home Audience 5 Modern view on the treatment of chronic diffuse telogen effluvium in men. Methods for diagnosing trichology What can be found out using FTG

Modern view on the treatment of chronic diffuse telogen effluvium in men. Methods for diagnosing trichology What can be found out using FTG

In our clinic, hair diagnostics is carried out using a variety of methods: trichoscopy, trichogram, phototrichogram, spectral hair analysis, biopsy.

Phototychogram (PTG) is a computer diagnostic method that is based on calculating indicators in comparison with two zones of the scalp (androgen-dependent and androgen-independent). FTG is prescribed in cases where the patient complains of excessive hair loss, thinning and thinning. There are no contraindications to FTG.

The cost of a phototrichogram in our clinic is average in Moscow.

What can be found out using FTG:

study the hair growth cycle, its density and diameter in real time;
identify the percentage of hair in the growth phase (anagen) and in the phase (telogen);
calculate the average hair growth rate;
identify the amount of terminal (that is, full-fledged, healthy) and vellus (depleted, with a shortened life cycle) hair;
identify the number of follicular units;
calculate the percentage of vellus hair in the telogen phase that prematurely entered the hair loss phase under the influence of androgens - this parameter is of critical clinical importance for the diagnosis of androgenetic alopecia.

FTG allows

Conduct a differential diagnosis between telogen effluvium hair loss and androgenetic alopecia
Identify the subclinical form of alopecia, that is, the very beginning of the disease
Identify signs of skin diseases (seborrhea, etc.)
Assess the effectiveness of therapy over time and promptly adjust the course of treatment

PHT is currently considered the most informative method for diagnosing androgenetic alopecia. Our specialists prescribe this examination to almost all patients upon initial treatment who experience excessive hair loss.

Conducting FTG

FTG is carried out in two stages. First, two small areas are shaved on the patient’s head using a trimmer, each with an area of less than 1 cm2. The first area is located in the frontoparietal zone (androgen-dependent), the standard point is 2 cm from the midline and 2 cm from the frontal line. The second section is shaved in the occipital zone (androgen-independent), 2 cm to the left or right of the occipital protuberance. This concludes the first stage. The patient leaves the clinic.

A few days later the patient comes a second time. Now the doctor examines the hair in the shaved areas and takes macro photographs, which are entered into a special computer program. The program calculates all the necessary indicators, so any errors due to the human factor and the subjectivity of the results are completely excluded. The use of a computer program makes it possible to save hair images, the results of the initial diagnosis, and subsequently compare the initial data with subsequent images.

The patient receives the results of FTG, as well as detailed recommendations from the trichologist.

You can’t cope with hair loss and suspect androgenetic alopecia, and don’t know where to get a phototrichogram in Moscow? We are waiting for you in our clinic for diagnostics!

Examples of completed work

Good day to all! Today I will talk about a diagnostic procedure for hair. One of the very, very few that actually help with the problem of hair loss, and not just take money out of the pocket without any benefit for its owner.

A lyrical digression or a few thoughts out loud...

I am endlessly amazed at the backwardness of most people regarding hair. Moreover, this remains a purely selective one, because very few people can complain about the lack of logic.

If, God forbid, you get a kidney attack, will you run to the store for an obscure liquid sold without a prescription to immediately begin “treatment”? Or will you persistently, week after week, rub a miraculous mixture of onion broth and mustard into your side just because you came across a similar “recipe” somewhere on the Internet?

No, you’ll probably still go to the doctor, get an ultrasound, and first find out whether anything needs to be treated at all. And if necessary, then with what.

What about hair?

Logic suddenly disappears.

Faced with hair loss, we will be perplexed for years as to why our hair is coming out again: autumn has played a dirty trick on us again, or what vitamins our body is asking for. Rubbing eggs, onions or another soup set into the scalp, buying unknown means that work (or more often not working at all) and making spells for the Moon.

Instead of finding out what the problem actually is.

Perhaps this situation has developed due to the fact that procedures that help diagnose the type of hair problem are somehow not well known.

And it’s always so convenient to speculate on ignorance, so shampoos for hair loss, miracle serums “to increase thickness” and other unrealities multiply endlessly and endlessly.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

What is a phototrichogram (PTG)?

This is a diagnostic method that answers the question about the type of hair loss, which you encountered - reactive* or chronic = androgenetic alopecia (AGA).

* associated with the action of some reactive factor, for example, imbalance in the hormonal part (hormonal / hormone-dependent / androgenic / postpartum loss, loss due to uncompensated problems with the thyroid gland, the consequences of stress (post-stress loss, loss due to taking serious medications, consequences of previous operations), etc.

The main difference between these two types of prolapse is if in case of reactive prolapse, the cause must be treated, that is, eliminate the factor that causes hair loss (and not buy useless grinding products in this case), after which the loss ends by itself, then in the second case the cause (factor) is irremovable, and therefore It is the hair itself that needs to be treated.

This is why FTG is carried out - in order to direct your strength and energy in the right direction in a timely manner. And don’t rush around, wasting precious time, grabbing at one thing or another.

I did FTG twice.

For the first time - in 2009, when I received my disappointing diagnosis - "AGA", and recently - just out of interest: what was left on my head after 8 years on minoxidil, while, judging by the horror stories on the Internet, " It only works for 2 years, and then it depletes the follicles and they die."

Visually, I didn’t see any deterioration, but it’s always interesting to find out for sure. You never know, maybe all the hair under minoxidil has died, but I don’t even notice?

How is FTG carried out?

This procedure is carried out in clinics (trichological centers). The price greatly depends on the location of the clinic, and on the greed of the center - how actively they will sell you additional services (other tests, consultations before and after FTG, etc.).

Do not confuse FTG with other types of diagnostics also offered by clinics (and non-clinics): FTG is always carried out in 2 stages (on 2 different days) and to carry it out it is not enough to simply shine a flashlight into the scalp.

