Alopecia areata (hereinafter: A.a.) is a frequent, usually benign chronic disease of hair the couses of which have not been fully investigated yet. A.a. may appear without any warning in both sexes. It may occur at any age, but it is most frequent between ages 20 and 40. Characteristic symptom of A.a. is appearance of clearly outlined circular spots without hair. In 60% of cases the disease begins in capilicium, with appearance of completely hairless spots with diameter from 0,5 mm to 1 cm. The scalp skin retains the color, and hairs around the affected spot are easily pulled out. After the appearance of the first spots, other spots appear and join into lager bald areas.
Ethiology
Ethiology of alopecia areata is unknown. Although it is certain that alopecia areata often occurs after severe emotional stress, its pathogenesis has not been scientifically proved. Up to some ten years ago, the appearance of alopecia areata had always been examined in relation to focus (dental focus, chronic tonsillitis, and sinusitis). The latest approach hardly considers the FFF to be the cause. Alopecia areata can often be identified within one family. There are different opinions about teating alopecia areata a hereditary disease. Some authors have confirmed that in 27% of the patients had cases of alopecia areata within the family. Yet, some of them denied it.
The modern concept of etiopathogenesis of alopecia areata considers the autoimmune mechanism to be important for the hair follicle. Numerous facts affirm such concept. Hysto pathological finding confirms the existence of the lymphocytic infiltrate around the hair bulbus on alopetic patches. The method of the direct immune fluorescent technique (DIF) finds the C3 component deposit in the hair follicle. Alopecia areata in rare cases appears together with dysfunction of the timulus function, autoimmune tyreoditis, Hashimoto or vitiligo.
The HF finding of antibodies against the hair follicles in patients with alopecia areata in high titre serum, and the finding of decreased values of CD 44 glykoprotein of the cell membrane of sweat glands on alopetic patches, for which it is assumed that they pariticipate immune response regulation, support the autoimmune theory.
The newest research performed with monoclonal antibody method has proved the existence of decreased Cytokeratine expression 16 (CK – 16) in hair follicles on alopetic patches in cases of alopecia areata. Since cytokeratine (which is in normal follicles found in the inner membrane of the hair root and dermal papia) is the marker of epithelial differentiation, the significance of the epithelial proliferation dysfunction during the cycles of hair growth is to be taken into account when discussing the alopecia areata pathogenesis.
The Clinical Picture of Alopecia Areata
Alopecia areata is characterized by sudden appearance of round and oval alopetic patches of different sizes (picture 17). The number of these patches varies – one or more. Since they spread peripherally, they can spread over larger areas of capillicium. If there are several alopetic patches which are spreading, they can join and form larger patches, or, in rare cases, can form a complete alopecia areata most often seen in capillicium (picture 18, 19). Alopetic patch on occypital region of capillicium is called ophyasis. Ophyasis is regarded as a bad sign because it often proves tendency towards total alopecia areata. Activator Marbo cures this problem in 95% of the cases.
Although alopecia areata is most often seen on capillicium, it can develop on any other part of skin: brows, eye lashes, chin, body, hands, legs, etc. Exceptionally it can appear as alopecia universalis, covering the skin completely. Alopecia universalis is regarded as malign as opposed to other, benign cases.
Alopecia Areata is a frequent, usually benign chronic disease of hair the causes of which have not been fully investigated yet. Alopecia Areata may appear without any warning in both sexes. It may occur at any age, but it is most frequent between ages 20 and 40. Characteristic symptom of Alopecia Areata is appearance of clearly outlined circular spots without hair. In 60% of cases the disease begins in capilicium, with appearance of completely hairless patches with diameter from 0,5 mm to 1 cm. The scalp skin retains the color, and hairs around the affected spot are easily pulled out. After the appearance of the first patches, other patches appear and join into lager bald areas.
The loss of eye brows and eye lashes is a common, sometimes the only sign of alopecia areata. After the initial change, the disease can develop a different course. The diseased patches can spontaneously get filled with hair during the period of 3-6 weeks or several months, and then in cycles, in various intervals.
New hair growth can appear in one area, or simultaneously in other areas. In the beginning, the newly grown hair is thin and poorly pigmented, but later it assumes normal thickness and colour. In some cases, emotionally stressful events often precede the appearance of alopecia areata, or worsen its already existing symptoms.
Exceptionally, emotional stress follows the appearance of alopecia areata.
There are different opinions about the causes of alopecia areata. A majority of experts believe that it is an autoimmune disease significantly influenced by hereditary factors.
The fact that alopecia areata often comes together with other autoimmune disorders also proves that it is an autoimmune disease.
Most cases of alopecia areata have a favourable prognosis and need no treatment.
In the common forms of alopecia areata, there are great chances that new hair will grow in the first 6 months. There are no rules. It is well known that classic medicine cannot cure alopecia areata permanently, since various factors in each patient influence the course and diagnosis of the disease.