Means and methods of external treatment of circular alopecia

1. Glucocorticosteroid hormones

Mechanism of action: local immunosuppressive effect

Methods of use:

Appliques and occlusive dressings.

Indications: progressive stage of focal alopecia with lesion of less than 50% of the area of the scalp.

Good results of long-term use of strong glucocorticosteroids (fluocinolone, dexamethasone, etc.) have been reported in the form of lotions, creams and ointments. However, according to most dermatologists, this method of treatment is ineffective and persistent hair restoration is observed only in those cases when one could expect their spontaneous growth.

Side effects: skin atrophy, steroid dermatitis (erythema, telangiectasia, dyschromia), hypersensitivity to UV, folliculitis. With prolonged use of steroids for occlusion, the development of a systemic side effect is possible-suppression of the pituitary-adrenal system, which is manifested by a decrease in the level of cortisol in the plasma.

Introduction to the lesions. Indication: single, cosmetically difficult to conceal the focus of alopecia: maintaining the growth of eyebrows.

For intramuscular injection, a crystalline suspension of triamsinolone acetonide in lidocaine is more often used. The concentration range varies from 2.5 to 10 mg / ml. The suspension is administered intracutaneously in 0.1 ml of a distance of 1 cm from each other at a maximum total dose of 2 ml. The treatment procedure is repeated every 2-4 weeks. In the treatment of eyebrows, the concentration of triamsinolone should not exceed 2.5 mg / ml. Hair growth resumes, usually after 4 weeks; a cosmetically satisfactory result is achieved in 3-4 months. Often, a few months after stopping treatment, hair again falls out.

Side effects: soreness and atrophy of the skin at the injection sites. With the maintenance of brow growth, serious eye complications can occur (secondary glaucoma, cataracts).

Frequent administration of maximum doses of a steroid is fraught with the development of serious systemic complications.

2. Contact allergens

Substances such as dinitrochlorobenzene (DNBB), dibutyl salicylate (DBESC), diphenylcyclopropenol (DPPC) and Primula obconica cause contact allergic dermatitis and have been used for more than 30 years in the treatment of KO.

To explain the mechanism of their action, two concepts are proposed:

1. The immunogen attracts an additional population of T cells to the area to be treated, thereby activating the process of removing the putative antigen from the hair follicle.
2. According to the concept of "antigenic competition", the involvement of non-specific T suppressors in the skin site being treated leads to suppression of the autoimmune reaction to the putative antigen.

Indications: focal and subtotal alopecia, torpid to other methods of therapy. With the total and universal forms of the disease, the use of contact allergens is ineffective. It is not recommended to use contact sensitizers in patients with atopic disease, both because of their insignificant efficacy, and because of possible exacerbation of atopic manifestations.

Methods of using DHCP:

1. Sensitization is caused by applying to the skin a lesion of baldness 24, a solution of DNHB. Subsequent application in 10 days of a 0.1% solution of this allergen provokes an immune inflammatory reaction in sensitized patients - allergic contact dermatitis. Then, to maintain a moderate inflammatory response to the centers of circular alopecia, a DNXB solution of a very low concentration (up to 0.0001%) is applied weekly.
2. 2% solution of DNHB is first applied to the skin of the forearm, and after 10 days at the same place, allergic contact dermatitis is caused by the application of a 1% solution of the drug. In the subsequent weekly on a lesion of alopecia, a solution of low-concentration DHCB (0.0001%) is applied.

Duration of treatment is 3-12 months.

Side effects:

• Expected - discomfort caused by manifestations of allergic dermatitis (erythema, itching, rarely - vesicles, attachment of secondary infection).
• Potential mutagenic properties due to poor-quality purification from chloronitrobenzenes
• development of cross-sensitization to levomycetin and some other chemical preparations.

DPCF and DBESK are safer, but less effective than DHCP. These drugs do not have a teratogenic, mutagenic or carcinogenic effect; They are unable to induce cross reactions to other chemicals. Methods of their application are the same as DHCP.

