Alopecia areata

Introduction

Alopecia areata Alopecia areata is a sudden onset of patchy alopecia hair, with normal scalp and no inflammation and symptoms. The course of the disease is slow and can be relieved and relapsed. If the entire scalp hair falls off, it is called alopeciatotalis; if all the hair in the body is shed, it is called alopeciauniversalis. basic knowledge The proportion of illness: 0.04% Susceptible people: no special people Mode of infection: non-infectious Complications: hair loss, vitiligo

Cause

Alopecia areata

Neuropsychiatric factors (35%):

The etiology is still unclear, and neuropsychiatric factors are considered to be an important factor. Many cases have neuropsychiatric trauma such as long-term anxiety, anxiety, sadness, mental stress and emotional anxiety before the onset of the disease. Sometimes patients are in the course of the disease, these mental factors Can make the disease quickly increase.

Genetic allergy (20%):

About 10% to 20% of cases have a family history, and there are reports of alopecia areata in the same site at the same time. It is also reported that a fourth generation has alopecia areata, which is considered to be a genetic defect disease, which is seen from the clinical accumulation of disease. People with a genetically allergic constitution are prone to alopecia areata. In the United States, 18% of children with alopecia areata have eczema or asthma, or both. Adult alopecia areata accounts for about 9%; children with total alopecia are more likely than others. High, accounting for 23%, Japan's statistical alopecia areata patients with genetic allergies accounted for 10%, the Netherlands is as high as 52.4%, but the Netherlands established the basis of genetic allergies, is the positive skin test and genetic allergy family history also included Therefore, the diagnostic criteria for genetic allergies vary from country to country, and the data cannot be compared. A study on alopecia areata and human leukocyte antigens by Chen Shengqiang in China shows that the frequency of HLA-A9 antigen in alopecia areata patients (16.67%) is higher. Normal people (32.65%) were significantly reduced, supporting the genetic allergic factors of alopecia areata from an experimental perspective.

Autoimmune (15%):

The rate of some patients with autoimmune diseases is higher than that of the normal population, such as 0 to 8% with thyroid disease; 4% with vitiligo (only 1% for normal people), and autoantibodies for patients with alopecia areata The research reports are different. Some have existed and some have not been found. A study by Zhang Xinjiang in China on T cell subsets and 2 microglobulin suggests that T-cell network disorders and humoral immune disorders exist in patients with alopecia areata.

Down syndrome (15%):

The incidence of alopecia areata is increased in Down syndrome, often with total alopecia or general alopecia, and the presence of autoantibodies in these patients is significantly increased.

At present, it is not certain that alopecia areata is an autoimmune disease, but it may be associated with autoimmune diseases and temporarily effective for corticosteroids, suggesting that it tends to be autoimmune.

A long-term investigation by Ikeda in Japan suggests that alopecia areata can be divided into four types, and the age of onset, clinical manifestations and prevention of each type are different.

Type I, genetic allergic (10%): early onset, long course of disease, 75% developed into total baldness.

Type II, autoimmune (5%): often develops after 40 years of age.

Type III, prehypertension (4%): Young adults have an onset, one of their parents or parents is hypertensive, with a rapid onset, and the incidence of total baldness is 39%.

Type IV, vulgaris (83%): those who do not belong to type I-III, the disease occurs in late childhood or young people, the total course of disease is often within 3 years, a single alopecia areata can be long hair within 6 months, 6% of total alopecia.

Prevention

Alopecia areata prevention

(1) Life conditioning

Pay attention to hair hygiene, do not shampoo with too much alkaline soap, do not abuse hair care products, use hair dryer and hair dye as much as possible after haircut.

(2) Dietary conditioning

Diet should be diversified, to overcome and correct the bad habits of partial eclipse, oil wind is a kind of disease closely related to diet, according to local skin lesions syndrome differentiation and classification, develop a therapeutic plan.

Under normal circumstances, the disease is mostly young, often associated with mental annoyance, so in addition to maintaining emotional ties, should be given to calm and soothe the food, such as lily, lotus seeds, jujube kernels, etc., patients with insufficient blood should eat more Foods containing protein, such as sea cucumber, walnut kernel, etc.

Complication

Alopecia areata complications Complications, hair loss, vitiligo

The appearance of alopecia areata is not isolated, and often accompanied by other diseases.

(1) A lesion: the degree of lesion can be proportional to the degree of hair loss,

(2) genetic allergic diseases: often accompanied by allergic rhinitis, genetic allergic dermatitis, asthma and measles, etc.

(3) autoimmune diseases: including vitiligo, ulcerative colitis, pernicious anemia, systemic lupus erythematosus, rheumatoid arthritis, scleroderma, myasthenia gravis, etc.

