Alopecia areata ( Alopecia areata focal, alopecia areata )
Complete or partial hair loss occurs on the head or other parts of the body. Sick children, young people aged 20-30 years, as well as students and people of mental labor.
Etiology, pathogenesis of alopecia nasal
Disorders of the nervous system (neurasthenic syndrome, cerebral hypotension, nervous shocks, vegetovascular dystonia, etc.), the endocrine system, metabolism, impaired absorption of the small intestine, a decrease in zinc and an increase in copper in the hair play a role. Important importance focal infection (chronic cholecystitis, hepatitis, gastritis, enterocolitis, adnexitis, sinusitis, carious teeth, etc.). Indicated by an autoimmune character.
Clinic alopecia nest
On the scalp, often in the occipital region, 1-2 or several rounded, often symmetrical foci of baldness appear without signs of inflammation. The skin in the foci is mobile and folds, the follicular apparatus is preserved. There are progressive, stationary and regressive stages. In the progressive stage, the hair falls out not only in the focus, but also in the border zone (the area of loose hair) and is easily pulled out by bunches. The foci of baldness spread, merge and form large areas with polycyclic edges. New foci of hair loss may appear nearby. In the first days, mild hyperemia, skin hyperesthesia, burning, itching are noted in the baldness areas. After a while, fat and sweating decrease. The skin becomes ivory. In the stationary stage, broken, short, dark-colored hair is observed. The course is benign. After a few months, the areas of baldness begin to grow with hair, first thin, fluffy , and then normal, usually from the center to the periphery (regressive stage). Often, the disease acquires a malignant course. The areas of baldness increase, all the hair falls out on the scalp, face, vellus hair on the limbs and trunk. Subtotal, total or universal alopecia develops .
The disease is progressing. Thick hair falls out on the scalp and it remains only fluffy and short in the marginal zone or a few thin, discolored, which are easily pulled out. The areas of hair loss are increasing. Sometimes there is a rarefaction of the eyebrows and loss of eyelashes.
Etiology, pathogenesis of total alopecia
May be observed in children, adults. The causative factors can be infectious diseases (dysentery, malaria, viral infections, etc.), stressful situations, hormonal disorders, medication, toxic effects of chemicals, malnutrition, intoxication, etc.
Clinic of total alopecia
On the scalp and face, the hair completely falls out. Over the course of several years, first, thin, bleached eyelashes slowly appear, and later hair on the scalp. In some cases, hair appears only in the area of eyelashes and eyebrows, and the scalp remains hairless. Patients complain of weakness, malaise, severe headaches.
Differential diagnosis of total alopecia
Infiltrative suppuration trichophytosis of the scalp. Single, deep foci appear with bright hyperemia and purulent crusts. An abscess develops in the center with the destruction of the skin and hair follicles. Hair falls out, and pus is released from the empty follicles. The clinical picture resembles a honeycomb, Kerion Celsi ( Celsus’s honeycomb ). After regression, inverted scars remain, often fused with aponeurosis and foci of baldness. The causative agent of Trichophyton mentagrophytes . Syphilitic baldness. In the occipital and temporal region, on the beard, eyebrows, eyelashes, a large number of small up to 10-15 mm in diameter foci of baldness is rounded and not prone to fusion. In the foci of baldness, a sharp thinning of the hair is noted and not all hair falls out. The scalp resembles “moth-eaten fur”. Hair loss in the eyelash region is called “omnibus” or “tram” syphilis . When eyelashes are damaged, as a result of their partial loss and successive regrowth of new ones, they have different lengths of “step” eyelashes (sign of Pincus). Serological reactions (RV, RIF, RIBT) are positive.
