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Azimova Fatima Vahidovna, The head of the scientific department of dermatocosmetology of the Republican specialized scientific and practical medical center of dermatology and venereology
E-mail: evovision@bk.ru
NEW METHODS OF DIAGNOSTICS OF NON-TUBE ALOPECY
Abstract: In this study, patients with non-scarring alopecia of the Uzbek population underwent videotrich dermatoscopy. As a result, an algorithm for the diagnosis of non-scarring alopecia was developed, which accurately determines the form and stage of the disease, the degree of atrophy of the hair follicles, the presence of pathological hair in alopecia areata, and an increase in the number of hair-like hair less than 30 micro.- with androgenic alopecia. Such a diagnosis is also applicable in the monitoring of disease therapy and is in many cases an alternative to histological examination.
Keywords: videotrichodermatoscopy, non-scarring alopecia, vellus-like hair.
The problem of treatment of non-scarring alopecia - Evaluation of the phototrichogram in a semi-au-
in the modern world is one of the leading, as according tomatic mode.
to WHO, not only the number of people with alope- - Hair calculator and calculation of the speed of hair
cia grows, but their therapy is often ineffective, relapse of the disease occurs [1, 2]. Despite some success in studying the pathogenesis and therapy of patients with non-scarring alopecia, a new area of increased research interest is being formed, namely, accurate diagnosis of the disease [3, 4, 7]. For this purpose, a hairbrush is used in the scalp [5], which is important not only in determining the form of the disease, the stage, but also for monitoring therapy.
Purpose of the study. To develop algorithms for the diagnosis of non-scarring alopecia.
Materials and methods of research. We examined 247 patients with non-scarred alopecia, 94 (38.1%) patients with alopecia areata, 153 (61.9%) with androgenic alopecia. All patients underwent videotrich dermatoscopy of the scalp, which was performed with a camera Aramo-SG (Korea) with lenses X60 and X200 and computer program Trichoscience. This diagnostic program has the following capabilities:
- evaluation of the density and diameter of hair in the androgen-dependent and androgen-independent areas of the scalp.
- Calculation of the percentage of vellus hair, thin, medium and thick hair in the investigated areas.
- Evaluation of hair distribution in follicular units and the state of perifollicular phenomena.
growth. Automatic calculation of the total amount of hair on the patient's head, assessment of the individual rate of hair loss of the patient, calculation of the actual daily hair loss.
- Statistical processing of the results - the standard deviation, the average of the arithmetic mean.
- dermatoscopy - assessment of the skin condition of the scalp.
- evaluation of the condition of the hair shafts and hair follicles. Comparison with samples from the database.
- graphical representation of the received data, comparison with the norms.
Results and discussion: Determination of the ratio of hair in the stages of anagen and telogen in patients with focal alopecia areata showed a decrease in the amount of hair in the anagen stage - 62.1 ± 8.1% (p < 0.001), (control -87.1 ± 4, 3%) in the parietal region of the scalp and 69.4 ± 1.6% (p < 0.001), (control -85.4 ± 3.9%) in the occipital, and an increase in the number of hair in the telogen stage - 37, 9 ± 1.2% (p <0.001), (control - 12.9 ± ± 1.9%) in the parietal region ofthe scalp, and 30.6 ± 0.9% (p < 0.001), (control - 14.6 ± 2.3%) in the occipital (tabl. 1). In patients with polyocutaneous and ribbon-like alopecia areata, a more pronounced decrease in the amount of hair in the anagen stage was found - 46.3 ± 3.5%
(control -87.1 ± 4.3%) and an increase in the number of hair in the telogen stage - 53.7 ± 2.1% (control -12.9 ± 1.9%) in the parietal region of the scalp. In the occipital region there is also a decrease in the amount ofhair in the growth stage - 41.1 ± 3.8% (control
-85.4 ± 3.
and an increase in the number of hair in
the resting stage - 58.9 ± 2.4% (control - 14.6 ± 2.3%). The anagen phase was sharply reduced in patients with subtotal and alopecia areata form, in which the amount of hair in the growth stage in the parietal region of the head is 24.7 ± 1.1% (control -87.1 ± 4.3%) and resting at 75.3 ± 3.2% (control -12.9 ± 1.9%).
