Nest alopecia

Alopecia areata (syn.: circular, or focal, alopecia, pelada) is characterized by the appearance of rounded patches of baldness.

Patients with alopecia areata (AA) account for approximately 2% of dermatological patients. Men and women are equally susceptible to AA, with the peak incidence occurring between the ages of 20 and 50.

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Causes and pathogenesis

The causes of alopecia areata are not established. Alopecia areata is a heterogeneous clinical syndrome, in the development of which emotional stress, acute and chronic infections, physical trauma, and genetic factors play a role. The genetic heterogeneity of this disease explains its clinical polymorphism, which is well known to doctors.

Alopecia areata is considered an organ-specific autoimmune disease, as evidenced by hereditary predisposition, increased frequency of detection of organ-specific antibodies and impaired T-cell regulation of the immune response.

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Symptoms of Alopecia Areata

Symptoms The disease begins with the sudden appearance of a round bald spot without subjective sensations, only some patients report paresthesia. The boundaries of the lesion are clear; the skin within it is unchanged or slightly hyperemic, sometimes of a doughy consistency and more easily than healthy skin, gathers into folds; the mouths of the hair follicles are preserved. In the progressive stage, healthy-looking hair at the edges of the lesion is easily epilated (zone of loose hair); the pathognomonic sign is the appearance of hair in the form of exclamation marks. These are club-shaped hairs about 3 mm long, the distal end of which is split and thickened.

The further course of the disease is unpredictable. Sometimes hair growth in the lesion is completely restored. New lesion may appear, some of them may merge due to the loss of hair separating them. Diffuse hair thinning without the formation of bald spots is possible. Long-term existence of lesion may lead to dystrophic changes and death of follicles.

The first lesions often appear on the scalp. Hair loss in the beard area, hair loss on the trunk, in the armpits and pubic areas is possible. In many cases, eyebrows and eyelashes fall out. Various dystrophies of the nail plates are found in 10-66% of patients.

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Classification of alopecia areata

There is no single classification of the disease. Depending on the area of the lesion, there is focal alopecia (one or more large, up to several centimeters in diameter, bald spots), which, if the disease progresses unfavorably, can decompose into subtotal, total and universal forms. Subtotal alopecia is diagnosed when small areas of hair growth remain on the scalp; total alopecia is characterized by a complete absence of hair on the scalp. Universal (malignant) alopecia is characterized by the absence of hair in all areas of hair growth.

In addition to the forms of the disease, which differ in the area of the lesion, there are three more varieties of alopecia areata: ophiasis (snake-shaped form) - hair loss in the occipital region with the spread of the lesion to the auricles and temples; point (pseudosyphilitic) - the appearance of small (several millimeters) contacting foci; shearing - rounded foci of hair breakage.

Differential diagnostics are carried out with cicatricial alopecia (pseudopelada), mycosis of the scalp, small-focal alopecia in secondary syphilis, trichotillomania, artificial diffuse alopecia, and alopecia in congenital hair shaft dystrophies.

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Treatment of alopecia areata

To date, no safe drug has been found that would permanently rid the patient of alopecia areata and have stable success in the treatment of total and universal alopecia.

Resistance to therapy and an unfavorable prognosis are possible under the following circumstances: family history of the disease, concomitant atopic condition, combination with autoimmune diseases, onset of the disease before puberty, frequent relapses, ophiasis, total and universal forms of alopecia areata, combination with severe dystrophic damage to the nail plates, loss of newly growing vellus hair.

Therapy should be comprehensive and individual. Treatment should be preceded by a thorough examination of the patient in order to identify and correct concomitant diseases and background disorders.

Read also: The most effective remedies for hair loss have been named

External treatments

1. Glucocorticosteroid hormones (applications and injection into the lesion).
2. Contact allergens - dinitrochlorobenzene, etc.
3. Irritants: hydroxyantrones (dithranol, anthralin), red pepper powder, badyaga, onion juice, garlic, horseradish, etc.
4. Products that stimulate hair growth.
5. Placenta preparations with photosensitizing action: Melagenin-1, pilooctiv meagenin (antialopecium).
6. Traditional medicine, including the already listed group of irritants. Herbal preparations are becoming increasingly popular due to their harmlessness and availability.

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General treatments for alopecia areata

Basic therapy means are used, aimed at correcting the concomitant diseases and background disorders identified in patients, and pathogenetic therapy means have an immunosuppressive effect. Physiotherapeutic procedures are a necessary addition to complex therapy.

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