Peculiarities of clinical course and diagnostic of alopecia areata with comorbidity. Clinical observations

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Abstract

Nest alopecia (circular baldness) ― acquired non-pubescent alopecia, which begins, as a rule, with rounded foci on the scalp. During nest alopecia, there are three stages ― active (progressive, or progressive), stationary and regressive. The study of the causes and mechanisms of the pathogenesis of nest alopecia indicates a pronounced role of neurotrophic disorders, autoimmune and genetic factors, endocrine diseases and injuries.

The course of alopecia areata is often chronic, recurrent (more than one episode was found in 85% of patients), however, spontaneous remission without treatment is possible in 50% of patients. In cases where the manifestations of alopecia areata start before puberty, the risk of developing a total form of the disease is high (up to 50%). The probability of a complete cure in severe forms of alopecia is less than 10% of cases.

The development of alopecia areata is often accompanied by damage to the nail plates, however, the incidence of onychodystrophies varies significantly (6–77%). More than ten types of changes in the nail plates have been described. According to our observations, onychodystrophies were seen in all 6 patients with alopecia areata, with thimble-type deformities in children and longitudinal lines in adults. The lack of evidence in the literature on the frequency and specificity of damage to the nail plates requires additional research.

Comorbid conditions in patients (systemic lupus erythematosus, psoriasis, vitiligo, atopic dermatitis, etc.) can be trigger factors in the development of nest alopecia and complicate the diagnosis and treatment of the underlying disease and concomitant dermatoses. This determines the need for a clear distinction between therapeutic and diagnostic approaches, based on their reliable significance, which will eliminate outdated or unreasonable therapeutic procedures.

The article presents two clinical observations: a combination of alopecia areata with anemia, chronic gastrointestinal diseases and celiac disease in a one-year-old child and with anemia, thyroiditis, and gastrointestinal diseases in an adult patient with post-COVID syndrome.

About the authors

Valeriy V. Dubenskiy

Tver State Medical University

Author for correspondence.
Email: valerydubensky@yandex.ru
ORCID iD: 0000-0002-1671-461X
SPIN-code: 3577-7335

MD, Dr. Sci. (Med.), Professor

Russian Federation, 4, Sovetskaya st., Tver’, 170642

Elizaveta G. Nekrasova

Tver State Medical University

Email: nekrasova-7@mail.ru
ORCID iD: 0000-0002-2805-6749
SPIN-code: 5831-5824

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, 4, Sovetskaya st., Tver’, 170642

