well as their introduction into the foci of baldness using mesotherapy and microneedling of the scalp, electrophoresis. Glucocorticoids have pronounced immunosuppressive (decreased local immunity), anti-inflammatory and anti-edematous effects.
- Physiotherapeutic methods - iono- and phonophoresis. microcurrent therapy. cryomassage, Darsonval currents. small doses of ultraviolet irradiation, low-intensity laser therapy, paraffin applications for the scalp, ozone therapy. In order to suppress local immunity, PUVA therapy is used, which is exposure to soft long-wavelength ultraviolet rays(UVA) in combination with taking psoralens (P) orally in the form of tablets, capsules or topically in the form of lotions and creams before UV irradiation.
- Hereditary predisposition to the disease;
- Congenital underdevelopment of follicles. With this disease, even in the first year of a child’s life, hair grows very poorly and falls out quickly. In this case, they say that this is total alopecia in children;
- Disruptions in the hormonal system caused by pathology of the thyroid gland, ovaries, pregnancy, menopause;
- Autoimmune diseases (scleroderma, lupus erythematosus). In case of disturbances in the immune system, immune cells attack hair follicles, considering them foreign agents, causing self-destruction of the latter;
- Neuropsychic disorders and severe emotional experiences that cause inhibition of microcirculation around the hair follicles;
- Limiting protein and microelements in the diet. For strict diets or illnesses gastrointestinal system, leading to a failure in the absorption of beneficial micronutrients, the nutrition of the hair shaft is disrupted;
- Radiation and toxic effects on the body;
- Heavy infectious diseases(tuberculosis, syphilis);
- Use of anticancer drugs.
- Analysis for hormonal status;
- General and biochemical blood test;
- Immunogram (shows the state of immune cells);
- Trichogram (shows the quality and density of hair on one square centimeter of skin);
- Skin biopsy (if necessary).
By clinical features and the origin of alopecia in dermatology are distinguished
congenital
symptomatic
seborrheic
premature
nesting
Congenital alopecia is caused by ectomesodermal dysplasia; it can manifest itself as an independent disease or be part of a complex pathology, combined with various dysplasias. Congenital baldness is based on the partial or complete absence of hair follicles (hypotrichosis).
Symptomatic alopecia is a complication of severe common diseases: acute and chronic infections, such as syphilis and connective tissue diseases, endocrinopathy, or the result of poisoning. This is a consequence of toxic or autoimmune influences on the hair papillae; the disease is focal (often cicatricial), diffuse or total in nature.
physical damage (mechanical, thermal, radiation), infections: fungal (infiltrative-suppurative trichophytosis, favus),
Pseudopelada Broca is more often observed in middle age (35-40 years), mainly in women, although it can also develop in childhood.
The process begins with the appearance of small patches of baldness in the parietal or frontal areas. The skin of these areas is slightly hyperemic, the mouths of the hair follicles are absent, pronounced atrophy of all layers of the skin develops, in the center of the lesions you can sometimes find single, unchanged long hairs, there is no peeling or crusts on the scars.
The disease in most cases has a long-term irreversible course, sometimes total cicatricial alopecia may develop within 2-3 years. On unaffected areas, hair is usually not changed, but is easily removed along the periphery of the lesions.
Histologically, fresh lesions reveal a moderate, predominantly perifollicular infiltrate of lymphocytes located around the middle third of the hair follicle. IN late stage There is significant fibrosis in the dermis.
Little-Lassuer syndrome characterized by a triad of symptoms:
- progressive cicatricial atrophy of the scalp (pseudopelade),
- hair loss in the armpits and pubic area (without clinical signs of atrophic scars)
- follicular papules similar to papules of lichen planus on the skin of the body.
The disease most often develops in women aged 30-70 years.
Histologically, a sharp expansion and filling of the hair follicle with a horny plug is revealed, at the lower pole of which a dense lymphoid infiltrate is expressed.
Alopecia toxic develop under the influence of a number of chemicals, including during production activities, or when taking certain medications. The pathological process, as a rule, is diffuse in nature. Once exposure to the chemical stops, hair growth returns.
Alopecia seborrheic- a complication of seborrhea. It develops in approximately 25% of people, usually starting during puberty and reaching its maximum severity by 23-25 years.
At the same time, the hair becomes shiny, oily, as if lubricated with oil, and sticks together in strands. On the hair and skin there are more or less tightly seated oily, yellowish color scales. The process is often accompanied by itching. Phenomena of eczematization often develop. At first, hair falls out moderately, the lifespan of new hair is shortened, it becomes thinner, thinner and gradually replaced by vellus hair. Subsequently, the process quickly increases, sometimes catastrophic hair loss is observed and a bald spot becomes noticeable, which starts from the edges of the forehead and goes back to the back of the head or from the crown of the head towards the forehead and back of the head. The bald spot is always bordered on the back of the head and on the side surfaces of the head with a narrow ribbon of tightly fitting normal hair.
Alopecia premature (androgenic alopecia) observed mainly in men, begins to appear during puberty and is formed by 25-30 years.
The development of this type of baldness is associated with the special action of androgenic hormones, which is probably due to hereditary factors. The main clinical sign of premature baldness is the replacement of long hair in the temporo-fronto-parietal region with gradually thinning vellus hair, which shortens over time and loses pigment. The sequence of changes is usually as follows: the appearance of a receding hairline in both temporal regions is followed by the involvement of the parietal region in the pathological process. Over time, gradually expanding, the frontal bald patch merges with other bald areas of the head. Throughout the frontoparietal region there are only secondary vellus hairs, which can also easily fall out.