(4) Dowm syndrome: This disease is a genetic disease with chromosomal abnormalities, which suggests the genetic background of the disease.

(5) Eye diseases: including drooping pupil dilation, eyeball invagination, vascular and pigmentary malformations, crystal opacity and cataract.

Generally, the prognosis of patients with mild disease is better. The patient can gradually grow yellow and white slender soft bristles, and then gradually become thick and black, and finally return to normal. Generally, 1-2 patients with occipital alopecia are not obvious progress. The more serious the disease is, the worse the prognosis is. It is difficult to recover from the total baldness of children. However, it has recovered after 20 years and 30 years. About half of the cases have recurred, especially children, and it is easy to develop into total baldness.

Symptom

Alopecia areata symptoms common symptoms wind-sparing blood dry hair loss

[clinical manifestations]

Alopecia areata can occur at any age from infants to the elderly, but there are more middle-aged people and the gender differences are not obvious.

The disease is long-term unintentionally discovered or discovered by others, no symptoms, and a small number of cases may have mild abnormal feelings at the beginning of the disease.

From the beginning, there are 1 or several round or oval hair loss areas with clear boundaries. The straight play is about 1~2cm larger. There are often loose and easy-to-remove hairs at the edge of the hair loss area, and some have been broken. The hair on the end tends to shrink. If the hair is pulled out, it can be seen that the hair is thick and thin like an exclamation mark (!), and the hair pigment in the lower part is also lost. This phenomenon is a sign of the progress period, and the phenomenon of de-discovery continues to increase. Each piece also expands and can be fused to form an irregular shape. If it continues to progress, it can be completely bald. In severe cases, eyebrows, eyelashes, manes, pubic hair and body hair are also shed, which is a baldness.

Hair loss can also be stopped. At this time, the hair loss area is no longer enlarged, and the hair on the edges is firmer and difficult to pull out. After several months, the hair can grow gradually or rapidly, and some patients grow white fur first, and then gradually become coarse. Black, long, and become normal hair.

The hair loss of the scalp is normal, smooth, and free of inflammation. Sometimes it looks thinner and slightly concave. This is due to the disappearance of hair and hair roots, rather than the actual thinning of the scalp.

The baldness that occurs in children's pillows is called ophiasis.

Examine

Alopecia areata

First, the detection of the body's immune function

Including interleukin 2 and its receptor level determination, T lymphocyte and its subpopulation determination, NK cell level determination and so on.

Second, hair trace element detection (CU, Pc, Ca, Zu, Mn, Pb)

Hair is the end-excretion organ of the human body. The change of trace element content directly reflects the metabolism of the human body. Studies have shown that elements such as zn can regulate the immune function of the body, thus affecting the course of the baldness.

Third, endocrine testing

The growth of hair is regulated directly or indirectly by endocrine, such as increased adrenal cortical hormone, which can cause hirsutism. Testosterone can promote hair growth in the trunk, limbs, whiskers and genitals. In addition, the thyroid gland, parathyroid glands, pituitary gland, etc. Function also plays an important role in the course of alopecia areata.

Fourth, the head skin microcirculation detection

Microcirculation perfusion plays an important role in the growth and regrowth of hair. The scalp hair follicle is located in the upper part of the subcutaneous tissue, and the lower third is surrounded by abundant vascular plexus. The growth and regeneration of hair depends on the hair follicle. Nutritional blood supply, studies have shown that the blood flow of alopecia areata lesions is significantly reduced, directly leading to the permanent contraction of the capillaries of the affected area to the nipple supply disorder, loss of nutrition and shedding.

Five, scalp pathology

Early development of dysplastic growth hair, lymphocytic infiltration at the lower end of the hair follicle, the volume of hair follicles in the late stage is greatly reduced, and moved up to the upper part of the dermis, usually without hair, the connective tissue under the dermal papilla is perivascular degeneration, The hair follicles of the whole bald and general bald are seriously damaged.

Diagnosis

Diagnosis of alopecia areata

According to the sudden onset, round or elliptical hair loss, the scalp in the hair loss area is normal, not difficult to diagnose, and must be identified with the following diseases:

1. The white peony is not completely removed, the hair is mostly broken, the residual hair root is not easy to be pulled out, and the scales are attached. It is easy to find the mold in the hair loss, which is good for children.

2. Although syphilitic alopecia is also plaque-like baldness, no scars are formed in the hair, but the edges are irregular and worm-like. The hair loss in the hair loss area is not complete. The number is large, and it occurs on the posterior side with other syphilis symptoms. Syphilis serology is positive.

3. The scalp of the pseudo-alopecia areata is atrophied, smooth and lustrous. The hair follicle opening is not visible, and there is no thick and thin hair loss at the edge of the patch.

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