Alopecia Areata is customarily also called “hair cut by ghost” or circular alopecia, characterizing as appearance of circular, or oval, non-inflammatory, non-cicatricial hair loss, mostly without self-conscious symptoms. The first hair-losing area may produce at any part of body, but usually on head.
Development stages of alopecia areata: according to the developing conditions of diseases clinically, the alopecia areata can divide into three stages:
1. Growing stage: The damaged area of hair and skin will increasingly enlarge, the normal skin surface around the bald area can be found that the hair is loose and easy to shed off, some hair broken is only 0.5cm long; the hair shaft near the scalp is atrophied, and without pigment, and the end of hair is thick and black and wooden-club-shaped, so the upper part is thick and the down part is thin, like exclamation mark (!). Some mouths of hair follicles can often be seen in the bald area, some hair follicle mouths can see the black mouth, which is denatured hair blocks left in hair follicles, and medically called “Dead Hair”.
2. Resting Stage: After some time of growth, the alopecia areata can stop growing, and keep the original state, hairs surrounding the bald area are attached quite firmly to scalp.
3. Recovering Stage: The new hair can be seen to grow out, which are originally found to be thin, soft, white, similarly like fine hair, in future, increasingly become thicker and black, and gradually recover to be normal.
Whichever stage patients are in, most patients have no the self-conscious discomfortable symptoms, part of patients have abnormal senses on local scalp before hair loss, such as scorching hot, twinge, oppressing sense, anaesthesia, formication, pruritic, etc; few patient probably feel light-headed, and have the paroxysmal vertigo, mental fatigue and weak limps and arms, insomnia, excessive dreaming, lumbago, tinnitus, giddiness, hoarseness of voice, etc. symptoms. when the few initial patients are examined that some erythema and dropsy can be found at bald area and the hair follicles are seen clearly.
In addition, some patients of alopecia areata, especially those who have been suffering from being tired for long term or patient of alopecia totalis (about 10%-20% according to statistic), may cause the pathogenic changes, it features the nail is hollow, some shows that nails become ridged vertically, the nail plank is thin and fragile, with vertical ridged protuberance, the end is often broken and layered, occasionally the nails are shed off.
Category of Alopecia Areata
Due to the multiple symptoms showed, alopecia areata can be grouped into the following seven types.
- Single Alopecia Areata: there is only one hair-losing spot.
- Multiple Alopecia Areata: there are over two hair-losing spots.
- Alopecia Totalis: the whole hairs on head are shed off.
- Alopecia Universalis: All hairs are shed off, also involved in eyebrows, hirci, pubes,
Generally speaking, the above four types can be recovered well after active treatment.
- Reticular Extensive Alopecia Areata: The hair-losing spot is round at the beginning stage, shortly and become the radiative alopecia, but basically keep the round state, the range of hair loss will even increasingly expand.
- Virulent Alopecia: the range of hair loss are widespread, except for hairs, even the eyelash, beard, limbs hairs also shed.
7. Snake-moving Alopecia: The hair bulb of bald area show the atrophied state, only produce short and fine soft hairs which are easy to fall, appear the baldness like snake moves in twisting way, the course of disease is chronic and continuously extend and fail to treat it well.
Paying attention to the discernment between Alopecia Areata and Alopecia Cicatrisata
Alopecia cicatrisata also called atrophied alopecia is a inflammatory cicatricial alopecia, the pathogenic causes are uncertain, generally it is believed that some changes are brought about because of the damages of hair follicles by some other diseases, such as lichen planus, chronic lupus erythematosus, localized scleroderma, porous lichen, foliculitis decalvans, etc. The patients’ scalp surface is smooth and bright, like white paper, the skin is atrophied and thinning, and slightly hollow, the demarcation between bald area and it surrounding is clear, but the edge is not very regular. The disease lacks effective treatment method.
Pathogenic Factors of Alopecia Areata
The pathogeny of alopecia areata are related to the following factors.
1. Mental factors: including the family factors—family hard economy, life dissension, serious diseases or death of relatives, children’s education, etc.; personal factors—examination and entrance to a higher school, frustration of love and marriage, contradiction with colleagues, criminal punishment, missing of relatives and friends, etc.; diseases factors—incurable diseases and paralysis and blindness, etc.; work factors—busy workload, , rush of business travel, tense job, etc.