At the first stage of FTG, the hair on the patient's head is shaved in 2 places, and a micro-tattoo is placed on the skin. The area of the shaved area with a high-quality FTG is at least 0.5 sq. cm., and better - more (1 cm.). Analysis of data on microscopic areas (like 16 sq. mm.) is not representative.

Micro patches, of course, do not look very attractive, but after a few days they are difficult to notice. Standard location:

the first point is at a distance of 2 cm from the frontal line and 2 cm from the midline of the head; the second point is an area located 2 cm to the right/left of the occipital protuberance.

At the first stage, a syringe and a dye mixture are used (photo on the left), at the second - only a camera (photo on the right).

The second stage is usually scheduled after 2 days - macro photographs are taken from the shaved areas, which are entered into a special program. The results can be seen in the printout you receive, and you don’t have to be a trichologist to decipher them.

Source: KOSMETIK international journal, No. 1/2013, p. 22

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Stages of providing trichological care

First of all, it should be noted that the methods of managing trichological patients in the CIS countries and abroad differ significantly, since in the West trichology has developed over a long time and is now a structured industry in which the stages of providing “trichological care” to the population are quite clearly distributed between specialists of different levels, while in our country these stages are “blurred” and do not have clear boundaries. IN table 1 The stages of trichological diagnostics, which are more typical for non-CIS countries, are schematically presented: after discovering a hair problem (on their own or with the help of relatives and friends), the patient seeks specialized trichological, most often non-medical, help (trichologist-consultant) and only then, in the case of if necessary, seek highly specialized medical care (dermatologist/dermatocosmetologist-trichologist).

This feature is associated both with the low availability of trichologists and the high cost of their services in Western countries, and with the presence of a well-developed network of trichologists of a paramedical profile who have received appropriate training and qualifications and are able to provide in-demand services at a high level. In addition, the relationship between a trichologist and a trichologist increases the range of services provided and increases patient compliance. Thus, if the trichological center has a specially trained hairdresser with the skills of a trichologist-consultant, the patient, even at the initial stage of treatment, can visually improve the condition of his hair by selecting a hairstyle that increases volume, selecting nanofibers that mask thinning, and also, if necessary, using an individually selected hairpiece according to the color and structure of your own hair.

To work successfully in modern conditions, a trichologist needs to be aware of global trends in the field of diagnosis and treatment of diseases of the hair and scalp, master new diagnostic and therapeutic techniques, constantly improving their professional level. At the present stage, a specialist involved in the diagnosis and treatment of diseases of the hair and scalp needs to navigate fields of medicine related to dermatology, such as therapy, endocrinology and gynecological endocrinology, psychoneurology, psychoneuroimmunology and psychodermatology.

Diagnostic methods in trichology

The effectiveness of patient treatment will depend not only on the specialist’s practical experience, but also, no less important, on his success in mastering modern diagnostic methods in trichology, the importance of which is growing every day.

Depending on the aspects of trichological diagnostics considered, methods for assessing the condition of hair and scalp can be divided into:

specialized and non-specialized;
methods intended primarily for research purposes and practical work;
from the point of view of the manipulations performed with the patient - non-invasive, semi-invasive and invasive.

Non-specialized methods include ultrasound examination of the human body, as well as laboratory (clinical) diagnostic methods, which make it possible to obtain data on the patient’s health status based on the study of biomaterial of the human body in vitro using hematological, biochemical, immunological, serological, molecular biological, bacteriological , genetic, cytological and other methods. These methods give an idea of the general condition of the human body and can be prescribed to the patient by both a trichologist and relevant specialists.

Laboratory diagnostic methods make it possible to exclude conditions such as iron deficiency anemia or latent iron deficiency, deficiency of vitamins and/or chemical elements, thyroid dysfunction and hyperandrogenemia, which can be both the main cause of hair loss and factors aggravating this problem.

It should be remembered that the main task of a specialist is to treat not the disease, but the patient, that is, to correctly interpret the obtained laboratory information and, comparing it with the patient’s existing picture of the disease, use it for further effective clinical use of the results obtained.

This paper will discuss some diagnostic methods that are most important for the effective practical work of a trichologist.

Specialized methods of trichological diagnostics

Today, the range of modern techniques for examining a patient with hair and scalp problems, in addition to the classic history taking and physical examination of the patient, may include trichoscopy, trichogram and phototrichogram with contrast, specialized diagnostic computer programs that allow measuring hair, its thickness and density, the number of follicular units per unit area, biopsy and numerous types of microscopy, as well as the method of survey photographs.

Let us dwell in more detail on those specialized techniques that have the greatest practical significance for daily practice and are most accessible to the practitioner - these are trichoscopy, phototrichogram and the method of overview photographs.

Trichoscopy

Today, trichoscopy has become a necessary tool when examining a trichological patient and conducting differential diagnosis of diseases of the hair and scalp. This non-invasive method, which has become widespread since the beginning of the 21st century (the term was introduced by L Rudnicka in 2006), is based on the use of a hand-held dermatoscope or videodermatoscopy of hair and scalp skin and is actively used by trichologists due to its accessibility, simplicity and non-invasiveness in combination with a fairly high informative.

There are trichoscopy using immersion liquid (immersion) and without using immersion (“dry”). The use of immersion trichoscopy helps to assess the condition of the vessels and skin of the scalp, while “dry” trichoscopy is the most informative for assessing the presence of peeling, manifestations of seborrhea, and perifollicular hyperkeratosis.

