西医是如何治疗斑秃的?

斑秃是一种比较严重的脱发现象，这种脱发治疗起来难度比较大。当然治疗斑秃的方法也是很多的。西医就是治疗斑秃的常见方法。下面我们一起看下西医是如何治疗斑秃的?

　　(一)全身治疗：1、皮质类固醇激素：强的松每天15～40mg口服，数周后逐渐减量，然后以每天lOmg维持2～3个月，因停药后易复发，故不作为常规治疗，常用于控制来势凶猛的斑秃。

　　2、免疫调节剂：常用转移因子、胸腺素、干扰素、左旋咪唑等。

　　3、血管扩张剂：烟酸lOOrng，每日3次，口服。

　　4、安定药：安定2.5mg，每日3次，或5mg，每晚1次。

　　(二)局部治疗：1、局部注射：用皮质类固醇激素，如去炎松混悬液(3～5mg/m1)，每4～6周1次局部注射，每次总量不超过20mg，适用于范围较小的脱发，要注意避免引起局部皮肤萎缩和凹陷。

　　2、外涂：可选用1%长压定霜剂或溶剂，每日涂1-2次;0.25-0.8%蒽林软膏或霜剂，每日涂1至数次，以使局部皮肤出现轻度发光为限;0.05%地塞米松50%二甲亚砜溶液外用或加封包;盐酸氮芥配成每ml含0.2rug的溶液，每日外涂1-3次。

　　3、局部光化学疗法：先在脱发区外涂0.1%-0.15%甲氧补骨脂素溶液(软膏或洗剂)1-2小时，局部照射长波紫外线，照射后必须将皮肤洗净，只适用于个别难治病例，勿用于儿童，以免出现远期副作用。

　　4、液氮冷冻疗法：用液氮喷射或用棉签蘸液氮后直接按压局部，每隔数分钟1次，连续2～3次。

西医是如何治疗斑秃的?通过上述介绍相信大家都有所了解了。西医治疗斑秃具有见效快的特点，但是很多西医疗法治疗斑秃长远效果并不理想。所以我们建议患者还是选择毒副作用小的方法进行治疗。北京广济医院推出的中医激活疗法治疗斑秃，从斑秃的根源入手进行治疗，修复激活休眠的毛囊，精选中药材，改善毛乳头的血液循环，平衡油脂分泌并激活休眠的毛囊，从而达到治愈的目的。是斑秃患者最理想的选择。

西医如何治疗斑秃？西医认为，脂溢性脱发与遗传有关，患者的毛囊对雄激素过度敏感，相对偏高的雄激素水平导致头发的生长期缩短，毛囊萎缩、退化、脱落，从而使头发逐渐变得稀疏。因此，部分阻断雄激素对毛囊的破坏作用成为西医治疗的目标。12药网小编为您整理的西医治疗斑秃方法如下：

(1)全身治疗

可服肮脏酸、泛酸钙、维生素族等。有明显精神因家者．可服镇静剂如溴剂、安定等。全秃、普秃或久治不愈的斑秃可试月阳的松3—4周，有效即有新发生长者，可继续服3。6月。以后逐渐减量，维持3—6月(无效者应即停用)*府情发展迅速，病变范围广泛，可内服皮质类固醇激素，一般主张采用小剂量法，维持10个月或更长时间停药。

(2)局部治疗

局部治疗的原则为刺激局部充血，改善局部血行，促进毛发生长。常用的可改进毛发生长的药物如10％辣椒配和鲜姜等，或用皮质类固醇激素软膏或二甲基亚砚溶液外搽，以减少炎症反应。

以上就是对西医治疗脱发的介绍，脱发的治疗可以采用西医，也可以采用中医，但是不管是哪种方法都要先找对病因再进行治疗，这样才可能会有一个较好的治疗效果，而且治疗效果也不能太单一，不妨多尝试几种方法。

12药网药师推荐：治疗斑秃的明显产品有一下几种：

米诺地尔酊：用于治疗男性型脱发和斑秃。

养血生发胶囊：养血祛风，益肾填精。用于血虚风盛，肾精不足所致的脱发，症见毛发松动或呈稀疏状脱落、毛发干燥或油腻、头皮瘙痒;斑秃、全秃、脂溢性脱发与病后、产后脱发见上述证候者。

复方斯亚旦生发酊：育发，润发，固发。用于秃发，斑秃，脂溢性脱发及其它不明原因的脱发。

［诊断］

　　1．根据头部突然出现圆形或椭圆形秃发斑，局部皮肤无炎症，平滑光亮，无自觉症状，诊断不难。

　　2。应与假性斑秃鉴别，后者患处头皮萎缩，毛发不能复生，表面常有岛屿状正常毛发束，边缘具有细狭的红晕。

　　［治疗］

　　1、西医药治疗

　　（1）内服药治疗：

　　①去除可能诱因，帮助患者树立治愈的信心。有明显精神因素者，可给予镇静剂。

　　②全身疗法：内服或注射维生素B族；内服胱氨酸片或复方胱氨酸片（发维佳，每次4片，每日3次）；对全秃及普秃患者可应用强的松，每日15—30mg，数周后逐渐减量，维持2—3个月；还可以给予免疫治疗，如胸腺素和环孢素等。（2）外用药治疗：可选用o．2％-1％葸林软膏或霜、1％敏乐啶霜或溶液、氮芥溶液（o．2mg/ml）；皮质类固醇激素制剂局部外用或皮损内注射；还可应用光化学疗法（PUVA），即局部先外搽8—甲氧补骨脂素酊剂，45分钟后照射长波紫外线，开始每周2次，以后逐渐减少治疗次数。

