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

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 (677%). 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distinction between therapeutic and diagnostic approaches, based on their reliable significance, which will eliminate outdated or unreasonable therapeutic procedures.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.