Table 1.- Hair ratio in stages of growth and rest on the scalp in p2atients with alopecia areata
Ratio of hair on the scalp (%) control group (n = 25) focal (n = 50) Forms of alopecia areata
multifocal and tape-visible (n = 23) subtotal (n =21)
parietal region anagen anagen 87.1 ± 4.3 62.1 ± 8.1*** 46.3 ± 3.5*** 24.7 ± 1.1***
telogen 12.9 ± 1.9 37.9 ± 1.2*** 53.7 ± 2.1*** 75.3 ± 3.2***
Occipital areal anagen 85.4 ± 3.9 69.4 ± 1.6*** 41.1 ± 3.8*** 35.4 ± 1.7***
telogen 14.6 ± 2.3 30.6 ± 0.9*** 58.9 ± 2.4*** 64.6 ± 1.3***
Note:* the differences with respect to the control group are significant (*** - P < 0.001)
In the occipital region of the scalp, there is a less pronounced decrease in the amount of hair in the anagen's steel - 35.4 ± 1.7% (control - 85.4 ± 3.9%) and hair growth in the telogen stage - 64.6 ± 1.3% (control - 14.6 ± 2.3%).
Consequently, in patients with alopecia nest with an increase in the severity of the disease, there is a significant increase in hair density throughout the entire scalp, a violation of the ratio of hair phases in the anagen and telogen phases in favor of the latter, indicating a progressive stage of the disease.
In the outbreaks of alopecia, a large number of "yellow dots" (empty hair follicles) were observed, pathological hair in the form of "exclamation marks" and "cadaveric" hair, as well as dysplastic roots of the hair follicles, which confirm the progress ofthe disease, were observed in alopecia areas.
Trichodermatoscopy of the scalp in male patients with androgenic alopecia showed a sharp significant
decrease in the number of hairs in the parietal region compared to the occipital and this decrease was more pronounced with increasing degree of lesion. The study of the phases of anagen and telogen in male patients with androgenic alopecia showed a highly significant decrease in the amount ofhair in the anagen phase and an increase in the number of hair in the telogen stage in the parietal region, whereas the ratio of growth and rest phases in the occipital regions was not reliable at grade III and significantly decreased at III-IV and IV-V stages. Thus, in patients with grade 3 androgenic alopecia (Table 2), the amount of hair in the growth stage in the parietal region was 58.4 ± 3.1%, III-IV degree - 41.7 ± 1.1%, IV-V degree - 32.1 ± 0.8%, whereas in the control group this indicator was 87.1 ± 4.3%. In parallel, the amount ofhair in the resting stage increased from 41.6 ± 1.8% at grade III, 58.3 ± 2.4% at grade III-IV to 67.9 ± 2.0 at grade IV-V.
Table 2.- Hair ratio in stages of growth and rest on the scalp in male patients with androgenic alopecia
Ratio of hair on the scalp (%) control group (n = 25) III degree (n = 47) Types of androgenic alopecia
III-IV degree (n = 38) IV-V degree (n = 36)
parietal re-gion anagen anagen 87.1 ± 4.3 58.4 ± 3.1*** 41.7 ± 1.1*** 32.1 ± 0.8***
telogen 12.9 ± 1.9 41.6 ± 1.8*** 58.3 ± 2.4*** 67.9 ± 2.0***
Occipital areal anagen 85.4 ± 3.9 81.7 ± 1.1 79.2 ± 3.2 72.1 ± 1.8***
telogen 14.6 ± 2.3 18.3 ± 2.4 20.8 ± 1.4* 27.9 ± 2.5***
Note * - the differences with respect to the control group are significant (* - P < 0.05, ** - P < 0.01, *** - P < 0.001)
Note * - the differences with respect to the control group are significant (* - P < 0.05, ** - P < 0.01, *** - P < 0.001)
A study of the relationship between the phases of hair growth and rest in women with androgenetic alopecia showed a significant decrease in the amount of hair in the anagen phase and an increase in hair in the telogen stage in the parietal region of the scalp. Also disproportion of phases is observed in the occipital region of the head, which distinguishes female androgenic alopecia from the male. Thus, at the I degree of androgenetic alopecia in the parietal region in women, the amount of hair in the anagen phase was 68.1 ± 3.02%, at II -59.7 ± 5.2%, at III - 51.4 ± 8.7%, while the same parameters in the control group were
Table 3.- Hair ratio in stages of in female patients with
87.1 ± 4.3%. The amount of hair in the telogen stage increased and amounted to: 31.9 ± 2.1% at grade I, 40.3 ± 8.9% at grade II, 48.6 ± 10.2% at grade III (control - 12.9 ± 1.9%). In the occipital region, the amount of hair in the anagen stage in women with androgenic alopecia significantly decreases: at grade I 73.2 ± 1.9 at II -63.7 ± 3.5%, at III - 58.9 ± 1.3% while the same parameters in the control group were 85.4 ± 3.9%. The amount of hair in the telogen stage parallel to the anagen stage increased significantly: 26.8 ± 1.4% at grade I, 36.3 ± 2.2% at grade II, 41.1 ± 1.07% at grade III (Table 3) (control -14.6 ± 2.3).