斑秃的常见西医治疗方法有哪些？专家介绍，临床上常见的斑秃的西医治疗方法主要有六种，下面专家为大家一一介绍。

斑秃的常见西医治疗方法

（1）胱氨酸：每次100毫克，每日3次，口服。

（2）维生素B6：每次20毫克，每日3次，口服。

（3）泛酸钙：每次20毫克，每次3次，口服。

（4）甲状腺素片：每次30毫克，每日2次，口服。

常见的斑秃西医治疗方法

（5）安定：（用于失眠患者），每晚1片，口服。

（6）强的松：每日20～40毫克，口服。1个月后可逐渐减量。

本病是一种自身免疫性的非瘢痕性脱发，常发生于身体有毛发的部位，局部皮肤正常，无自觉症状。

目录

1病因

2临床表现

3鉴别诊断

4治疗

1病因编辑

病因不明。在毛囊周围有淋巴细胞浸润，且本病有时合并其他自身免疫性疾病（如白癜风、特应性皮炎），故目前认为本病的发生可能存在自身免疫的发病机制。遗传素质也是一个重要因素，可能与HLAⅡ型相关，25%的病例有家族史。此外，还可能和神经创伤、精神异常、感染病灶和内分泌失调有关。

2临床表现编辑

可发生于任何年龄，但以青壮年多见，两性发病率无明显差异。皮损表现为圆形或卵圆形非瘢痕性脱发，在斑秃边缘常可见“感叹号”样毛发。头发全部或几乎全部脱落，称为全秃。全身所有的毛发（包括体毛）都脱落，称为普脱。还可见匍行性脱发。病区皮肤除无毛发外，不存在其他异常。

有时可出现甲异常，最常见的是甲凹陷，还有脆甲、甲剥离、反甲等。还可并发眼白内障、Down综合征、甲状腺病和白癜风等。

3鉴别诊断编辑

需和头癣、瘢痕性脱发、牵引性脱发、梅毒性脱发、雄激素性脱发等鉴别。

4治疗编辑

大多数普通斑秃有自然痊愈倾向，少数病例反复发生，所以治疗困难。但有很多疗法可以联合治疗脱发。

1.外用药

（1）米诺地尔5%米诺地尔霜或溶剂，每日涂1或2次，可能与它的血管扩张作用有关。

（2）蒽林0.5%～1%蒽林软膏或霜，是一种原发刺激剂。每日外涂1至数次，以使局部皮肤出现轻度皮炎为限。

（3）接触致敏剂二苯环丙烯酮（DCP）最常用。

（4）糖皮质激素强效激素外用或封包。0.05%地塞米松，50%二甲基亚砜溶液外用常比霜剂等有更好疗效。

2.内用药

（1）糖皮质激素泼尼松内服，数周后逐渐减量，然后以小剂量维持6个月。糖皮质激素效果好，但副作用大，停药后易复发，故不作为常规疗法。但对急性斑秃，为避免发展为全秃或普秃可试用。

（2）环孢素疗程6～12个月。部分病例有效，如4个月后无效应停药。

（3）胸腺五肽肌内注射，持续3周。

（4）血管扩张药烟酸口服。

3.局部注射法

局部注射糖皮质激素，适用于范围较小的脱发，或普秃患者的重要美容部位（如眉毛）。可直接注射脱发区，也可注射其周缘部，以期控制脱发范围的继续扩大。要注意避免可能引起的局部皮肤萎缩和凹陷。

4.神经封闭疗法

对枕大神经做封闭术，该神经被封闭后，其支配区域的皮肤温度上升，有利于毛发再生。

“鬼剃头”是怎么回事？浏览量：19351

“鬼剃头”是斑秃的俗称，是一种突然发生的局限性脱发。为什么叫“鬼剃头”呢？世上本没有鬼，自然就谈不上给人剃头的鬼了，因为头发是在不知不觉中突然脱落的，患者本人也不清楚头发是什么时候掉的，常于无意中发现或被别人发现，也即脱发过程短暂、神奇之故吧。祖国医学经典著作《诸病源候论》中写到：“人有风邪，有于头，在偏虚处，则发失落、肌肉枯死，或如钱大，或如指大，发不生，亦不痒，故为之“鬼舔头”。鬼舔头非鬼所为，而是风邪侵袭正气虚弱的人体而发病的，一旦风邪侵入头部，而头部阳气不足便致脱发。

斑秃有哪些表现呢？

斑秃可发生于任何年龄。不少患者在发病前有精神创伤和精神刺激史。初起为1个或数个边界清楚的圆形、椭圆形或不规则形的脱发区，局部头皮正常、光滑，活动期脱发区边缘头发松动，很容易被拔出。本病病程经过缓慢，可自行缓解和复发。若整个头皮毛发全部脱落，称全秃；若全身所有毛发均脱落，称普秃。



斑秃的表现



引起斑秃的原因有哪些呢？

目前病因尚不完全清楚，研究普遍认为斑秃是一种具有遗传素质和环境激发因素的自身免疫性疾病。

自身免疫：班秃患者伴有一些自身免疫性疾病的比率比正常人群高，7%～27%的斑秃患者伴有甲状腺疾病，包括甲状腺肿、粘液性水肿和桥本甲状腺炎，4%～9%的斑秃患者合并有白癜风。

