Alopecia, Diseases and treatment with folk and medicines. Description, application and healing properties of herbs, alternative medicine

Alopecia areata (GA) is a chronic organ-specific autoimmune inflammatory disease with a genetic predisposition, characterized by damage to hair follicles and sometimes nail plates (in 7-66% of patients), persistent or temporary non-scarring hair loss.

Etiology and epidemiology

At the heart of the development of the disease, a local autoimmune mechanism of damage to the hair follicle is assumed, 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 HA depend on geographic and ethnic differences, as well as on the immunogenetic background of patients. The disease affects both sexes.

The predisposition to GA is genetic. 10–20% of patients have a family history of the disease, and the true incidence is likely even higher, as mild cases may go unnoticed. The genetic predisposition is of a polygenic 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) can be associated with total and universal alopecia.

Trigger factors of the disease can be stress, vaccination, viral diseases, infectious diseases, reception antibacterial drugs, anesthesia, etc.

GA-associated states.

Autoimmune diseases 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 HA. Vitiligo is observed in 3-8% of patients with GA. Atopy in comparison with the general population is recorded in patients with HA 2 times more often.

Relatives of patients with GA have an increased risk of developing type 1 diabetes; on the contrary, the incidence rate among patients themselves may be lower than in the general population. HA patients have high level mental illness, especially anxiety and depressive disorders.

The frequency of occurrence of GA is 0.7-3.8% of patients seeking help from a dermatologist. Risk of occurrence
diseases during life is 1.7%. GA occurs equally in men and women. The first focus of alopecia 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 areata universal
• L63.2 Acute baldness (ribbon-like)
• L63.8 Other alopecia areata

Symptoms of alopecia areata

Depending on the volume and type of hair loss, the following clinical forms of GA are distinguished:

• local (limited);
• subtotal;
• total;
• universal.

Other forms of GA are:

• multifocal (mesh) location of alopecia areata;
• ophiasis;
• inverse ophiasis (sisapho);
• diffuse form.

With a local (limited) form of GA on the scalp, one or several well-defined rounded foci of alopecia are determined.

In the subtotal form of HA, more than 40% of the hair is absent on the scalp.

With ophiasis, the foci of alopecia are ribbon-shaped, covering 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 GA is characterized by partial or complete diffuse thinning of hair on the scalp.

With the total form of HA, there is a complete loss of terminal hairs on the scalp.

With the universal form of HA, hair is absent on the scalp, in the area of \u200b\u200bgrowth of eyebrows, eyelashes, and on the skin of the trunk.

Stages of the pathological process

Active (progressive, progressive) stage.

Subjective symptoms, as a rule, are absent; some patients may complain of itching, burning or pain in the affected area. Typical lesions are areas of non-scarring alopecia of a round or oval shape with unchanged skin color. Less commonly, foci of moderate red or peach color are observed. Proximally tapered and distally wide, exclamation mark hairs are a characteristic feature often seen in the affected area or around its periphery. In the active phase of the disease at the borders of the lesions, the hair tension test can be positive - the "loose hair" zone. The border of the zone does not exceed 0.5-1 cm.

HA can spread to almost any area of \u200b\u200bthe scalp, but in about 90% of patients, the scalp is affected. Initially, the disease does not affect gray hair.

Stationary stage.

Around the focus of alopecia, the "loose hair" zone is not defined, the skin in the focus is unchanged.

Regression stage.

In the focus of alopecia, there is a growth of velus - depigmented vellus hair, as well as a partial growth of terminal pigmented hair. When hair regrowth, the original hair is usually hypopigmented, but color usually returns over time.

In patients with GA, specific degenerative changes in nails may be observed: pinpoint ulceration of the nails, trachyonychia, Bo lines, onychorexis, thinning or thickening of 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 have more than one episode of the disease. With the manifestation of GA before puberty, the likelihood of developing alopecia totalis is 50%. With total / universal alopecia, the chance of complete recovery is less than 10%.

The forecast is aggravated early age the onset of the disease, its duration, family history, the presence of concomitant atopy and other autoimmune diseases.

Diagnostics of the alopecia areata

The diagnosis is based on clinical picture diseases:

• the presence on the skin of foci of alopecia with clear boundaries;
• the presence of hair stumps in the outbreak in the form of an exclamation mark and a "loose hair zone" on the border of the outbreak (active stage);
• detection during microscopic examination of dystrophic proximal ends epilated from the hair focus in the form of a "broken rope";
• the presence of light vellus hair in the growth focus (in the regression stage); sometimes along one edge of the hearth there are fragments of hair in the form of an exclamation mark, and on the opposite - the growth of velus;
• detection of signs of onychodystrophy when examining the nails: thimble-like indentations, longitudinal striation, changes in the free edge in the form of wavy patterns;
• detection during trichoscopy (dermatoscopy of the scalp) "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 the skin and hair for the presence of pathogenic fungi;
• microscopic examination of hair, epilated from the marginal zone of the focus (identification of dystrophic ends of the hair - a feature pathognomonic for HA);
• histological examination of a fragment of the scalp. Histologically, GA is characterized by an inflammatory infiltrate consisting mainly of T cells in and around the bulbs of anagen hair follicles. However, the histopathological signs of GA depend on the stage of the disease; in the case of a chronic course of the disease, classical signs may be absent;
• clinical blood test;
• serological tests to exclude lupus erythematosus and syphilis;
• determination of the level of cortisol in the blood (when planning treatment with glucocorticoid agents of systemic action - before treatment and 4 weeks after its completion);
• biochemical blood test: ALT, AST, total protein, bilirubin, cholesterol, blood sugar, alkaline phosphatase (if you suspect toxic alopecia, as well as before prescribing photochemotherapy with the use of photosensitizers inside);
• plain X-ray of the skull (to exclude volumetric formations of the Turkish saddle area);
• blood tests for thyroid hormones (free T3, free T4, TSH, AT to TPO, AT to TG) to exclude thyroid pathology and prolactin to exclude prolactinemia.

According to the indications, consultations of other specialists are prescribed: a neurologist, an endocrinologist, a psychotherapist.

Differential diagnosis

The differential diagnosis is carried out with trichotillomania, diffuse toxic alopecia, trichophytosis of the scalp, cicatricial alopecia.

With trichotillomania, the foci of alopecia are irregular in shape, usually located in the temples, crown, eyebrows, eyelashes. Terminal hair growth is often observed in the central part of the lesion. In the outbreak, the hair may be broken off at different lengths. Microscopic examination determines the hair roots in the anagen or telogen stage; dystrophic hair is absent.

Diffuse toxic alopecia is usually associated with acute toxic conditions: poisoning with salts of heavy metals, chemotherapy, taking cytostatics, prolonged temperature rise to 39 ° C and above.