Sometimes when treating DPPC, the phenomenon of tolerance is observed when, in order to achieve a moderate inflammatory reaction, it becomes necessary to constantly increase the concentration of the drug (up to 2%), which ultimately results in the loss of all the newly grown hair.

The use of DBESK should not be combined with PUVA therapy due to a decrease in the effectiveness of treatment, presumably because of the alleged suppression of PUVA of the functional activity of Langerhans cells.

3. Irritant agents

• Hydroxyanthrons (dithranol 0.1% -1% and anthralin 0.1% -1%)
• 10% tincture of red pepper
• bastard
• fresh juice of onion, garlic, horseradish, radish
• tincture of magnolia vine, zamanichi, eucalyptus, aralia, calendula
• 20% turpentine solution in castor oil
• Burr oil
• 30% propolis ointment
• other

Indications: focal form of circular alopecia after cessation of hair loss (in a stationary stage).

Annoyances have long been used to treat circular alopecia; The mechanism of action and effectiveness of most of them have not been tested in modern comparative studies. In fact, irritating agents cause formal dermatitis, manifested by erythema and, sometimes, swelling of the skin at the site of contact, as well as subjective sensations (itching, burning). Perhaps irritants provoke an inflammatory reaction around the hair follicles, which partially distracts the immune cells from the follicles.

Currently, the most frequently used irritating substances from the group of synthetic hydroxyanthrones are used: dithranol and anthralin, close to it in chemical composition.

Dithranol (1-8-dihydroxy-9-anthrone) is a chemical analogue of the natural substance - chrysarobin.

Mechanism of action: The drug has a pronounced cytotoxic and cytostatic local irritant effect. In the place of application there are manifestations of official dermatitis and dyeing of the skin in a yellow-brown color. It is suggested that for dermatitis caused by hydroxyanthrons, other mediators play a dominant role than with dermatitis after the use of other irritants. Nonspecific immunomodulating effect is proved by the growth of hair without clinical manifestations of dermatitis.

Dithranol is available in the form of ointments, lipsticks (chignoderm, dithranol). Addition of paraffin allows you to achieve more accurate application, which is convenient when applied to small foci of alopecia.

Anthralin. The chemical composition and mechanism of action is similar to dithranol.

Method of use: The agent is applied for 30 minutes; in the subsequent, depending on the individual tolerance, the exposure is gradually increased. Efficiency increases with increasing drug concentration. For washing, shampoos containing zinc pyrithionate are used. Patients are warned about the need to wash their hands after applying dithranol (anthralin) and protect the treated skin from exposure to sunlight. It is not recommended to use the product for a long period of time during pregnancy. Hair growth is observed after 3 months, a cosmetically satisfactory effect - after 6 months.

4. Means that stimulate hair growth

Indication: all forms of circular alopecia, regardless of stage.

• Minoxidil (Regeyn)
• Lotion 101-G and others

Difference: with circular alopecia, external treatment can be stopped after achieving a cosmetically satisfactory effect.

5. Preparations improving tissue trophism:

Indication: all forms of circular alopecia, regardless of stage

Containing pantothenic acid

• Bepanten (cream, ointment) - contains pantothenic acid
• Panthenol (aerosol) - contains dexpanthenol
• Trichokam - contains pantothenic acid, palm extract Sabal, essential oils, vitamins, zinc sulfate, amino acids.

Mechanism of action: pantothenic acid is a part of coenzyme A, plays an important role in the process of acetylation and oxidation, participates in carbohydrate, fat metabolism and in the synthesis of acetylcholine; has some anti-inflammatory effect.

Method of use: apply (spray) on the foci 1-2 times a day.

Side effects: allergic reactions to the components of the drugs are possible.

Contraindications: hypersensitivity to the components of the drug.

Preparations from the blood of calves

• Actovegin (gel, ointment).
• Solcoseryl (gel, ointment).

Mechanism of action: activate metabolism in tissues, promote the absorption of oxygen and nutrients by tissues, accelerate the synthesis of ATP, stimulate angiogenesis.

Methods of use: applied to the outbreak 1-2 times a day

Side effects: there may be a burning sensation that does not require discontinuation of treatment.