Alopecia areata (alopecia alopecia)- acquired hair loss in the form of rounded lesions of varying sizes. Neurotrophic disorders, possibly with an autoimmune component, endocrine diseases, and head injuries play a significant role in the pathogenesis of the disease.
The process is most often localized on the scalp, but can also affect the area of the beard, mustache, eyebrows, eyelashes and other areas of the skin. The areas of baldness are initially small in size (up to 1 cm in diameter). The skin within the lesion is usually normal; sometimes there may be slight hyperemia, which gradually regresses. On the skin of the lesions you can see the mouths of the hair follicles. As the process develops, foci of baldness grow along the periphery, new ones appear, merge with each other to form large areas of baldness with scalloped outlines. In the circumference of bald spots there is a “loose hair zone.” The hair here is easily and painlessly pulled out, at the root it is devoid of pigment and brain matter, ending in a club-shaped thickening in the form of a white dot. They are called "hair in the form of exclamation point" The absence of a “loose hair zone” with hair “in the form of an exclamation mark” indicates the end of the progression of the process and its transition to the stationary stage. After a few weeks or months, hair growth may resume in the original lesion, but at the same time, the appearance of new lesions is possible. The newly growing hair is initially thin and colorless, but gradually it restores its structure and color.
There are several forms of alopecia areata:
1) total alopecia areata - often begins in childhood as alopecia areata, but there is a rapid appearance of new lesions merging with each other, which leads to complete hair loss on the head, including the face. The duration of development of complete baldness ranges from 48 hours to 2-3 months;
2) subtotal form of alopecia areata occupies about 50% of the entire surface of the head, is characterized by slow progression, the appearance of new lesions with the preservation of vellus and short hair in the marginal zone and individual areas where there are thin, crimped, colorless single hairs or groups of hair that easily fall out when pulled on. Often there is thinning of the outer part of the eyebrows and partial loss of eyelashes;
3) alopecia areata universalis - a rare form characterized by hair loss over the entire skin. It is often combined with dystrophic changes in the nails and is accompanied by pronounced neurotic syndrome with vegetative dystonia:
4) marginal form of alopecia areata (ophiasis) - spread of baldness along the edge of the scalp, most often in the area of the back of the head and temples, while temporary preservation of vellus hair in the marginal zone with their complete loss in the future is often observed;
5) ringworm alopecia areata (idiopathic trichoclasia) occurs more often in people with mental disorders, is characterized by the appearance in the frontal and parietal regions of areas where hair is broken off at a distance of 1.0-1.5 cm from the surface of the skin and is easily removed by twitching. Spontaneous regression is possible after a few weeks.
Histologically, with alopecia areata, small hair papillae are identified, the bulbs are located at a shallow depth. The hair shaft is thin and not completely keratinized. Connective tissue is located around the changed hair, the vessels are obliterated. In old lesions, the number of reduced hair follicles is increased, but most of them retain the ability to form hair.
Differential diagnosis of alopecia
Differential diagnosis is made with mycoses (microsporia, trichophytosis), syphilis.
Treatment of alopecia
elimination of dysfunctions of the nervous and endocrine systems, digestive tract, liver, kidneys, foci of chronic infection, helminthic infestation, etc. contributing to the development of alopecia.
psychotropic and nootropics(sibazone, azafen, nootropil),
vitamins (A, E, multivitamins, including those containing microelements), phytin, biotin,
immunocorrective drugs (decaris, methyluracil, T-activin).
For alopecia areata, except listed drugs, angioprotectors (Doxium) and drugs that improve microcirculation (Trental) are prescribed.
In severe cases, corticosteroid therapy can be used (orally or in the form of puncturing lesions), but it does not guarantee against relapse of the disease, which is aggravated by developing steroid atrophy of the skin.
In the treatment of seborrheic and premature alopecia in women, antiandrogenic drugs are prescribed (Diane-35, etc.).
For all types of baldness, Darsonval currents are used; in severe cases, it is advisable to combine UV rays with photosensitizers (ammifurin, beroxan) or carry out photochemotherapy.
Reflexology, including laser reflexotherapy, is also indicated. Externally - irritating alcohol rubs (red pepper tincture, naphthalan oil extract), corticosteroid creams (for a short period - to avoid the development of skin atrophy), the drug "Regaine", which contains minoxidil (for seborrheic and premature alopecia).
Pilastin (cholera vaccine) and Silacast. Rubbing pilastin into the lesions is carried out in courses of 6 days (once a day) with an interval of 1.5 months (most effective for alopecia areata). The composition of Silacast includes mival (organosilicon compound), castor oil and dimexide. They lubricate the affected areas 1-2 times a day for several months (for all types of baldness, except congenital).
Proper washing of the hair is essential (it is better to use boiled water, neutral superfat soaps, and for rinsing - infusions and decoctions of herbs: nettle, burdock root, chamomile, string, celandine, St. John's wort, etc.).
For seborrheic and premature alopecia, it is advisable to exclude irritating foods from the diet (alcohol, coffee, smoked foods, pickles, seasonings, marinades, extractives), limit the intake of fats and carbohydrates (exclude sweets, flour and pasta). For all types of baldness, it is advisable to include in the diet fresh vegetables (especially carrots and cabbage), fruits (apples, apricots, dried apricots), as well as products containing gelatin (jelly, aspic, jelly), and seaweed.