growth and rest on the scalp androgenic alopecia
Ratio of hair on the scalp (%) control group (n = 25) I degree (n = 9) Degrees of androgenic alopecia among women
II degree (n = 12) III degree (n = 11)
parietal re-gion anagen anagen 87.1 ± 4.3 68.1 ± 3.02** 59.7 ± 5.2*** 51.4 ± 8.7***
telogen 12.9 ± 1.9 31.9 ± 2.1** 40.3 ± 8.9** 48.6 ± 10.2**
Occipital areal anagen 85.4 ± 3.9 73.2 ± 1.9* 63.7 ± 3.5*** 58.9 ± 1.3***
telogen 14.6 ± 2.3 26.8 ± 1.4** 36.3 ± 2.2*** 41.1 ± 1.07***
Typical for this type of alopecia is the pronounced thinning of the hair rods in the parietal region (polymorphism), reaching up to 80% of fine hair (< 10% norm). Many empty hair follicles in the form of "yellow points", as well as single units. In the occipital region, in men, hair shaft changes in the form of thinning were not observed. Only 13% of male patients had a slight decrease in hair density and polymorphism in the occipital region of the scalp, which is probably associated with a high duration of the disease (more than 7-10 years). At this category of patients, atrophic hair follicles were observed. All examined female females showed a change in the hair rods in the form of thinning and in the occipital region, but less pronounced in the parietal region. When examining the scalp under the X200 lens, oily, sometimes dry seborrhea was more often noted, the hair follicles of the hair being examined were mostly in the telogen stage. One of the important criteria for the visual-dermatoscopic examination of the skin of the scalp is the phototricho-gram, which is used to conduct a differential diagnosis between androgen-dependent and diffuse hair loss. A characteristic feature of the phototrichogram of patients
with androgenic hair loss, held in the parietal zone, is an increased amount of velus hair and thinned hair - more than 40%.
Because of our studies, we determined algorithms for the diagnosis of alopecia:
1. Trichoscopic criteria for androgenic alopecia:
- in male patients:
III degree - "yellow" points 54.8%, "white" points 45.2%, phototrichogram> 40.8%
III-IV degree - "yellow" points 28.3%, "white" points 71.7%, phototrichogram > 55.6%
IV-V degree - "yellow" points 11.4%, "white" points 88.6%, phototrichogram > 73.2% - in female patients:
I degree-II degree - "yellow" points 86.1%, "white" points 13.9%, phototrichogram > 34.1%
III degree - "yellow" points 63.5%, "white" points 36.5%, phototrichogram > 69.1%
2. Trichoscopic criteria for nested alopecia (Table 5):
- chain and poliochagovaya form - "yellow" points 91.2%, "white" points 8.8%, pathological hair 76.5%
- subtotal form of "yellow" points 58.6%, "white" points 41.4%, pathological hair 21.7%
- total and universal forms - "yellow" points 4.1%, "white" points 95.9%, pathological hair 3.4%.
Conclusion: Thus, trichodermatoscopy is a newly developed method that has significant potential in der-matological practice. The results of the research showed
that, being a non-invasive and accurate method of visualization of hair structures, trichodermatoscopy can be used not only to diagnose androgenic alopecia, but also to evaluate the effect of various therapeutic agents and cosmetic products on the condition of the hair and scalp.
Table 4.- Trichoscopic criteria for alopecia areata
Criteria for diagnosis
Forms of alopecia areata Non-atrophied hair fol-licles «yellow» Atrophied hair follicles «white» Pathological hair cadaveri-zed hair and hair in the form of an
points (%) points (%) exclamation mark (%)
Focal and polyocidal 91.2 8.8 76.5
Subtotal 58.6 41.4 21.7
Total and universal 4.1 95.9 3.4
Perhaps, trichodermatoscopy will later be successfully applied in various monitoring studies
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2. Ruk A., Dauber R. Diseases of the hair and scalp. Trans. sangl.- M: Medicine - 1985.
3. Amos Gilhar and Richard S. Kalish Alopecia Areata: A tissue specific autoimmune disease of the hair follicle // Autoimmunity Reviews.- 2006.- Vol. 5.- Issue 1.- P. 64-69.
4. D'Ovidio R., Claudatus J., Di Prima T. Alopecia areata: review of particular clinical forms and insight into possible pathogenetic mechanisms // Ann Dermatol Venereol. - 2002.- Vol. 129.- P. 15515.
5. McElwee K., Hoffman R. Growth factors in early hair follicle morphogenesis // Eur J Dermatol.- 2000.-Vol. 10.- P. 341-350.