This method is an important tool in practical work, allowing differential diagnosis for various types of alopecia. During trichoscopy, lenses with different magnifications are used - from 10 to 1,000 times, the most commonly used are lenses with a magnification range from x 20 to x 70. The method allows you to assess in vivo the state of trichoscopic structural units, namely: hair shafts - their structure and diameter , condition of the mouths of hair follicles and blood vessels of the scalp, perifollicular epidermis. Trichoscopy is used in the differential diagnosis between alopecia areata and trichotillomania,
scarring and non-scarring alopecia. The method has also proven effective in diagnosing seborrhea and psoriasis of the scalp. Visualization of structural disorders of the hair shafts during trichoscopy makes it possible to diagnose genetic diseases of the hair shafts, such as Netherton Syndrom, monilethrix and others.

Trichoscopy allows you to distinguish normal terminal hair from vellus (vellus-like), the thickness of which is no more than 0.03 mm, and also allows you to distinguish hair in the form of an exclamation mark, characteristic of alopecia areata, the length of which is no more than 1-2 mm.

The method allows you to assess the condition of the mouths of the hair follicles; the changes observed in this case are usually described using the term “point”. Blackheads (cadaverized hairs) characteristic of alopecia areata (AA) have been described. (photo 1), yellow dots found in both alopecia areata and androgenetic forms of alopecia (AGA) (photo 2), as well as yellow “3D” dots for cicatricial alopecia and red dots characteristic of discoid lupus erythematosus.

Photo 1. Yellow dots and black dots in GA. Author's observation
Photo 2. Yellow dots with AGA. Author's observation

Using trichoscopy, you can also evaluate the features of skin microvascularization. Thus, twisted and lace-like vascular loops are a characteristic sign of scalp psoriasis, and branching vessels inside the yellow dots are found in discoid lupus erythematosus.
Violations of the structure and changes in the color of the skin of the scalp, which are visualized during trichoscopy, include hyperpigmentation in the form of a “honeycomb”, indicating excessive exposure to insolation on the scalp (photo 3), peripillary (perifollicular) marks that appear in the early stages of androgenetic alopecia (photo 4), as well as perifollicular fibrosis, characteristic of various forms of fibrous alopecia.

Photo 3. Hyperpigmentation in the form of a “honeycomb”. Author's observation
Photo 4. Trichoscopy of a patient with AGA. There are peripillary signs and yellow dots (highlighted in yellow), vellus hairs (highlighted in red), fillicular units - mostly single. Author's observation

Characteristic trichoscopic signs of cicatricial alopecia are areas of milky red color (mainly in lichen planus) or ivory color (in the initial stage of frontal fibrosing alopecia), combined with the absence of the orifices of the hair follicles, as well as perifollicular hyperkeratosis in the form of rays resembling a star ( characteristic of folliculitis decalvans), or in the form of concentric scales around the mouths of the follicles (found in lichen planus).
Trichoscopy helps to identify anisotrichosis - the presence of hair of different diameters: terminal, interdeterminate and vellus (a specific sign of androgenetic alopecia), as well as the number of hairs in the follicular units and their location relative to each other. Clinically important is an increase in the number of single follicular units and a decrease in the number of follicular units with 2, 3 or more hairs, as well as an increase in the distance between follicular units (photo 5) .

Photo 5. Trichoscopy of a patient with AGA. Anisotrichosis, increased distance between follicular units. Author's observation

Visually, this will be manifested by progressive thinning and decrease in hair volume, which is characteristic of androgenetic alopecia. An increase in the number of follicular units with 4 or more hairs is characteristic of cicatricial alopecia, in particular lichen planus and folliculitis decalvans.

Not long ago, trichoscopes appeared that allow research using UV rays with a wavelength corresponding to the spectrum of a Wood's lamp. Their use is intended to facilitate diagnosis in cases of suspected superficial mycoses (dermatomycosis) of the scalp, folliculitis caused by fungi of the genus Pityrosporum, various types of porphyrias (photo 6) .

Photo 6 (a, b). Trichoscopy of pityrosporum folliculitis using the UV region of the spectrum (365 nm) and without the use of ultraviolet. Author's observations

We should not forget that, despite all the advantages, the described method also has its limitations and does not give the specialist the right to make a diagnosis based only on the signs detected during trichoscopy. In addition, the trichoscopic picture is not always obvious and unambiguous. If cicatricial alopecia is suspected, as well as in complex cases and if differential diagnosis is necessary, a biopsy comes to the aid of the trichologist, allowing you to look “inside” the hair follicle (photo 7) .

Photo 7. Biopsy of a patient with frontal fibrosing alopecia. Author's observation. The study was carried out by K.B. n. Trunovoy

Biopsy is a highly specialized diagnostic method and requires appropriate qualifications not only from the trichologist who takes the material for further research, but also from the pathologist/histologist who will evaluate biopsy samples of the scalp.

Phototrichogram

Non-invasive methods include standard phototrichogram and phototrichogram with contrast (using specialized computer programs - TrichoSciencePro or similar).

This method is generally accepted and widely used in clinical trichological practice due to its high accuracy and accessibility.
An important feature of the phototrichogram (PTG) method is its ability to detect the subclinical form of androgenetic alopecia in the early stages of the disease, carry out differential diagnosis between AGA and diffuse telogen effluvium, and also evaluate the effectiveness of alopecia treatment over time.

The phototrichogram method allows you to study the hair growth cycle in vivo and measure various of its parameters, including density and diameter, the percentage of hair in the growth phase (anagen) and in the loss phase (telogen), average growth rate, and the number of terminal and vellus (thinning) hairs. hair. In addition, the program allows you to calculate such an important parameter, which is of great importance for the differential diagnosis of androgenetic alopecia, as the percentage of vellus in telogen, that is, those hairs that thin and prematurely enter the hair loss phase under the influence of androgens.