Contraindications: hypersensitivity to the components of the drug.

6. Drugs that improve microcirculation

Indication: all forms of circular alopecia, regardless of stage.

Gepatrombin (gel, ointment) - a combined drug containing heparin sodium, allantoin, dexpanthenol.

Mechanism of action: heparin has a local antithrombotic, anti-inflammatory effect, improves blood flow. Allantoin has an anti-inflammatory effect, stimulates metabolic processes. Dexpanthenol - pantothenic acid is a part of coenzyme A. Plays an important role in the process of acetylation and oxidation, participates in carbohydrate-Nom, fat metabolism and in the synthesis of acetylcholine; has some anti-inflammatory effect.

Method of use: applied to the centers of alopecia 1-3 times a day, slightly rubbing with massaging movements.

Side effects: local allergic reactions are possible.

Contraindications: hypersensitivity to the components of the drug.

Heparin ointment is a combined preparation containing hepari sodium, benzocaine, benzilnicotinate.

Mechanism of action: antithrombotic, locally anesthetic, anti-inflammatory.

Method of use: applied to the focus 2-3 times a day.

Side effects: allergic reactions are possible.

Contraindications: decreased blood clotting, thrombocytopenia

7. Biologically active preparations from the placenta, having photosensitizing action

Indication: all forms of circular alopecia after cessation of hair loss.

Melagenin-1 - lotion; is applied to the skin of the lesion with a subsequent light rubbing 3 times a day after 8 hours. After a day's rubbing, the focus is irradiated with infrared rays for 11 minutes.

Piloactive melagenin (anti-alopecium) - lotion; is applied to the skin of the hearths once a day. After rubbing - irradiation with infrared rays.

Mechanism of action: stimulation of protein synthesis, improvement of blood flow, normalization of the function of sebaceous glands.

8. Silicon-containing preparations that improve the structure of the hair

Silocast is a combined preparation consisting of 1-chloromethyl silatran (3 g), dimexide (65 ml) and castor oil (up to 100 ml); is available in 100 ml glass bottles.

Mechanism of action: promotes hair growth

Indications: alopecia areata after hair loss is stopped.

Method of use: 1 patch of baldness with a cotton swab, moistened preparations by lightly soaking (do not rub!) 2 times a day, in the morning and in the evening The daily dose of 1 to 5 ml of the solution, depending on the duration and severity of the disease , as well as the patient's age. The duration of treatment is 3 months.

Side effects: there may be a burning sensation and itching, which occurs 3-5 minutes after application of the drug, which takes 15-20 minutes.

9. Stimulants of Keratinocyte Proliferation

Etonium is a bischetvertichnoe ammonium compound.

Form release - powder for the preparation of 1% solution (on isotonic sodium chloride solution) and 2% ointment (on a vaseline-lanolin base).

The mechanism of action: has antimicrobial and local anesthetic effect, stimulates the proliferation of keratinocytes.

Method of use: applied to the outbreak 1-2 times a day. There is a method of simultaneous application of 1-1.5% solution of etonia (2 times a day) and 5% acyclidine ointment (holinomimetic) for a long time before hair regrowth.

10. Alternative medicine, used for alopecia of various origins

In this section, we can refer to therapy with any preparations of plant origin, including those already listed in the group of irritants. Recently, phytopreparations are becoming increasingly popular due to comparative harmlessness and accessibility.

A. A variant of complex therapy used in the treatment of both focal and androgenic alopecia.

Vegetable collection:

• Grass of St. John's Wort 15,0
• Grass of Sage 15,0
• Calendula flowers 15,0
• Grass of oregano 10.0
• Leaves of nettle 20,0
• Burdock root 15.0
• Hop cones 10.0

1 tbsp. Collecting herbs pour 1 glass of water and boil for 5 minutes, insist 2 hours, filter and take a warm 1/2 cup 2 times daily before meals. Course 2-3 months.

Saparal

• Table. 0.05 g №50
• 2 tablespoons morning and afternoon to eat. Course 2-3 months.

