Alopecia areata (alopecia areata) – a disease that accounts for 2% of cases among all types of baldness. Alopecia areata is characterized by sudden hair loss on the skin of the scalp, face (beard area), sometimes, extremely rarely, on the skin of the trunk.
We asked Yevgeny Yuryevich Eroshkin, Candidate of Medical Sciences, Clinic of Dermatology and Cosmetology "Evgeniy Eroshkin MD"
Possible causes of alopecia
Е.Е.: Alopecia areata refers to trophoneurotic diseases, in the pathogenesis of which pathologies of the nervous system play an important role.
It is also believed that the process of hair loss in alopecia areata depends on the violation of the activity of inhibitors of enzyme processes, hypo- and hyperfunction of the endocrine glands.
Some authors have pointed to a possible autoimmune nature of the disease, and recent research has been conducted into the presence of a genetic predisposition.
In addition, alopecia areata is almost always associated with foci of chronic infection (chronic tonsillitis, sinusitis, carious teeth).
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Characteristic manifestations of alopecia
Е.Е.: The disease is typically characterized by the appearance of various, more often rounded, bald patches on the skin of the scalp.
The first lesions are usually single, subsequent ones occur at a small distance from the first focus and can be located symmetrically. At the onset of the disease, hyperemia is noted on the affected areas of the skin, accompanied by burning, and / or itching, skin hyperesthesia.
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In the following days, the hyperemia gradually disappears and the skin, devoid of hair, acquires the color of ivory. Long hair falls out painlessly, follicular openings gape, the skin within the area of hair loss becomes slightly atrophic.
Prognosis of the development of the disease alopecia areata
E.E.: The prognosis for alopecia areata is most often favorable. After 3-6 months from the onset of the disease, new hair growth resumes in the areas of baldness.
First, bleached vellus hair grows, then it thickens, becomes pigmented and reaches the thickness and length of normal hair. Hair growth in the lesions resumes at different times, and, as a rule, the old lesions are the first to grow.
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In most cases, normal hair growth is restored in all lesions, and a clinical cure occurs.
However, in some cases, the disease can acquire a malignant course: the number of areas of hair loss increases, all hair falls out on the scalp, face, vellus hair in the armpits and on the pubis. Subtotal, total or universal alopecia develops.
Features of the diagnosis of alopecia areata
Е.Е.: Alopecia areata should be differentiated from syphilitic, leprosy, toxic alopecia, congenital atrophy of the skull skin. An important role in the diagnostic process is played by the histological examination of the skin biopsy from the lesions.
Histologically, in the initial stage of alopecia areata, the main changes occur in the hair follicles: the epithelial sheaths of the hair are separated from the connective tissue membranes of the follicles, the structure of the outer and inner epithelial sheaths is disturbed, they are separated, the papilla of the hair atrophies, the hair follicle changes.
The neuro-receptor apparatus of the skin also undergoes visible changes: the nerve endings located near the hair follicles are destroyed, losing their ability to stain with silver.
In the stabilization phase of the process, the pathomorphological picture changes significantly: vasodilation in the dermis is determined with thickening of their walls, multiple perivascular lymphohistiocytic infiltrates are detected. The number of hair follicles is drastically reduced.
In the enlarged follicle mouths there are remnants of hair in the form of exclamation marks and accumulations of horny masses. Hair follicles shorten.
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Treatment of alopecia areata
Despite the fact that in most cases, alopecia areata resolves on its own, without requiring any intervention, there is a generally accepted European protocol for the treatment of this pathology.
According to the protocol, the following methods received the highest degree of evidence in blind studies:
- topical application of topical corticosteroids of strength class 4;
- intralesional administration of corticosteroids;
- topical contact immunotherapy with DNCB or DNCP.
Other methods of treatment of the described pathology showed either a significantly lower effectiveness of treatment, or the absence of any therapeutic effect at all in participants in clinical trials.
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Possible errors in the treatment of alopecia areata
The main therapeutic error in the treatment of alopecia areata can be the use of methods and / or drugs that do not have proven clinical effectiveness.
Currently, in order to treat this pathology, such dermatocosmetological techniques as mesotherapy and the use of platelet-rich plasma are often used.
Both the first and the second of these methods do not currently have proven clinical efficacy in the treatment of the described pathology, which indicates the inappropriateness of their use in patients with alopecia areata.
In addition, there are attempts at medical therapy with drugs with unproven efficacy in this case. These include the appointment of vitamin complexes, local irritants, preparations of zinc and other trace elements, gelatin, biotin and others.
New protocol for the treatment of alopecia: mesotherapy combined with botulinum therapy.
Source estet-portal.com
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