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Pasini-Pierini atrophoderma
O. L. Ivanov, A. N. Lvov
Alopecia areata and methods of its treatment
Targeted demographic studies have shown that alopecia areata, or alopecia areata, occurs in 0.05-0.1% of the population at least once in a lifetime. The onset of the disease can be at any age, but its first signs in most people are noted mainly at 15-30 years of age. In 34-50% of patients, recovery occurs within 1 year, but almost all patients experienced more than one episode of the disease.
Patchy baldness, despite the absence of a direct threat to health, leads to serious cosmetic defects, especially when severe forms. This causes problems for many people mental state, up to severe depression, which further complicates the course of the disease. The ineffectiveness of treatment or the occurrence of relapses against its background is a high risk of social isolation and self-isolation, especially in adolescents and women.
Alopecia areata is a chronic inflammatory disease without the formation of skin scars that affects the hair follicles and, in some cases, the nails. As a result, hair falls out on the head, face and other parts of the body. Typically these areas are round in shape.
Causes and clinical forms of the disease
Among the mechanisms of development of alopecia areata, over the last 10 years, the autoimmune mechanism has been given primary importance. Its meaning is that the body perceives hair follicles that have different structures in different areas bodies as alien formations. The basis for this assumption was the discovery of immune complexes C3 and immunoglobulins G, M, A in different parts of the hair follicles, a violation of the ratio of immunoglobulins in plasma and a deficiency of cellular immunity. Alopecia areata occurs at the same rate in women as in men, but is more common in people with dark hair.
Predisposing and provoking factors are considered:
Clinical forms
Alopecia areata manifests itself in six clinical forms:
The disease most often affects only the scalp. Significant hair loss is rare - no more than 7% of patients. Alopecia areata in men can sometimes be limited to only the chin area (no beard growth). Clinical forms can change from one another, which is especially pronounced in the malignant course of the disease.
Stages and signs of the disease
Depending on the course of the process and symptoms, three stages of baldness are distinguished:
Dystrophic damage to the nails in mild forms of focal alopecia is rare (in 20%), with total and universal alopecia - in 94% of patients. The nail plates take on a dull appearance, longitudinal striations and/or pinpoint “thimble-shaped” depressions, and a wavy patterned line along the edge of the nail.
Dystrophy of the nail plate with severe manifestations alopecia areata
If the duration of the disease is more than six months, then we are talking about a chronic course.
Treatment of alopecia areata
Due to the lack of a clear understanding of the causes and mechanism of development of the disease, there is not enough clarity in matters of its prevention and prevention of relapses. The choice of treatment methods also poses considerable difficulties. Therefore, most authors consider it necessary to take a comprehensive and maximally individual approach when choosing means and methods of influence.
The main components of treatment are:
(1) anti-inflammatory drugs (if there are foci of infection in the body);
(2) sedatives, vasodilators and improve microcirculation (Trental, Troxevasin, Cavinton, Sermion);
(3) improving tissue nutrition (Solcoseryl, Actovegin);
(4) nootropic (Piracetam, Nootropil) drugs;
(5) complexes of vitamins with microelements, silicon-containing preparations, adaptogens and biostimulants (extracts of lemongrass, echinacea, eleutherococcus, mumiyo, honey), immunocorrectors, mesotherapy cocktails (Dermaheal HL);
(6) Phenibut is also prescribed, which has sedative, psychostimulating, antioxidant and antiplatelet (preventing blood elements from sticking together) effects. In particularly severe and resistant cases of the disease, adults are recommended to take oral glucocorticoid drugs.
Carrying out the mesotherapy procedure with a mesoscooter
In severe cases of alopecia areata, the effect can only occur as a result of long-term complex individually selected treatment. In its absence, hair transplantation or wearing a wig is recommended.
Total alopecia treatment in women and children
Alopecia is called the disease of the new millennium because the number of people suffering from it is rapidly getting younger and growing. Unfavorable environment, hormonal imbalances, unbalanced diet, extreme stress - all these factors are part of modern life and they contribute to the development of hair loss. Although some researchers consider alopecia to be an evolutionary mechanism, because we do not need hair to survive in modern conditions (we have hats to keep warm) and serve only an aesthetic role.
There are many types of alopecia, easily changing from one to another. For example, focal or alopecia areata in advanced cases can turn into total. As a rule, untreated areas of baldness merge into larger ones, gradually covering the entire head and moving to the body. Depending on the size of the area of baldness, subtotal and total alopecia are distinguished. So, total alopecia is one of the severe forms of alopecia areata. characterized by complete loss of hair throughout the entire body.
Signs of total alopecia
The most important symptom is a very rapid rate of hair loss on the head and face (eyebrows, beard, eyelashes). In just two to three months, the hair completely falls out, and changes in the structure of the nails may be observed. A feature of this type of alopecia is the slow restoration of hair growth compared to other methods. Within several years after the start of treatment, the growth of eyebrows and eyelashes, thin and colorless, is resumed, and only then the hair on the head itself. An unfavorable prognosis is also possible - the appearance of only hairs on the eyebrows and eyelashes, while the head remains forever without hair.
Since the development of total baldness involves disruptions in the immune system, it is possible accompanying illnesses with an autoimmune mechanism (inflammation of the thyroid gland, ovarian lesions, atopic dermatitis).
