Alopecia areata is very common in clinical practice and can affect the patient’s appearance and quality of life, and is gaining increasing attention in modern society. Skin diseases that commonly manifest as hair loss include seborrheic alopecia (androgenic alopecia) and alopecia areata.
I. Diagnosis.
1.Diagnosis is mainly based on the clinical pattern of hair loss (upward and backward movement of hairline at both temples and forehead, thinning and thinning of hair at the top of the head, etc.).
2, Combined with family genetic history.
3.Microscopic examination of hair.
4.Hair light pull test.
Second, the condition classification
According to the degree of hair loss, men are divided into grade Ⅰ~Ⅶ (Hamilton grading method) and women are divided into grade Ⅰ~Ⅲ (Ludwig grading method).
Determination of efficacy.
1.Naked eye observation. According to the hair loss and hair recovery, before and after comparison to determine the efficacy.
2.Fixed head position photography, before and after comparison.
3.Microscopic examination of hair.
4.Hair light pull test.
Laboratory examination: blood routine, urine routine, liver and kidney function or biochemistry, thyroid function, total prostate-specific antigen. With hirsutism, seborrhea, acne to check reproductive hormones.
Third, treatment.
1, general treatment with drugs: Western medicine such as cystine, vitamin B complex, zinc gluconate, selenium yeast. Chinese medicine such as ginseng and wheat Dihuangwan, Cistanches Yi kidney granules, Wu Ling capsule, blood drink oral liquid, etc.
2.5％ minoxidil tincture for external use, once in the morning and once in the evening. A few patients will have local irritation.
3.Finasteride is taken orally, 1mg, qd. Very few patients will have slight sexual hypogonadism.
4.Oral administration of our homemade hair loss agreement formula.
5.Chinese medicine identification treatment.
6.With seborrhea, increased dandruff and itchy scalp, give Hilsen lotion and compound bitter ginseng lotion to wash the hair.
7.Antiandrogen therapy: Androstadienone, cimetidine.
8.Severe (male grade VI and above, female grade III) patients are recommended to do hair transplantation.
The following points should be noted in medical history taking.
1.Sleep condition, mental, emotional and stress condition.
2. Previous treatment.
3. History of previous diseases, including endocrine diseases, anemia. Previous nutritional status. History of medication use.
IV. Diagnosis.
1.Diagnosis is mainly based on the sudden occurrence of patchy hair loss and normal scalp in the hair loss area.
2.Some patients have family history of heredity.
3, progressive hair light pull test positive, microscopic hair stem proximal atrophy, a thick upper and lower “exclamation point” type.
V. Clinical typing
According to the clinical manifestations, there are three types of baldness: patchy baldness, total baldness, and general baldness. According to the activity of the disease, it is divided into progressive stage and stationary stage.
Heavy baldness refers to baldness where the area of hair loss is greater than 1/3 of the scalp area or where the disease has been in progress for more than one year without any trend of improvement.
VI. Determination of efficacy.
1.Naked eye observation. According to the area of the hair loss area and the new hair, compare before and after to judge the efficacy.
2.Take photos and compare before and after.
3.Microscopic examination of hair.
4.Hair light pull test.
Laboratory tests: blood routine, urine routine, biochemistry, immunoglobulin and complement, thyroid function, rheumatoid factor, ANA.
VII. Treatment.
1, general treatment medication: Western medicine such as cystine, vitamin B complex, zinc gluconate, selenium yeast. Chinese medicines such as ginseng and wheat dihuang pill, cistanches yi kidney granules, wuling capsule, nourishing blood drink oral liquid, etc. Topical medications such as Haxenaid solution, Mometasone furoate cream, Halometasone ointment, etc. If you have mental tension and poor sleep, you should take glutamate, sleeping pills, etc.
2. For progressive and heavy baldness, glucocorticoids such as prednisone tablets orally, 15~30mg/day, or compound betamethasone injection intramuscularly, 1ml, once every 3~4 weeks. Pay attention to the side effects of long-term application of glucocorticoids such as increased blood pressure, increased blood sugar, peptic ulcers, electrolyte disorders and osteoporosis.
3.5％ minoxidil tincture for external use, once in the morning and once in the evening. A few patients will have local irritation.
4.Compound glycopyrrolate tablets for oral use, 2 tablets, tid. some patients have complications such as elevated blood pressure, sodium retention and edema of both lower limbs and low potassium.
5.Compound betamethasone injection for local closed treatment, 1~2ml each time, once every 3~4 weeks. It can be added 1:1 to 2% lidocaine injection. Some patients have side effects such as local tissue atrophy.
6.TCM evidence-based treatment.
7.Immunomodulator. BCG polysaccharide nucleic acid injection intramuscularly, 2ml, qod; transfer factor, thymidine, etc.
The following points should be noted in the medical history taking.
1, sleep condition, mental, emotional and stress condition.
2. History of previous diseases, especially immune diseases such as vitiligo, lichen planus, systemic lupus erythematosus, Hashimoto’s thyroiditis, diabetes mellitus and rheumatoid arthritis.
3, family history of heredity.