To conduct a phototrichogram, the specialist selects an area for subsequent measurements, usually located at a standard point in the frontoparietal zone or in another area of severe hair thinning. At the first stage of FTG, hair is shaved off in selected areas with a trimmer in areas measuring 10 x 10 mm. If further observation is necessary in the phototrichogram area, it is necessary to place a tattoo mark for repeated phototrichograms in the same area. During the second stage, after 2-3 days, among the shaved hair, it will be possible to detect regrown anagen hair and telogen hair remaining the same length. The area is tinted with a special dye composition, and then, using a trichoscope connected to a computer, images taken at 40-60x magnification are entered into a specialized computer program (in Russia, the TrichoSciencePro program is most widely used).

It is diagnostically important that most hairs in the telogen phase (photo 8, pink arrows), are vellus-like (parameter “vellus among telogen hairs”), that is, sensitive to androgens, which makes the diagnosis of androgen-dependent alopecia obvious. In addition, this phototrichogram clearly shows an increase in the number of single follicular units, the presence of peripillary signs, yellow dots, and areas of focal atrichia, which also indicates the presence of androgenetic alopecia.

Photo 8. Phototrichogram of a patient with androgenetic alopecia. Author's observation

It should be noted that the phototrichogram method is highly accurate and reproducible only if the procedure is carried out by a qualified specialist who has the appropriate practical skills and sufficient practical experience in compliance with the protocol of the diagnostic technique, since the calculation of data in the program occurs in a semi-automatic mode and requires the specialist to have appropriate qualifications .

Below (photo 9, 10, 11) Some errors often observed during phototrichograms are presented (author's observations).

Photo 9. Image of a phototrichogram without the use of immersion liquid
Photo 10. In this case, calculating the phototrichogram may be difficult due to the fact that the specialist did not remove the bubbles that arose as a result of the use of the immersion agent

Photo 11. A variant of a correctly taken image for calculating phototrichogram parameters is presented.

So far, attempts to eliminate the human factor from the phototrichogram procedure, replacing it with automatic calculation of the studied parameters, have not been successful. Thus, the automated program for phototrichogram presented on the Western market, despite the convenient automatic counting mode, causes numerous complaints from specialists due to the insufficient accuracy of the calculations. Since in automated mode two or three thin hairs located close to each other can be recognized by the program as one thick hair, then when using such a fully automated counting method, its accuracy cannot be guaranteed.

Survey photo method

This method has long been used in both dermatology and trichology to study the condition of the skin and hair, as well as to evaluate the effectiveness of treatment. The standardization of the photographic survey method was first described in 1987 by Lederle, but this method became widespread after its use in clinical studies to evaluate the effectiveness of finasteride.

When conducting clinical studies, not only are photographs taken of problem areas using stereotactic devices, but further photographs obtained during observation (before and after treatment) are evaluated with the involvement of a panel of independent experts.

A stereotaxic device (SD) for photography is a device that combines a device that fixes the patient’s head in one position, a camera with a specially configured flash system, and a special panel or ruler that measures and records the distance between the device and the patient. The main task of a stereotactic device is to create reproducible imaging conditions for the area being studied. At the BioMi Vita clinic, we use a stereotactic device SU-p.1 (Russia), equipped with a fixator for the position of the patient’s head, a photosystem with standardized parameters, and a panel for measuring the distance between the device and the photographed area. SU allows you to reproduce the specified parameters during subsequent sessions and evaluate the results of treatment over time, subject to standardized conditions. It is recommended to evaluate results after 3-4, 6 and 12 months from the start of treatment.

When using a stereotactic device in clinical practice, the specialist will be guaranteed to obtain high-quality images and will avoid errors in assessing the patient’s condition due to incorrectly selected shooting parameters and related problems (insufficient sharpness, flare, excessive glare, incorrectly set ISO parameters, etc.). d.).
In addition to the method of standard survey photographs, it is also of interest to photograph the affected area on the scalp and smooth skin using fluorescent diagnostics using rays of a narrow long-wavelength ultraviolet spectrum. The method is effective not only for diagnosing dermatomycosis, but is also of interest for identifying and visualizing porphyria, seborrhea, folliculitis and other diseases (photo 12) .

Photo 12. Author's observations. A) overview photograph of the frontal area; B) photograph of the same area when examined in the rays of the UV spectrum (365 nm). Blue arrows - orange glow, characteristic of pityrosporum folliculitis. Author's observations

Conclusion

It is important to understand that when making a diagnosis, a combination of methods should be used, combining available specialized diagnostic techniques with anamnesis data and the clinical picture. Taking into account the results obtained based on the use of only one of the methods - for example, when interpreting only trichoscopic data without performing a phototrichogram in the differential diagnosis of androgenetic alopecia and diffuse telogen effluvium hair loss - the specialist may make a serious mistake when making a diagnosis and will not be able to prescribe adequate treatment in a timely manner. treatment. The presence in the doctor’s arsenal of such basic specialized methods as trichoscopy, phototrichogram and the method of survey photographs, combined with practical experience, is the key to correct diagnosis and effective treatment.

In conclusion, a version of the algorithm for examining a patient with complaints of hair loss and/or thinning is given.

A brief algorithm for examining a trichological patient

Stage I.

Initial consultation: after collecting anamnesis and conducting a physical examination, a primary specialized examination is carried out - trichoscopy.
The issue of the need to use additional examination methods (laboratory, instrumental diagnostics) and prescribe consultations with related specialists is being resolved.

Stage II.

A phototrichogram is performed, the purpose of which is to establish or clarify the diagnosis and monitor the effectiveness of treatment.
The specialist uses the method of survey photographs: a) using a stereotactic device, if necessary; b) using diagnostics using UV rays to record the patient’s condition at the time of initial treatment and the possibility of monitoring the effectiveness of treatment in the future.
Making a preliminary diagnosis.

Stage III.

Repeated consultation based on the results of clinical and laboratory studies.
Making a final diagnosis.
Development of a treatment and observation plan.