Causes of total alopecia
Statistics indicate that every thousandth person on the planet suffers from total baldness. Let's look at the reasons for such terrifying numbers for this disease.
Total alopecia in women
One of the reasons for total baldness is the excessive production of male sex hormones in female body. Such problems arise with ovarian pathologies, menopause and other hormonal disorders. As a rule, androgenization is accompanied by the appearance of a rough voice in a woman, a mustache above the lips and abundant hair growth throughout the body. Every woman deep down is afraid of this terrible diagnosis and panics at the sight of the first patches of baldness, thereby aggravating the already severe course of the disease.
According to statistics, total alopecia in women is cured several times more often than in men. Competent correction hormonal disorders with reception oral contraceptives will speed up hair restoration.
Total alopecia in children
At congenital pathology the formation of hair follicles is caused by their underdevelopment or poor functioning. Already six months after birth, sparse hair growth and further thinning and hair breakage may be observed. Total alopecia in children can be acquired in the process of general allergization of the child (atopic dermatitis as one of the manifestations).
Trichologists are usually in no hurry to cure total alopecia in children, because there are frequent cases of spontaneous regrowth of hair. If hair restoration is not observed within a year, methods that also work in adults are used. TO hormonal drugs the attitude is special, they try to prescribe them rarely and in small dosages for advanced cases.
Diagnosis of total alopecia
An experienced trichologist should send the patient for a comprehensive laboratory test
Based on the results of laboratory and instrumental studies, a consultation with doctors of other specialties (endocrinologist, gynecologist, neurologist) is prescribed and individual treatment is selected.
Treatment of total alopecia
Total alopecia treatment involves the following methods:
Impact on the immune system.
For immune correction, glucocorticosteroids, Cyclosporine A, and immunomodulators (Anthralin) are used. In severe cases, intravenous prednisolone is used.
Impact on the nervous system.
For a sedative effect, tranquilizers, nootropics, and antidepressants are used. Possible use of sedatives plant based(Novopassit, Persen).
Effects on the gastrointestinal tract.
Treatment of diseases of the gastrointestinal system will help improve the absorption of microelements and dietary fiber. You will also need to adjust your diet with the introduction of protein foods, rich in iron, zinc, selenium, taking dietary supplements.
Impact on the follicles themselves.
Minoxidil, available in the form of a spray or foam, is considered a topical medicine with proven effectiveness and a growth stimulator. Vasodilating ointments, irritating rubbing (tincture) are used as adjuvant therapy hot pepper, mustard, onion juice).
Physiotherapeutic methods.
Complex treatment of total baldness is well complemented by mesotherapy. iontophoresis, darsonvalization. microcurrent therapy, manual and vacuum massage.
Hair transplantation.
During this surgical procedure, follicles are transplanted from the occipital and temporal areas to areas of baldness.
Prognosis for treatment of total alopecia
Total baldness can only be cured in the office of a trichologist. None folk remedies and widely advertised cosmetics will not help .
These remedies can only save you from seasonal hair loss and not severe hair loss. The prognosis is disappointing, because treatment does not guarantee positive result. In addition to the fact that the treatment is very long and takes a heavy toll on the wallet, patients, due to increased anxiety about their condition, only aggravate the course of the disease. In fact total loss Hair loss is only an aesthetic flaw; it does not affect your health in any way.
If treatment for total alopecia fails, the most radical solution is possible – hair transplantation. Unfortunately, this method cannot protect already transplanted hair follicles from the damaging effects of the immune system or hormonal imbalance.
If you or your loved ones suspect total alopecia, do not put off your visit to a trichologist - contact your doctor today. Remember that there are many cases of complete cure of the disease, and with early treatment, the chances of hair restoration increase dramatically.
Alopecia is the absence or thinning of hair on the skin in places where it grows normally (usually on the scalp).
Code according to the international classification of diseases ICD-10:
Frequency
By the age of 50, 50% of men have clear signs of male pattern baldness. 37% of postmenopausal women report some signs of alopecia.
Predominant age
the frequency of androgenetic alopecia increases in proportion to age; dermatomycosis of the scalp and traumatic
alopecia
Alopecia (baldness, baldness) - absence or thinning of hair (usually on the head). Alopecia can be total (complete absence of hair), diffuse (severe hair thinning) and focal (lack of hair in limited areas).
Based on their origin and clinical characteristics, several types of alopecia are distinguished.
.
Congenital
Caused by genetic defects, it manifests itself as significant thinning or complete absence of hair, often in combination with other ectodermal dysplasias.
Forecast
bad. Symptomatic
is a complication of severe general diseases ( acute infections, diffuse connective tissue diseases, endocrinopathies, syphilis, etc.). It is focal, diffuse or total in nature and is a consequence of toxic or autoimmune influences on the hair papillae.
depends on the outcome of the underlying disease. Seborrheic
- a complication of seborrhea, usually of a diffuse nature.
depends on the success of seborrhea treatment. Premature
observed on the head of young and middle-aged men, it is diffuse and focal in nature with the formation of bald spots and bald patches. Hereditary predisposition is of primary importance. Hair is not restored. Gnezdnaya
(alopecia alopecia) is acquired hair loss in the form of rounded lesions of varying sizes.
