Alopecia areata, commonly known as “ghost shaving”, is a sudden appearance of round or oval shaped patches of hair loss on the head. Initially, it is a small area of hair loss, one or several pieces, with no conscious symptoms. In a few patients, all the hair can be lost within a short period of time, so it is called total baldness, and if body hair is also lost, it is called general baldness. Although baldness is not fatal or disabling, it has a great impact on the quality of life and psychological well-being of patients.
1.Incidence The incidence of baldness in the population is about 0.1%~0.2%, and 1.7%~2.0% of the population will experience baldness in their lifetime. It can occur in both children and adults, and although it is uncommon for children within 3 years of age to develop it, most patients are younger, with 66% of patients developing it before the age of 30 and only 20% after the age of 40. There is no significant difference in the incidence between men and women.
The causes of baldness and its mechanisms are not fully understood, but may be related to psychosomatic, autoimmune and genetic factors.
3.Treatment Local treatment Intradermal glucocorticoid injection: It is the treatment of choice for adult patients with alopecia areata <50%< span="">, and can result in localized new growth in 60%-67% of patients. Adverse effects include localized pain, skin atrophy and pigment loss, and a high relapse rate when treatment is interrupted.
Topical glucocorticoids: Topical glucocorticoid ointments have been widely used to treat childhood baldness or adult baldness with <50%< span=""> hair loss, with folliculitis being the most common adverse effect. The treatment alleviates the pain of patients and the compliance of children is good, which is worth promoting.
Topical minoxidil: Minoxidil has long been used to treat male pattern baldness, often in combination with other methods for the treatment of baldness.
Topical anthralin: Anthralin has anti-inflammatory and immunosuppressive effects and can be used for the treatment of pemphigus vulgaris. It is mainly used to treat adult or pediatric patients with long-standing baldness. Its adverse effects include folliculitis, contact dermatitis, and local lymph node enlargement.
Topical contact sensitizers: The use of sensitizers on baldness lesions, thereby inducing artificial contact dermatitis, the latter of which can lead to local hair regrowth. Diphenylcyclopropenone and dibutyl squareate are the most commonly used contact sensitizers for the treatment of baldness, of which diphenylcyclopropenone can be the treatment of choice for total baldness.
Systemic treatment: Glucocorticoids: Glucocorticoids mainly include oral and intravenous administration. Adverse effects include acne-like dermatitis, weight gain, gastrointestinal discomfort, full moon face and scanty menstruation, which may gradually resolve or disappear after 3 months of discontinuation. Since glucocorticoid treatment brings more adverse reactions, clinical use should be cautious, and it should only be used for total baldness, general baldness or rapidly progressing baldness where general treatment is ineffective.
Oral compound glycyrrhizin: The commonly used dose is 2~3 tablets orally each time, 3 times a day, for 2~3 months as a course of treatment. Compound glycyrrhizin is a two-way immunomodulator. It has anti-inflammatory, immunomodulatory, anti-metabolic, and steroid-like effects.
Physical therapy: Excimer laser: a new type of medium-wave ultraviolet light source, which can be used clinically to treat stubborn baldness where general treatment is ineffective.
Other physical treatments: Narrow-spectrum medium-wave ultraviolet irradiation, photodynamic therapy, and liquid nitrogen freezing have also been reported for the treatment of baldness, but they are mainly effective for limited baldness and are not effective for total baldness and general baldness.
In addition to the above treatments, other immunosuppressants (such as azathioprine), traditional Chinese medicine and autologous hair transplantation have also been used to treat baldness.
4.Summary The causes of baldness are mainly related to genetic susceptibility, autoimmunity, environmental factors and psycho-psychological factors, which can aggravate or recur the condition. The choice of treatment plan should be based on the severity of the condition. However, not all patients with baldness need to be treated. About 30% to 50% of patients with restrictive baldness can remit or heal on their own within one year, and patients whose hair loss affects their beauty and whose long-term treatment is not satisfactory can also consider wearing a wig instead of over-treating.