The preparation consists of the sum of ammonium bases of salts of triterpene glycosides, obtained from the roots of Manchu aralia. Has a tonic effect.

Contraindications: epilepsy, hyperkinesis, increased excitability.

To avoid disturbance of sleep, do not appoint in the evening hours.

BioSede Injection

• 1 ml in / m №30

The drug is an aqueous extract of herbs.

Action: biostimulant, enhances the processes of metabolism and regeneration, has a general tonic and anti-inflammatory effect.

Contraindications: Achilles, peptic ulcer, malignant neoplasms.

The centers of alopecia are smeared with tincture of St. John's wort in a mixture with table vinegar in the ratio 1: 1 2 hours before UFO.

UFO up to 1.5 Biodozy, 15 sessions per course.

In the centers of alopecia, every evening, rub, alternating every 5 days, the tincture of valerian, eleutherococcus extract, cheremichnuyu water, rotokan (a mixture of liquid extracts of chamomile, marigold, yarrow 2: 1: 1) maraslavin, sour kalanchoe or plantain.

B. Other alternative means.

• Drink tea from herbs Veronica officinalis 15 g per 1 liter of water
• drink tea from deaf nettle, tri-colored violet, string and leaves of wild strawberry. The dose is arbitrary.
• decoction of burdock root - 10 g per 1 glass of water - taken inside during the day
• With a decoction of cuckoo flax, the head is washed; for broth take 20 g of grass, boiled in 300 ml of water, evaporated to 1/3 of the original volume of liquid. The broth can be sweetened with honey and drunk like tea with the addition of red wine.
• wash the head 3 times a week with a strong decoction of a mixture of grass nettle and mother-and-stepmother (1: 1)
• Rinse hair after washing with infusion of young leaves of black currant
• tincture of the roots of the cheddar moisten the hair: 1 part rhizome 120 parts vodka or 70 ° alcohol insist 2 weeks, strain
• rub wax into the scalp of the wormwood - 2 tablespoons per 1 cup of boiling water
• mixture of burdock roots 20 g, calendula flowers 10 g per 1 liter of water, boil for 20 minutes and wash the head at least 2 times a week
• a strong broth of roots of calamus and flowers of calendula rinse the scalp weekly, do not wipe, but allow yourself to dry, for a course of 5-7 procedures
• Infusion of rhizomes of calamus (10 g per 1 cup of boiling water) is used to wash the head and rub into the roots of the hair
• decoction of leaves or birch buds, flowers of black elderberry in equal proportions rub into the skin of the scalp
• hot infusion of cornflower flowers - 1 tablespoon of flowers per 1 cup of boiling water, rubbed into the skin of the scalp
• hot infusion of flower baskets of tansy or chamomile on vinegar and water (2 tablespoons of raw material for 200 ml of apple cider vinegar and 200 ml of water) for daily rubbing with light hair
• strong decoction of leaves of mother-and-stepmother wash the scalp
• decoction of the horsetail of the field (15 g per 200 ml of water), condensed by evaporation in a water bath to half, rubbed into the scalp
• infusion of herb sage (10 g per 200 ml of water) daily rubbed into the scalp
• tincture of the kidneys of black poplar (10 g per 100 ml of vodka, insist 7-10 days), for rubbing into the skin of the scalp every other day for 7-20 days.
• wash the head with a strong decoction of equal parts of willow and burdock roots
• wash the head with a decoction of rhizomes of the egg capsules on the beer
• crushed plant cocklethorn after removing the thorns lubricate the focus of alopecia
• alcohol tincture of birch buds (10 g for 200 ml of vodka) every other day, rubbed into the scalp
• decoction of honeysuckle stems (dose of any) rinse hair after washing
• 1 tablespoon of burdock roots, rhizomes of calamus, calendula flowers, hop cones; brew in 1 liter of boiling water, insist 30 minutes and moisten the head for the night 2-3 times a week
• crushed fresh root of a white water lily mixed with spruce or pine grease is applied to the areas of baldness after washing the head with a decoction of plants. Sosnovuyu gum is not recommended for patients with atopic disease due to the turpentine contained in it, which has a sensitizing effect.
• wash the head and rub after washing decoctions of rhizomes with the root of a big burdock, stepping over the dioecious, the willow willow grass, the tartar, the black poplar buds (20 g per 200 ml of water), the broth is evaporated to half and heated, mixed in half with the internal fat (22)

Means and methods of general treatment

There are funds for basic therapy aimed at correcting the concomitant diseases and background disorders detected in patients, and pathogenetic therapy agents that have an immunosuppressive effect.