Alopecia: Causes
Etiology
Mature hair loss: After childbirth as a consequence of physiological changes in the body of a pregnant woman Drugs (oral contraceptives, anticoagulants, retinoids, beta-blockers, antitumor drugs, interferon [IFN]) Stress (physical or mental) Endocrine pathology (hypo- or hyperthyroidism, hypopituitarism) Nutritional factors (malnutrition, deficiency of iron, zinc) Loss of growing hair: Mycosis fungoides X-ray therapy Drugs (antitumor drugs, allopurinol, bromocriptine) Poisoning (bismuth, arsenic, gold, boric acid, thallium) Scar.
: Developmental anomalies and congenital defects Infections (leprosy, syphilis, herpetic infection, cutaneous leishmaniasis) Basal cell carcinoma Epidermal nevi Exposure to physical factors (acids and alkalis, extreme temperatures [burns, frostbite], radiation) Cicatricial pemphigus Lichen planus Sarcoidosis Androgenic.
unknown.
Pathogenesis
local neurotrophic disorders, possibly with an autoimmune component.
Symptoms
the sudden appearance on the hairy skin (often the head, face) of several rounded areas of complete hair loss without any other changes. The lesions can grow, merge and lead to total baldness. Spontaneous recovery is possible, but relapses are common. With the total form, the hair often does not recover.
Alopecia: Signs, Symptoms
Clinical picture
Hair loss With ringworm of the scalp - itching, peeling, inflammation With ringworm of the scalp and traumatic alopecia - hair breaking With alopecia areata: sudden appearance on the scalp and face of several round foci of complete hair loss without any other changes; hair along the periphery of the lesions is easily pulled out; the lesions can grow, merge and lead to total baldness.
Alopecia: Diagnosis
Laboratory research
Study of thyroid function Complete blood count (to identify possible dysfunctions of the immune system) Level of unbound testosterone and dihydroepiandrosterone sulfate in women with androgenic alopecia Plasma ferritin concentration Von Wassermann reaction to exclude syphilis Number of T and B lymphocytes (sometimes reduced in patients with alopecia areata).
Special studies
Hair pulling test: gently tugging (without force) on the hair shaft to remove it; positive (hair is easily removed) for alopecia areata Microscopic examination of the hair shaft Examination of areas of flaking using potassium hydroxide; positive for ringworm of the scalp. The use of antifungal drugs can lead to false-positive results. Examination of scaly areas for the presence of fungi. Biopsy of the scalp with conventional microscopy and direct immunofluorescence examination allows the diagnosis of dermatomycosis of the scalp, diffuse alopecia areata and cicatricial alopecia developed against the background of SLE, lichen planus and sarcoidosis. .
Alopecia: Treatment Methods
Treatment
Lead tactics
Mature hair loss. Hair loss maximum 3 months after the causative effect (drugs, stress, nutritional factors); after eliminating the cause, hair growth is quickly restored. Loss of growing hair.
Hair loss begins a few days or weeks after the causative effect, hair growth is restored after the cause of scarring is eliminated.
The only effective treatment method is surgical (skin graft transplantation or excision of scarring areas) Androgenic
After 12 months of topical use of minoxidil, 39% of patients noted hair growth of varying severity. An alternative treatment method is surgical Gnezdnaya
sedatives, vitamins, phytin, irritating alcohol rubs, corticosteroid ointments. In severe cases - photosensitizers (ammifurin, beroxan) in combination with ultraviolet irradiation, oral corticosteroids, photochemotherapy.
Alopecia- absence or thinning of hair on the skin in places where it usually grows (usually on the scalp).
Code according to the international classification of diseases ICD-10:
- L63 - Alopecia areata
- L64 - Androgenetic alopecia
- L65- Other non-scarring hair loss
- L66- Scarring alopecia
- Q84. 0 - Congenital alopecia
Frequency
By the age of 50, 50% of men have clear signs of male pattern baldness. 37% of postmenopausal women report some signs of alopecia.Predominant age
the frequency of androgenetic alopecia increases in proportion to age; dermatomycosis of the scalp and traumatic alopecia occur more often in children.Alopecia: Causes
Etiology
Mature hair loss: . After childbirth as a consequence of physiological changes in the pregnant woman’s body. Medicines (oral contraceptives, anticoagulants, retinoids, beta-blockers, antitumor drugs, interferon [IFN]). Stress (physical or mental). Endocrine pathology (hypo- or hyperthyroidism, hypopituitarism). Nutritional factors (malnutrition, iron, zinc deficiency). Loss of growing hair: . Mycosis fungoides. X-ray therapy. Medicines (antitumor drugs, allopurinol, bromocriptine). Poisoning (bismuth, arsenic, gold, boric acid, thallium). Scar alopecia: . Developmental anomalies and congenital defects. Infections (leprosy, syphilis, herpes infection, cutaneous leishmaniasis). Basal cell carcinoma. Epidermal nevi. Exposure to physical factors (acids and alkalis, extreme temperatures [burns, frostbite], radiation). Cicatricial pemphigus. Lichen planus. Sarcoidosis. Androgenic alopecia: . Hyperplasia of the adrenal cortex. Polycystic ovary syndrome. Ovarian hyperplasia. Carcinoid. Pituitary hyperplasia. Medicines (testosterone, danazol, ACTH, anabolic steroids, progesterones). Gnezdnaya alopecia. Etiological factors are unknown, autoimmune nature is possible; inherited forms are described. Traumatic alopecia: . Trichotillomania (uncontrollable urge to pull out one's own hair). Damage caused by braiding hair or tying bows tightly. Dermatomycosis of the scalp: . Fungi of the genus Microsporum. Fungi of the genus Trichophyton.Genetic aspects