遗传：许多研究提示斑秃的发生具有一定的遗传基础。有报道单卵双生的双胞胎同时发生相同形式的斑秃，还有报道一家4代均有斑秃。10%～20%曾发生斑秃的父母，其子女中至少有一个会发生斑秃。

环境因素：可能与斑秃的易感性、严重程度、病程、对治疗的反应和预后等有一定关系。

精神因素：如精神创伤（极度悲伤、愤怒、恐惧等）、情绪紧张（儿童和青少年考试前紧张）、受刺激（如儿童被狗咬、惊吓或被打骂等）常是诱发及促使病情加重的原因。此外过度劳累和睡眠不足（通宵上网、玩麻将、游戏等）也可影响血管运动中枢, 反射性地引起血管舒缩功能失调，头部毛发血液供应发生障碍而发生斑秃。

中医认为与气血双虚,肝肾不足,血瘀毛窍有关。发为血之余，气虚则血难生，毛根不得需养，故发落成片；肝藏血，肾藏精，精血不足则发无生长之源；阻塞血路,新血不能养发，故发脱落。

斑秃怎么治疗呢？

斑秃的治疗，首先是精神因素，注意休息、劳逸结合，睡眠要充足，心情舒畅，避免烦躁、忧愁、动怒等。可口服胱氨酸、维生素B族、斑秃丸等。局部可外用皮质类固醇激素、米诺地尔溶液；或鲜姜擦用，以刺激头皮，增加皮肤的血液循环，促进毛发的生长。对顽固的斑秃患者，可局部应用皮质类固醇激素封闭治疗。此外，还可用紫外线照射、梅花针等治疗。中医则以补肾、养血、祛风为主要治疗原则。

斑秃在我们的日常生活中均能碰到，对于患斑秃的患者，要嘱其保持积极乐观的态度，正确认识和面对它，同时要加强营养，多食富含维生素的食物，纠正偏食的不良习惯。平时要注意头发卫生，加强头发的护理，不用碱性强的肥皂洗发，少用电吹风吹烫头发。尽量减少染发和烫发的次数。

斑秃治疗新进展（转载）

全网发布：2011-08-16 10:24发表者：刘科峰2165人已访问

斑秃治疗新进展（lordhobo摘译）

Treatment of alopecia areata: “What is new on the horizon?”

作者Maria K. Hordinsky（美国摘译：lordhobo

关键词：斑秃、临床试验、全组基因相关研究（GWAS）

斑秃是多基因、免疫介导的靶部位是生长初期毛囊的疾病。特征性表现为圆形或椭圆形毛发脱失斑、头皮全部毛发脱失（全秃）、所有体毛脱失（普秃）或者匍行性脱发，斑秃是相对常见的自身免疫性疾病，影响全世界各种族、各个年龄段的男性和女性。美国人一生中出现斑秃的风险大约是2%.河南大学第一附属医院皮肤科刘科峰

不幸的是，目前对这个慢性病没有治愈方法，尽管有许多可用的治疗，但没有普遍证明有效的方法。在美国，没有FDA批准用于斑秃治疗的方法，所有治疗被认为是“未依照说明书的”。目前的治疗选择常常根据疾病的程度和持续时间以及患者的年龄。治疗包括外用、皮损内注射和系统治疗。

病理生理学

斑秃的病理生理学标记是出现毛囊周围炎症，特别是在生气初期毛囊周围大量淋巴细胞浸润。这个浸润常常呈“蜂窝样”，在活动性疾病患者中比较典型（图1）。当斑秃比较慢性后，这个浸润可能不显著，而毛发周期的静止期或者毛发生长初期早期阶段浸润占优势（图2）。用严重免疫缺陷小鼠的移植研究已经证明斑秃可转移T细胞。也有证据认为斑秃部位的免疫豁免丢失。

目前的治疗

斑秃的一线治疗常常包括皮损内注射或者外用皮质类固醇激素以及一些同系物、外用免疫疗法。缺乏皮损内注射皮质类固醇激素治疗斑秃的随机研究，然而，有数个已经发表的文献研究了外用皮质类固醇治疗这个疾病的有效性。许多皮肤科医师优先选择的外用免疫疗法，目前没有对照研究其有效性.

斑秃的二线治疗包括外用米诺地尔、地蒽酚和补骨脂素紫外线（UVA）光疗。此外，二线疗法还包括口服皮质类固醇激素、柳氮磺胺吡啶、环孢菌素、甲氨蝶呤等系统治疗或者联合治疗。

其他显示有些疗效的治疗包括准分子激光、外用贝沙罗汀、光动力疗法、前列腺素类似物以及点阵光热作用。一个天然治疗选择，芳香疗法已经报道在有些患者有效。

尽管有个别病例报道使用不同生物制剂治疗斑秃有效，生物制剂直接或者间接改变T细胞功能治疗这个疾病在临床试验中没有成功。在研究中检查了：（i）阿来法塞，与CD2结合并抑制T细胞活性的融合蛋白标记物，（ii）伊那西普，肿瘤坏死因子-α抑制剂，以及（iii）依法珠单抗，抗CD11a的重组人单克隆抗体，在临床试验中都没有显示有效。其中，依法珠单抗制造商自此被中断。此外，有使用阿达木单抗、英夫利昔单抗或伊那西普治疗其他自身免疫疾病时出现斑秃的报道。

