Alopecia: causes, symptoms, diagnosis, treatment

Alopecia (alopecia) - abnormal hair loss on the head, face, rarely - on the trunk and extremities.

There are cicatricial and non-scarring alopecia. Scar alopecia occurs due to destruction of hair follicles due to inflammation, atrophy or scarring in case of lupus erythematosus, pseudoplellagra, Little-Lasseur syndrome. Follicular mucinosis.

Non-scarred alopecia develops without previous skin lesions (nesting, androgenetic, anogenous, telogen).

Nesting alopecia is characterized by the appearance of oval or round foci of alopecia on the scalp, face. According to American researchers, about 1% of the population of the USA by 50 years at least once suffered nest alopecia and about 0.1% of the entire population at least once observed hair loss. The disease is equally common in both women and men, in representatives of all races and is distributed relatively evenly across all continents.

Causes and pathogenesis of alopecia. To date, the etiopathogenesis of the disease remains controversial, and the weight of the viewpoints considered (nervous, immune, endocrine, etc.) have equal rights to exist.

Most authors suggest an autoimmune mechanism of hair follicle damage. Changes in the content of T and B lymphocytes, an increase in immune complexes and the presence of lymphocytic infiltrates around the hair follicles and antibodies against hair follicles in patients with alopecia have been revealed. Alopecia areata are often combined with other autoimmune diseases (Hashimoto's thyroiditis, nodular goiter, vitiligo, autoimmune poly-glandular syndrome, etc.).

Symptoms of alopecia. There are focal, subtotal, total and universal forms of alopecia. With the focal form, the hair falls out gradually, the bald patches form for a few weeks or months. Hair loss can be insignificant and inconspicuous for the patient. In the affected areas, hair growth after a while resumes, but at the same time new foci of alopecia appear. The skin in the focus of alopecia is usually not changed. In some patients in the first days of the disease, on the areas of alopecia, a mild redness can be seen, which is accompanied by itching, burning, hyperesthesia of the skin. Subsequently, the redness disappears, and the skin, devoid of hair, acquires the usual color or color of ivory. Foci of alopecia are oval or rounded, single or multiple. On their periphery, the hair is unstable with weak stretching drop out in small bundles (the zone of shaky hair). This diagnostic feature is characteristic for the progressing stage of the disease. On the hair deprived of hair, the empty mouths of the hair follicles are visible. Foci of lesions expand around the periphery, adjacent foci merge into one large focus. The size of lesions from a few millimeters to several centimeters. In the stationary stage of the disease, broken, short, dark-colored hair can be found, which can cause diagnostic errors. Foci of alopecia after a certain time, even without treatment, can spontaneously resolve, which corresponds to the stage of regression. Foci of alopecia can be localized on the scalp, eyebrows, eyelashes, in the pubic region, in the zone of the beard and mustache. Sometimes alopecia acquires a malignant course. In this case, the centers of alopecia increase in size and quantity. All the hair falls out: on the scalp, face, tufted hair on the trunk, limbs, ie, subtotal, total and universal forms of alopecia develop.

With subtotal alopecia, hair loss slowly progresses, the patches of baldness gradually increase, thick hair falls out on the scalp. Persistent and short hair in the back of the neck and temples and in separate areas of the skin, where there are thin, discolored single hair, which with a slight sipping for the free end drop out.

Total alopecia develops rapidly, that is, within 1-2 months the hair on the head and face fall completely. This form of alopecia is accompanied by various neurological disorders.

With universal alopecia, hair loss is noted not only on the scalp and face, but also on the trunk and extremities; also the nails (onycholysis, the "thimble" symptom, longitudinal and transverse striations, increased fragility) and neurological status (vegetative-vascular dystonia, neurotic syndrome) also change.

Differential diagnosis. Alopecia should be distinguished from toxic, syphilitic alopecia, hair loss caused by dermatophytia (trichophytosis, microsporia), trichotilomania.

Treatment of alopecia. Elimination of bad habits (alcohol consumption, smoking) and concomitant diseases. In the focal form, irritants (dinitrochlorobenzene, tincture of pepper, etc.), which cause artificial allergic contact dermatitis, are used. A good therapeutic effect has external photochemotherapy, applications of strong and very strong corticosteroids, injections of corticosteroids into the lesion focus. With subtotal, total and universal forms of alopecia, systemic corticosteroids or PUVA-therapy are prescribed. However, after the abolition of corticosteroids, a relapse of the disease often occurs. Long-term use of steroids is undesirable because of side effects. With all forms of alopecia, in addition to the above therapy, it is desirable to prescribe vitamin therapy, biogenic stimulants and microelements.

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