Clinical picture of .The disease begins imperceptibly for the patient and is most often identified by combing or cutting hair. At first, one or more bald patches are found, which gradually increase and merge, forming foci of alopecia of larger sizes.
In the development of nested baldness, three stages are distinguished: progressive, stationary and the stage of hair regrowth.
The progressing stage is characterized by the following features: the skin on the outbreak of alopecia is not externally altered and only slightly swollen;hair, as a rule, completely drop out;on the periphery of the focus, the hair is weakened and easily removed( the zone of "shattered" hair).In this stage of the disease, the bald patches increase and new foci can appear. Possible complete loss of all hair on the head, in the eyebrows, mustaches and beard. In rare cases, complete loss of the entire hair cover is observed, including hair follicles( alopecia totalis).
Stationary stage. The skin on the centers of alopecia is smooth, shining like a "billiard ball";It is not inflamed, does not peel, but is paler than in areas with preserved hair;when palpation is found mild atrophy. Sometimes in the focus of alopecia there is a markedly weak sagging due to the spread of atrophy;not only on the skin, but also on the periosteum. Hair on the hearth of alopecia is completely absent, and in the immediate vicinity of the bald patches they are completely unchanged.
The stage of hair regrowth is characterized by the appearance on the foci of alopecia of hair follicles, which gradually turn into long, often gray hair. In the future, gray pigmented hair grows in the same color as before the disease.
The duration of all these stages varies widely - from several months to 2-3 years. The disease occurs at any age.
Etiology of .There are several theories of the onset of this disease. The most popular is the neurogenic theory. Proponents of it are based on the appearance of nested baldness after a nervous shock, after n damage.occipitalis minoris et n.auricularis magni, obtained as a result of surgical operations of the region of the auricles, after extraction of the teeth and various other injuries and traumas of the nervous system. Disorders of the endocrine system can also be the cause of nesting baldness, in favor of which is indicated by favorable therapeutic results after the use of endocrine drugs, in particular hormones, gonads, adrenals and the pituitary gland.
Pathohistology .In the stationary stage, in the histological sections, there is a pronounced atrophy of the epidermis and an almost complete absence of hair. A small number of extant follicles are atrophic. In the dermis a slight perivascular infiltrate, consisting mainly of lymphocytes.
Diagnosis of .When making a diagnosis, it is necessary to exclude syphilitic alopecia, trichophytosis and microsporia.
Syphilitic alopecia ( alopecia areolaris) is characterized by small foci of alopecia, with not all hair falling out on the bald patches, some of them remain;uniform spots of hair thinning are formed. With alopecia areata, the centers of alopecia are larger, round, with clear boundaries, hair on them: completely absent. It should, however, be remembered that with syphilitic alopecia, there can sometimes be large foci of alopecia and even a complete loss of all the hair on the head, and the disease can resemble total alopecia. Therefore, in all such cases it is necessary to examine the skin and mucous membranes of the patient, check the condition of the lymph nodes, and examine the blood according to Wasserman.
Trichophytosis and microsporia are characterized by peeling.that lesions, simultaneous presence of broken and undamaged hair. In doubtful cases, the diagnostic difficulty is resolved by microscopic examination of hair suspected of fungi.
The forecast is favorable in most cases. Hair grows in different terms: in 3-5-8-10 months, in a year, and in some cases in 2-3 years. With total alopecia, the prognosis is less favorable.
Treatment of Nesting Baldness .First of all, treatment is used to eliminate the cause that caused the disease, and, if possible, nervous and endocrine disorders. To this end, recommend bromine preparations and appropriate endocrine drugs. Encouraging results in subsequent years were obtained from treatment with adrenocorticotropic hormone in doses of 10 units 2 times a day to a total dose of 700-800 units. With appropriate indications, it is possible to combine injections of adrenocorticotropic hormone with the appointment of sex hormones. Favorable results give the appointment of prednisolone inside tablets, as well as rubbing into the foci of the lesion of steroid creams( hydrocortisone, prednisolone or sex hormones).Of the agents that promote hair growth, you can recommend arsenic in the form of injections or inside in drops or pills.
Simultaneously carry out local irritant treatment. With this slot, you can apply Rosenthal paste.
Recently, a favorable result has been obtained from the use of drugs from the psoralen group( see Vitiligo).
More on the treatment of nested baldness.