Currently, it is difficult to call the work of a practicing doctor in the field of diagnosis and treatment of hair diseases high quality without the use of a dermatoscope (trichoscope). It is trichoscopic techniques, as well as the phototrichogram method, that currently make it possible to thoroughly assess the condition of the hair structure, the mouths of the hair follicles, the activity of the sebaceous glands, the condition of the skin of the scalp, as well as assess the most important morphometric parameters of hair - density in different parts of the scalp, hair diameter in the same zones, percentage of vellus hair, anisotrichosis (dispersion of hair diameters). Phototrichogram, in addition to the listed parameters, allows you to evaluate the ratio of hair in the anagen and telogen phases, as well as the percentage of vellus and terminal hair in different phases. The totality of the data obtained allows us to accurately assess the current status, activity of hair loss, and the activity of the hair thinning process. If there is sufficient experience and qualifications, the specialist assesses not only the current state, but also, with a certain degree of accuracy, the prospects for further development of the process. Carrying out dynamic studies allows you to accurately assess changes under the influence of treatment, and, if necessary, timely correct treatment measures. Knowledge of dermoscopic criteria allows one to assess the condition of the hair structure, scalp and perifollicular areas, and identify signs specific to different types of alopecia.

Trichoscopy can be performed using the “dry” method and using immersion. Typically, ultrasound gel, immersion oil, saline, or alcohol are used for this purpose. It is worth noting that when assessing the functioning of sebaceous glands, crusts, scales and other elements, it is better to use the “dry method”, and to assess perifollicular signs (PPS) - the immersion method.

We studied the main morphometric parameters of hair accompanying the development of androgenetic alopecia (AGA) in women in the early stages of its development (Clinico-pathophysiological characteristics of metabolic disorders in androgenetic alopecia in women of fertile age. Tkachev V.P. Dissertation Ph.D. 2008)

To solve this problem, 2 groups of women were formed. The first group included 94 women aged 16 to 45 years, diagnosed with stage 1 androgenetic alopecia. according to Ludwig's classification. The duration of the disease ranged from 1 to 5 years. The second (control) group consisted of women of the same age (n=32) who had no signs of androgenetic alopecia. All patients underwent a comparative phototrichogram in the parietal and occipital zones with determination of hair density, the percentage of hair in the telogen and anagen phases, measurement of the average hair diameter, calculation of the percentage of vellus-like hair (diameter less than 30 microns), fine hair (diameter 30-50 microns ), medium hair (diameter 50-70 µm) and thick hair (diameter > 70 µm). The percentage of single follicular units in both areas of the scalp was calculated. To conduct the study, a section of hair with an area of 8x8 mm was shaved. in the androgen-dependent (parietal) zone and the androgen-independent (occipital) zone. After 48 hours, the shaved areas were colored using eyebrow and eyelash dye (Londa, Germany). The paint was fixed for 10 minutes, after which the residues were washed with ethyl alcohol. The study was carried out using a Trichoscope with a lens magnification of x 50, connected to a PC. The study results were processed using a specialized computer program Trichoscience (Russia).

Based on the work carried out, the following conclusions were made:

Based on the identified differences in the condition of the hair between the parietal and occipital zones, it is possible to accurately differentiate between androgen-dependent and diffuse alopecia in cases where laboratory parameters do not reveal hyperandrogenism, and a clear clinical picture of alopecia has not yet formed. Reliable signs that distinguish AGA in the early stages of its development from diffuse telogen effluvium hair loss in women are the following:

In the early stages of AGA, despite a decrease in hair density in the parietal zone, the total number of hair shafts within the parietal zone remains higher than in the occipital zone. The average hair diameter in the parietal zone with AGA also decreases, but this indicator does not differ significantly from the hair diameter in the occipital zone.
The percentage of vellus-like hair during the development of AGA averages 20±3.9%, while in the control group this figure averages 12±1.5%. When “yellow dots” appear, reflecting the presence of empty follicles, it is inappropriate to calculate the percentage of vellus-like hair, because their numbers begin to decline.
There is pronounced anisotrichosis (polymorphism) of the hair. When calculating the anisotrichosis coefficient using the Trichoscience program, already in the early stages of AGA this parameter exceeds 12.
An increase in the number of fine hairs (diameter 30-40 microns) in the parietal zone, compared to the occipital zone.
Decreased number of thick hairs (diameter > 70 µm) in the parietal zone compared to the occipital zone.
An increase in the percentage of single units (more than 30%) in the parietal zone compared to the occipital zone.
A significant increase in the percentage of telogen hair in the parietal zone compared to the occipital zone.
If all hair in the telogen stage is taken as 100%, then the proportion of vellus-like hair among them is more than 50%. It is worth noting that in the later stages of AGA, the proportion of vellus among telogen hairs may decrease as empty follicles appear in place of thinning hair.
The presence of spiky hair indicates the intensity of hair loss, but does not reflect progressive hair thinning. Progressive thinning of hair is best reflected by anisotrichosis and the proportion of vellus-like hairs among telogen hairs.

Below is an example of a phototrichogram and the conclusion of patient M., Diagnosis: Androgenetic alopecia, stage 1.

The study was carried out using the TrichosciencePro program.

Rice. 1

Area - 18.8 sq.mm. Total hair - 330.7 per square cm.
Hair growth rate for this window: 0.30mm per 24 hours
The average diameter of all hairs is 42 +/- 2.0 microns. The average diameter of all terminal hairs (>35 µm) is 52 +/- 1.8 µm.
Vellus hair (<30 мкм): - 39%
Among the terminals:
Fine hair (30-60 microns): - 74%
Medium hair (60-80 microns): - 26%
Anisotrichosis - 42 +/- 15.7 microns.
Anagen cells only 80% (44) Telogen cells only 20% (11) Terminal among anagen cells - 64%
Terminal among telogen cells - 45% Vellus among anagen cells - 36%
Vellus among telogen cells - 55%
“Yellow dots” are circled in yellow.

