Alopecia (baldness) is a progressive hair loss that leads to baldness of the head or other hairy areas of the skin. There are diffuse alopecia (thinning and thinning of hair throughout the head), focal (the appearance of foci of complete absence of hair), androgenic (male-type, associated with the level of male sex hormones in the blood) and total (hair is completely absent). The form of the disease is diagnosed according to trichoscopy, hormonal tests, skin biopsy, hair examination. Complex treatment: selection of hair care products, diet, mesotherapy, physiotherapy, if necessary – hair transplantation.
ICD 10
L63 L64 L65 L66
Meaning
Alopecia is a complete or focal hair loss in the places of their normal growth. More often, alopecia is observed on the scalp. Both men and women are susceptible to various types. About half of men over the age of 50 and a third of women have various signs. This disease is a pronounced cosmetic defect and a serious psychological problem.
Causes of alopecia
The loss of mature hair usually leads to a decrease in the density of the hair cover and quite rarely to total alopecia. There are quite a lot of reasons for the loss of mature hair, for example, due to physiological changes in the body during pregnancy, the phenomena can occur after childbirth. Long-term use of retinoids, oral contraceptives and drugs that slow blood clotting, especially in combination with constant stressful situations and endocrine disorders, quite often cause alopecia. The lack of iron, zinc and other nutritional disorders in the body also adversely affects the density of the hair cover.
Pathogenetically, alopecia of this type is caused by mycoses, radiation therapy, poisoning with bismuth, arsenic, gold, thallium and boric acid. Hair loss and alopecia may be preceded by antitumor therapy using cytostatics.
Symptoms of alopecia
As a rule, disease begins gradually with the appearance of small bald patches in the parietal or frontal part of the head, the skin acquires a glossy sheen, the phenomena of atrophy of hair follicles are observed, in the center of the foci you can find single long hair that does not change in appearance. If the cause of alopecia is the loss of growing hair, then over time this can lead to complete hair loss.
Androgenic alopecia
Androgenic alopecia is observed mainly in men, it begins to manifest itself after puberty and forms by the age of 30-35. The development of disease in this case is associated with an increased amount of androgenic hormones, which is due to hereditary factors. Clinically, androgenic alopecia is manifested by the replacement of long hair with fluffy ones, which eventually shorten even more and lose pigment. At first, symmetrical bald patches appear in both temporal areas with gradual involvement of the parietal zone in the process. Over time, the receding hairline merges due to peripheral growth.
Scar alopecia
Cicatricial alopecia, in which hair loss is accompanied by the appearance of shiny and smooth areas of the scalp, differs in that such areas do not contain hair follicles. The cause of this type may be a congenital anomaly and defects of the hair follicles. But much more often, infectious diseases such as syphilis, leprosy and herpes infections lead to scar alopecia. Changes in the ovaries and pituitary gland by the type of hyperplasia and polycystic, basal cell carcinoma, prolonged use of steroid drugs also provoke scar-type alopecia. Exposure to aggressive chemicals, burns, frostbite of the scalp are the most common exogenous causes of scar alopecia.
Nest alopecia
Nest alopecia, when areas of baldness are not accompanied by scarring and are located in the form of rounded foci of different sizes, appears suddenly. The causes of nest alopecia are not known, but meanwhile, areas with alopecia phenomena tend to peripheral growth, which can lead to total hair loss. More often, nest alopecia is observed on the scalp, but the process of baldness can affect the area of the beard, mustache, eyebrows and eyelashes. Initially, the foci have small sizes up to 1 cm in diameter, the skin condition is not changed, but sometimes there may be slight hyperemia.
The mouths of the hair follicles in the affected area are clearly visible. With the peripheral growth, the foci acquire a scalloped character and merge with each other. In the circumference of the sections there is a zone of loose hair, which, with a slight impact, can be easily removed, the hair in this zone at its root is devoid of pigment and ends in a bulbous thickening in the form of a white dot. They were called “hair in the form of an exclamation mark”. The absence of such hair indicates that the nest alopecia has passed into the stationary stage and the end of the progression of hair loss.
After a few weeks or months in the foci, hair growth is restored. At first they are thin and colorless, but over time their color and structure acquire a normal character. The fact that hair growth has resumed does not exclude the possibility of relapses.
Seborrheic alopecia
Seborrheic alopecia is observed in about 25% of cases of seborrhea. Baldness begins during puberty and reaches its maximum severity by the age of 23-25. At first, the hair becomes greasy and shiny, looks like oiled. The hair is glued together into strands, and there are tight-fitting greasy yellowish scales on the scalp. The process is accompanied by itching and often seborrheic eczema joins.
Baldness begins gradually, at first the life span of the hair is shortened, they become thin, thin and gradually long hair is replaced by fluffy. As seborrheic alopecia develops, the process of hair loss begins to increase, and the bald spot becomes noticeable, it begins from the edges of the frontal zone towards the back of the head or from the parietal zone towards the frontal and occipital. The focus of baldness is always bordered by a narrow ribbon of healthy and tightly fitting hair.
Traumatic alopecia
Trichotillomania, when a person has an uncontrollable attraction to pulling out his own hair and damage to hair follicles with excessively tight braiding of braids can lead to traumatic alopecia, which, taking a chronic character, often ends in complete baldness.
Diagnostics
Diagnosis of alopecia is not difficult, since the patient has either a decrease in the density of the hair cover, or areas with a complete absence of hair. It is much more difficult to identify the cause of alopecia in order to prescribe a treatment regimen. This requires the consultation of a trichologist.