新进展

在2009年8月，对斑秃感兴趣的科学家和临床医师以及大多数自身免疫学专家在科罗拉多州丹佛参加了由国家斑秃协会主办的大会。这个1天会议的主要目的是形成进一步研究斑秃的方向和机会。这次会议有4个主要结果，其中的1个是确定新的有潜力的治疗方法。其他3个结果主要是关注进一步研究的主要部位、形成研究团队立即寻找斑秃免疫机制认识的关键缺口以及发展基金策略以从事毛发研究和斑秃的自身免疫世界研究。

会议结束时，产生了一组对临床试验/临床研究感兴趣的研究者。给这组研究者费用来回顾和发展临床研究，使用装置以及对其他自身免疫疾病有效的非说明书产品治疗。这些装置和治疗根据免疫学知识和斑秃的基因学进行选择。

HairMaxLaserCombProfessionalHairMax赫尔曼可丝激光生发梳采用美国Lexington（列克星敦）科技公司的专利技术

Questions and Answers about Alopecia Areata

This booklet contains general information about alopecia areata (al-oh-PEE-shah ar-ee-AH-tah). It describes what alopecia areata is, its causes, and treatment options. Information is also provided on current research. At the end is a list of key words to help you understand the terms in this booklet. If you have further questions after reading this booklet, you may wish to discuss them with your doctor.

Alopecia areata is just one cause of alopecia, or hair loss. This booklet deals only with alopecia areata.

What Is Alopecia Areata?

Alopecia areata is considered an autoimmune disease, in which the immune system, which is designed to protect the body from foreign invaders such as viruses and bacteria, mistakenly attacks the hair follicles, the structures from which hairs grow. This can lead to hair loss on the scalp and elsewhere.

In most cases, hair falls out in small, round patches about the size of a quarter. In many cases, the disease does not extend beyond a few bare patches. In some people, hair loss is more extensive. Although uncommon, the disease can progress to cause total loss of hair on the scalp (referred to as alopecia areatatotalis) or complete loss of hair on the scalp, face, and body (alopecia areatauniversalis).

∙ What Causes It?

∙ Who Is Most Likely to Get It?

∙ Is My Hair Loss a Symptom of a Serious Disease?

∙ Can I Pass It On to My Children?

∙ Will My Hair Ever Grow Back?

∙ What Can I Expect Next?

∙ How Is It Treated?

∙ How Will Alopecia Areata Affect My Life?

∙ How Can I Cope With the Effects of This Disease?

∙ What Are Some Promising Areas of Research?

∙ Where Can People Find More Information About Alopecia Areata?

∙ Key Words

What Causes It?

In alopecia areata, immune system cells called white blood cells attack the rapidly growing cells in the hair follicles. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continuously supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair.

Scientists do not know exactly why the hair follicles undergo these changes, but they suspect that a combination of genes may predispose some people to the disease. In those who are genetically predisposed, some type of trigger—perhaps a virus or something in the person’s environment—brings on the attack against the hair follicles.

Who Is Most Likely to Get It?

Alopecia areata affects nearly 2 percent of Americans of both sexes and of all ages and ethnic backgrounds. It often begins in childhood.

If you have a close family member with the disease, your risk of developing it is slightly increased. If your family member lost his or her first patch of hair before age 30, the risk to other family members is greater. Overall, one in five people with the disease has a family member who has it as well.

Is My Hair Loss a Symptom of a Serious Disease?

Alopecia areata is not a life-threatening disease. It does not cause any physical pain, and people with the condition are generally healthy otherwise. But for most people, a disease that unpredictably affects their appearance the way alopecia areata does is a serious matter.

The effects of alopecia areata are primarily socially and emotionally disturbing. In alopecia universalis, however, loss of eyelashes and eyebrows and hair in the nose and ears can make the person more vulnerable to dust, germs, and foreign particles entering the eyes, nose, and ears.

Alopecia areata often occurs in people whose family members have other autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison’s disease. People who have alopecia areata do not usually have other autoimmune diseases, but they do have a higher occurrence of thyroid disease, atopic eczema, nasal allergies, and asthma.

Can I Pass It On to My Children?

It is possible for alopecia areata to be inherited. However, most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children.

Alopecia areata is not like some genetic diseases in which a child has a 50–50 chance of developing the disease if one parent has it. Scientists believe that there may be a number of genes that predispose certain people to the disease. It is highly unlikely that a child would inherit all of the genes needed to predispose him or her to the disease.

Even with the right (or wrong) combination of genes, alopecia areata is not a certainty. In identical twins, who share all of the same genes, the concordance rate is only 55 percent. In other words, if one twin has the disease, there is only a 55-percent chance that the other twin will have it as well. This shows that other factors besides genetics are required to trigger the disease.

To learn more about the genes and other factors involved in alopecia areata risk, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) sponsored the development of an alopecia areata registry. (For more information about the registry, see “What Are Some Promising Areas of Research?”)

Will My Hair Ever Grow Back?

There is every chance that your hair will regrow with or without treatment, but it may also fall out again. No one can predict when it might regrow or fall out. The course of the disease varies from person to person. Some people lose just a few patches of hair, then the hair regrows, and the condition never recurs. Other people continue to lose and regrow hair for many years. A few lose all the hair on the scalp; some lose all the hair on the scalp, face, and body. Even in those who lose all their hair, the possibility for full regrowth remains.