With trichophytosis of the scalp during examination, an inflammatory roller is found along the periphery of the focus and the presence of "stumps" - hair broken off at a level of 2-3 mm from the skin surface. The disease can be accompanied by inflammation and desquamation, 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 of cicatricial alopecia sometimes cause difficulties in diagnosis, in this case, histological examination is recommended.

In children with a congenital single patch of alopecia in the temporal zone, differential diagnosis with temporal triangular alopecia.

In rare cases of HA with damage to the frontal hairline and temporal zone, frontal fibrous alopecia should be excluded - scar hair loss, which mainly affects women in fasting menopause... The disease may be accompanied by perifollicular erythema and desquamation, which are not observed in GA.

Treatment of alopecia areata

Treatment regimens

Drug therapy

Systemic therapy for severe forms of GA.

Glucocorticosteroid drugs.

• prednisone
• methylprednisolone

Antimetabolites

• methotrexate

Immunosuppressants.

• cyclosporine

Systemic therapy for local (limited) HA:

• zinc sulfate

External therapy for severe forms of GA.

• minoxidil, solution 5%
• clobetasol propionate, ointment 0.05%

External therapy for local (limited) HA: - Intrafocal 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 analogs are used in the formation of alopecia in the area of \u200b\u200beyelash growth (C).

• latanoprost, solution 0.03%
• bimatoprost, solution 0.03%

Non-drug therapy

For local GA - narrow-band phototherapy using an excimer laser with a wavelength of 308 nm

In severe forms of GA - 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

• Resumption of hair growth in foci of alopecia.

Tactics in the absence of treatment effects

Patients with prolonged absence of eyebrows may be offered dermatography or medical tattooing. Hair prostheses, wigs, hairpieces and other onlays are recommended for patients with hypertension during the period of therapy or in the absence of treatment effect.

Prevention

• There are no prevention methods.

If you have any questions about this disease, then contact the doctor dermatovenerologist Kh.M. Adaev:

WhatsApp 8 989 933 87 34

Email: [email protected]

Instagram @ dermatolog_95

The loss of mature hair usually leads to a decrease in the density of the hairline and, quite rarely, to alopecia totalis. There are many reasons for mature hair loss, for example, due to physiological changes in the body during pregnancy, the phenomena of alopecia can occur after childbirth. Long-term use of retinoids, oral contraceptives and drugs that slow down blood clotting, especially in combination with constant stressful situations and endocrine disorders, often cause alopecia. Lack of iron, zinc and other nutritional disorders also adversely affect the density of the hairline.
As a rule, alopecia begins gradually with the appearance of small bald patches in the parietal or frontal part of the head, the skin acquires a glossy shine, the phenomena of atrophy of the hair follicles are observed, in the center of the lesions one can find single, unchanged long hair.
If the cause of alopecia is the loss of growing hair, then over time this can lead to complete hair loss. Pathogenetically, this type of alopecia is caused by mycoses, radiation therapy, poisoning with bismuth, arsenic, gold, thallium and boric acid. Hair loss and alopecia can be preceded by anticancer therapy using cytostatics.
Androgenic alopecia is observed mainly in men, it begins to manifest itself after puberty and is formed by the age of 30-35. The development of alopecia in this case is associated with an increased amount of androgenic hormones, which is due to hereditary factors. Clinically, androgenic alopecia is manifested by replacement long hair on cannon, which over time become even more shortened and lose pigment. Initially, symmetrical bald patches appear in both temporal regions with gradual involvement of the parietal zone in the process. Over time, the bald patches merge due to peripheral growth.
Cicatricial alopecia, in which hair loss is accompanied by the appearance of shiny and smooth areas of the scalp, differs in that such areas do not contain hair follicles. This type of alopecia can be caused by congenital anomaly and defects of hair follicles. But more often, infectious diseases such as syphilis, leprosy and herpes infections lead to cicatricial alopecia. Changes in the ovaries and pituitary gland of the type of hyperplasia and polycystic, basal cell carcinoma, prolonged use of steroid drugs also provoke cicatricial alopecia. Exposure to harsh chemicals, burns, and frostbite of the scalp are the most common exogenous causes of cicatricial alopecia.
Alopecia areata, when areas of baldness are not accompanied by scarring and are located in the form of rounded foci of different sizes, appears suddenly. The causes of alopecia areata are not known, but, meanwhile, areas with symptoms of alopecia tend to grow peripherally, which can lead to total hair loss. Most often, alopecia areata occurs on the scalp, but the balding process can affect the area of \u200b\u200bthe beard, mustache, eyebrows and eyelashes. Initially, the foci of alopecia are small, up to 1 cm in diameter, the skin condition is not changed, but sometimes slight hyperemia can be observed.
The mouths of the hair follicles in the affected area are clearly visible. With peripheral growth, the foci of alopecia acquire a scalloped character and merge with each other. In the circumference of the plots there is a zone of loose hair, which can be easily removed with a slight effect; the hair in this zone at its root is devoid of pigment and ends in a clavate thickening in the form of a white point. They got the name "hair in the form of an exclamation mark." The absence of such hair indicates that alopecia areata has passed into the stationary stage and the progression of hair loss has ended. After a few weeks or months, hair growth is restored in the alopecia areata. At first they are thin and colorless, but over time their color and structure acquire a normal character. The fact that hair growth has resumed does not exclude the possibility of recurrence.
Seborrheic alopecia occurs in about 25% of cases of seborrhea. Baldness begins at puberty and reaches its maximum severity by 23-25 \u200b\u200byears. Initially, the hair becomes greasy and shiny and looks like oiled. The hair sticks together in strands, and on the scalp there are dense, fatty yellowish scales. The process is accompanied by itching and seborrheic eczema often joins. Baldness begins gradually, at first, the life of the hair is shortened, it becomes thin, thinning and gradually long hair is replaced by vellus hair. As seborrheic alopecia develops, the process of hair loss begins to grow, and the bald spot becomes noticeable, it starts from the edges of the frontal zone towards the back of the head or from the parietal zone towards the frontal and occipital. The baldness area is always bordered by a narrow band of healthy and dense hair.

Alopecia - the absence or thinning of hair on the skin in places of their usual growth (more often on the scalp).

Code for the international classification of diseases ICD-10:

• L63 - Alopecia areata
• L64 - Androgenic alopecia
• L65 - Other non-scarring hair loss
• L66 - Cicatricial alopecia
• Q84. 0 - Congenital alopecia

Frequency

50% of men by the age of 50 have distinct signs of male pattern baldness. 37% of postmenopausal women report some signs of alopecia.

