Alopecia Adnata and Skin Diseases Simulating Alopecia

There are two types of alopecia adnata – partial (hypotrichosis) and diffuse (atrichosis). It is usually combined with some development defect (Rothmund syndrome, Werner syndrome, epidermolysis bullosa, Siemens syndrome — ectodermal genetic polydysplasia). In the case of congenital alopecia hair loss is combined with atrophy of hair follicles (smoothing of the scalp). Hair is missing on the whole of the skin when malignant forms of alopecia universalis develop. Partial genetic alopecia in the form of diffuse thinning or foci is observed more often than diffuse atrichia. In the latter case the areas of atrichia are most often observed in the location of a trauma (for example, in the case of pathological delivery).

Congenital hypotrichosis may be expressed by a decrease in the number of hair on all areas of the skin or solely on the scalp. Meanwhile the hair is thin, brittle, slow-growing, short, sometimes, discolored.

Diagnosis. Any type of congenital hypotrichosis is characterized by its emergence either at the moment of birth or in the first months of life of the child. The diagnostics is facilitated by presence of other congenital ectodermal dysplasias, which affect nails, teeth and bone-joint apparatus.

Methods of treatment of congenital alopecia. The prognosis for Alopecia Agnata is rather unfavorable. Courses of administration of corticosteroid hormones are carried out on a permanent basis — in combination with combination of various topical applications: placental ointment, vacuum massage, corticosteroid ointments and creams, ultraviolet irradiation, as well as Teonicol (Compilamin) and vitamins A and E.

Sometimes it is possible to stimulate hair growth by various irritants: red pepper, Veratrum album tincture, chloroform solution, or iodine. However, the effect will be short- term even if such an effect is obtained.

Pseudopelade or Alopecia Atrophica was first described by French dermatologist Brocq in 1855 (“pelade” means circle-shaped alopecia in French, so “pseudopelade” can be interpreted as alopecia resembling circular alopecia).

In such cases the skin areas affected by alopecia vary in size and have irregular-shaped zigzag, digitule or angular contours.

Initially in the affected areas the skin is slightly hyperaemic, later it takes on a waxy coloring, resembling a scar. Sometimes petechial singular ostial folliculites are observed around individual foci. The focus of alopecia has an area of eroded hair, which is easily removed. This dermatosis is occasionally considered to be atypical staphyloderma due to presence of ostial folliculites. However, taking into consideration the presence of cicatricial changes, Brocq’s pseudopelade can be considered a symptom of several dermatoses which end with atrophy (lichen spinulosus, scleroderma).

The diagnosis is carried out when ulerythema develops and openings of sebaceous-hair follicles are absent. Differential diagnosis is carried out in the case of circular alopecia, lupus erythematosus, scleroderma.

Diagnosis in the case of lupus erythematosus is facilitated by presence of telangiectasias, follicular hyperkeratosis and polycyclic or regular circular shapes of affected areas. Additional examination may identify presence of antinuclear antibodies in blood and photosensitivity.

Circular alopecia is differentiated without any problems by absence of atrophy, regular circular shape of the foci of alopecia and positive Zalkind iodine test (smearing with 2% alcohol solution of iodine. Meanwhile black dots are visible in patients with circular alopecia – which are absent in the case of pseudopelade). Focal scleroderma is expressed in the scalp with large areas of rather deep ulyrethema with skin shrinkage and sinking). Differentiation against mycoses is carried out easily based on negative results of luminescent and microscopic analysis.

Alopecia Atrophica and Its Treatment. Currently broad-spectrum antibiotics are applied, e.g. erythromycin, semi-synthetic penicillins, lincomycin, Fusidin-sodium. Calcium gluconate, salicylates, resochin(synthetic anti-malarial preparations) are simultaneously applied. Methyluracil, autohemotherapy, vitamins A and E are prescribed for immunostimulation. All methods and means enumerated with the purpose of treatment of circular alopecia, are recommended for topical use. However, the total prognosis is unfavorable as it is impossible to restore hair in areas affected by ulerythema.