Usually, a comprehensive examination of the patient is carried out, which includes a hormonal background examination – a study of the functions of the thyroid gland and determination of the level of male hormones in the blood. A complete blood test is also required to detect or exclude disorders of the immune system. It is necessary to exclude or confirm the syphilitic nature of alopecia, for which a serological examination of the blood and an RPR test are performed. In patients with nest alopecia, the number of T- and B-lymphocytes is usually reduced and a positive test with hair pulling – careful pulling on the hair shaft leads to its easy removal.
Microscopic examination of the hair shaft and foci of baldness for the presence of fungi is mandatory, a biopsy of the scalp skin allows you to identify or exclude dermatomycosis and scar alopecia that have developed against the background of systemic lupus erythematosus, sarcoidosis or against the background of lichen planus. Additionally, a spectral analysis of the hair is carried out.
Treatment of alopecia
In the treatment of alopecia, the mode of shampooing can be arbitrary, with the exception of seborrheic alopecia, when shampooing should be no more than once a week. The use of non-aggressive detergents, which include herbal extracts, promote hair growth.
In addition to vitamin complexes and basic treatment, it is necessary to reconsider the diet. With baldness and hair loss, food should contain a large amount of zinc and copper. The diet should include liver, seafood, grains and cereals, mushrooms, green vegetables, orange and lemon juice – these products should be consumed at least once a day. The exclusion of coffee, alcohol and extractive substances contribute to the normalization of the autonomic nervous system, and in addition, these substances are contraindicated while taking medications prescribed for alopecia.
If the main cause of hair loss is the loss of mature hair, then the maximum manifestations of alopecia are observed three months after exposure. As a rule, after the withdrawal of medications, normalization of the lifestyle and nutrition, hair loss is quickly restored. In alopecia due to the loss of growing hair, their maximum loss is observed a week or a few days after exposure to the provoking factor. When the root cause is eliminated, hair growth is quickly restored.
Scar alopecia requires the elimination of the underlying cause in order to prevent total hair loss, after which they resort to surgical treatment with excision of areas of scar tissue and hair transplantation.
With androgenic alopecia, medicinal solutions containing hair growth stimulants contribute to the restoration of hair in a significant part of patients. However, it should be borne in mind that their effectiveness depends on the duration of use. Usually, hair growth is observed 10-12 months after the start of therapy. An alternative way to treat androgen alopecia is to take hormonal drugs to correct the hormonal background and subsequent hair transplantation.
For the treatment of androgenic and seborrheic alopecia in women, antiandrogenic oral contraceptives are prescribed, which normalize the hormonal background and have a beneficial effect on the condition of the skin, hair and nails. They try to choose such oral contraceptives that have a minimum of contraindications and practically do not cause side effects.
Nest alopecia usually resolves on its own within two to three years, but even with self-healing, frequent relapses are observed. Since the main cause of this alopecia is stress and hypovitaminosis, vitamin therapy, thyroid normalizing drugs and sedatives have a good effect. To stimulate hair growth in trichology, furocoumarin preparations (medicinal substances based on plants) are used. It should be borne in mind that the treatment regimen for alopecia depends on individual sensitivity and on the time of year, and therefore the use of these drugs during alopecia therapy should be under the supervision of a doctor.
Therapy of traumatic alopecia should be carried out jointly with psychologists and psychiatrists, since the cure occurs after the hair pulling stops. The use of sedatives and behavior correction can completely or partially eliminate the manic behavior that led to traumatic alopecia.
If the cause of alopecia is dermatomycosis, then antifungal therapy is carried out in compliance with all antiepidemic measures in the focus. After healing, hair growth usually resumes. However, for example, with a prolonged course of favus, persistent postfavus alopecia is observed and then the only method of recovery is hair transplantation.
Forecast
If the cause of hair loss is dermatomycosis, hormonal disorders and trichotillomania, then after correction there is a complete restoration of the hair cover. With scarring and total nest alopecia, the hair usually does not recover, since the hair follicles have serious damage, then hair transplantation is required.
In general, the success treatment depends on how well all the doctor’s prescriptions are followed and at what stage of the disease the patient sought medical help. Folk remedies in combination with medical treatment can accelerate recovery. Independent therapy is usually not advisable and ineffective, since it does not eliminate the main causes of alopecia.
Literature
- Jackson A. J., Price V. H. How to Diagnose Hair Loss // Dermatologic Clinics. — 2013; 31(1): 21-28. link
- Harrison S., Bergfeld W. Diffuse hair loss: Its triggers and management // Cleveland Clinic Journal of Medicine. — 2009; 76(6); 361-367. link
- Singal A., Sonthalia S., Verma P. Female pattern hair loss // Indian Journal of Dermatology, Venereology, and Leprology. — 2013; 79(5): 626. link
- Banka N., Bunagan M. J. K., Shapiro J. (2013). Pattern Hair Loss in Men // Dermatologic Clinics. — 2013; 31(1): 129-140. link
- Frank Spano, Jeff C. Donovan (2015). Alopecia areata. Part 1: pathogenesis, diagnosis, and prognosis // Canadian Family Physician. — 2015; 61(9): 751-755.
- Williamson D., Gonzalez,M., & Finlay A. The effect of hair loss on quality of life // Journal of the European Academy of Dermatology and Venereology. — 2001; 15(2): 137-139.
- Vañó-Galván S., Camacho F. (2017). Novedades terapéuticas en tricología // Actas Dermo-Sifiliográficas. — 2017; 108(3): 221-228. link
- Wolff H., Fischer T. W., Blume-Peytavi U. The Diagnosis and Treatment of Hair and Scalp Diseases // Deutsches Aerzteblatt Online. — 2016; 113 (21): 377-386.