There are at least 90 known inherited diseases and syndromes accompanied by alopecia. Congenital alopecia with keratosis of the palms and soles (104100, Â) . Congenital total alopecia(*104130, Â): combined with giant pigmented nevi, periodontitis, seizures, mental retardation. Gnezdnaya alopecia(104000, В) . Family alopecia(transformation anagen - telogen, foci of baldness, 104110, Â). Total alopecia(203655, 8p12, HR gene, r) . Various degrees of hypotrichosis, up to complete absence of hair, are characteristic of hereditary ectodermal dysplasia (see Ectodermal dysplasia).Risk factors
Family history of baldness. Physical or mental stress. Pregnancy. Gnezdnaya alopecia— Down syndrome, vitiligo, diabetes.Types
Mature hair loss (telî gen effluvium) is diffuse hair loss, leading to a decrease in hair density, but not to complete baldness. Loss of growing hair (anà gen effluvium) - diffuse hair loss, including growing hair, with possible complete baldness. Scar alopecia- the presence of shiny, smooth areas on the scalp that do not contain hair follicles. Androgenic alopecia- hair loss, usually developing in both sexes; possibly due to the effect of male sex hormones on the cells of the hair follicles. Gnezdnaya alopecia(alopecia) is acquired hair loss in the form of rounded lesions of varying sizes in certain areas of the scalp, eyebrows, and beard area, not accompanied by scarring. Traumatic alopecia- hair loss in certain areas of the skin due to chronic trauma, which in the early stages is not accompanied by scarring. Dermatomycosis of the scalp (tinea capitis) - the presence of limited foci with the absence of hair on the scalp, possibly combined with an inflammatory reaction; caused by a fungal infection.Alopecia: Signs, Symptoms
Clinical picture
Hair loss. With dermatomycosis of the scalp - itching, flaking, inflammation. With dermatomycosis of the scalp and traumatic alopecia - hair breaking. With alopecia areata: sudden appearance on the scalp and face of several rounded areas of complete hair loss without any other changes; hair along the periphery of the lesions is easily pulled out; the lesions can grow, merge and lead to total baldness.Alopecia: Diagnosis
Laboratory research
Study of thyroid function. Complete blood test (to identify possible dysfunctions of the immune system). Levels of unconjugated testosterone and dihydroepiandrosterone sulfate in women with androgenetic alopecia. Plasma ferritin concentration. Von Wasserman reaction to exclude syphilis. The number of T - and B - lymphocytes (sometimes reduced in patients with alopecia areata).Special studies
Hair pulling test: gently tugging (without force) on the hair shaft to remove it; positive (hair is easily removed) for alopecia areata. Microscopic examination of the hair shaft. Examination of areas of peeling using potassium hydroxide; positive for ringworm of the scalp. The use of antifungal drugs may lead to false positive results. Examination of areas of peeling for the presence of fungi. A biopsy of the scalp with conventional microscopy and direct immunofluorescence study allows the diagnosis of dermatomycosis of the scalp, diffuse alopecia areata and cicatricial alopecia developed against the background of SLE, lichen planus and sarcoidosis.Alopecia: Treatment Methods
Treatment
Lead tactics
Mature hair loss. Hair loss maximum 3 months after the causative effect (drugs, stress, nutritional factors); Once the cause is eliminated, hair growth is quickly restored. Loss of growing hair. Hair loss begins a few days or weeks after the causative effect, hair growth is restored after the cause is eliminated. Scar alopecia. The only effective treatment method is surgical (skin graft transplantation or excision of scarring areas). Androgenic alopecia. After 12 months of topical use of minoxidil, 39% of patients noted hair growth of varying severity. An alternative treatment method is surgery. Gnezdnaya alopecia. Usually the disease goes away on its own within 3 years without treatment, but relapses often occur. Traumatic alopecia. Cure can occur only after hair pulling stops. Intervention from a psychologist or psychiatrist may be required. Successful treatment involves medication, behavior modification, and hypnosis. Dermatomycosis of the scalp: treatment is carried out for 6-8 weeks. Thorough hand washing and washing of hats and towels is necessary.Drug therapy
Finasteride tablets. Good results have been obtained for various forms of alopecia. For androgenetic alopecia - minoxidil (2% r - r) for topical use. For alopecia areata. Sedatives, vitamins, irritating alcohol rubs. HA preparations for topical use. In severe cases - photosensitizing drugs (Beroxan) topically in combination with ultraviolet irradiation (UVR), HA orally. For dermatomycosis of the scalp - griseofulvin (adults 250-375 mg/day, children 5, 5-7, 3 mg/kg/day) or ketoconazole 200 mg once a day for 6-8 weeks.Surgery
Skin transplantation.Course and prognosis
Mature and growing hair loss: Permanent baldness is rare. Scar alopecia: Hair follicles are constantly damaged. Androgenic alopecia: prognosis and course depend on treatment. Gnezdnaya alopecia: Spontaneous recovery is possible, but relapses are common; in the total form, the hair usually does not recover. Traumatic alopecia: the prognosis and course depend on the success of correcting the patient’s behavior. Ringworm of the scalp: usually completely resolved.Synonyms
Atrichia. Atrichosis. Baldness. BaldnessICD-10. L63 Gnezdnaya alopecia. L64 Androgenic alopecia. L65 Other non-scarring hair loss. L66 Scarring alopecia. Q84. 0 Congenital alopecia
Alopecia areata (AA) is a chronic organ-specific autoimmune disease inflammatory disease with a genetic predisposition, characterized by damage to the hair follicles and sometimes the nail plates (in 7-66% of patients), persistent or temporary non-scarring hair loss.