A. Fundamental therapy

Selection of funds of this group is determined by the spectrum of background violations detected during the examination of the patient.

When vegetovascular insufficiency is recommended to use vasodilator drugs (xanthinal nicotinate - komplamin, tinicol), which contribute to improving peripheral circulation, including in the hair follicles. The duration of the course is 1-1.5 months, the usual dosages.

The adenosine triphosphate (ATP) possesses an expressed vasoactive effect due to the stimulation of adenosine monophosphate (AMP). The drug also has a membrane-stabilizing effect. ATP is prescribed at 1.0 v / m at day 15 on the course; repeated course - in 2-3 months.

When detecting hemorheological and coagulologic changes with increasing blood and plasma viscosity, increasing erythrocyte aggregation and weakening their deformability), corresponding to the syndrome of "hyperviscosity", their targeted correction is necessary.

The basic means of treatment of hyperviscosity syndrome is rheopolyglucin, a preparation of low molecular weight dextran. Reopoliglyukin reduces the viscosity of blood due to hemodelution, causes disaggregation of erythrocytes, mobilizes endogenous heparin, inhibits the formation of thrombin thromboplastin. The drug is administered intravenously drip slowly (40 capillaries per minute) to 400 ml with an interval of no more than 2 days; 6-8 infusions per course.

A combination of rheopolyglucin (400 ml) with pentoxifylline (100-200 mg) and no-spike (4 ml) is beneficial, which makes it possible to enhance the effectiveness of each of the preparations.

Pentoxifylline exerts a vasodilating effect, improving microcirculation and rheological properties of blood. The drug is not prescribed for acute myocardial infarction, bleeding, severe atherosclerotic lesions of the brain vessels, violation of heart rhythm, pregnancy and lactation.

The optimal method of reocorrection is the alternation of infusions of rheopolyglucin with pentoxifylline and intravenous injections of isotonic sodium chloride solution (250 ml) and solcoseryl (4 ml); on the course - 6-8 infusions. Solcoseryl is a deproteinized extract from the blood of calves. The drug stimulates angiogenesis, promotes revascularization of tissues, stimulates energy metabolism, improves rheological properties of blood. The drug is not used for intravenous administration for heart failure, pulmonary edema, oliguria, hyperhydration. Solcoseryl can be prescribed and intramuscularly daily for 5 ml, for 4-6 weeks.

To correct the rheological and coagulogic properties of the blood, Piyavit, a preparation containing the secretion of the salivary glands of leeches, can also be used - 0.3 g (2 capsules) 3 times a day for 10 days.

Treatment with all drugs of this group is carried out under the control of a coagulogram.

With hydrocephalic syndrome (increased intracranial pressure, spasm of cerebral vessels, cerebrospinal fluid disturbance and hemocirculation), along with sedatives, dehydrating agents (veriotiron, diacarb, triampur) and nootropics are used. The treatment course is repeated 3-4 times a year; duration of reception of dehydrating agents - no more than 3 weeks. Therapy of hydrocephalic syndrome should be coordinated with a neuropathologist.

With intracranial hypertension, patients are prescribed 25% solution of magnesium sulphate 3-6 ml intramuscularly No. 6-10, which also has a sedative effect.

Since alopecia of any type (circular, androgenic, diffuse) in the hair shaft there is a decrease in the level of calcium, magnesium, zinc, selenium and silicon, it is necessary to prescribe drugs containing these trace elements. One of the most effective drugs of this series is HSN (hair, skin, nails) containing a set of necessary trace elements.