Prevailing age

the frequency of androgenic 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 result of physiological changes in the body of a pregnant woman. Drugs (oral contraceptives, anticoagulants, retinoids, b - adrenergic blockers, antineoplastic drugs, interferon [IFN]). Stress (physical or mental). Endocrine pathology (hypo - or hyperthyroidism, hypopituitarism). Alimentary factors (nutritional disorders, iron deficiency, zinc). Growing hair loss:. Mushroom mycosis. X-ray therapy. Drugs (antineoplastic drugs, allopurinol, bromocriptine). Poisoning (bismuth, arsenic, gold, boric acid, thallium). Cicatricial alopecia:. Developmental anomalies and congenital defects... Infections (leprosy, syphilis, herpes infection, cutaneous leishmaniasis). Basal cell carcinoma. Epidermal nevi. Impact physical factors (acids and alkalis, extreme temperatures [burns, frostbite], radiation). Cicatricial pemphigus. Lichen planus. Sarcoidosis Androgenic alopecia:. Hyperplasia of the adrenal cortex. Polycystic ovary disease. Ovarian hyperplasia. Carcinoid. Hyperplasia of the pituitary gland. Drugs (testosterone, danazol, ACTH, anabolic steroids, progesterones). Nest alopecia... The etiological factors are unknown, an autoimmune nature is possible; inherited forms are described. Traumatic alopecia:. Trichotillomania (an irresistible urge to pull out one's own hair). Damage due to braiding or tight bows. Dermatomycosis of the scalp:. Mushrooms of the genus Microsporum. Mushrooms of the genus Trichophyton.

Genetic aspects

There are at least 90 known inherited diseases and syndromes associated with alopecia. Congenital alopecia with keratosis of the palms and soles (104100, Â). Congenital total alopecia (* 104130, Â): combined with giant pigmented nevi, periodontitis, convulsions, lag in mental development... Nest alopecia (104000, Â). Family alopecia (transformation anagen - telogen, foci of alopecia, 104110, Â). Total alopecia (203655, 8p12, HR gene, r). Various degrees of hypotrichosis, up to the complete absence of hair, are characteristic of hereditary ectodermal dysplasias (see ectodermal dysplasia).

Risk factors

Family history of baldness. Physical or mental stress. Pregnancy. Nest alopecia - Down syndrome, vitiligo, diabetes mellitus.

Types

Mature hair loss (telî gen effluvium) - diffuse hair loss, leading to a decrease in hair density, but not to complete baldness. Growing hair loss (anà gen effluvium) - diffuse hair loss, including growing hair, with possible complete baldness. Cicatricial alopecia - the presence of shiny smooth areas on the scalp that do not contain hair follicles. Androgenic alopecia Hair loss, usually affecting both sexes possibly due to the effect of male sex hormones on the cells of the hair follicles. Nest alopecia (circular baldness) - acquired hair loss in the form of rounded foci of various sizes on certain areas of the scalp, eyebrows, beard area, not accompanied by scarring. Traumatic alopecia - hair loss in certain areas of the skin due to chronic trauma, in the early stages, not accompanied by scarring. Dermatomycosis of the scalp (tinea capitis) - the presence of limited foci with the absence of hair on the scalp, possibly a combination with an inflammatory reaction; caused by a fungal infection.

Alopecia: Signs, Symptoms

Clinical picture

Hair loss. With dermatomycosis of the scalp - itching, peeling, inflammation. With dermatomycosis of the scalp and traumatic alopecia - breaking off the hair. With alopecia areata: the sudden appearance on the scalp, face of several rounded foci of complete hair loss without any other changes; hair on the periphery of the lesions is easily pulled out; lesions can grow, merge and lead to total baldness.

Alopecia: Diagnosis

Laboratory research

Examination of thyroid function. Complete blood count (to identify possible dysfunctions immune system). Unbound testosterone and dihydroepiandrosterone sulfate levels in women with androgenetic alopecia. Plasma ferritin concentration. Von Wassermann reaction to rule out syphilis. The number of T - and B - lymphocytes (sometimes reduced in patients with alopecia areata).

Special studies

Hair pulling test: gently pulling (without force) on the hair shaft to remove it; positive (hair is easily removed) with alopecia areata. Microscopic examination of the hair shaft. Study of peeling foci with potassium hydroxide; positive for dermatomycosis of the scalp. The use of antifungal drugs can lead to false positives... Examination of peeling foci for the presence of fungi. Scalp biopsy with conventional microscopy and direct immunofluorescence examination can diagnose dermatomycosis of the scalp, diffuse alopecia areata, and cicatricial alopecia that develop against the background of SCI, lichen planus and sarcoidosis.

Alopecia: Treatment Methods

Treatment

Management tactics

Loss of mature hair. Hair loss maximum 3 months after the causal effect (drugs, stress, nutritional factors); after eliminating the cause, hair growth is quickly restored. Growing hair loss. Hair loss begins a few days or weeks after the causative effect, hair growth is restored after the cause is eliminated. Cicatricial alopecia... Only effective method treatment - surgical (skin graft or excision of areas of scarring). Androgenic alopecia... After 12 months local application minoxidil 39% of patients noted hair growth of varying severity. An alternative method of treatment is surgery. Nest alopecia... Usually the disease goes away on its own within 3 years without treatment, but relapses often occur. Traumatic alopecia... Healing can come only after stopping hair pulling. The intervention of 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 to 8 weeks. Thorough hand washing and hats and towels are required.

Drug therapy

Finasteride tablets. Received good results with different forms of alopecia. With androgenic alopecia - minoxidil (2% r - r) for topical use. With alopecia areata. Sedatives, vitamins, irritating rubbing alcohol. HA preparations for topical use. In severe cases - photosensitizing drugs (beroxan) topically in combination with ultraviolet radiation (UFO), HA 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 r / day for 6-8 weeks.

Surgery

Skin transplantation.

Course and forecast

Loss of mature and growing hair: Permanent baldness is rare. Cicatricial alopecia: Hair follicles are constantly damaged. Androgenic alopecia: prognosis and course depend on treatment. Nest alopecia: spontaneous recovery is possible, but relapses are not uncommon, with a total form, hair is usually not restored. Traumatic alopecia: prognosis and course depend on the success of the patient's behavior correction. Dermatomycosis of the scalp: Usually resolves completely.

Synonyms

Atrichia. Atrichosis. Baldness. Baldness

ICD-10. L63 Female alopecia ... 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 with subsequent self-replacement of the place of hair loss with connective tissue.

Alopecia, according to the international directory of diseases, according to the symptoms and appearance of the affected area of \u200b\u200bthe scalp is divided into four main types:

Nest;

Diffuse;

Focal;

Total.

