Alopecia areata is commonly known as “ghost shaving”. Patients often suddenly develop round or oval-shaped patches of hair loss on the head. Initially, it is a small area of hair loss, one or several patches, with no conscious symptoms. In a few patients, all the hair may fall out 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 patient’s quality of life and psychological well-being.
1.Incidence.
The incidence of baldness in the population is about 0.1% to 0.2%, and 1.7% to 2.0% of the population will experience baldness in their lifetime. It can develop 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.
2. Etiology.
The causes of baldness and its mechanism are not fully understood, and may be related to psychosomatic, autoimmune and genetic factors.
3.Treatment.
Topical treatment
(1) Intradermal glucocorticoid injection: This is the treatment of choice for adult patients with alopecia areata <50%, and can result in localized new growth in 60% to 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, so it 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 baldness. It is mainly used to treat adult or pediatric patients with long-lasting baldness. Adverse effects include folliculitis, contact dermatitis, and local lymph node enlargement.
(5) Topical contact sensitizers:Sensitizers are used on baldness lesions, thereby inducing artificial contact dermatitis, 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.
(1) Glucocorticoids: Glucocorticoids mainly include oral and intravenous administration. Adverse effects include acne-like dermatitis, weight gain, gastrointestinal discomfort, full moon face and scanty menstruation, etc. They 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 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.
Physical therapy.
(1) 308 excimer laser: a new type of medium-wave ultraviolet light source, which can be clinically used to treat stubborn baldness for which general treatment is ineffective.
(2) Other physical treatments: Narrow-spectrum medium-wave ultraviolet radiation, photodynamic therapy and liquid nitrogen freezing 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), 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.