Baldness. Causes. Diagnostics. Treatment.
Since the formation of hair follicles, hair enters a cycle of active growth. The relative duration of the phases of the cycle varies depending on the genetic characteristics, age, sex, the state of hemostasis and the neuroendocrine properties of each individual. The cycle of hair growth consists of three stages: anagenic, catagenic and telogen. The phase of anagen is characterized by the initial stage of formation and maturation of the root and core of the hair. The catagenic phase represents the period of complete formation of the hair, and the last, the telogen phase indicates the wilting of the onion and root, followed by hair loss. In addition to genetic factors, age, sex, metabolic and neuro-endocrine activity, the character of the stage development and hair formation is strongly influenced by the seasonality of the year, the nature of nutrition, the mode of work and rest, and the emotional state.
Full or partial hair loss on the head or other parts of the body is called baldness, baldness (alopecia). Distinguish congenital full or partial alopecia, combined with other genetically determined ectodermal dysplasia, and symptomatic alopecia, as a result of bacterial infection or toxic effect on the papillae of hair of severe common diseases, pregnancy, advanced infections. Separately, the age-related as well as premature alopecia are isolated, the formation of which is genetically mediated and largely depends on the state of health and lifestyle. Diffuse hair thinning is often a consequence of seborrhea. The most common pathological process in adults and children is circular, or nest, alopecia areata – hair loss in the form of rounded foci of different sizes.
Causes of baldness.
The role of infection in the formation of alopecia areata was assumed back in the 30s, when epidemic cases of the process in children’s groups were noted. Recently, there are reports of the presence of staphylococci and streptococci in the lesions of the affected skin, identical in phage-type.
Other causes of baldness?
- fast (literally within 3-7 days) loss of a large amount of hair can be caused by severe poisoning and intoxications (for example, heavy metal salts). In this case, the main therapeutic measure will be the removal of toxins from the body (reception of enterosorbents, intravenous infusions of detoxicants), restoration of immunity, protection of the liver. And hair will be restored after recovery within several months.
- prolonged loss of a large number of hair on the entire surface of the scalp – this form occurs with prolonged use of medications (antibiotics, analgesics, immunomodulators and many others). Restorative therapy of the whole organism also helps here; gentle care of hair; rubbing of funds that increase blood flow to the scalp (for example, pepper tincture); zinc preparations for oral administration. Period of hair restoration takes more than 6 months.
- focal alopecia (nesting, circular) – often occurs due to a violation of blood supply and innervation of the hair follicles for problems in the cervical spine (this problem requires consultation of a neurologist and, perhaps, a course of physiotherapy and massage).
- there is also a “male” form of alopecia (although it is often found in women). This form is directly related to the male sex hormone dihydrotestosterone (the hair follicles are sensitive to it) and is hereditary. In women, this form can occur with hormonal disorders in the body (adrenal and ovarian diseases, menopause). Fortunately, there are drugs that block the action of the hormone on the hair follicle (they are injected mesotherapy with microinjections into the scalp, rubbed into solutions, used as shampoos). This greatly helps in solving the problem.
- unfortunately, there are forms of baldness, which are difficult to treat (many of them are of cicatricial origin). Scarring changes in the scalp could occur after trauma, inflammation, radioactive exposure, as a result of skin diseases (fungal, pustular), occasionally it is a congenital form. Here absorbable drugs (lidase), stimulators of blood flow, sometimes hormones are applicable.
In the pathogenesis of alopecia areata there are also genetic, local neuro-trophic features, endocrine and autoimmune disorders. Evidence of autoimmune genesis is the data on the excessive number of pathological circulating immune complexes in the blood serum, the accumulation of lymphoid cells around the hair bulbs during the active phase of the disease, the deposition of immune complexes in the hair follicles.
Patients with focal alopecia showed marked changes in the system of hemostasis and rheological properties of the blood.
