Focal alopecia

Appearance and development of the focus of alopecia

Alopecia areata (alopecia areata) is a rare disease, which nevertheless attracts the attention of many scientists. It is interesting that the loss of hair, starting with complete well-being, just as suddenly stops. It can last a long time and lead to complete baldness in some parts of the head or even the body, and can quickly stop.

Alopecia areata usually begins with a small patch of alopecia, which can develop into a complete loss of hair on the head (alopecia totalis) or on the entire body (alopecia universalis). Extensive hair loss is observed only in a small part of people affected by focal alopecia, which is about 7%, although in the recent past this part of the patients was 30%.

There are three types of hair along the edge of the patch of alopecia - cone-shaped, clavate and in the form of an exclamation mark. Restoring hair is thin and unpigmented, and only later they get a normal color and texture. Hair restoration can occur on one part of the head, while in another area, hair loss can continue.

According to various estimates, from 7 to 66% (an average of 25%) of people suffering from focal alopecia have also deviations in the formation of nails. Dystrophy of the nails can fluctuate from weakly expressed (roughness, shabbiness) to an extreme degree.

The causes of various manifestations of the disease have not been studied well enough. For a long time it remained to be questioned whether different forms of hair loss were the same disease. In the emergence and development of the disease, there appear to be some differences that are not yet known to scientists. Intensive research is being carried out in this direction, and something has already been clarified.

Who is prone to focal alopecia

Demographic studies have shown that 0.05-0.1% of the population undergoes alopecia at least once. In England, patients with focal alopecia are 30-60 thousand, in America - 112-224 thousand and throughout the world - 2.25-4.5 million people. The first signs of alopecia appear in most people aged 15-25 years.

It is shown that in 10-25% of cases the disease has a family origin. The majority of people suffering from focal alopecia are healthy, except for cases of alopecia caused by Down's syndrome, Addison's disease, thyroid disorders, vitiligo and a number of other diseases.

There are two points of view about the incidence of focal alopecia in men and women: either it is believed that the disease affects men and women equally (1: 1), or more women (2: 1). With many autoimmune diseases, an even greater number of women are exposed to the disease (10: 1 in systemic lupus erythematosus).

It is believed that this is due to differences in the hormonal levels of men and women.

Humoral and cellular immunity of women is more active on average than in men, it is better against bacterial and viral infections. But such a highly mobile immunity is more susceptible to the development of autoimmune processes. It is known that many hormones, including sex steroids, adrenaline, glucocorticoids, thymus and prolactin hormones, affect the activity of lymphocytes. But the most powerful hormone that affects the immune system is estrogen - a female sex hormone.

The strategy of treatment of focal alopecia

Hair is capable of recovery even after many years of disease. In a significant number of patients, especially those with a mild disease, spontaneous hair restoration is possible. With proper treatment, remission can occur even with severe illness. Of course, there are incurable forms, and cases where hair growth is restored only with constant treatment, and when it stops hair again falls out within a few days.

In some patients, despite the treatment, the disease recovers. Unfortunately, there are no universal means and methods for treating focal alopecia. Here are some useful practical tips:

• to maximize the cosmetic effect of treatment of intensive, conspicuous focal alopecia, it is necessary to treat the surface of the entire head, and not only the obviously affected areas;
• Do not expect any positive changes in less than three months;
• cosmetic restoration of hair growth can occur within a year or more, permanent treatment increases the probability of permanent hair growth, but individual patches of baldness can then appear, then disappear;
• in patients with intermittent hair loss, the effect of treatment improves with prophylactic administration of antihistamines;
• the growth of hair is also facilitated by the preventive intake of multivitamins; in severe cases, injections of B vitamins are recommended;
• an important factor for the effectiveness of treatment is the psychological factor. There are a number of treatments that can achieve some success, but when they are canceled, the disease returns. All currently used methods are most effective in mild forms of the disease and less effective in severe lesions. Different methods of treatment can be divided into several groups:
• nonspecific stimuli: anthralin, croton oil, dithranol, etc .;
• agents that cause contact dermatitis: dinitrochlorobenzene, diphenylcyclo-propenone, dibutyl ether of square acid, etc .;
• nonspecific immunosuppressors: corticosteroids, 8-methoxypsoralen in combination with UVA (PUVA-therapy);
• specific immunosuppressors: cyclosporine;
• methods of direct action on hair bulbs: minoxidil;
• non-traditional methods of treatment;
• experimental treatment: neoral, tacrolimus (FK506), cytokines.

Medicines for combating hair loss

Until recently, scientists were only amazed at the credulity of people who were ready to try any means promising hair restoration. However, studies have shown that a person is so well informed that hair growth in him can be caused by an inert substance.