In some, the initial hair regrowth is white, with a gradual return of the original hair color. In most, the regrown hair is ultimately the same color and texture as the original hair.

What Can I Expect Next?

The course of alopecia areata is highly unpredictable, and the uncertainty of what will happen next is probably the most difficult and frustrating aspect of the disease. You may continue to lose hair, or your hair loss may stop. The hair you have lost may or may not grow back, and you may or may not continue to develop new bare patches.

How Is It Treated?

Although there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. The following are some treatments for alopecia areata. Keep in mind that although these treatments may promote hair growth, none of them prevent new patches or actually cure the underlying disease. Consult your health care professional about the best option for you. A combination of treatments may work best. Ask how long the treatment may last, how long it will take before you see results, and about the possible side effects.

∙ Corticosteroids. Corticosteroids are powerful antiinflammatory drugs similar to a hormone called cortisol, which is produced in the body. Because these drugs suppress the immune system if given orally, they are often used in the treatment of various autoimmune diseases, including alopecia areata. Corticosteroids may be administered in three ways for alopecia areata:

o Local injections. Injections of steroids directly into hairless patches on the scalp, and sometimes the brow and beard areas, are effective in increasing hair growth in most people, and are the most common treatment in adults in the United States. Injections deliver small amounts of cortisone to affected areas, avoiding the more serious side effects encountered with long-term oral use. Side effects may include transient pain, as well as temporary depressions in the skin that usually fill in by themselves.

o Oral corticosteroids. Corticosteroids taken by mouth are a mainstay of treatment for many autoimmune diseases and may be used in extensive alopecia areata. But because of the risk of side effects of oral corticosteroids, such as hypertension, weight gain, osteoporosis, and cataracts, they are used only occasionally for alopecia areata and for short periods of time.

o Topical ointments. Ointments or creams containing steroids rubbed directly onto the affected area are less traumatic than injections and, therefore, are sometimes preferred for children. However, corticosteroid ointments and creams alone are less effective than injections.

∙ Minoxidil (5 percent). Topical minoxidil solution promotes hair growth in several conditions in which the hair follicle is small and not growing to its full potential. Minoxidil is approved by the U.S. Food and Drug Administration (FDA) for treating male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata. The topical solution, applied twice daily, has been shown to promote hair growth in both adults and children, and may be used on the scalp, eyebrow, and beard areas.

∙ Anthralin.Anthralin, a synthetic tar-like substance that alters immune function in the affected skin, is an approved treatment for psoriasis. Anthralin is also commonly used to treat alopecia areata. It is applied topically.

∙ Topical sensitizers. Topical sensitizers are medications that, when applied to the scalp, provoke an allergic reaction that leads to itching, scaling, and eventually hair growth. Two topical sensitizers are used in alopecia areata: squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP). They should be administered by doctors familiar with these products.

∙ Photochemotherapy. In photochemotherapy, a treatment used most commonly for psoriasis, a person is given a light-sensitive drug called a psoralen either orally or topically and then exposed to an ultraviolet light source. This combined treatment is called PUVA. Patients must go to a treatment center where the equipment is available at least two to three times per week. If used for long periods, the treatment may increase the risk of developing skin cancer.

∙ Alternative therapies. When drug treatments fail to bring sufficient hair regrowth, some people turn to alternative therapies. Alternatives purported to help alopecia areata include acupuncture, aromatherapy, evening primrose oil, zinc and vitamin supplements, and Chinese herbs. Most alternative therapies are not backed by clinical trials, and because hair can regrow spontaneously in alopecia areata, it is difficult to evaluate the effectiveness of these alternatives. Furthermore, just because these therapies are natural does not mean that they are safe. As with any therapy, it is best to discuss these treatments with your doctor before you try them.

In addition to treatments to help hair grow, there are measures that can be taken to minimize the effects of excessive sun exposure or discomforts of lost hair.

∙ Sunscreens are important for the scalp, face, and all exposed areas.

∙ Eyeglasses (or sunglasses) protect the eyes from excessive sun and from dust and debris when eyebrows or eyelashes are missing.

∙ Wigs, caps, or scarves protect the scalp from the sun and keep the head warm.

∙ An ointment applied inside the nostrils keeps them moisturized and helps to protect against organisms invading the nose when nostril hair is missing.

How Will Alopecia Areata Affect My Life?

This is a common question, particularly for children, teens, and young adults who are beginning to form lifelong goals and who may live with the effects of alopecia areata for many years. The comforting news is that alopecia areata is not a painful disease and does not make people feel sick physically. It is not contagious, and people who have the disease are generally healthy otherwise. It does not reduce life expectancy and it should not interfere with going to school, playing sports and exercising, pursuing any career, working, marrying, and raising a family.

The emotional aspects of living with hair loss, however, can be challenging. Many people cope by learning as much as they can about the disease, speaking with others who are facing the same problem, and, if necessary, seeking counseling to help build a positive self-image.

How Can I Cope With the Effects of This Disease?

Living with hair loss can be difficult, especially in a culture that views hair as a sign of youth and good health. Even so, most people with alopecia areata are well-adjusted, contented people living full lives.

The key to coping is valuing yourself for who you are, not for how much hair you have or don’t have. Many people learning to cope with alopecia areata find it helpful to talk with other people who are dealing with the same problems. Nearly 2 percent of Americans have this disease at some point in their lives, so you are not alone. If you would like to be in touch with others with the disease, the National Alopecia Areata Foundation (NAAF) can help through its pen pal program, message boards, annual conference, and support groups that meet in various locations nationwide. To find contact information for NAAF and other organizations that can help people with alopecia areata, see “Where Can People Find More Information About Alopecia Areata?”

