total baldness
Introduction
Introduction Common knowledge of total baldness: About 5% to 10% of cases of alopecia areata can develop gradually or rapidly. In a few days or months, all hair falls off and becomes completely bald. The symptoms of total bald are more likely. Involved in eyebrows, beards, manes, pubic hair, etc., very few serious cases of body hair can also be stripped, this is called alopecia.
Cause
Cause
The cause is still unknown. Neuropsychiatric factors are considered an important factor. Many cases have neuropsychiatric trauma such as long-term anxiety, anxiety, sadness, nervousness and emotional upset before the onset of illness. Sometimes, during the course of the patient's illness, these mental factors can make the condition worse. In recent years, the treason of alopecia areata is related to the following factors:
Genetic allergy
About 10% to 20% of cases have a family history. It has been reported that a single egg twin has alopecia areata at the same site, and there are reports that a fourth generation has alopecia areata, which is considered to be a genetically deficient disease. It can be seen from the clinically accumulated disease that 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, accounting for 23%. Japanese alopecia areata patients with genetic allergies account for 10%, and the Netherlands is as high as 52.4%. However, the establishment of genetic allergies in the Netherlands is based on the inclusion of positive skin tests and family history of genetic allergy. 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 showed that the frequency of HLA-A9 antigen in alopecia areata patients (16.67%) was significantly lower than that in normal subjects (32.65%), and the genetic allergic factors of alopecia areata were supported from an experimental perspective.
Autoimmune
The rate of some patients with autoimmune diseases is higher than that of the normal population. For example, those with thyroid disease accounted for 0 to 8%; those with vitiligo accounted for 4% (normally only 1%). In the alopecia areata patients, there are different reports on autoantibodies, some of which exist, and others that have not been found. A study on T cell subsets and 2 microglobulin in China suggests that T-cell network disorders and humoral immune disorders exist in patients with alopecia areata.
3.Down syndrome
The incidence of alopecia areata in Down syndrome is increased, often with total baldness or general baldness. The presence of autoantibodies in these patients has increased significantly. 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, clinical manifestation 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%): usually develops after 40 years of age.
Type III: Prehypertensive (4%): Young adults develop morbidity, and one of their parents or parents is a hypertensive patient. The condition is rapid and the incidence of total baldness is 39%.
Type IV: vulgaris (83%): not belonging to type I to III. In the late stage of children or young people, the total course of disease is often within 3 years, and a single alopecia areata can grow hair within 6 months. 6% of all baldness occurred.
Examine
an examination
Related inspection
Immunopathological examination endocrine function test scalp examination
1. Laboratory examination.
2. Detection of immune function of the body: including the determination of interleukin 2 and its receptor levels, the determination of T lymphocytes and their subpopulations, and the determination of NK cell levels.
3. Hair trace element detection (CU, Pc, Ca, Zu, Mn, Pb): Hair is the terminal excretion organ of the human body, and the change of trace element content directly reflects the metabolism of the human body. Studies have shown that zn and other elements can regulate the body immunity. Function, which affects the course of the baldness.
4. Endocrine detection: Hair growth is regulated directly or indirectly by endocrine, such as increased adrenal cortical hormone, which can cause hirsutism. Testosterone promotes hair growth in the trunk, limbs, whiskers and genitals. In addition, the thyroid gland, the parathyroid gland. The function of the pituitary gland also plays an important role in the course of alopecia areata.
5. Scalp pathological section: Early development of dysplastic growth hair, lymphocytic infiltration at the lower end of the hair follicle. In the late stage, the hair follicles are greatly reduced in size and moved up to the upper part of the dermis, usually without hair. The connective tissue under the dermal papilla is devascularized around the blood vessels. The hair follicles of the whole bald and general bald are seriously damaged.
6. 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 of it is surrounded by abundant vascular plexus. The growth and regeneration of hair depends on sufficient nutrient supply to the hair follicle. Studies have shown that the blood flow of alopecia areata lesions is significantly reduced. It directly leads to the permanent contraction of the capillaries of the affected part to the blood supply of the nipple, and loses nutrition and falls off.
Diagnosis
Differential diagnosis
According to the sudden onset, round or oval hair loss, the scalp in the hair loss area is normal and not difficult to diagnose. Must be identified with the following diseases:
White
Incompletely removed, the hair is mostly broken, and the residual hair roots are not easily pulled out, with scales attached. It is easy to find mold in the break. Occurs in children.
2. syphilitic baldness
Although it is also plaque-like baldness, the hair is not scarred, but the edges are irregular and worm-like. Hair loss in the hair loss area is not complete, the number is large, and it occurs on the back side. With other symptoms of syphilis, syphilis serology is positive.
3. Pseudo- alopecia areata
The scalp of the affected area is atrophied, smooth and shiny, and the hair follicle opening is not visible. There is no thick and thin hair loss at the edge of the patch.
Lymphocytes infiltrate around the hair follicles, and some can invade the hair follicle wall and have denaturation of hair matrix cells. New bristles may form in the hair follicles from which hair has been shed. New long hair lacks pigmentation. Late hair follicles, hair bulbs, and their dermal papillas are all smaller and their positions are also moved up. The surrounding matrix is significantly reduced, the surrounding connective tissue is degenerated, and the blood vessels have thrombosis. The number of hair follicles also decreased over time, and cell infiltration was not obvious at this time.