Traditionally, zinc oxide in powders is prescribed to 0.05 g 3 times a day for 3 months. After a one-month break, the course is renewed, such courses are conducted 3-4. In the intermissions between the intake of zinc oxide, agents containing calcium, phosphorus, magnesium, and iron are used. The opinion is expressed that the purpose of zinc preparations is effective in the complex therapy of severe forms of alopecia areata, especially in patients with immunodeficiency after the abolition of glucocorticosteroid therapy.

It is possible to use zinctal, in which 1 tablet contains 200 mg of zinc sulfate (1 tablet 3 times daily before meals). The maximum daily dose is 6 tablets. Taking these zinc preparations can cause nausea, vomiting, and abdominal pain.

Acceleration of regeneration processes is achieved by the appointment of biogenic stimulants (aloe extract, placenta extract, appenin, apilac, nonsteroidal drug with anabolic effect, potassium orotate), improving cellular metabolism, trophic and tissue regeneration. Preparations are prescribed in usual therapeutic doses for a month. According to the type of action, anabolics include riboksin, which is capable of increasing the activity of a number of enzymes in the Krebs cycle, stimulating the synthesis of nucleotides, and improving metabolic processes in tissues; it is prescribed for 0.1 g 3 times a day for a month.

Attention is drawn to the use of dalargin, a synthetic analogue of leyencephalin in the treatment of non-severe forms of KO in the progressing stage. The drug has immunocorrecting and anti-stress action, prevents the development of trophic disorders. A side effect of dalargin is a decrease in blood pressure.

In the treatment of the focal form of circular alopecia, glycyram, an extract of the licorice root, moderately stimulating the function of the adrenal cortex, the hormones of which promote the resumption of hair growth has found application. Glytsiram take 2 tables. 3 times a day for 2 months. Licorice root is also included in the elixir "Amber Plus", which is assigned to 3 tables. In the morning for a month.

Even in the absence of anamnestic indications of stress as a possible triggering factor of the disease, sedatives and anxiolytics (sibazon, atarax, etc.) should be included in the treatment complex, as sudden loss of hair inevitably causes neurosis, hypochondriacal state, depression in patients.

Treatment with sedatives is recommended to combine with central metabolites of amino acids and nootropics (cerebrolysin, aminalon nootropil, pantogam), which improve brain function, affecting microcirculation (suppression of platelet aggregation, restoration of rigid red blood cells), energy and protein metabolism

B. Means of pathogenetic therapy

• Glucocorticosteroids

In many cases of circular alopecia, including total alopecia, general treatment with corticosteroids promotes the restoration of normal hair growth: hair loss ceases, hair is quickly pigmented and thickens.

Analysis of numerous publications allows us to identify 3 main methods of corticosteroid treatment.

1. Short-term prescription of prednisolone (5 days - 15 mg / day, days - 10 mg / day, 5 days - 5 mg / day) in the progressing stage of the disease as part of complex therapy.
2. Pulse therapy with prednisolone
   • minimum 4-month course of prednisolone at a dose of 300 mg per month (10 mg per day) with an interval between courses of 4 weeks.
   • minimum 4-month course of prednisolone at a dose of 1000 mg per month (32 mg per day) with an interval between courses of 4 weeks.
3. Permanent treatment with prednisolone for up to 6 months for 1-2 months appoint 20 to 40 mg of prednisolone per day, followed by a reduction in the dose to the supporting dose. Therapy with corticosteroids is recommended to combine with the external application of minoxidil.
   • long-term use of small doses of dexamethasone (1-1.5 mg / day) as part of complex therapy.

However, despite the good immediate results of treatment and the serious theoretical background of the use of GCS (immune or autoimmune pathogenesis of the disease), there is no consensus on the appropriateness of their use. Restoring the normal cycle of the hair follicle, corticosteroids, unfortunately, cause a number of common serious complications, the heaviest of which can lead to the death of the patient. The main complications of steroid therapy include: exogenous Itenko-Cushing syndrome, immunosuppressive state, stomach ulcer and duodenal ulcer, diabetes mellitus, patient's psyche disorder, muscle atrophy, vessel fragility, water-salt balance disturbance, hypoproteinemia, hypercoagulable syndrome.

