Alopecia is a condition that affects the scalp and leads to a spot completely devoid of hair, usually in a circular or oval form, single or multiple, and free of willows or scarring.
This condition can affect any part of the body covered with hair, but the scalp and chin area remain the most affected areas, and the alopecia can be divided into several sections according to the severity of the injury: the alopecia may be defined by the appearance of one or more hair-free spots, and the alopecia may be complete through The absence of hair from the entire scalp, and may be comprehensive through the absence of hair from the scalp and body.
The causes of disease:
The exact causes are still unknown, but there are risk factors that increase the likelihood of developing alopecia, including:
1 - Genetic factors - hereditary - usually there is a family history of a patient with alopecia with a rate of up to 10-40%, and in the case of twins it was noted that the probability of developing the second twin may reach 55% and in the event that one of the twins has alopecia.
In the case of Mongolian disease - a genetic defect - in chromosome 21, a high incidence of alopecia was observed for them, up to 9%.
Alopecia is believed to be a polygenic disease - a defect in more than one gene.
2 - Immunological factors: Alopecia has been observed to be associated with some immune diseases such as vitiligo, immune thyroid disease, lupus erythematosus, severe myasthenia gravis, anemia and diabetes, and it has been proven that there is an immune defect that leads to the body secreting self-antibodies against hair follicles and the resulting stopping hair growth.
3- Infectious factors: There are hypotheses about viral causes of alopecia, especially some herpes viruses.
4- Psychological factors: the psychological state and its negative impact on hair follicles.
5 - Neurotrophic factors: There are neurotransmitters that stimulate hair growth, and a decrease in the level of these neurotransmitters has been observed. Alopecia remains a relatively common disease, and it is also a relatively chronic disease, and the global incidence of alopecia may reach about 2%. Of age, the infection rate of persons under the age of 20 years may reach 60% and in terms of gender, it is almost equal with a 2-1 greater probability of afflicting males with respect to females.
Also, there is no ethnic preference, as it affects all races.
Clinically:
Alopecia manifests itself as a spot or more completely devoid of hair and the skin is normal and no changes occur in it such as cutaneous atrophy, scarring or willow, and the follicular orifices are present and intact, and sometimes it is noticed in the vicinity of the alopecia area some fragile hairs that are broken and take a somewhat distinct shape where they are thick in diameter On the tip and thinning of the diameter from the tip touching the scalp (exclamation mark notice) and its presence is considered evidence that alopecia is still in the active and active stage, and it is one of the factors that indicate the poor course of the disease.
The most common sites affected are the scalp, eyebrow, eyelashes, the chin area and the pubic area.
In advanced cases, the nails may be affected by changes accompanying the course of the disease and mainly manifest with the occurrence of small puncture pits on the surface of the nail. The rate of injury to the nails in the case of alopecia may reach 10% -66%, which is also one of the factors that indicate poor disease progression.
Diagnosis:
It is mainly carried out depending on the clinical examination, and the following tests can be used: 1- Blood test: to make sure that there are no other diseases, especially immunological ones.
2- A microscopic examination to rule out the presence of tinea capitis.
3- Biopsy.
Differential diagnosis:
Alopecia areata should be differentiated from tinea capitis, trichotillomania, baldness vulgaris, and lupus erythematosus (early stages).
Disease course:
There is a saying about alopecia that says that the only thing that can be expected in the course of alopecia is that it is an unpredictable disease. There are cases in which a spontaneous recovery occurs within 8 months to a year, and there are cases in which the disease extends to become more widespread and affects more than one place in the body, and sometimes it affects the entire body.
Note that there are many factors that may give us an idea about the course of the disease, which in this case are bad warning factors for the course of the disease.
1- If the injury occurred before puberty.
2- Having a family history of alopecia.
3- The presence of more than one affected area of the body.
4- Injury to the nails.
5- Presence of atopic dermatitis associated with alopecia.
6- The presence of other immune diseases associated with alopecia.
It is noteworthy that alopecia is one of the relapsing diseases that the patient may become infected with again after a healing period that may be prolonged or short.
treatment:
Despite the great development that has occurred in recent years in methods of treating alopecia, there is currently no cure for alopecia completely.
Most of the treatments are palliative and work to correct the immune defect that causes this phenomenon. In addition to psychological support, the treatment is based on the following:
1. Topical treatment
2. Systemic (oral) treatment
3. Phototherapy
The use of ultraviolet rays and the treatment method generally depends on the severity of the injury and the age of the patient, and each of these methods has its advantages and caveats
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