- Nervous factors: caused by disfunction of autonomic nerves or central nerves.
- Inheritance: has the hereditary history of alopecia areata, the mother and daughter would suffer from the alopelica areata, also the twins do.
- Lower immune function:some disfunctions of humoral immunity, cell immunity and complementary system.
- Incretionary Abnormality: patients are suffering from thyroid diseases and can complicate into alopecia areata frequently, which are closely related to hyperthyroidism.
- Infected by Pathogen: Infection by bacteria, etc. can result in the thrombus of blood vessels or inflammation of capillary vessel，hairs controlled by blood vessels can be shed off due to the obstacle of blood supply. What’s more, some scholars pointed out that the third molar block or theinfection around the hair root should be taken into consideration as the factor of permanent alopecia areata.
- The block of blood circulation in scalp.
Mechanism of Alopecia Areata
Alopecia areata is a disease caused by abnormality of humoral immunity and cell immunity, especially the abnormality of cell immunity, which changed the balance of immune and regulatory lymphocytes of hair follicles and surrounding and gave rise to the denaturation of hair follicles and surrounding tissues but without atrophy and necrosis, the potential of hair growth by hair follicles is still normal.
Under normal situation of body, T cells of different subgroups in hair follicles and thereby are in relatively balance.If the body are under function of various pathogenic factors, and appear the abnormal situation, the initial symptoms is that the inhibitive T lymphocytes in nearby blood will decrease; if there are non-organic specific autoantibody—smooth muscle antibody (SMA), antinuclear antibody(ANA), anti-mitochondrial antibody (AMA), BCLA, rheumatoid factor (RF); organic specific self-antibody--anti-thyroid antibody, anti-stomach wall antibody, antiadrenal antibody, so the inhibitive T lymphocytes will reduces greatly, Langerhans cells and T lymphocytes will become the target organ for cells immune reaction. When hair follicles and the inhibitive TS around decrease or their functions lower, and propel the control of B cells and release immunoglobulin, and produce the body fluid immune hyperfunction; The effect T cells (TE) disembarrass the control and become more active, so the immune tolerance will be damaged, and it will cause autoimmune phenomena. The immune reaction will result in the buildup of lymphocytes, etc. inflammatory cells around hair follicles and nearby, further cause the degeneration of hair follicles and surrounding tissues, therefore, the function maintaining normal life cycle of hair will be inhibited temporarily and circular or oval alopecia will occur and further form the alopecia areata.
Several problems should be noticed for preventing the alopecia areata:
1. Generally speaking, alopecia areata can be cured, and easily and better treated. Because the immunoreaction just trigger the change of reversible degeneration of hair follicles and their surrounding tissues, and do not cause the irreversible and necrotic change of hair follicles and their surrounding tissues; the function that hair follicles produce new hair is just inhibited temporarily but not lost. The potentials that hair follicles regrow hair are still normal.
2.Whether the alopecia areata is serious or not and chronic or acute, it is just related to the decrease degree speed of inhibitive T lymphocytes in surrounding blood. If the inhibitive T lymphocytes in surrounding blood decrease greatly and speedily, the pathogenic condition of alopecia areata will be serious and acute; if the inhibitive T lymphocytes in surrounding blood decrease slightly and slowly, the degree of immunoreaction will be slight and the speed will be slow, and the pathogenic condition of alopecia areata will be slight and slow.
3.The treatment of alopecia areata has no direct relationship with the serious or light pathogenic condition and long or short course of diseases, just related to the patient’s constitution, immune response and pharmacodynamics. Clinically proved that many patients of alopecia areata with serious pathogenic conditions and long course of diseases have been treated for several times, the satisfactory curative effects have been achieved; however, many patients of alopecia areata with light pathogenic conditions and short course of diseases have not achieved the satisfactory effect until several courses of treatment have been made, which can fully demonstrate this problem.
4. The pathogenic conditions of alopecia areata will recur repeatedly and the conditions will aggravate even each time, which are decided by the immunological memory. Someantibody the body first contacted was removed and later the body will still keep the “memory” for long time; when contacting with the same antibody, the body will produce speedier and stronger immune response and cause the alopecia areata once again.
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