Etiology and epidemiology
The basis for the development of the disease is assumed to be a local autoimmune mechanism of damage to the hair follicle, which leads to a violation of the immune tolerance of the cells that form the follicle and the cessation of specific reception from its hair papilla.
The incidence and prevalence of GA depend on geographical and ethnic differences, as well as on the immunogenetic background of patients. The disease affects people of both sexes.
Predisposition to GA is genetic. 10-20% of patients have a family history of the disease, and the true incidence of the disease is likely even higher, since mild cases may go undetected. Genetic predisposition is polygenic in nature. There is a connection between GA and certain HLA class II alleles, especially with DQB1*03 and DRB1*1104. HLA alleles DQB1*0301(HLA-DQ7) and DRB1*1104 (HLA-DR11) may be associated with alopecia totalis and alopecia universalis.
Trigger factors for the disease may include stress, vaccination, viral diseases, infectious diseases, taking antibacterial drugs, anesthesia, etc.
Conditions associated with GA.
Autoimmune diseases of the thyroid gland are observed in 8-28% of patients, while the presence of thyroid antibodies in the blood has no clinical correlation with the severity of GA. Vitiligo is observed in 3-8% of patients with HA. Atopy, compared to the general population, is registered in patients with HA 2 times more often.
Relatives of patients with HA have an increased risk of developing type 1 diabetes; on the contrary, the incidence rate in the patients themselves compared with the general population may be lower. Patients with GA have a high rate of mental illness, especially anxiety and depressive disorders.
The incidence of GA is 0.7-3.8% of patients seeking help from a dermatologist. Risk of occurrence
disease during life is 1.7%. GA occurs equally in both men and women. The first focus of baldness appears in 20% of patients in childhood, in 60% of patients under the age of 20, in 20% of patients over the age of 40.
Classification
- L63.0 Alopecia totalis
- L63.1 Alopecia universalis
- L63.2 Area baldness (band-shaped)
- L63.8 Other alopecia areata
Symptoms of alopecia areata
Depending on the volume and type of baldness, the following are distinguished: clinical forms GA:
- local (limited);
- subtotal;
- total;
- universal.
Other forms of GA are:
- multifocal (mesh) arrangement of alopecia areas;
- ophiasis;
- inverse ophiasis (sisapho);
- diffuse form.
With a local (limited) form of HA, one or more clearly defined round foci of alopecia are determined on the scalp.
In the subtotal form of HA, more than 40% of hair is absent from the scalp.
With ophiasis, alopecia foci have a ribbon-like shape and cover the entire marginal zone of hair growth in the occipital and temporal regions.
With inverse ophiasis (sisapho), ribbon-shaped foci of alopecia spread to the fronto-parietal and temporal regions.
The diffuse form of HA is characterized by partial or complete diffuse hair thinning on the scalp.
In the total form of HA, complete loss of terminal hair on the scalp is observed.
With the universal form of HA, there is no hair on the scalp, in the area of eyebrows, eyelashes, or on the skin of the body.
Stages of the pathological process
Active (progradient, progressive) stage.
Subjective symptoms are usually absent; some patients may complain of itching, burning or pain in the affected areas. Typical lesions are areas of non-scarring baldness of a round or oval shape with unchanged skin color. Less commonly observed are lesions of moderate red or peach color. Proximally narrowed and distally broad exclamation point-shaped hairs are a characteristic feature often seen at or around the affected area. In the active phase of the disease, at the borders of the lesions, the hair tension test may be positive - the “loose hair” zone. The zone border does not exceed 0.5-1 cm.
HA can spread to almost any area of the scalp, but in approximately 90% of patients the scalp is affected. At the initial stage, the disease does not affect gray hair.
Stationary stage.
Around the alopecia lesion, the area of “loose hair” is not identified, the skin in the lesion is unchanged.
Regression stage.
In the area of alopecia, growth of vellus is observed - vellus depigmented hair, as well as partial growth of terminal pigmented hair. When hair regrowth occurs, the original hair is usually hypopigmented, but color usually returns over time.
In patients with GA, specific dystrophic changes in the nails may be observed: pinpoint ulceration of the nails, trachyonychia, Beau's lines, onychorrhexis, thinning or hardening of the nails, onychomadesis, koilonychia, pinpoint or transverse leukonychia, red spotted lunulae.
Up to 50% of patients, even without treatment, recover within a year (spontaneous remission). Moreover, 85% of patients experience more than one episode of the disease. When GA manifests before puberty, the probability of developing total alopecia is 50%. With total/universal alopecia, the likelihood full recovery is less than 10%.
The prognosis is aggravated early age onset of the disease, its duration, family history, presence of concomitant atopy and other autoimmune diseases.
Diagnosis of alopecia areata
The diagnosis is made based on clinical picture diseases:
- the presence of alopecia areas on the skin with clear boundaries;
- the presence of stumps of hair in the lesion in the form of an exclamation mark and a “loose hair zone” at the border of the lesion (active stage);
- detection when microscopic examination dystrophic proximal ends epilated from the source of hair in the form of a “broken rope”;
- the presence of light vellus hair in the growth area (in the regression stage); sometimes along one edge of the lesion there are fragments of hair in the form of an exclamation mark, and on the opposite - the growth of vellus;
- detection of signs of onychodystrophy during examination of nails: thimble-shaped indentations, longitudinal striations, changes in the free edge in the form of wavy patterns;
- detection during trichoscopy (dermatoscopy of the scalp) of “yellow dots”, cadaverized hair, hair in the form of exclamation marks.