Varieties of baldness

The most common alopecia areata, the site of which is the scalp. It is recognized by the L63.2 code and does not affect the entire area of \u200b\u200bthe cover, but some part of it, or the focus. Moreover, it happens that several foci appear at once in different places. Gradually growing, bald patches can lead to complete baldness.

ICD-10 code L63.0 means total baldness. The symptomatology of this pathology includes the almost complete (94%) absence of hair on the head. The disease mainly affects the heads of men.

Alopecia areata has an index in the international directory of diseases L63.2. At the time of being in the state of the disease, bald areas of a round, sometimes ring-shaped and nest-like shape are observed on the patient's head, hence the name of the pathology. Acute baldness is inherited and usually affects the heads of middle-aged and older men and women.

L63.8 is the ICD-10 code for diffuse alopecia. Unlike previous types of baldness, this baldness spreads over the entire scalp and represents thinning hair. The patient has 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 with diffuse baldness, the patient's scalp is visible, which is usually observed in elderly people.

According to ICD-10, all types of baldness, including alopecia areata, can be treated with drugs that can act at the genetic level. Basically, these are all kinds of corticosteroid drugs and photosensitizers. In extreme cases, hair transplantation can help.

Alopecia areata, unspecified

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Alopecia areata

Alopecia areata (syn. Circular, or focal, alopecia, pelada) is characterized by the appearance of rounded foci of alopecia.

ICD-10 code

Causes and pathogenesis

Symptoms of alopecia areata

Symptoms of the disease begins with the sudden appearance of a round focus of baldness without subjective sensations, only some patients note paresthesia. The boundaries of the focus are clear; the skin within it is not changed or slightly hyperemic, sometimes with a doughy consistency and is easier to fold than healthy; the mouths of the hair follicles are preserved. In a progressive stage, healthy-looking hair at the edges of the lesion is easily epilated (loose hair zone); a pathognomonic sign is the appearance of hair in the form of exclamation marks. This hair is clavate about 3 mm long, the distal end of which is split and thickened.

The first lesions often appear on the scalp. Hair loss in the area of \u200b\u200bbeard growth, loss of hair on the trunk, axillary and pubic areas is possible. In many cases, eyebrows and eyelashes fall out. In 10-66% of patients, various dystrophies of the nail plates occur.

Alopecia - general information on etiopathogenesis and treatment

The constant increase in the number of people with excess hair loss resulting from different types 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 the quality of life and a violation 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 areata is a pathological partial or complete loss of hair on the head, face and / or other parts of the body that occurs as a result of damage to the hair follicles. There are many classifications of it, some of which are based on the forms of baldness, others on the alleged causes and mechanism of development. Most of them are based on both, which does not facilitate the understanding of the disease and the choice of methods for its treatment.

But all classifications combine the types of alopecia into two large groups:

cicatricial;

non-scarring.

Cicatricial alopecia

Causes of the disease

The end of the skin manifestations of these diseases is 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, in contrast to 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 type of alopecia

Immune and autoimmune disorders, which in last years the leading role is assigned. They lead to the formation of immune complexes and auto-aggression of the body in relation to the hair follicles. These disorders occur both independently and in combination with some autoimmune diseases - chronic lymphocytic thyroiditis, vitiligo, hypoparathyroidism, adrenal insufficiency.

Genetic predisposition due to a gene predisposing to inappropriate biochemical processes in the skin and an increased sensitivity of follicle receptors to androgens.

Diseases and disorders of the function of the endocrine glands, various metabolic disorders, including amino acids, proteins and trace elements - selenium, zinc, copper, iron, sulfur.

Acute stress conditions and long-term negative psychoemotional effects, leading to spasm of peripheral vessels and malnutrition of the follicles.

Vegetative, cerebral and other types of disorders of the sympathetic innervation of the scalp and face, leading to disorders of blood microcirculation in the skin vessels. From this point of view, chronic neurotic and acute stress conditions, long-term repeated negative psychoemotional effects, chronic inflammatory processes in the nasopharynx, larynx and paranasal sinuses, chronically enlarged and painful submandibular the lymph nodes, osteochondrosis of the cervical spine, neuritis of the occipital nerves. All of this is an irritant to the upper cervical sympathetic ganglia that innervate the scalp.

Diseases of the digestive system that lead to impaired absorption nutrients and trace elements.

Exposure to certain drugs (cytostatics), acute and chronic industrial or household intoxication with chemicals (mercury, bismuth, borates, thallium), exposure to radioactive radiation.

Classification of non-scarring baldness

The classifications of non-scarring alopecia proposed today are fuzzy, they are based on signs of a mixed nature: both the main external clinical manifestations and causal factors. The most convenient classification is the division into alopecia:

Diffuse.

Focal, or nest, or circular baldness.

Androgenetic.

Diffuse alopecia

Diffuse alopecia can occur as a result of physiological hormonal changes in the body during puberty, pregnancy and lactation, during menopause. In the first two cases, excessive hair loss is not considered pathological and is transient after hormonal stabilization. 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 over the entire head. Loss of all hair is extremely rare. It is subdivided into:

anagenic, which occurs during the period of active hair growth;

telogen - hair loss in the resting phase of the follicles.

Most often, diffuse baldness is provoked by a stressful condition, taking narcotic, some drugs and contraceptives, lack of micronutrients, especially with latent iron deficiency in women with impairments menstrual cycle, as well as in people who have undergone gastric resection, due to poor absorption of iron due to lack of vitamin "B12".

Anagenic alopecia

Alopecia areata

Alopecia areata in women and men occurs with the same frequency. It accounts for about 5% of all patients with skin diseases. Single (initially) symmetrical foci of hair loss have a rounded or oval shape and appear more often in the occipital region. They tend to grow and merge, resulting in large patches of hair loss, the edges of which reflect cyclicality. The course of alopecia areata in most cases is benign and proceeds in three stages:

1. Progressive, during which hair falls out not only at the site of the lesion, but also in the border zone with it. This stage lasts from 4 months to six months.
2. Stationary - the termination of the formation and merging of new foci of baldness.
3. Regressive - restoration of normal hair growth.
4. regional... in which foci occur along the edges of the scalp, more often in the back of the head and temples; a variation of this form is crown baldness;
5. revealing... characterized by the formation of large foci, capturing the entire head, with the preservation of hair in small areas;
6. shearing - hair breaks off in the lesion at a height of 1-1.5 cm; this variety is differentiated with a fungal infection (trichophytosis).

Regional form of alopecia areata

Alopecia areata revealing type

Androgenic alopecia of the female and male type is also distinguished, associated with an imbalance of male and female sex hormones with their normal content 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 \u200b\u200bdamage and the nature of the flow, such forms of alopecia areata are distinguished:

7. benign, described above;
8. malignant, which includes subtotal, total and universal forms.

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 also combined with the loss of eyelashes and hair in the outer zones of the eyebrows.