Another weighty argument against the use of these potentially dangerous drugs for circular alopecia are relapses of the disease that occur in 2/3 of the patients after corticosteroid withdrawal, and sometimes in the process of reducing their dose. It was suggested that a persistent positive effect is achieved in those patients whose recovery would have occurred without the use of corticosteroids, but would have been slower. There is no consensus on the method and duration of corticosteroids.

• Cyclosporin A

Identification of the role of the immune system in the development of circular alopecia led to attempts to treat this disease with an immunosuppressive drug - cyclosporin A, or sandimmunom. The drug reduces the activity of T-lymphocytes in the skin, but unlike cytostatics and other immunosuppressors, it does not affect the main functions of macrophages and granulocytes, does not cause lymphocytolysis, selectively acting at the level of cytokines, disrupting the cooperation of immunocompetent cells.

Side effects: usually depend on the dose and decrease when it decreases. The most frequently observed violation of the kidneys, liver and gastrointestinal tract (nausea, vomiting, diarrhea), hypertrichosis, tremor, gingival hypertrophy; less often - headaches, mild anemia, hyperkalemia, weight gain, swelling, paresthesia, dysmenorrhea.

The observation of 6 patients with a long-term (on average - 8 years) total alopecia receiving cyclosporine A at 6 mg / kg (ie more than the maximum allowable dose of 5 mg / kg). Cosmically acceptable hair regrowth was in 3 out of 6 patients. There was a clear correlation between the clinical improvement and the reduction in the scalp of the number of infiltrating immune cells due to a significant decrease in T-helpers. A positive clinical effect was observed 2-4 weeks after the initiation of therapy, but 3 months after cessation of therapy the disease recurred.

Other immunosuppressors were used with a similar result: inosiplex (groprinosin), timopentin (active part of thymopoietin), levamisole.

Thus, the temporary positive effect of immunosuppressive therapy has a theoretical value, confirming the role of the immune system in the development of circular alopecia. Due to the high nephro- and hepatotoxicity, these drugs can not be recommended for general use.

• Photochemotherapy (FTX, PUVA-therapy)

FTX (PUVA) therapy is a combined use of photosensitizers and UV-A radiation with a wavelength range of 320-400 nm. In the quality of photosensitizers, preparations from the psoralen group, intended for oral administration (8-methoxapsoralen and 5-methoxapsoralen, 8-MOP and 5-MOP, respectively) are more often used, and for external use (1% oily emulsion of 8-MOS or 1 % methoxypsoralen ointment). Installations for FTX therapy have various modifications, allowing to irradiate the entire surface of the skin and separately the head.

Mechanism of action: the immunosuppressive effect of FTX therapy is realized by affecting T-lymphocytes and suppressing the antigen-presenting function of Langerhans cells in the skin. It is believed that photochemotherapy also provides general immunosuppression by direct or indirect (via interleukin 1) stimulation of prostaglandins.

Numerous contraindications for photochemotherapy, including benign and malignant tumors, tuberculosis, gastrointestinal diseases, diabetes mellitus, thyrotoxicosis, hypertension, liver, kidney, heart, central nervous system, pregnancy, cachexia, cataract, etc. Should be taken into account.

Nearest side effects: dyspeptic disorders, headache, palpitations; dryness, itching and soreness of the skin, acute photodermatitis.

Remote side effects: systemic immunosuppression; Induction of photoimmune processes, skin cancer, keratoses; uneven pigmentation, lentigo, onycholysis.

Methods of application:

1. Local FTX-therapy.

The photosensitizer is used externally for 30 min. Before irradiation. Local UV-A irradiation is carried out 4-5 times a week, on a course of 20-40 procedures. Repeated courses are prescribed after 1-3 months depending on the clinical effect.

2. General FTX-therapy.

The photosensitizer is taken orally (0.6 mg / kg) in tablets 2 hours before irradiation; possible combination with external application of the drug. General UV-A irradiation is carried out 4-5 times a week, on a course of 20-40 procedures.