treatment of alopecia
Find out and eliminate the causes of the disease. Consultations of an endocrinologist, neurologist, otolaryngologist, dentist. Remediation of focal infection. Milk and vegetable fortified diet. In vegetoneurosis, sedatives, biogenic stimulants (tone up the central and autonomic nervous system, enhance tissue metabolism). According to indications, antibiotics. It is advisable to use sulfur-containing amino acids (methionine, cysteine) at 0.25 g 4 times a day, 2-3 months. Vitamins A, C, PP, groups B (B2, B5, B6, B12), multivitamins with the content of micro and macro elements, 2-4 months. ” Solcoseryl ” is prescribed ( deproteinized hemodialysate and ultrafiltrate from the blood of dairy calves; 1 ml of the solution contains 42.5 mg of dry matter), which is administered intramuscularly or intravenously, 5-10 ml once a day, for 20-30 days, or foci of baldness are cleaved. With progression, arsenic and iron preparations. Furocoumarin preparations ( meladinin , ammifurin , beroxan , psoralen , peutsedanin ). Ammifurin 2% solution externally and orally at 0.02 g; Beroxan , 0.02 g orally and 0.5% solution for external use; psoralen inward at 0.005 g (0.01 g and 0.02 g) and outwardly 0.1%; peucedanin 0.01 g orally and 0.5% ointment externally. While taking furocoumarin preparations, it is necessary to carry out control studies of urine, blood, (albuminuria and leukopenia may occur). With ultraviolet radiation, blisters, itching of the skin may appear. At the beginning of treatment, the drugs are rubbed into the lesions in the evening, and in the morning, a mercury-quartz lamp is irradiated. In the following days, a solution or ointment is rubbed 4-3-2 and 1 hour before irradiation. The distance from the source to the mercury-quartz lamp is 100 cm, begin with a Vi dose and this exposure is maintained throughout the course of treatment (20-25 exposures). Tablets are taken in the morning daily, every 2 hours, 1 tablet. The first 6-7 days, 2 tablets, then 4. It is necessary to conduct 4-6 courses with 15-20 day breaks between them. The total dose for treatment with ammifurin and beroxan is 250-300 tablets. Psoralen and peucedinin take 3 months in a row and then repeat the course after 1-2 months , only 2-3 courses. Photochemotherapy (PUVA therapy) is used. Photosensitizers ( furocoumarin preparations ) and long-wave ultraviolet radiation. Glucocorticosteroid hormones 30-40 mg of prednisone are prescribed per day. After application, by the end of the 3rd week, growth of cannon hair is observed , and by the end of the month of real hair, after which the daily dose is reduced to 5-10 mg. The duration of the course is 2-2.5 months , but there are relapses. Effectively with focal baldness, intradermal chipping with hydrocortisone (diluted with novocaine) 25 mg 2 times a week (each lesion is chipped once every 2 weeks), on average, 5-8 injections for each lesion. In this case, hair growth is observed after 3-4 weeks. Apilak (dry native royal jelly of working bees, increases vascular tone and stimulates the function of the nervous system) – 0.01 g 3 times a day before meals under the tongue, 2 months. Reflexology. Women with estrogen deficiency are prescribed the estrogen preparation dimestrol 0.6% oil solution of 1 ml per follicular phase for 3-4 ovarian-menstrual cycles. Given the decrease in zinc in blood plasma, zinc oxide of 50 mg is recommended 3 times a day (washed down with milk), for 20-30 days with a 7-10 day break; hair growth begins after 4-8 months. Solcoseryl is rubbed into the foci of baldness 2-3 times a day (1 g contains deproteinized hemodialysate from the blood of dairy calves – 4.15 mg; jelly and ointment). DNCB ( dinitrochlorobenzene ) – local applications in concentrations of 0.1%, 0.2%, 0.5%, 1% and 2%, depending on the degree of reaction. 2 weeks after sesibilization, DNCB is applied once every 7-14 days. Abroad, applications of anthrolin , mechlorethamine are used . It is noted that often the disease develops against the defeat of the upper symptomatic nodes and in the treatment of gangliolitis (electrophoresis with novocaine, ganglioblockers inside, compresses with ichthyol ointment on the lymph nodes, vitreous body), symptoms decrease, hair growth improves. External treatment begins during the termination of mass hair loss. In order to cause a rush of blood to the foci, improve metabolism and nutrition of the hair roots, alcoholic solutions with tincture of red pepper, Spanish flies in increasing concentrations, chloroform alcohol, Rosenthal paste are applied locally , massage of the scalp is performed. The head should be washed 1 time in 5-7 days with hot water (+ 40 + 45 ° C) with baby soap or egg yolk. Appliques of eggs, henna and basma, chamomile, yogurt (15-20 minutes) are used. Irradiation of foci with erythema doses of ultraviolet rays, diathermy of the cervical sympathetic nodes, d’Arsonval , paraffin applications. To stimulate the adrenal cortex, inductothermy of the lumbar region or a course of inductotherapy for cervical sympathetic ganglia is performed (15 procedures every other day with inductothermy in the lumbar region). In order to obtain hyperemia in the foci, electrophoresis with 1% nicotinic acid solution is used. Irrigation with chloroethyl to the formation of frost, cryotherapy with liquid nitrogen, snow massage of carbonic acid are used. Procedures are prescribed daily or every other day, for a course of 25-30 sessions. After 1.5-2 months, the course can be repeated.
Prevention of alopecia
Elimination of possible causes of the disease (stress, focal infection, hypovitaminosis, etc.). Examination by specialists (neuropathologist, therapist, gynecologist, otolaryngologist) at least 1 time per year. Clinical examination of patients with total and universal forms of baldness for the entire duration of treatment.