Another way to cope with the disease is to minimize its effects on your appearance. If you have extensive hair loss, a wig or hairpiece can look natural and stylish. For small patches of hair loss, a hair-colored powder, cream, or crayon applied to the scalp can make hair loss less obvious by eliminating the contrast between the hair and the scalp. Skillfully applied eyebrow pencil can mask missing eyebrows.

Children with alopecia areata may prefer to wear bandanas or caps. There are many styles available to suit a child’s interest and mood. It is often helpful if a parent informs teachers, coaches, and others that the child has alopecia areata, that it is not contagious, and that the child is healthy.

For women, attractive scarves can hide patchy hair loss, and proper makeup can camouflage the effects of lost facial hair. If you would like to learn more about camouflaging the cosmetic aspects of alopecia areata, ask your doctor or members of your local support group to recommend a cosmetologist who specializes in working with people whose appearance is affected by medical conditions.

What Are Some Promising Areas of Research?

Although a cure is not imminent, researchers are making headway toward a better understanding of the disease. This increased understanding will likely lead the way to better treatments for alopecia areata and eventually a way to cure it or even prevent it.

The National Institutes of Health (NIH) and other organizations support research into the disease and its treatment. Here are some promising areas of research:

∙ Developing animal models. This is a critical step toward understanding any disease, and much progress has been made. Researchers have identified an inbred strain of mice that spontaneously develops a condition similar to the adult-onset form of alopecia areata. By studying mice with a disease similar to human alopecia areata, researchers hope to learn more about the mechanism of the disease and eventually develop immune system treatments for the disease in people.

∙ Studying hair follicle development. By studying how hair follicles form in mouse embryos, researchers hope to gain a better understanding of hair growth cycle biology that may lead to treatments for the underlying disease process.

∙ Understanding stem cell biology. Epithelial stem cells are immature cells that are responsible for regenerating and maintaining a variety of tissues, including the skin and the hair follicles. Stem cells in the follicle appear to be spared from injury in alopecia areata, which may explain why the potential for regrowth is always there in people with the disease. By studying the biology of these cells, scientists hope to gain a better understanding of factors that trigger the disease.

∙ Finding genes. Scientists are studying the possible genetic causes and mechanisms of the disease both in families that have one or more people with the disease and in the general population. They look at families with three or more affected individuals and then look at large numbers of unrelated affected people and compare their genetic markers with unaffected people; this is called a “genomewide association study” or “GWAS.”

∙ Scientists have identified genetic variations associated with the development of alopecia areata. They also discovered that alopecia areata has genetic similarities to other autoimmune diseases, namely type 1 diabetes, rheumatoid arthritis, and celiac disease. An understanding of the genetics of the disorder will aid in disease prevention, early intervention, and development of specific therapies. To assist researchers searching for such genetic clues, the NIAMS sponsored the development of the National Alopecia Areata Registry, a network of five centers, to identify and register patients with the disease and collect information and blood samples (which contain genes). Data, including genetic information, is made available to researchers studying the genetic basis and other aspects of the disease and disease risk. For more information, log onto the registry website at www.AlopeciaAreataRegistry.org.

More information on research is available from the following resources:

∙ ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.

Website: www.clinicaltrials.gov

∙ NIH Clinical Research Trials and Youhelps people learn more about clinical trials, why they matter, and how to participate.

Website: www.nih.gov/health/clinicaltrials

∙ NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding.

Website: www.projectreporter.nih.gov

∙ PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine,

nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences.

Website: www.ncbi.nlm.nih.gov/pubmed

Where Can People Find More Information About Alopecia Areata?

You can get additional information through the following organizations:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-0001

Phone: 301-495-4484

Toll Free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: http://www.niams.nih.gov

Other Resources

National Center for Complementary and Alternative Medicine

National Institutes of Health

Website: http://nccam.nih.gov

National Alopecia Areata Foundation (NAAF)

Website: http://www.naaf.org

American Academy of Dermatology (AAD)

Website: http://www.aad.org

American Hair Loss Council

Website: http://www.ahlc.org

For additional contact information, visit the NIAMS website or call the NIAMS Information Clearinghouse.

Key Words

Acupuncture. A traditional Chinese system of healing in which symptoms are relieved by inserting needles beneath the skin at selected points and then stimulating the points by rotating the needles or exposing them to heat or electrical current.

Addison’s disease. A condition that occurs when the adrenal glands (a pair of glands situated on top of the kidneys) fail to secrete enough corticosteroid hormones. Without treatment, the disease can be fatal.

Alopecia areata. An autoimmune, often reversible disease in which loss of hair occurs in sharply defined areas usually involving the scalp or beard, but any area of the body where hair grows can be affected.

Alopecia areatatotalis.A form of alopecia areata characterized by the total loss of hair on the scalp.

Alopecia areatauniversalis. A form of alopecia areata in which all hair on the scalp, face, and body is lost.

Aromatherapy. The therapeutic use of essential oils (highly concentrated aromatic extracts distilled from a variety of aromatic plant materials including grasses, leaves, flowers, needles and twigs, fruit peels, wood, and roots) to promote the health of body, mind, and spirit.