Total - all hair on the head and face falls out within 3 months. 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.

With a 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 distinguished by most authors as an independent one, although by its external manifestations it is mainly diffuse in nature and is often combined with oily seborrhea. The disease is associated with a hereditary autosomal dominant gene, the function of which is realized, presumably, through mechanisms that affect the action of enzymes in the hair follicles and papillae. These mechanisms lead to an increased transformation of testosterone into a more active form, and in women, into estrone. Therefore, the types of hair loss in men and women may be different.

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 areata is classified as a polyetiological disease with polypathogenetic mechanisms. In the development of baldness, a certain role is played by functional disorders of the nervous system, endocrine diseases, foci of chronic infection, changes in the immune status, genetic factors, disorders of the peripheral vascular system and cerebral vessels, imbalance of trace elements, changes in the rheological properties of blood, etc. Normally, a person loses up to 100 hairs daily, the loss of more hair is a pathology and leads to the development of baldness.

• total (complete absence of hair)
• diffuse (sharp hair thinning)
• focal (lack of hair in limited areas)

By clinical features and the origin of alopecia in dermatology are

congenital

symptomatic

seborrheic

premature

nest

Alopecia areata is caused by ectomesodermal dysplasia, can manifest itself as an independent disease or be an integral part of a complex pathology, combined with various dysplasias. The basis of congenital baldness is 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 effects on the papillae; the disease is focal (often cicatricial), diffuse or total in nature.

physical damage (mechanical, thermal, radiation), infections: fungal (infiltrative-suppurative trichophytosis, favus),

Brock's Pseudo-Pelada more often observed in middle age (35-40 years), mainly in women, although it can develop in childhood.

The process begins with the appearance of small foci of baldness in the parietal or frontal regions. The skin of these areas is slightly hyperemic, the mouths of the hair follicles are absent, a pronounced atrophy of all layers of the skin develops, in the center of the lesions one can sometimes find single, unchanged long hairs, there are no peeling or crusts on the scars.

The disease in most cases is characterized by a long irreversible course, sometimes total cicatricial alopecia may develop within 2-3 years. In unaffected areas, the hair is usually not changed, but is easily removed along the periphery of the lesions.

Histologically, in fresh foci, a moderate, predominantly perifollicular infiltrate from lymphocytes is found, located around the middle third of the hair follicle. In the late stage, significant fibrosis is noted in the dermis.

Little Lassuer syndrome characterized by a triad of symptoms:

- progressive cicatricial atrophy of the scalp (pseudopelada),

- hair loss in the armpits and on the pubis (without clinical signs of atrophic scars)

- follicular papules of the type of lichen planus papules on the skin of the trunk.

The disease develops more often in women aged 30-70 years.

Histologically, there is a sharp expansion and filling of the hair sac with a horny plug, at the lower pole of which a thick lymphoid infiltrate is expressed.

Toxic alopecia develop under the influence of a number of chemicals, including during production activities, or when taking certain medications. In this case, the pathological process, as a rule, has a diffuse character. After cessation of exposure chemical hair growth is restored.

Alopecia seborrheic - complication of seborrhea. It develops in about 25% of people, usually beginning during puberty and reaching its maximum severity by 23-25 \u200b\u200byears.

At the same time, the hair becomes shiny, greasy, as if oiled, sticking together in strands. On the hair and skin there are more or less densely sitting fat, yellowish scales. The process is often accompanied by itching. Phenomena of eczematization often develop. Hair at first falls out moderately, the life of new hair is shortened, it becomes thinner, thinner and gradually replaced by fluffy hair. Subsequently, the process grows rapidly, sometimes a 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 towards the forehead and back of the head. The bald patch is always bordered on the back of the head and on the lateral surfaces of the head with a narrow band of firmly seated normal hair.

Premature alopecia (androgenic alopecia) observed mainly in men, begins to manifest itself during puberty and is formed by the age of 25-30.

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 Premature baldness is the replacement of long hair in the temporoparietal region with gradually thinning vellus hairs, which shorten over time and lose 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 receding hairline merges with other bald areas of the head. Throughout the fronto-parietal region, there are only secondary vellus hairs, which can also easily fall out.

Alopecia areata (alopecia areata) - Acquired hair loss in the form of rounded lesions of various sizes. In the pathogenesis of the disease, neuro-trophic disorders, possibly with an autoimmune component, endocrine diseases, and head trauma play a significant role.

The process is more often localized on the scalp, but it can also affect the area of \u200b\u200bthe beard, mustache, eyebrows, eyelashes and other areas of the skin. The foci of alopecia are initially small in size (up to 1 cm in diameter). The skin within the focus is usually normal, sometimes mild hyperemia may be observed, 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. There is a “loose hair zone” around the bald lesions. Hair here is easily and painlessly pulled out, at the root they are devoid of pigment and medulla, end in a clavate thickening in the form of a white point. They got the name "hair in the form of an exclamation mark." 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 a stationary stage. After a few weeks or months, hair growth may resume in the original lesion, at the same time, the appearance of new lesions is possible. The newly growing hair is initially thin and colorless, but gradually it regains its structure and color.

There are several forms of alopecia areata:

1) alopecia areata - more often begins in childhood as alopecia areata, however, there is a rapid appearance of new lesions merging with each other, which leads to complete loss of hair on the head, including the face. The duration of the 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, curly, colorless single hairs or their groups, which easily fall out when pulled on them. Often there is a rarefaction of the outer part of the eyebrows and partial loss of eyelashes;

3) universal alopecia areata - a rare form, characterized by hair loss on the entire skin. It is often combined with dystrophic changes nails and is accompanied by severe neurotic syndrome with vegetative dystonia:

4) marginal form of alopecia areata (ophiasis) - the spread of baldness along the edge of the scalp, more often in the back of the head and temples, while there is often a temporary preservation of vellus hair in the marginal zone with their complete loss in the future;

5) ringworm alopecia areata (idiopathic trichoclasia) more often occurs in persons with mental disorders, is characterized by the appearance in the frontal and parietal regions of areas where the hair is broken off at a distance of 1.0-1.5 cm from the skin surface and is easily removed with twitching. After a few weeks, spontaneous regression is possible.

Histologically, with alopecia areata, small hair papillae are isolated, the bulbs are located at a shallow depth. The hair shaft is thin, not completely keratinized. Around the changed hair is connective tissue, 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

The differential diagnosis is carried out with mycoses (microsporia, trichophytosis), syphilis.

Alopecia treatment

elimination of dysfunctions of the nervous and endocrine systems, digestive tract, liver, kidneys, foci of chronic infection, helminthic invasion, and others contributing to the development of alopecia.

psychotropic and nootropic drugs (sibazon, azafen, nootropil),

vitamins (A, E, multivitamins, including those containing trace elements), phytin, biotin,

immunocorrective drugs (decaris, methyluracil, T-activin).

