Alopecia areata is a non-scarring inflammatory chronic recurrent hair loss disease characterized by sudden onset of limited round hair loss. Alopecia areata has a significant impact on the quality of life and psychosocial well-being of patients. Currently, alopecia areata is considered to be an autoimmune disease mediated by T-lymphocytes, and the disruption of the immune immune immune function of normal hair follicles plays an important role in the development of the disease. Its etiology and pathogenesis are not fully understood.
Psychological factors are an important factor in triggering baldness. Many patients have mental trauma before the onset of the disease, such as sudden or prolonged anxiety, apprehension, sadness, mental tension and emotional disturbance. In some patients, these mental factors can cause rapid aggravation of the condition during the course of the disease.
1, autoimmune factors: lymphocyte infiltration around the hair follicles in the hair loss area, some patients have combined autoimmune diseases, and the serum levels of various autoantibodies are elevated.
2. Other factors: Some people believe that it is related to genetics, infection, endocrine dysfunction and poisoning.
Clinical manifestations of baldness
The hair falls out in flakes, in a round or oval shape, and if left untreated, the area will keep expanding. After hair loss, the hair follicles shrink, the pores are not clear, and the scalp is often smooth, some have a downward concave feeling, and some patients have edema of the scalp, which is bread-like. Hair plucking is positive in the progressive stage of the disease.
According to the morphology of the lesions are divided into.
1. patch-shaped: round or oval in shape.
2, reticulated shape: in a reticulated distribution.
3, snake-shaped: band-like distribution along the occipital and temporal forehead hairline.
4, horseshoe-shaped: reverse serpentine distribution, located in the frontal and parieto-temporal regions, not involving the surrounding hairline.
5. Diffuse shape: it may resemble male or female androgenic baldness.
Severe baldness.
A baldness with hair loss area greater than 1/3 of the scalp area or a disease duration of more than 1 year with no tendency to improve is considered severe baldness. In addition to hair loss, eyebrow hair, eyelashes, nose hair, beard, axillary hair, pubic hair and even whole body hair are all lost in general baldness. Severe alopecia areata has a large area of hair loss and is very aggressive, causing great mental suffering and seriously affecting the quality of life of the patient.
Treatment of baldness
I. Local treatment
1.Injecting glucocorticoids into the skin lesions.
It is the first choice of treatment for adult patients with hair loss <50%, and the adverse effects include local pain, skin atrophy and pigment loss.
2. Topical glucocorticosteroids.
Topical glucocorticoid ointment has been widely used for the treatment of childhood baldness or adult baldness with hair loss area <50%, folliculitis is its most common adverse effect.
3. Topical minoxidil.
Minoxidil has long been used for the treatment of male pattern baldness, and its mechanism of promoting hair growth is unclear, probably related to its local expansion of scalp blood vessels, inhibition of perifollicular T lymphocyte infiltration and improvement of peripheral microcirculation. It is often used clinically in combination with other methods to treat baldness.
4. Topical anthralin.
Anthralin has anti-inflammatory and immunosuppressive effects, promotes IL-10 production and inhibits the expression of TNF-α and IFN-γ, and can be used to treat baldness. Its adverse effects include folliculitis, contact dermatitis, local lymph node swelling, etc.
5. Topical contact sensitizers.
The use of sensitizing agents on the lesions of baldness , thus inducing artificial contact dermatitis, the latter can cause local hair regeneration.
II. Systemic treatment
1.Glucocorticoids.
Glucocorticoids mainly include oral and intravenous administration, and the most commonly used shock therapy is intravenous infusion of methylprednisolone. Adverse reactions include acne-like dermatitis, weight gain, gastrointestinal discomfort, full-moon face and scanty menstruation, etc., which can gradually ease or disappear after 3 months of discontinuation of the drug. Since glucocorticoid treatment brings more adverse reactions, clinical use should be cautious, and it is only suitable for total baldness, general baldness or rapidly progressing baldness where general treatment is ineffective.
2. Compound glycyrrhizin.
Compound glycyrrhizin is a two-way immunomodulator. It has anti-inflammatory, immune regulating, anti-metamorphic and steroid-like effects.
Physical therapy
1, 308 excimer laser: a new medium-wave ultraviolet light source, its mechanism of action is mainly to induce T-lymphocyte apoptosis, inhibit cytokine production and antigen presentation of Langerhans cells, clinically it can be used to treat persistent baldness where general treatment is ineffective.
2. Other physical treatments: Narrow-spectrum medium-wave ultraviolet irradiation and photodynamic therapy have also been reported for the treatment of baldness, but they are mainly effective for limited baldness and not effective for total baldness and general baldness. In addition to the above treatment methods, other immunosuppressive drugs (such as azathioprine), traditional Chinese medicine and autologous hair transplantation have also been reported for the treatment of baldness, but they are not suitable for clinical application due to small sample size and large adverse drug reactions or unclear immunopharmacological mechanisms.
Warm tip: Please combine the specific medication with the clinical situation and be guided by the doctor’s face-to-face consultation.