References

  1. Federal clinical guidelines. Dermatovenerology-2015. Skin diseases. Sexually transmitted infections. Moscow: Business Express; 2016. Р. 28–38. (In Russ).
  2. Katsambas FD, Lotti TM. European guidelines for the treatment of dermatological diseases. Transl. from English. 3rd ed. Moscow: MEDpress-inform; 2014. Р. 40–45. (In Russ).
  3. Alopecia. Diagnostics and treatment. Ed. by P. Bohann, E. Bohann. Trans. from English. Ed. by A.G. Gadzhigoroeva. Moscow: GEOTAR-Media; 2020. 320 p. (In Russ). doi: 10.33029/9704-5540-1-ADL-2020-1-320
  4. Barilo AA, Smirnova SV, Lenina IM. Clinical case of focal alopecia in a child with atopy. Medical Immunology. 2021;23(1):191–196. (In Russ). doi: 10.15789/1563-0625-CCO-2074
  5. Russian Society of Dermatovenerologists and Cosmetologists. Federal clinical guidelines [electronic resource]. Nest alopecia. Ed. by A.A. Kubanov, Yu.A. Gallyamova, I.N. Kondrakhina, A.N. Mareeva. Moscow; 2020. (In Russ).
  6. Goldsmith LA, Katz SI, Gilcrest BA, et al. Fitzpatrick’s dermatology in clinical practice. Trans. from English. Ed. by N.N. Potekaev, A.N. Lvova. 2nd ed., corrected, revised and supplemented. Moscow: Panfilov Publishing House; 2015. Р. 1100–1102. (In Russ).
  7. Butov YuS. Dermatovenerology. National leadership. Short edition. Moscow: GEOTAR-Media; 2020. Р. 623–668. (In Russ).
  8. Baltabaev AM, Tkachev VP, Baltabaev MK. Differential diagnostic criteria of nest alopecia. Russian Journal of Skin and Venereal Diseases. 2016;19(6):259–263. (In Russ).
  9. Alkhalifah A, Alsantali A, Wang E, et al. Alopecia areata update: part I. Clinical picture, histopathology and pathogenesis. J Am Acad Dermatol. 2010;62(2):177–188. doi: 10.1016/j.jaad.2009.10.032
  10. Zlatogorsky A, Shapiro D. Trichology. Ed. by A. Litus. Transl. from English. Yu. Ovcharenko. 2nd ed., supplement and revision. Kiev: Rodovid; 2016. 276 p. (In Russ).
  11. Biran R, Zlotogorski A. The genetics of alopecia areata: new approaches, new findings, new treatments. J Dermatol Sci. 2015;78:11–20.
  12. Spano F, Donovan JC. Alopecia areata: part 1: pathogenesis, diagnosis, and prognosis. Can Fam.Physician. 2015;61(9):751–755.
  13. Suchonwanit P, Kositkuljorn C, Pomsoong C. Alopecia areata: an autoimmune disease of multiple players. Immunotargets Ther. 2021;10:299–312. doi: 10.2147/ITT.S266409
  14. Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: a multifactorial autoimmune condition. J Autoimmun. 2019;98:74–85. doi: 10.1016/j.jaut.2018.12.001
  15. Betrolini M, Zilio F, Rossi A, et al. Abnormal interactions between perifollicular mast cells and CD8+ T-cells may contribute to the pathogenesis of alopecia areata. PLoS One. 2014;9(5):94260. doi: 10.1371/journal.pone.0094260
  16. Nekrasova EG, Alexandrova OA, Dubensky VV, Muravyeva ES. Features of consulting children with hair pathology by a dermatologist. In: XIV St. Petersburg dermatological readings: materials of the scientific and practical conference. Saint Petersburg; 2020. Р. 80–81. (In Russ).
  17. Mulinari-Brenner F. Psychosomatic aspects of alopecia areata. Clin Dermatol. 2018;36(6):709–713. doi: 10.1016/j.clindermatol.2018.08.011
  18. Puavilai S, Puavilai G, Charuwichitratana S, et al. Prevalence of thyroid diseases in patients with alopecia areata. Int J Dermatol. 1994;33(9):632–633.
  19. Huang KP, Mullangi S, Guo Y, Qureshi AA. Autoimmune, atopic and mental health comorbid conditions associated with alopecia areata in the United States. J Am Acad Dermatol. 2013;149(7):789–794. doi: 10.1001/jamadermatol.2013.3049
  20. Rork JF, Rashighi M, Harris JE. Understanding autoimmunity of vitiligo and alopecia areata. Curr Opin Pediatr. 2016;28(4):463–469. doi: 10.1097/MOP.0000000000000375
  21. Van der Steen PH, Boezeman J, Duller P, Happle R. Can alopecia areata be triggered by emotional stress? An uncontrolled evaluation of 178 patients with extensive hair loss. Acta Derm Venerol. 1992;72(4):279–280.
  22. Celiac disease in children. Federal clinical guidelines. Moscow: Union of Pediatricians of Russia; 2016. (In Russ).
  23. Karyakina LA, Kukushkina KS, Karyakin AS. Comorbidity of nest alopecia and celiac disease. Experimental and Clinical Gastroenterology. 2021;(4):194–198. (In Russ). doi: 10.31146/1682-8658-ecg-188-4-194-198
  24. Sakaniya LR, Melnichenko OO, Korsunskaya IM. Hair loss due to a new coronavirus infection: treatment approaches. Medical Council. 2021;(8):77–80. (In Russ). doi: 10.21518/2079-701X-2021-8-77-80
  25. Chang YJ, Lee YH, Wang YH, Wei JC. Impact of rheumatoid arthritis on alopecia: a nationwide population-based cohort study in Taiwan. Front Med. (Lausanne). 2020;7:150. doi: 10.3389/fmed.2020.00150
  26. Lim CP, Severin RK, Petukhova L. Big data reveal insights into alopecia areata comorbidities. J Invest Dermatol Symp Proc. 2018;19: 57–61. doi: 10.1016/j.jisp.2017.10.006
  27. Molochkov VA, Snarskaya ES. Giant genital warts of Buschke-Levenshtein in a patient with HIV infection. Russian Journal of Skin and Venereal Diseases. 2006;(5):14–16. (In Russ).
  28. Dubensky VV, Nekrasova EG, Muravyova ES, Alexandrova OA. Psoriasis in a patient with vitiligo. Russian Journal of Skin and Venereal Diseases. 2017;20(4):232–233. (In Russ). doi: 10.18821/1560-9588-2017-20-4-232-233
  29. Olisova OYu, Garanyan LG. Epidemiology, etiopathogenesis and comorbidity in psoriasis ― new facts. Russian Journal of Skin and Venereal Diseases. 2017;20(4):214–219. (In Russ). doi: 10.18821/1560-9588-2017-20-4-214-219
  30. Dubenskiy VV, Nekrasova EG, Aleksandrova OA, Muravyova ES. Vulgar psoriasis and squamous cell carcinoma in a patient with discoid lupus erythematosus. Bulletin of Dermatology and Venereology. 2020;96(4):60–66. (In Russ). doi: 10.25208/vdv1120-2020-96-4-60-66

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2. Fig. 1. Patient A., diagnosis: “Alopecia areata, subtotal form, progressive stage. Hair loss on the head and thinning of the eyebrows”: a ― patient A., 10 months; b ― dermatoscopy, ×20: presence of «black dots» and hair in the form of an «exclamation mark» within the hair follicles; c ― clinical recovery: restoration of hair growth at the age of 3 years; d ― deformation of the finger nail plates in the form of a “thimble” at the age of 3 years.

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3. Fig. 2. Patient I., 24 years old, diagnosis: “Alopecia areata, progressive stage, universal form”: a ― hair loss every day; b ― total hair loss on the scalp, in the area of eyebrows, eyelashes and armpits; c ― restoration of hair growth after 3 months; d ― longitudinal grooves on the nail plate of the second finger of the left hand (top image), transverse grooves (Bo lines) of the nail plate of the first toe of the left foot (bottom image); e ― complete hair restoration after 6 months.

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