In case of alopecia areata, in addition to the listed drugs, angioprotectors (doxium) and drugs that improve microcirculation (trental) are prescribed.

In severe cases, corticosteroid therapy can be used (by mouth or in the form of injecting lesions), but it does not guarantee against recurrence of the disease, which is aggravated by the developing steroid skin atrophy.

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 the reception of photosensitizers (ammifurin, beroxan) or to carry out photochemotherapy.

Reflexology is also shown, including laser reflexology. Outwardly - irritating alcohol rubbing (tincture of red pepper, naphthalan oil extract), corticosteroid creams (for a short period - to avoid the development of skin atrophy), the drug "Regaine", which includes minoxidil (with seborrheic and premature alopecia).

Pilastine (cholera vaccine) and silacast. Rubbing pilastine into lesions is carried out in courses of 6 days (1 time per day) with an interval of 1.5 months (it is most effective for nested baldness). Silakast contains mival (organosilicon compound), castor oil and dimexide. They lubricate the affected areas 1-2 times a day for several months (with all types of baldness, except congenital).

Proper shampooing is essential (it is better to use boiled water, neutral fatty soaps, and for rinsing - infusions and decoctions of herbs: nettle, burdock root, chamomile, string, celandine, St. John's wort, etc.).

With seborrheic and premature alopecia, it is advisable to exclude irritating foods from the diet (alcohol, coffee, smoked meats, 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 fresh vegetables (especially carrots and cabbage), fruits (apples, apricots, dried apricots) in the diet, as well as products containing gelatin (aspic, aspic, jelly), and seaweed.

Back to the list of articles about skin diseases

Atrophoderma of Pasini-Pierini

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 the first signs in most people are noted mainly at the age of 15-30. In 34-50% of patients, recovery occurs within 1 year, but almost all patients have more than one episode of the disease.

Focal alopecia, despite the absence of a direct threat to health, leads to serious cosmetic defects, especially in severe forms. Many people experience violations because of this. mental state, up to severe depression, which further aggravates the course of the disease. 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 chronic illness inflammatory in nature without the formation of skin scars, affecting the hair follicles and, in some cases, nails. As a result, hair falls out on the head, face and other areas of the body. Usually these areas are rounded.

Causes and clinical forms of the disease

Among the mechanisms of development of alopecia areata over the past 10 years, the autoimmune mechanism is of primary importance. Its meaning is that the body perceives hair follicles, which have a different structure in different parts of the body, as foreign formations. The basis for this assumption was the detection 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 in women occurs with the same frequency as in men, but more often in people with dark hair.

Predisposing and provoking factors are:

• genetic predisposition, since in 10-25% of the pathology is family in nature;
• acute viral infection;
• the presence of foci of chronic infection in the body - rhinosinusitis, tonsillitis, dental caries and others;
• stressful conditions;
• dysfunction of endocrine organs: in such patients, deviations from the normal function of the adrenal cortex, thyroid gland, hypothalamus or pituitary gland are often found;
• disorders of the function of the autonomic nervous system, leading to a violation of microcirculation in the form of a pronounced spasm of precapillaries and arterioles, a decrease in the number of functioning capillaries, increased blood viscosity, a slowdown in the speed of its flow; the more pronounced such violations, the more severe the course.

Clinical forms

Alopecia areata manifests itself in six clinical forms:

• local ... which is characterized by isolated rounded or oval hair loss;
• ribbon-like (ophiasis of Celsus) ... a characteristic unfavorable course; the focus of alopecia spreads from the occipital to the temporal region in the form of a tape;
• subtotal ... characterized by the fusion of small foci with the formation of large areas of damage;
• total ... in which hair is absent 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 foci, new ones appear or after periods of remission relapses occur; usually repeated exacerbations occur in milder forms;
• alopecia areata ... accompanied by damage to the nails - the most severe form of the process.

The disease often affects only the scalp. Significant hair loss is rare - in no more than 7% of patients. Alopecia areata in men can sometimes be limited to only the chin area (no beard growth). Clinical forms able to cross one another, which is especially pronounced when malignant course disease.

Stages and signs of the disease

Depending on the course of the process and symptoms, there are three stages of baldness:

• Progressive or active stage... The skin in the lesions becomes edematous and hyperemic (red), has an inflamed appearance. The patient is worried about itching, tingling and burning. The presence of broken hair and the so-called "loose hair" zone at the borders of the baldness area is characteristic. It has a width of approximately 3 mm to 1 cm. By lightly pulling the hair in this area, it is painless and easy to pull out. The bulbous ends of the hair shafts are dystrophic and look like a “broken 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 zone.
• Regression stage... at which a gradual growth of pigmented terminal hair begins and the growth of vellus blond hair (velus), gradually thickening and acquiring pigmentation over time.

Dystrophic damage to the nails with mild form alopecia areata is rare (20%), with total and universal - in 94% of patients. The nail plates acquire a dull appearance, longitudinal striation and / or dotted "thimble" depressions, as well as a wavy patterned line along the edge of the nail.

Dystrophy of the nail plate with severe manifestations of alopecia areata

If the duration of the disease is more than six months, then we are talking about a chronic course.

Alopecia areata treatment

Due to the lack of a clear understanding of the causes and mechanism of the development of the disease, there is insufficient clarity in the issues of its prevention and prevention of relapse. The choice of methods of treatment is also quite difficult. Therefore, most authors consider it necessary to have a comprehensive and maximally individual approach when choosing means and methods of influence.

The main components in treatment are:

• Providing psychological assistance, explaining the reasons for the complexity of the 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 does not occur until 3 months after its occurrence. There are also cases where discontinuation effective treatment baldness resumes.
• Application medications, contributing to the correction of disorders in the body and the treatment of concomitant diseases that are identified during a full examination. These include:

(1) anti-inflammatory drugs (if there are foci of infection in the body);

(2) sedatives, vasodilators and improving 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 schisandra, echinacea, eleutherococcus, mummy, honey), immunocorrectors, mesotherapeutic cocktails (Dermaheal HL);

(6) Phenibut is also prescribed, which has sedative, psychostimulating, antioxidant and antiplatelet (preventing the adhesion of blood elements) actions. In especially severe and resistant cases of the disease, adults are recommended to take oral glucocorticoid drugs.

• Various creams, ointments, lotions, tinctures are applied externally. They include heparin, which reduces thrombus formation in small vessels, and verapamil, which blocks the calcium tubules of cells that are involved in the regeneration and function of keratinocytes. Irritant (irritating) drugs are also prescribed to improve microcirculation - bodyag, 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 by means of mesotherapy and microneedling of the scalp, electrophoresis. Glucocorticoids have pronounced immunosuppressive (decreased local immunity), anti-inflammatory and anti-edema effects.