In case of a doubtful diagnosis, as well as before prescribing treatment, laboratory tests are recommended:
- microscopic examination of skin and hair for the presence of pathogenic fungi;
- microscopic examination of hair epilated from the marginal zone of the lesion (detection of dystrophic hair ends - a sign pathognomonic for HA);
- histological examination of a fragment of scalp skin. Histologically, HA is characterized by a predominantly T-cell inflammatory infiltrate in and around the anagen hair follicle bulbs. However, the histopathological features of GA depend on the stage of the disease, in the case of chronic course disease, classic signs may be absent;
- clinical blood test;
- serological studies to exclude lupus erythematosus and syphilis;
- determination of cortisol levels in the blood (when planning treatment with systemic glucocorticoids - before treatment and 4 weeks after its completion);
- biochemical blood test: ALT, AST, total protein, bilirubin, cholesterol, blood sugar, alkaline phosphatase (if toxic alopecia is suspected, and also before prescribing photochemotherapy with the use of photosensitizers orally);
- plain radiography of the skull (to exclude volumetric formations area of the sella turcica);
- blood test for thyroid hormones (free T3, free T4, TSH, anti-TPO, anti-TG) to exclude thyroid pathology and prolactin to exclude prolactinemia.
According to indications, consultations with other specialists are prescribed: neurologist, endocrinologist, psychotherapist.
Differential diagnosis
Differential diagnosis is carried out with trichotillomania, diffuse toxic alopecia, trichophytosis of the scalp, cicatricial alopecia.
In trichotillomania, alopecia lesions have an irregular shape and are usually located in the temples, crown, eyebrows, and eyelashes. In the central part of the lesion, terminal hair growth is often observed. In the outbreak, hair can be broken off at different lengths. Microscopic examination reveals hair roots in the anagen or telogen stage; dystrophic hair is absent.
Diffuse toxic alopecia is usually associated with acute toxic conditions: salt poisoning heavy metals, chemotherapy, taking cytostatics, prolonged rise in temperature to 39˚C and above.
In case of trichophytosis of the scalp, during examination, an inflammatory ridge is detected along the periphery of the lesion and the presence of “stumps” - hair broken off at a level of 2-3 mm from the surface of the skin. The disease may be accompanied by inflammation and peeling, which, as a rule, is not observed with GA. Microscopic examination of hair fragments for fungi reveals fungal drusen inside or outside the hair shaft.
With cicatricial alopecia, the skin in the lesion is shiny, the follicular apparatus is not expressed. Clinical manifestations cicatricial alopecia sometimes causes difficulties in diagnosis; in this case, histological examination is recommended.
In children with a congenital single area of baldness in the temporal zone, a differential diagnosis should be made with temporal triangular alopecia.
In rare cases, GA with damage to the frontal hairline and temporal zone Frontal fibrous alopecia, a scar-like hair loss that mainly affects postmenopausal women, should be excluded. The disease may be accompanied by perifollicular erythema and desquamation, which are not observed with GA.
More curable than alopecia areata
Treatment regimens
Drug therapy
Systemic therapy for severe forms of GA.
Glucocorticosteroid drugs.
- prednisolone
- methylprednisolone
Antimetabolites
- methotrexate
Immunosuppressants.
- cyclosporine
Systemic therapy for local (limited) GA:
- zinc sulfate
External therapy for severe forms of GA.
- minoxidil, solution 5%
- clobetasol propionate, ointment 0.05%
External therapy for local (limited) GA: - Intralesional administration of glucocorticosteroid drugs.
- triamcinolone acetonide
- betamethasone dipropionate (2 mg)
- Minoxidil
- minoxidil, solution 2%
- minoxidil, solution 5%
Topical glucocorticosteroid drugs:
- fluocinolone acetonide, cream 0.25%
- betamethasone valerate, foam 0.1%, cream
- betamethasone dipropionate, lotion 0.05%, cream
- clobetasol propionate, cream 0.05%
- hydrocortisone butyrate, cream 0.1%, emulsion
- mometasone furoate, cream 0.1%, lotion
- methylprednisolone aceponate, cream 0.1%, emulsion
Prostaglandin F2a analogues are used in the formation of alopecia in the eyelash growth area (C).
- latanoprost, solution 0.03%
- bimatoprost, solution 0.03%
Non-drug therapy
With local GA – narrowband phototherapy using an excimer laser with a wavelength of 308 nm
For severe forms of HA – PUVA therapy (C). Psoralen and its derivatives are used at a dose of 0.5 mg per kg of body weight
Indications for hospitalization
None.
Requirements for treatment results
- Renewal of hair growth in areas of alopecia.
Tactics in the absence of treatment effects
Patients with long-term absence of eyebrows may be offered dermatography or medical tattooing. Hair prostheses, wigs, hairpieces and other extensions are recommended for patients with hypertension during the period of therapy or in the absence of treatment effect.
Prevention
- There are no methods of prevention.
If you have any questions about this disease, please contact dermatovenerologist Adaev Kh.M:
WhatsApp 8 989 933 87 34
Email: [email protected]
Instagram @dermatolog_95
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