Various emotions, spiritual mood can strongly affect the hair, causing their growth or loss. All this makes it difficult to objectively evaluate the effectiveness of various means of alopecia. Additional difficulties arise from the fact that baldness can begin for various reasons. Accordingly, in one form of alopecia, a substance can act, and with another it does not.

For the treatment of alopecia, the following substances related to drugs are used:

• minoxidil and its analogues;
• blockers of dihydrotestosterone and other antiandrogens;
• anti-inflammatory substances (corticosteroids);
• irritants with immunosuppressive action;
• substances that regulate proliferative processes in the epidermis;
• photosensitizers used in photochemotherapy. A good help in the complex treatment of alopecia are physiotherapy methods and so-called alternative medicine - preparations based on natural compounds and plant extracts used by different peoples to strengthen and grow hair.

Photochemotherapy of focal alopecia

A significant place in the treatment of alopecia is UV irradiation. It is known that the short stay of patients in sunny regions has a positive effect on hair growth.

However, it also happens that some patients experience an exacerbation of alopecia in the summer. PUVA therapy (photochemotherapy) is an abbreviated name for the method using photosensitizers (psoralens) and long-wave UV radiation of the A band. The separation of the ultraviolet region of the spectrum into the A (320-400 nm), B (280-320 nm) and C (< 280 nm) is introduced in medicine on the basis of different skin sensitivity to these types of radiation.

The skin is less sensitive to UVA radiation.

At present, local (with mild and moderate forms of focal alopecia) and general (with severe forms of the disease) PUVA therapy are used, using psoralens externally in the form of solutions (for mild forms), orally in the form of tablets or combined (in severe forms). The course of treatment consists of 20-25 light irradiation procedures or 25-30 procedures for moderate and severe forms of the disease, conducted 4-5 times a week. The courses are repeated after 1-3 months depending on the clinical effect.

The following groups of psoralenes are used:

• for oral administration - 8-methoxy-psoralen, 5-methoxy-psoralen;
• for topical application - 1% oil emulsion of 8-methoxypsoralen ("Oxoralen-Ultra") and synthetic preparation 4,5,8-trimethylpsoralen (used as baths).

The main advantage of topical application of psoralens is the exclusion of nausea, headaches (a side effect observed in a significant proportion of patients taking psoralens orally).

Psoralens have an effect on the skin only when exposed to ultraviolet light. In the process of photosensitization in the epidermis, the synthesis of cellular DNA is selectively suppressed by its photochemical binding to psoralen, which has a direct effect on the immune system of the skin, without inhibiting the function of the epidermal cells. It is assumed that PUVA-therapy affects the function of T-cells and antigen presentation, suppresses local immunological attack on the hair follicle due to its depleting effect on Langerhans cells. PUVA therapy provides general immunosuppression by direct or indirect (through interleukin 1) stimulation of prostaglandins E2, which results in an efferent lymphatic blockade.

PUVA-therapy is carried out only in the conditions of a medical institution by a doctor who has special training and experience. The patient takes psoralen together with lean food or milk 1.5-2 hours before irradiation. In the first session, an average dose of 0.5 to 3.0 J / cm2 (depending on skin type) or a minimum phototoxic dose is given. The amount of time for each patient, conducted in the treatment booth, is different. The irradiation time is recorded and increased with each session. The local use of an 8-methoxapsoralen oil emulsion (1 mg / l) at 37 ° C and UV irradiation with single doses of 0.3 to 8.0 J / cm2 for 20 minutes 3-4 times a week gives good results. After 24 weeks at a total dose of 60.9 to 178.2 J / cm2, almost complete restoration of hair growth is observed in 8 out of 9 patients.

Some patients may experience a relapse of the disease with a gradual reduction in PUVA, an average of 10 weeks after discontinuation of treatment. Also, the effectiveness of PUVA therapy depends on the clinical form of baldness, the duration of the disease, the stage of the process and the duration of the last relapse. PUVA-therapy is combined with topical corticosteroids, anthralin, calcipotriol, aromatic retinoids (acitretin, etretinate). This combination makes it possible to use a smaller total dose of UV irradiation.

Contraindications for the use of PUVA therapy are: individual intolerance of drugs, acute gastrointestinal diseases, diabetes mellitus, hyperthyroidism, hypertension, tuberculosis, pregnancy, cachexia, cataract, tumors, liver, kidney, heart, nervous system diseases, diseases characterized by increased sensitivity to light. It is inappropriate to administer therapy to children and persons under the age of 18, as well as patients older than 55 years.

A comparative analysis of scientific publications over the past 10 years suggests a lower effectiveness of PUVA therapy compared with topical immunosuppressive therapy in patients with focal alopecia.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]