Focal scar scar tissue with irreversible hair loss, or pseudopelagus, is not a separate nosological form, but represents the final result of the evolution of a number of atrophying dermatoses of the scalp (acquired or congenital).
Causes and pathogenesis of focal scar scar tissue. Focal scar scar tissue (ORO) can be caused by trauma (mechanical, thermal, chemical, radiation, including ionizing radiation). In these cases, the time and type of exposure can be easily ascertained from an anamnesis. Other causes include infectious skin diseases (pyoderma, dermatomycosis, viral dermatoses, skin tuberculosis, syphilis, leprosy, leishmaniasis), non -oidal formations and skin lesions, developmental defects and genodermatosis, and some acquired dermatoses. All of them gradually lead to atrophy and sclerosis of the skin and hair follicles on the head and result in persistent atrophic alopecia. Most often, some acquired dermatosis is caused by focal cicatricial scarring when localized on the scalp of the scalp: red follicular decalver (more than 50% of cases), discoid lupus erythematosus, decalculating folliculitis (or lupoid sycosis), dermatomycosis, limited scleroderma. Much less often, cicatricial cicatrical alopecia develops in sarcoidosis of the skin, lipoid necrobiosis, skin lymphoma, histiocytosis of the skin from Langerhans cells, scarring pemphigoid, and also in some genodermatoses (scarring follicular keratoses, follicular dyskeratosis, congenital ichthyosis, epidermolysis congenital bullous dystrophic, etc.). Thus, the causes and mechanisms of development of focal cicatricial alopecia are diverse and correspond to the etiology and pathogenesis of that dermatosis, which resulted in focal atrophy of the skin
Symptoms of focal scar scar tissue. Atrophic dermatoses on the scalp appear 3 times more often in middle-aged women. Regardless of the dermatosis that caused focal cicatricial alopecia, the clinical picture is dominated by atrophy of scalp skin of different sizes with persistent hair loss. Foci of cicatricial cicatrical alopecia, or pseudopelagus, are usually located in the parietal and frontal areas, they tend to sink, within their limits are often visible individual preserved hair and hair bundles. Notice cicatrical baldness accidentally, sometimes patients are concerned about the feeling of tension of the affected skin or a slight itch. The predominant complaint is a cosmetic defect (especially in women), which leads to psychological trauma. The skin in the foci of atrophy is poor-yellow, smooth, shiny, stretched, thinned, devoid of hair and mouth of hair follicles. When squeezing, it is collected between the fingers in small creases. In a number of cases, in addition to the prevalent atrophic alopecia, primary or secondary secondary eruptions can not be detected. This is probably due to the "smoldering" course of pathological processes in the deep layers of the dermis and the predominance of sclerotic and atrophic changes in the affected skin and hair follicles. It has long been noted that on the scalp different dermatoses, differ little in their clinical manifestations, often occur atypically, with a small number of primary elements of the rash. Sometimes, in a zone bordering with the locus of alopecia, they show mild hyperemia, peeling, horny "corks" in the mouths of hair follicles (follicular form of red flat lichen, discoid lupus erythematosus, follicular keratosis, etc.). Folliculitis with follicular pustules in the border zone occurs with decalving folliculitis, infiltrative-suppuration form of mycosis, shingles and in which other dermatoses. Sometimes in the lesions on the scalp can detect nodules, nodes, tubercles, etc. Various atrophy dermatitis of the scalp slowly progress, the area of focal atrophy gradually increases, and after many years, persistent baldness can become very pronounced (subtotal, total). When combined focal scarring of the scalp with rashes in other locations or with nail damage, it is also important to establish their origin, since in most cases these manifestations have a single genesis.
Pathomorphology of focal cicatricial alopecia. In the study of the characteristic primary element of the rash at early stages of development, pathomorphological changes depend on the nosological form of dermatosis, which has caused focal cicatricial alopecia. Taking into account the frequent atypical, "smoldering" course of atrophying dermatosis on the scalp, histological examination does not always help diagnosis of dermatosis.
Diagnostics and differential diagnostics. With the localization of dermatosis, which has caused focal scar scar tissue, only on the scalp (which happens more often) the clarification of the disease nosology becomes more complicated. First of all, focal cicatricial baldness needs to be differentiated from circular alopecia, since the treatment and prognosis in them are paradisiacal. With circular alopecia, there is no skin atrophy, the mouth of the hair follicles is retained; In the marginal zone of the focus of alopecia, there are hair in the form of exclamation marks (pathognomonic sign when traction of hair). In the future it is rational at first to exclude diseases that most often lead to focal cicatricial alopecia: follicular decalcifying the shape of the red flat lichen, discoid and disseminated red capillary, decalving folliculitis, atrophic forms of dermatophytosis. The dermatologist should find out the anamnesis of the disease, carefully examine the entire patient, if necessary, conduct microscopic, microbiological, histological and immunological studies. During the examination, special attention is paid to the zone bordering the hearth where cicatrical alopecia was formed. There may be active "manifested" dermatosis (primary or informative secondary elements of the rash). It is necessary to establish the morphology of the primary element of the rash and its characteristics (color, size, shape, connection with the hair follicle, the presence of a horn spine in the center, possible changes in the hair, etc.). If a rash is found in other localizations, their morphology and nosology are established, which practically predetermines the diagnosis of the initial deramatosis on the scalp. In the absence of active manifestations of dermatosis on the scalp and in other localizations, monitoring of the patient in dynamics is shown.
Treatment of focal cicatricial alopecia. Rational treatment of the patient is possible only after the establishment of the nosology of dermatosis, which caused focal cicatrical alopecia. When appointing drugs, the doctor should always measure the real benefits and possible harm from treatment, since dermatoses, often causing focal scar scar tissue, have a chronic chronic recurrent course, course treatment and dispensary observation of patients is necessary.
With noticeable foci of cicatrical alopecia, patients are advised to properly model hair, wear a hairpiece or wig, and use other methods of camouflage. With stabilization of dermatosis that caused focal cicatrical alopecia, patients who are not satisfied with the proposed methods of camouflage and who are not reconciled with a persistent cosmetic defect, it is possible to perform a surgical correction of the focus of alopecia (removal of the focus or autotransplantation of hair in the focus).
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