Furalin, Beroxane, ammifurin can also be used as photosensitizers. When hair growth occurs, PUVA therapy is stopped.

The accumulated experience of using FTX therapy for circular alopecia allows us to state that hair growth is restored, mainly in patients with focal alopecia (up to 60% of patients); with the total form of the disease the method is of little effect. The best results are achieved with total FTX therapy. Termination of treatment leads to relapse of the disease in 50-90% of patients. Thus, FTX therapy can not be considered a safe and effective method of treating circular alopecia and recommend for widespread use.

Physiotherapeutic methods of treatment of circular alopecia

Physiotherapeutic procedures are a necessary complement to the complex therapy of patients with circular alopecia. The methods of physiotherapy are as diverse as the medications.

Methods of reflex action are used in the progressing stage of the disease:

• D'Arsonvalization of the collar zone
• Ultraton-therapy of the collar zone
• Galvanic collar for Shcherbak
• Effects on cervical sympathetic and parasympathetic ganglia (amplipulse, diadynamic therapy, etc.)
• The effect of a static field (electrotrichogenesis, general franklinization)
• Reflexotherapy (acupuncture, electro-puncture, exposure to various types of electromagnetic radiation - laser, microwave).

Methods of local effects are used in the stationary stage of alopecia:

• Massage (manual, vacuum, cryomassage)
• Irrigation with chloroethyl
• The application of paraffin (ozocerite)
• Therapy by the currents of d'Arsonval
• Ultrason therapy
• UFO

Since both reflex and local physiotherapy procedures have a general effect on the patient's body, the choice of method should be agreed with the physician-physiotherapist.

Tactics of management of patients with circular alopecia

In focal alopecia of the usual type with a total lesion area not exceeding 25% of the scalp area (S1B0), examination and treatment of the patient can be carried out on an outpatient basis. During the examination, the main attention is traditionally paid to the search and sanitation of foci of chronic infection (odontogenic infection, ear, nose, throat, etc.). With a progressive stage of circular alopecia among topical treatments, the best results are given by glucocorticosteroids (occlusive dressings and intraocular administration). Physiotherapeutic methods of reflex action are used. In the stationary stage of circular alopecia, irritants are used externally; drugs that improve tissue trophism and microcirculation; hair growth stimulants; biologically active preparations from the placenta; means of alternative medicine. The choice of the means and the method of external treatment is not fundamental, since for this form of the disease spontaneous hair restoration is characteristic. Any methods of local and reflex physiotherapeutic influence are effective.

In focal alopecia with the same lesion area (S1B0), but with a pronounced tendency to progression (hair is easily epilated over the entire surface of the scalp), it is advisable to examine and treat the patient in a dermatological hospital. In addition to foci of chronic infection, endocrine diseases and various background disorders are often detected in such patients. The spectrum of the revealed changes determines the choice of means of general therapy. Correction of concomitant diseases (conditions) favorably affects the compensatory reactions of the body and brings real benefits, even if the hair in the lesion focus does not begin to grow in the short term. In the appointment of treatment should be used only those means that do not lead to functional disorders of other important organs and systems and do not reduce the protective reactions of the patient's body. Thus, in atopic disease, antibiotics should be avoided and the use of contact sensitizers should be avoided, with ulcer disease of corticosteroids, etc.

General treatment with corticosteroids and other immunosuppressors is only permissible in hospital settings in exceptional cases of the combination of circular alopecia with a serious disease that is dangerous to the health of the patient, a disease in which the purpose of these drugs is indicated.

In ophthalmic, total or universal (malignant) alopecia, which began at a prepubertal age in a patient with atopy and a family history of the disease, that is, with an obviously unfavorable prognosis, long-term use of unsafe for the organism patient expensive medications can not be justified. It is advisable to use rational means of basic therapy, as well as psychological help in adapting a patient to his condition and to wearing a wig.

The main thing for a doctor is not to forget that circular hair loss is just a cosmetic defect, and carefully measure the real benefit and harm of the therapy.

[1], [2], [3], [4]