Phototrichogram is an excellent tool for a trichologist in assessing the dynamics of treatment. This method allows you to accurately detect even minimal changes during the treatment process.

The figure shows the dynamics in the treatment of androgenetic alopecia with a cosmetic product and laser (Nanogane + Hair Max). There is a clearly noticeable increase in hair diameters, a significant increase in hair in the anagen phase, as well as an increase in the number of hairs per square meter.

Dynamics during the treatment of a patient with AGA with a cosmetic preparation (Nanogane) and the Hair Max laser. On the left - before treatment, on the right - after 16 weeks during treatment. Observation by T. Tsimbalenko. 2008

If there is no technical capacity to carry out a phototrichogram, you can use the trichogram method.

Trichogram was performed using the TrichosciencePro program.

With this method, it is advisable to count hair in the anagen, telogen and catagen phases, as well as dysplastic and dystrophic hair.

The most common finding when assessing the condition of the perifollicular zones is “yellow dots”. “Yellow dots” reflect the delay of hair follicles in the telogen phase. A morphological study reveals empty follicles filled with epithelial horny masses and sebaceous secretions. According to A. Rakowska, yellow dots are present in 66% of patients with AGA. At the same time, yellow dots are a constant sign of alopecia areata and are often detected in discoid lupus erythematosus. Blackheads are detected in 53% of those with alopecia areata (Kowalska-Oledzka et al. 2011). According to Inui et al. (2010), blackheads may also be present in patients with abscessive perifolliculitis; chemotherapy-induced alopecia; hypotrichosis (hypotrichosis simplex); trichotillomania.

Fig. 2. “Yellow and black spots” with alopecia universalis.

“Yellow dots” and “black dots” in alopecia areata reflect the severity of the process, while broken hair and hair in the form of an exclamation mark reflect its activity ( Clinicalsignificanceofdermoscopyinalopeciaareata: analysisof 300 cases. Inui S , Nakajima T , Nakagawa K , Itami S . Department of Regenerative Dermatology, Osaka University School of Medicine, and Department of Dermatology, Saiseikai Tondabayashi Hospital, Osaka, Japan).

Rice. 3 Broken hair (black arrows), exclamation point hair (red arrows) and conical hair (green arrows) are characteristic signs of alopecia areata

According toSlowinskaetal(JAAD2008) andR. Hughesetal2011, “comma-shaped” hair (commahairs) and hair “in the shape of a corkscrew” (corkscrewhairs) are characteristic of microsporia (tineacapitis)

Rice. 4 Comma hair (black arrow) and corkscrew hair (blue arrow) (Slowinska 2008; Hughes 2011).

When assessing the perifollicular zone, we attach great importance to the signs of perifollicular inflammation, most often in the form of brownish halo and hyperpigmentation. Perifollicular hyperpigmentation appears to reflect inflammatory activity. On histological examination, brown dots are usually associated with signs of perifollicular, interfollicular infiltrate, mastocytosis and fibrosis) (1. Perifollicular and interfollicular lymphocytic infiltrates, mastocytes and fibrosis) (Abell E (1988) Histologic response to topically applied minoxidil in male-pattern alopecia. Clin Dermatol 6:191–194 2. Kligman AM (1988) The comparative histopathology of male pattern baldness and senescent baldness.Clin Dermatol 6:108–118 3. Lattanand A, Johnson WC (1995) Male pattern alopecia: a histopathologic and histochemical study J Cutan Pathol 2:58–70 4. Young JW, Conte ET, Leavitt ML, Nafz MA, Schroeter AL (1991) Cutaneous immunopathology of androgenetic alopecia.J Am Osteopath Assoc 91:765–771.Similar features are more often associated with androgenetic alopecia. In some cases, the presence of signs of perifollicular inflammation allows us to suspect a diffuse form of alopecia areata.

“Brown dots” ( brownish halo ) with a diffuse form of alopecia areata

An important factor in assessing the condition of hair is assessing its diameter.

Due to the polymorphism of this indicator, even under normal conditions, the assessment of the average hair diameter does not have any serious significance. In our opinion, it is much more appropriate to measure the percentage and diameter of thin, medium and thick hair, calculate the percentage of vellus-like hair and estimate the anisotrichosis coefficient.

Various researchers have vague views on the criterion that allows one to separate terminal hairs from vellus-like hairs. A number of researchers take the figure of 30 microns as a borderline value, others adhere to the value of 40 microns. In our opinion, the threshold value should be “floating”. So for patients with thin hair, the threshold is 30 µm, for patients with average hair thickness - 35 µm, and for patients with initially thick hair, the threshold is 40 µm. Please note that the hair type taken into account is only the one that the patient had initially, before the development of the pathology, because hair could become thinner due to a pathological process. Since hair thinning in AGA is “selective” in nature, it is almost always possible to detect unaffected hair that reflects the “original” diameter.

Thus, when assessing hair diameter in the Trichoscience program, the threshold between terminal and vellus-like hair is determined automatically based on the diameter of the thickest hair. The anisotrichosis coefficient is also automatically calculated.

TrichosciencePro program. Calculation of hair density, diameter, anisotrichosis coefficient. The diameter threshold between terminal and vellus-like hairs is defined as 35 μm (black arrow).

Trichoscopy can be an extremely useful, non-invasive technique for the differential diagnosis of certain types of cicatricial alopecia. Thus, A. Rakowska, L. Rudnicka and co-authors described a number of trichoscopic criteria detected in discoid lupus erythematosus, lichen planus, folliculitis decalvans, and Hoffmann's abscessive perifolliculitis.