Autoimmune disease.A disease that results when the immune system mistakenly attacks the body’s own tissues. Rheumatoid arthritis, systemic lupus erythematosus, and type 1 diabetes are autoimmune diseases (“auto” means self).

Chemotherapy.The use of strong drugs to suppress the immune system. Though originally associated with cancer treatment, chemotherapy is used for many different diseases involving the immune system.

Corticosteroids.Potent anti-inflammatory hormones that are made naturally in the body or synthetically (man-made) for use as drugs. They are also called glucocorticoids. The most commonly prescribed drug of this type is prednisone.

Diabetes. A disease in which the body does not produce or properly use insulin, a hormone that is necessary to convert sugar, starches, and other food into energy.

Evening primrose oil.The oil of a weedy plant containing the essential fatty acid gamma linolenic acid (GLA), which is converted into anti-inflammatory agents by the body. Evening primrose oil is available as a nutritional supplement and touted as a pain and inflammation reliever.

Hair follicle.A small, narrow, tube-like structure in the skin from which hair grows.

Immune system.A complex network of specialized cells and organs that work together to defend the body against attacks by “foreign” invaders such as bacteria and viruses. In some autoimmune conditions, it appears that the immune system does not function properly and may attack the body’s own tissues by mistake.

Pernicious anemia.A potentially dangerous form of anemia, usually caused by an autoimmune process, which results in a deficiency of vitamin B-12.

Rheumatoid arthritis.An autoimmune disease that targets primarily the membrane lining the joints, leading to pain, stiffness, swelling, and joint deformity.

Systemic lupus erythematosus. A chronic autoimmune disease of the connective tissue that can attack and damage the skin, joints, blood vessels, and internal organs.

Topical sensitizers. Medications that, when applied to the scalp, provoke an allergic reaction that leads to itching, scaling, and often hair growth. They include squaric acid dibutyl ester and diphenylcyclopropenone.

Acknowledgments

The NIAMS gratefully acknowledges the assistance of the following individuals in the preparation and review of previous versions of this booklet: George Cotsarelis, M.D., University of Pennsylvania Medical Center, Philadelphia; Vicki Kalabokes, National Alopecia Areata Foundation, San Rafael, CA; Alan Moshell, M.D., NIAMS, NIH; and David Norris, M.D., University of Colorado Health Sciences Center, Denver. A special acknowledgement goes to Vera Price, M.D., University of California, San Francisco, for assistance in the preparation of an updated version of this booklet. Mary Anne Dunkin was the original author of a previous version of this booklet.

DPCP for the Treatment of Alopecia Areata

C. Bolduc MD, FRCPC and J. Shapiro MD, FRCPC

Division of Dermatology, Faculty of Medicine, University of British Columbia, Vancouver, Canada

ABSTRACT



Topical immunotherapy with diphencyprone (DPCP) for the treatment of severe alopecia areata has been used since 1983 and is felt to be the treatment of choice by many dermatologists. Although there have been no major side effects reported since its initial use, there remain some unknowns regarding its safety. Because DPCP has at least a 40% success rate for cosmetically acceptable regrowth in extensive alopecia areata, its availability is an important matter for patients with alopecia areata.



Key Words: topical immunotherapy, diphencyprone, alopecia areata

Topical immunotherapy using diphencyprone (DPCP) is considered by many dermatologists to be the treatment of choice for extensive alopecia areata. Unfortunately, DPCP is not officially approved anywhere mainly because there is not enough evidence to support its safety.

DPCP

DPCP has been used throughout the world since 1983 for the treatment of extensive (>40%) alopecia areata. It is a compound used topically to induce an allergic contact dermatitis. Its exact mechanism of action is still unknown, but researchers hypothesize that the inflammatory reaction that is created diverts the immune system away from the hair follicle, thereby allowing new hair to grow.



The average response rate varies among patients with alopecia areata, but seems to be around 40% for cosmetically acceptable regrowth1,2. Forty percent of those who respond will maintain a cosmetically acceptable head of hair even 6 months after DPCP has been stopped1,2. The most common side effects are mild eczema, cervical lymphadenopathy and skin pigment changes1,2.



The US FDA is concerned that there are too many unknowns regarding DPCP. However, there are some encouraging data in favour of its safety. DPCP was not detected in the serum or urine of patients treated topically for alopecia areata, and no major side effects have been reported since its initial use.



Because of the safety controversy regarding DPCP, we discuss the issue with our patients before treating them and ask them to sign an informed consent. We have treated more than 200 patients with DPCP over the past 10 years and have had great patient satisfaction with no major side effects3.

Table 1: Summary3.

FDA Position

When we contacted the US FDA, they told us they could not release any information concerning a drug that is not approved because it is considered confidential. However, we were able to find out that DPCP appears to have been excluded for the following reasons:

1. There is a synthetic precursor and potential contaminant of commercial purified DPCP that is mutagenic in the Ames assay.

2. There are unknowns in the toxicology profile such as chronic toxicity, reproductive toxicity and human teratogenicity.

The FDA position is that pharmacies can still carry DPCP and squaric acid dibutyl ester (SADBE), but they cannot publicize across state lines that they have these products.



For physicians in Canada, we have contacted the Health Protection Branch (HPB – Ottawa) and there is, as yet, no formal regulation regarding the use of DPCP. The guidelines suggest that physicians in their office can use DPCP for their own patients, but they must assume liability for any adverse effects.

The Future

Although alopecia areata is a medically benign condition, it can cause extreme distress in a large number of patients.