Clinical picture. Hair loss occurs suddenly, usually on the head, less often in the area of the cheeks, chin, skin of the eyelids (loss of eyelashes). Single or multiple foci of alopecia usually have the correct round shape, clear boundaries, a tendency to peripheral growth and the formation of large areas, sometimes exciting the entire head (total alopecia). The skin of the affected foci is sometimes slightly hyperemic at first, and then sluggish, flattened, atrophic, shiny, resembling an elephant ivory. During the progression of the disease, the edge zone of loose, easily removable hair is well defined. Depending on the degree of spread of affected areas, several clinical varieties of dermatosis are isolated. When the location of the lesions on the periphery of the occipital and temporoparietal areas of alopecia is called band-shaped (ofiaz), sometimes diffuse alopecia surrounds the entire edge region and then this form is called koronovidnoy. With malignant course, the process progresses steadily, forming a total form of alopecia areata. In patients with a malignant form of alopecia at the same time defeat the scalp thinning eyebrows, eyelashes, hair fall in a mustache and beard, pubic hair, armpits and even disappear vellus hair around the skin surface. The course of the disease is torpid, prone to relapse. Hair grows gradually from the center to the periphery, separate islands; The newly growing hair is at first thin, atrophic, discolored and only gradually, slowly acquiring a normal structure. The disease may be associated with leukocytosis, eosinophilia, anemia, lymphocytosis, increased erythrocyte sedimentation rate, and hypergammaglobulinemia dysproteinemia.
Diagnosis. Diagnosis of baldness is based on the characteristics of clinical symptoms. Differential diagnosis is performed with microsporia, superficial trichophytosis and small-nosed baldness in patients with secondary syphilis.
Negative data from microscopic and luminescent studies of hair and scales on fungi can exclude dermatophytosis. The diagnosis of syphilitic alopecia is excluded on the basis of negative serological reactions and the absence of other manifestations of syphilitic infection.
Treatment of alopecia. Currently, in the treatment of alopecia areata attention is paid to microelements – zinc, copper, iron preparations. Zinc oxide is administered orally 0.05-0.1 g 2-3 times a day, in courses from 1 to 5-6 months, in combination with gemostimulin 0.25-0.5 g as well 2-3 times a day after meals . The effect on the occurrence of any form of alopecia has iron deficiency even in the absence of anemia, therefore iron preparations are also advisable in the appointment of photochemotherapy. UFV is combined with the intake of furocoumarinic agents (puvalene, Beroxane, ammifurin, psoralen). Children under 5 years of photosensitizing drugs do not prescribe inside, and instead of UVD, they apply lubrication with Rosenthal paste. To stimulate active hair growth hormonal preparations are used: glucocorticoids, thyroidin, somatotropin, anabolic drugs (nerobol and its analogs). Hormonal preparations can be rationally combined with vitamins A, E, C, B2, B6, B12, PP. In order to restore microcirculation in the lesions, trental, andecalin, ATP, and parmidinum are prescribed.
Assign funds that normalize the hemostasis and rheological indicators of the blood: tiklit, riboxin, polyene, piyavit in combination with photochemotherapy.
In the treatment of focal alopecia, a 2% solution of minoxidil (Rogaine) and betamethasone dipropionate (ointment diprogen, Beloderm), phytosan-2 is used.
In connection with the current concentration of autoimmune genesis of alopecia, local applications of dinitrochlorobenzene (DNHB) are recommended. It is believed that the inflammatory foci in the place of rubbing DHCP inhibit the formation of pathological immune complexes that hamper the synthesis of keratin in the hair follicles. For external treatment with various forms of baldness, numerous irritating and tonic stirring suspensions, ointments, creams, aerosols are used. More effective creams and ointments containing glucocorticoids, estrogens, androgens, naphthalan alcohol, Rosenthal paste, psoriasin ointment. Often used with good results are alcoholic and ethereal stirring suspensions containing dimexide, andecalin, lidaz, sulfur, valerian.
Physiotherapeutic methods also use irrigation with ethyl chloride, cryomassage with liquid nitrogen and carbonic acid snow, darsonvalization, vacuum massage, diathermy of the cervical sympathetic nodes, massage of the collar zone, phonophoresis of foci of alopecia with hydrocortisone and Aevitis, magnetotherapy. The combination of general therapy with the simultaneous application of external means that improve microcirculation, stimulating the formation of hair keratin, contributes to the restoration of the follicular apparatus and the renewal of the hairline.