In lichen planus pilaris (LPP), frontal fibrosing alopecia, the characteristic features are “milky-red areas lacking of follicular ostia”, concentric scales around the follicle mouths, reflecting perifollicular concentric scaling corresponds to perifollicular inflammation with band like subepidermal lymphocyte infiltrates in H.P.), elongated vessels located perpendicular to the follicular units (vessels: elongated, oriented perpendiculary along follicular units). In addition to lichen planus and frontal fibrosing alopecia, “white spots” are observed in centrifugal, alopecia areata and androgenetic alopecia, as well as on normal scalp in patients with dark skin (IV-VI phototrips) (Abraham L.S. at al 2010).

Frontal fibrous alopecia. White dots (black arrow)
and reddish milky lakes (red arrow). Concentric
scales (blue arrow). Observation of N. Barunova

In folliculitis decalvans (FD), a characteristic feature is perifollicular hyperkeratosis in the form of rays resembling a star (starburst pattern of perifollicular hyperkeratosis), as well as tufted hair growth.

With abscessing perifolliculitis (Hoffman) (Dissecting folliculitis) (DF), a common trichoscopic sign is considered to be “yellow and red areas”, “yellow dots” having a “three-dimensional structure” with “pepper grains” inside (yellow and red areas, yellow dots of “three-dimensional” structure with “grains of peppers” inside. Dissecting folliculitis).

Folliculitis decalvans. Observation by T. Silyuk

Discoid lupus erythematosus is characterized by the presence of “twisted thickened vascular loops” (DLE. Thick and twisted vascular loops), a “dirty appearance” reflecting the presence of brownish discoloration (“dirty appearance”), large, “bulging yellow dots”. Histopathological studies indicate the presence of hyperkeratotic plaques in the mouths of hair follicles (big, visibly bulging yellow dots, corresponds to hyperkeratotic plaques in follicular orifices seen in histopathology), yellow dots, with branching vessels inside (red “spider” in a yellow dot) with arborising vessels inside (a red spider in a yellow dot), red dots (follicular red dots), reflecting the dilated mouths of the follicles with dilated vessels and erythrocyte transudate (correlated with dilated infundible surrounded by dilated vessels with pronounced red blood cell extravasation in h.p.) .

Discoid lupus erythematosus. Dilated “vascular arches”. “Branching vessels”

Unlike discoid lupus erythematosus and seborrheic dermatitis, psoriasis reveals signs such as twisted vessels arranged in the form of spherical structures and rings.

Typical dermoscopic picture of psoriasis. “Twisted vessels”, “red spherical rings”.

With trichoscopy, it is easy to identify changes in hair structure as part of genetic syndromes - monilethrix, bamboo hair or invagination hair fragility in Netherton Syndrome, ring-shaped hair (pili annulati).

Monilethrix (observation by Rakowska A, Slowinska M et al. 2007)

Bamboo hair (Netherton's syndrome). Observation Burk C, Hu S et al (2008)

Ringed hair (observation by T. Silyuk 2009)

Trichonodiasis

Thus, trichoscopy is a simple and non-invasive technique, which, in combination with a phototrichogram, allows you to assess the main morphometric parameters of hair, the characteristics of its growth and the intensity of hair loss, growth rate, and the presence of progressive thinning. The technique allows you to exclude or confirm genetic or acquired abnormalities of the hair shafts, assess the condition of the skin of the scalp, and make a differential diagnosis between the main types of alopecia, including scarring. In addition, trichoscopy and phototrichogram are the most accurate and convenient methods for assessing the effectiveness of treatment.

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Liliya Ivanova, trichologist, certified by the International Association of Trichologists, dermatologist, doctor of the highest category at the Gold Standard Medical Center, Ph.D., Lipetsk

In the West, trichology as a separate field was formed back in the 50s of the twentieth century and is currently represented by national associations and societies involved in training specialists in the diagnosis and treatment of hair. The market for trichological services in Russia is now going through certain stages of recovery; it can be called spontaneous. There are no uniform methodological materials for the diagnosis, treatment and management of patients who seek help from a trichologist. There are few scientific articles covering the need for microdiagnostics to assess hair condition. But timely professional diagnosis gives the trichologist the opportunity to make the correct clinical diagnosis and draw up an effective treatment program.

Clinical example No. 1. Patient, 37 years old, occupation – administrative work. She complained of intense hair loss, thinning of the central parting and a decrease in hair volume more in the frontoparietal region with a pathological process duration of less than six months. She was independently treated with folk remedies, took vitamins, underwent a course of mesotherapy from a cosmetologist, but without effect, after which she was recommended to consult a trichologist to clarify the diagnosis.

– single follicular units 16.7%, double – 75.0%, triple – 8.3%;

– average diameter of all hairs 52 +/-3.2 microns;

– average diameter of all terminal hairs (>40 µm) 62 +/-3.7 µm;

– vellus hair (<40 мкм) 45%;

– among terminal: fine hair (40–60 µm) 42%, medium hair (60–80 µm) 50%, thick hair (>80 µm) 8%;

– anisotrichosis 52 +/-14.5 microns.

From the FTG conclusion of the fronto-parietal region:

– anagen only 32%;

– telogen effluvium only 68%;

– terminal among anagen 100%;

– terminal among telogen 100%;

– average diameter of all hairs 58 +/-2.1 microns;

– average diameter of all terminal hairs (>40 µm) 59 +/-2.0 µm;

– vellus hair (<40 мкм) 2%;

– among terminal: fine hair (40–60 µm) 50%, medium hair (60–80 µm) 39%, thick hair (>80 µm) 11%;

– anisotrichosis 58 +/-16.1 microns.

At the initial appointment, two preliminary diagnoses were in question: DTA or AGA. Androgenetic alopecia was supported by anisotrichosis, the difference in diameter between anagen and telogen, 45% vellus hair; The following signs indicated telogen loss: hair density in the occipital region is greater than in the parietal region, 75% of double follicular units and a small number of triple ones. Anisotrichosis can occur due to spiky hair.