Mesotherapy procedure with a mesoscooter

• Physiotherapy methods - ion - and phonophoresis. microcurrent therapy. cryomassage, Darsonval currents. small doses of ultraviolet radiation, laser therapy with low-intensity beams, paraffin applications of the scalp, ozone therapy. In order to suppress local immunity, PUVA therapy is used, which is exposure to soft long-wave ultraviolet rays (UVA) in combination with the intake of psoralens (P) orally in the form of tablets, capsules or topically in the form of lotions and creams before UV irradiation.

In severe cases of alopecia areata, the effect can occur only as a result of long-term complex individually selected treatment. If not, hair transplantation or wearing a wig is recommended.

Alopecia totalis 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 ecology, hormonal disruptions, an unbalanced diet, severe stress - all these factors are part modern life and it is they that contribute to the development of hair loss. Although some researchers consider alopecia to be an evolutionary mechanism, because hair is not necessary for us to survive in modern conditions (there are hats for warming) and serves only an aesthetic role.

There are many types of alopecia, which easily go from one to another. For instance, alopecia areata or alopecia areata in advanced cases can turn into total... As a rule, untreated foci of baldness merge into larger ones, gradually covering the entire head and moving on to the body. Depending on the size of the baldness area, subtotal and total alopecia are distinguished. So, alopecia areata is one of the most severe forms of alopecia areata. characterized by complete loss of hair throughout the body.

Signs of alopecia totalis

The most important symptom is a very fast rate of hair loss on the head and face (eyebrows, beard, eyelashes). In just two to three months, the hair completely falls out, changes in the structure of the nails can be observed. A feature of this type of alopecia is the slow restoration of the growth of curls in comparison with other methods. Within several years after the start of treatment, the growth of the eyebrows and eyelashes, moreover, thin and colorless, and only then the hair on the head itself resumes. An unfavorable prognosis is also possible - the appearance of only hairs on the eyebrows and eyelashes, while the head remains forever without hair.

Since in the development of total baldness there are failures in the immune system, concomitant diseases with an autoimmune mechanism are possible (inflammation of the thyroid gland, ovarian damage, atopic dermatitis).

The causes of alopecia areata

Statistics indicate that every thousandth inhabitant of the planet suffers from total baldness. Let's look at the reasons for such horrifying numbers of this disease.

• Hereditary predisposition to the disease;
• Congenital underdevelopment of the follicles. With this ailment, even in the first year of a child's life, hair grows very weakly and falls out quickly. In this case, they say that this is alopecia totalis 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 as foreign agents, causing the latter to self-destruct;
• Neuropsychiatric disorders and strong emotional experiences that inhibit microcirculation around the hair follicles;
• Restriction of protein and trace elements in the diet. With strict diets or diseases of the gastrointestinal system, leading to a failure in the assimilation of beneficial micronutrients, the nutrition of the hair shaft is disrupted;
• Radiation and toxic effects on the body;
• Heavy infectious diseases (tuberculosis, syphilis);
• The use of anticancer drugs.

Alopecia totalis in women

One of the reasons for total baldness is called the excessive production of male sex hormones in the female body. Such problems arise with pathologies of the ovaries, menopause and other hormonal disorders. As a rule, androgenization is accompanied by the appearance of a harsh voice in a woman, a mustache above the lips and abundant hair growth throughout the body. Deep down, every woman is afraid of this terrible diagnosis and panics at the first foci 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 of hormonal disorders with the use of oral contraceptives will speed up the restoration of hair.

Alopecia totalis in children

With congenital pathology of the bookmark of hair follicles, their underdevelopment or poor functioning occurs. As early as six months after birth, rare hair growth and further thinning hair breakage can be observed. Alopecia totalis 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 alopecia totalis in children, because there are frequent cases of spontaneous hair regrowth. If the restoration of the hair is not observed during the year, methods that work in adults are used. There is a special attitude towards hormonal drugs, they are tried to be prescribed rarely and in small dosages for advanced cases.

Diagnostics of the total alopecia

An experienced trichologist should send the patient for a comprehensive laboratory examination

• Analysis for hormonal status;
• General and biochemical blood tests;
• 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).

Based on the results of laboratory and instrumental studies, a consultation with doctors of other specialties (endocrinologist, gynecologist, neurologist) is appointed and individual treatment is selected.

Alopecia totalis treatment

Alopecia totalis treatment involves the following methods:

Effects on the immune system.

For immune correction, glucocorticosteroids, Cyclosporin A, immunomodulators (Anthralin) are used. In severe cases, it is used intravenous administration prednisolone.

Effects on the nervous system.

For a sedative effect, tranquilizers, nootropics, antidepressants are used. It is possible to use sedatives on a plant basis (Novopassit, Persen).

Effects on the gastrointestinal tract.

Treatment of diseases of the gastrointestinal system will help to improve the absorption of trace elements and dietary fiber. You will also need a correction of the diet with the introduction of protein foods rich in iron, zinc, selenium, taking dietary supplements.

Impact on the follicles themselves.

A topical drug with proven efficacy and growth stimulant is Minoxidil, available as a spray or foam. As adjunctive therapy vasodilating ointments are used that irritate rubbing (tincture of hot pepper, mustard, onion juice).

Physiotherapy methods.

Complex treatment of total baldness is well complemented by mesotherapy. iontophoresis, darsonvalization. microcurrent therapy, manual and vacuum massage.

Hair transplant.

During this surgical intervention follicles are transplanted from the occipital and temporal regions to areas of baldness.

Alopecia totalis treatment prognosis

Total baldness is cured only in the office of a trichologist. No folk remedies and widely advertised cosmetics will help .

These remedies can only save you from seasonal hair loss and not severe hair loss. The prognosis is not very encouraging, because treatment does not guarantee a positive result. In addition to the fact that the treatment is very long and severely hits the wallet, patients, due to increased anxiety for their condition, only aggravate the course of the disease. In fact, complete hair loss is only an aesthetic flaw, it does not affect health in any way.

In case of unsuccessful treatment of total alopecia, it is possible to use the most radical solution - hair transplant. Unfortunately, this method cannot protect already transplanted hair follicles from the damaging effects of the immune system or hormonal imbalances.

If you or your loved ones have a suspicion of alopecia totalis, do not postpone the visit to the trichologist on the back burner - go to the doctor today. Remember that there are many cases of complete cure of the disease, and with early treatment, the chances of hair restoration are dramatically increased.

Alopecia - the absence or thinning of hair on the skin in places of their usual growth (more often on the scalp).