After weighing the pros and the cons, the National Alopecia Areata Foundation and the US FDA are considering the possibility of making DPCP available as an investigational new drug. At this time, a decision has not been made as to whether the investigation will be done in a multi-center study, or by issuing “packets” that will be available to physicians in the US who want to take part. In Canada, once again, this whole process is not mandatory.

Conclusion

Within the next few years, the collection of all combined worldwide data, including Canada, should allow the US FDA and HPB – Ottawa to assess safety issues more accurately in order to ultimately gain full regulatory approval.

References

1. Rokhsar C, Shupack J, Vafai J, Washenik K. Efficacy of topical sensitizers in the treatment of alopecia areata. J Am AcadDerm 39(5 pt 1): 751–61 (1998 Nov).

2. Shapiro J, Price VH. Hair regrowth. Therapeutic Agents. DermatolClin 16(2): 341–56 (1998 Apr).

3. Shapiro J, Bolduc C. Unpublished data (2000).

Alopecia areata: Diagnosis, treatment, and outcome

How do dermatologists diagnose alopecia areata?

Sometimes a dermatologist can diagnose alopecia areata by looking at the hair loss.

If the patch of hair loss is expanding, the doctor may pull out a few hairs. These hairs will be looked at under a microscope.

Sometimes the dermatologist will perform a skin biopsy to confirm that the disease is alopecia areata. To perform a skin biopsy, the dermatologist removes a small piece of skin so that it can be studied under a microscope.

Blood tests may be necessary if the dermatologist thinks the patient might have another autoimmune disease.

How do dermatologists treat alopecia areata?

There is no cure for alopecia areata. Hair often re-grows on its own. Treatment can help the hair re-grow more quickly. A dermatologist may prescribe one or more of the following to help the hair re-grow more quickly:

∙ Corticosteroids: This medicine suppresses the immune system. It can be given as shots, with the dermatologist injecting the medicine into the places with hair loss. Sometimes a patient gets a topical (applied to the skin) form of this medicine. It may be a cream, lotion, or ointment. The patient applies the medicine to the bare spots. Less often, patients take corticosteroid pills.



For adults with alopecia areata, these shots are often the first treatment tried. Patients receive shots every 3 to 6 weeks. Hair growth begins about 4 weeks after the last shot. Sometimes, it takes longer.



Topical corticosteroids are less effective than shots. This is often the best treatment for children.



Corticosteroid pills can have serious side effects. Dermatologists do not routinely prescribe them for this reason. Pills may be a treatment choice for patients with many bald spots.

∙ Minoxidil: A hair re-growth medicine, minoxidil 5%, may help some patients re-grow their hair. Both children and adults can use it. Patients apply it twice a day to the scalp, brows, or beard. New hair may start to grow in about 3 months. Patients most often use this medicine with another treatment.

∙ Anthralin: This medicine alters the skin’s immune function. The patient applies a tar-like substance to the skin and leaves it on for 20 to 60 minutes. A dermatologist may call this short-contact therapy. After 20 to 60 minutes, the anthralin is washed off to avoid the skin from becoming irritated.

∙ Diphencyprone (DPCP): This medicine is applied to the bald skin. It causes a small allergic reaction. When the reaction occurs, a patient has redness, swelling, and itching. Dermatologists believe this allergic reaction tricks the immune system, causing it to send white blood cells to the surface of the scalp. This fights the inflammation. It also prevents the hair follicles from going to sleep, and causing the hair loss.



With DPCP, it can take 3 months for the hair to start re-growing.

∙ Other treatments: Patients often get more than 1 treatment at a time. A mix of 2 or more treatments often boosts success.

Ask your dermatologist about possible side effects (health problems that can result from the medicines). If you have a bad reaction to a medicine, call your dermatologist right away.

Researchers are working to advance the treatment of alopecia areata. They are exploring other medicines that work on the patient’s immune system. They also are looking at lasers and other light-based therapies.

Outcome

When a person has alopecia areata, the hair will start to re-grow when the body gets the right signals. Sometimes this happens without treatment. Even with treatment, new hair loss can occur. Everything depends on how the immune system reacts.

The following explains what can happen.

∙ Re-growing hair: It is likely that the hair will grow back even without treatment. It may fall out again, though. Most patients lose their hair more than once before the disease goes away for good. Even people who lose all the hair on their scalp and body can have their hair grow back. When hair loss is widespread (lots of hair loss on the scalp and/or body), there is a greater chance that the hair will not re-grow.



When hair re-grows, it can be white or fine at first. A person’s own hair color and texture often return later.

∙ How long it lasts: This varies. For some people, the disease never returns. Others lose and re-grow hair for many years. No one can predict when the hair might re-grow or fall out again. This lack of control makes the disease frustrating.

∙ Emotional toll: The emotional aspects of living with hair loss can be hard. Our world regards hair as a sign of youth and good health. The good news is that alopecia areata does not affect overall health. It should not stop you from achieving your goals and dreams. You should not let it stop you from doing well in school, sports, and work.



If your hair loss bothers you a lot, you may wish to join a support group.

　男性型脱发（MPHL）影响大多数男性。数十年来治疗MPHL已经有安全和有效的药物，但外用米诺地尔溶液和口服非那雄胺仍是治疗脱发的好制剂。对于药物治疗无效的患者，毛发移植也是一个重要的选择。患者个人喜好以及费用和生活方式在确定佳治疗中起重要作用。