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 significant impact on the quality of life and psychological well-being of the patient.
The incidence of baldness is about 0.1% to 0.2% in the population, and 1.7% to 2.0% of the population will experience baldness in their lifetime. It can occur in both children and adults, and although it is uncommon in children under the age of 3, most patients are younger, with 66% of patients developing the disease before the age of 30 and only 20% developing it after the age of 40. There is no significant difference in the incidence between men and women.
The causes of baldness and its mechanism are not fully understood, and may be related to psychosomatic, autoimmune and genetic factors.
1.Local treatment (1)Intra-lesion injection of glucocorticoid: It is the preferred treatment option for adult patients with alopecia areata <50%, and can cause localized new growth in 60%~67% of patients. Adverse effects include local pain, skin atrophy and pigment loss, and a high recurrence rate when treatment is interrupted. (2) Topical glucocorticoids: Topical glucocorticoid ointment has been widely used to treat childhood baldness or adult baldness with <50% hair loss, and folliculitis is its most common adverse effect. This therapy alleviates the pain of patients and the compliance of children is good, which is worth promoting. (3) Topical minoxidil: Minoxidil has long been used for the treatment of male pattern baldness, often in combination with other methods for the treatment of baldness. (4) Topical anthralin: Anthralin has anti-inflammatory and immunosuppressive effects and can be used to treat pemphigus vulgaris. It is mainly used to treat adult or pediatric patients with long-lasting baldness. Its adverse effects include folliculitis, contact dermatitis, and local lymph node enlargement. (5) Topical contact sensitizers: The use of sensitizers on baldness lesions, thereby inducing artificial contact dermatitis, the latter 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 used as the treatment of choice for total baldness. 2. Systemic treatment (1) Glucocorticoids: Glucocorticoids mainly include oral and intravenous administration. 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. Since glucocorticoid treatment brings more adverse reactions, clinical use should be cautious and only applied to total baldness, general baldness or rapidly progressing baldness where general treatment is ineffective. (2) 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. (3) Korean SKM hair minimally invasive treatment: highly recommended by ISHRS International Society for Hair Transplantation and Restoration, a new technology for hair growth and development. 3.Physical treatment (1) 308 excimer laser: a new medium-wave ultraviolet light source, which can be clinically used to treat stubborn baldness where general treatment is ineffective. (2) Other physical treatments: narrow-spectrum medium-wave ultraviolet irradiation, photodynamic therapy, liquid nitrogen freezing, etc. 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 treatments, other immunosuppressive drugs (such as azathioprine), Chinese herbal medicine and autologous hair transplantation have also been used to treat baldness. The causes of pemphigus vulgaris are mainly related to genetic susceptibility, autoimmunity, environmental factors and psychosomatic 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 limited baldness can remit on their own or heal on their own within 1 year. 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.