Code for the international classification of diseases ICD-10:

• Q84.0

Frequency. 50% of men by the age of 50 have distinct signs of male pattern baldness. 37% of postmenopausal women report some signs of alopecia.

Prevailing age: the frequency of androgenic alopecia increases with age; dermatomycosis of the scalp and traumatic alopecia are more common in children.

Causes

Etiology. Loss of mature hair: .. After childbirth as a result of physiological changes in the body of a pregnant woman .. Drugs (oral contraceptives, anticoagulants, retinoids, b - adrenoblockers, antineoplastic drugs, interferon [IFN]) .. Stress (physical or mental) .. Endocrine pathology ( hypo - or hyperthyroidism, hypopituitarism) .. Alimentary factors (malnutrition, iron deficiency, zinc). Growing hair loss: .. fungal mycosis .. X-ray therapy .. drugs (antineoplastic drugs, allopurinol, bromocriptine) .. poisoning (bismuth, arsenic, gold, boric acid, thallium). Cicatricial alopecia: .. Developmental anomalies and congenital malformations .. Infections (leprosy, syphilis, herpes infection, cutaneous leishmaniasis) .. Basal cell carcinoma .. Epidermal nevi .. Exposure to physical factors (acids and alkalis, extreme temperatures [burns, frostbite], irradiation) .. Cicatricial pemphigus .. Lichen planus .. Sarcoidosis. Androgenic alopecia: .. Hyperplasia of the adrenal cortex .. Polycystic ovary .. Hyperplasia of the ovaries .. Carcinoid .. Hyperplasia of the pituitary gland .. Drugs (testosterone, danazol, ACTH, anabolic steroids, progesterones). Alopecia areata. Etiological factors are unknown, possibly an autoimmune nature; inherited forms are described. Traumatic alopecia: .. Trichotillomania (irresistible urge to pull out one's own hair) .. Damage due to braiding or tied tight bows. Dermatomycosis of the scalp: .. Mushrooms of the genus Microsporum .. Mushrooms of the genus Trichophyton.

Genetic aspects. There are at least 90 known inherited diseases and syndromes associated with alopecia. Congenital alopecia with keratosis of the palms and soles (104100, Â). Congenital alopecia totalis (* 104130, Â): combined with giant pigmented nevi, periodontitis, seizures, mental retardation. Alopecia areata (104000, Â). Familial alopecia (transformation anagen - telogen, foci of alopecia, 104110, Â). Alopecia totalis (203655, 8p12, HR gene, r). Various degrees of hypotrichosis, up to the complete absence of hair, are characteristic of hereditary ectodermal dysplasias (see ectodermal dysplasia).

Risk factors. Family history of baldness. Physical or mental stress. Pregnancy. Alopecia areata - Down syndrome, vitiligo, diabetes mellitus.

Types. Mature hair loss (telîgen effluvium) - diffuse hair loss, leading to a decrease in hair density, but not to complete baldness. Growing hair loss (anàgen effluvium) - diffuse hair loss, incl. growing, with possible complete baldness. Cicatricial alopecia is the presence of shiny, smooth areas on the scalp that do not contain hair follicles. Androgenic alopecia - hair loss that usually occurs in both sexes possibly due to the effect of male sex hormones on the cells of the hair follicles. Alopecia areata (alopecia areata) - acquired hair loss in the form of rounded foci of various sizes on certain areas of the scalp, eyebrows, beard area, not accompanied by scarring. Traumatic alopecia - hair loss in certain areas of the skin due to chronic trauma, 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 a combination with an inflammatory reaction; caused by a fungal infection.

Symptoms (signs)

The clinical picture. Hair loss. With dermatomycosis of the scalp - itching, peeling, inflammation. With dermatomycosis of the scalp and traumatic alopecia - breaking off the hair. With alopecia areata: the sudden appearance on the scalp, face of several rounded foci of complete hair loss without any other changes; hair on the periphery of the lesions is easily pulled out; lesions can grow, merge and lead to total baldness.

Diagnostics

Laboratory research. Examination of thyroid function. Complete blood count (to identify possible dysfunctions of the immune system). Unbound testosterone and dihydroepiandrosterone sulfate levels in women with androgenetic alopecia. Plasma ferritin concentration. Von Wassermann reaction to rule out syphilis. The number of T - and B - lymphocytes (sometimes reduced in patients with alopecia areata).

Special studies. Hair pulling test: gently pulling (without force) on the hair shaft to remove it; positive (hair is easily removed) with alopecia areata. Microscopic examination of the hair shaft. Study of peeling foci with potassium hydroxide; positive for dermatomycosis of the scalp. Antifungal medications can lead to false positive results. Examination of peeling foci for the presence of fungi. Scalp biopsy with conventional microscopy and direct immunofluorescence examination can diagnose dermatomycosis of the scalp, diffuse alopecia areata, and cicatricial alopecia that develop against the background of SCI, lichen planus and sarcoidosis.

Treatment

TREATMENT

Management tactics. Loss of mature hair. Hair loss at most 3 months after causal exposure (drugs, stress, nutritional factors); after eliminating the cause, hair growth is quickly restored. Growing hair loss. Hair loss begins a few days or weeks after the causative effect, hair growth is restored after the cause is eliminated. Cicatricial alopecia. The only effective method of treatment is surgical (skin graft or excision of scarring). Androgenic alopecia. After 12 months of topical application of minoxidil, 39% of patients noted hair growth of varying severity. An alternative method of treatment is surgery. Alopecia areata. Usually the disease goes away on its own within 3 years without treatment, but relapses often occur. Traumatic alopecia. Healing can come only after stopping hair pulling. The intervention of a psychologist or psychiatrist may be required. Successful treatment includes drug therapy, behavior correction, and hypnosis. Dermatomycosis of the scalp: treatment is carried out for 6-8 weeks. Thorough hand washing and hats and towels are required.

Drug therapy. Finasteride tablets. Good results have been obtained for various forms of alopecia. With androgenic alopecia - minoxidil (2% r - r) for topical use. With alopecia areata .. Sedatives, vitamins, irritating alcohol rubbing .. HA preparations for local use .. In severe cases - photosensitizing drugs (beroxan) topically in combination with ultraviolet irradiation (UFO), HA 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 r / day for 6-8 weeks.

Surgery. Skin transplantation.

Course and forecast. Loss of mature and growing hair: Permanent baldness is rare. Cicatricial alopecia: The hair follicles are constantly damaged. Androgenic alopecia: prognosis and course depend on treatment. Alopecia areata: spontaneous recovery is possible, but relapses are frequent, with a total form, hair usually does not recover. Traumatic alopecia: prognosis and course depend on the success of the patient's behavior correction. Dermatomycosis of the scalp: Usually resolves completely.

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