Differential diagnosis was necessary, and a phototrichogram made it possible to make a final clinical diagnosis in favor of diffuse telogen effluvium hair loss. As a result, a series of laboratory tests were ordered, which revealed latent anemia and a significant deficiency of vitamin D3. After corrective therapy, hair loss stopped after four months.

Clinical example No. 2. Patient, 31 years old, occupation – hairdresser. She complained of hair loss in clumps (especially when washing), which began two months after giving birth. I even became afraid of washing my hair. She started washing them once a week, stopped dyeing them, and stopped blow-drying them. She did not undergo any treatment. I turned to a trichologist on the recommendation of a gynecologist.

From the conclusion on trichoscopic signs:

– single follicular units 52.9%, double – 41.2%, triple – 5.9%;

– average diameter of all hairs 46 +/-7.7 microns;

– average diameter of all terminal hairs (>35 µm) 58 +/-5.6 µm;

– vellus hair (<35 мкм) 30%;

– among terminal: fine hair (35–60 µm) 57%, medium hair (60–80 µm) 29%, thick hair (>80 µm) 14%;

– anisotrichosis 46 +/-21.8 microns.

From the FTG conclusion:

– anagen only 57%;

– telogen effluvium only 43%;

– terminal among anagen 92%;

– terminal among telogen 58%;

– vellus among anagen 8%;

– vellus among telogen 42%;

– average diameter of all hairs 57 +/-3.2 microns;

– average diameter of all terminal hairs (>40 µm) 66 +/-2.8 µm;

– vellus hair (<40 мкм) 20%;

– among terminal: fine hair (40–60 µm) 40%, medium hair (60–80 µm) 33%, thick hair (>80 µm) 28%;

– anisotrichosis 57 +/-23.4 microns.

At the initial appointment, a preliminary diagnosis was made: diffuse telogen effluvium hair loss due to the early postpartum period (trichoscopic signs were in favor of DTA). However, anisotrichosis and 30% of vellus hair were confusing. As a result of the FTG, androgenetic alopecia was diagnosed at an early stage.

The principles of therapeutic and preventive care were explained to the patient, including the frequency of hair washing to avoid hair accumulation syndrome. Thus, making a phototrichogram in a timely manner means saving the hair and maintaining its health, since problems identified at the initial stage can be eliminated in a short time using the correct treatment.

Clinical example No. 3. The patient is 39 years old, her occupation is a clinical laboratory assistant. He is under dynamic observation for two years with ongoing maintenance therapy (once every six months). Diagnosis: stage 1 androgenetic alopecia.

Using this example, we can track the positive dynamics of the treatment.

And the use of a computer program allows you to track the changes occurring and the progress of the treatment. Since hair treatment is usually a very long process, the first results can be seen only 6-12 months after the necessary therapy. And the ability to record the results obtained from treatment is a very important task.

The specialist should always remember that the human body, controlled by the nervous and endocrine systems, is largely controlled by emotions. And microdiagnostics will help the trichologist build an evidence base for establishing more trusting and effective relationships with each patient.

krasotapro.ru

What is trichoscopy

Trichoscopy (computer hair diagnostics) is an indispensable method for examining hair and scalp using a special device, a trichoscope, for diagnosis and proper treatment. The device is equipped with a video camera with magnifying optics, which allows you to examine the problem area of the scalp under high magnification. The obtained data is processed by a special computer program, which allows you to most accurately assess the condition of the hair and scalp.

Trichoscopy allows:

Set hair type
Get an opinion on the condition of the scalp skin
Examine the condition of the hair along its entire length
Set your scalp type
Find out the size of the hair follicle
Determine the degree of hair loss
Diagnose scalp skin diseases
Examine the condition of the entire hair growth system
Investigate the seboregulatory process

Equipment

Trichologists at our scientific center use modern, professional diagnostic equipment to diagnose hair and scalp - an Aramo SG video camera (ARAM HUVIS Co, Ltd - Korea) with special computer diagnostic programs.

Aramo SG video camera (ARAM HUVIS Co, Ltd – Korea).

Special computer diagnostic programs:

XairXPPRO program. The program allows you to determine the condition of the scalp, hair density, diameter of the hair shaft, and assess the condition of the hair shaft.
Trichoscience program. The program allows you to determine the hair density per square centimeter in the androgen-dependent and androgen-independent areas of the scalp; percentage of thick pigmented hair and vellus hair; measure the diameter of hair in different areas; determine the percentage of thin, thick and medium-diameter hair; conduct a phototrichogram, etc.

Indications for trichoscopy

Today, trichoscopy, which is the most informative and fastest diagnostic method in trichology, is recommended for all diseases of the hair and scalp:

all types of baldness (androgenetic, focal, diffuse, cicatricial)
all types of seborrhea (dry and oily)
all types of aesthetic problems with hair: dry, split ends, damaged, etc.
any pathological conditions of hair and scalp after aggressive exposure

There are no contraindications to trichoscopy

Preparation for trichoscopy

Trichoscopy technique

Method of performing trichoscopy: using a special trichoscope sensor, the trichologist gradually examines the scalp (both problem areas and healthy areas for comparison). During the examination and recording data into the computer, the doctor can comment on the results of the diagnostic examination to the patient, as well as change the magnification of the device to improve the effectiveness of the examination.

Control trichoscopy before, during and after treatment allows you to most accurately determine the condition of the hair and scalp, record and objectively evaluate the results of therapy.

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On-line consultation with a trichologist - Page No. 2

On-line consultation with a trichologist

Good afternoon Please tell me, my hair has been falling out for 3 years, 400-500 pieces at a time, half a year ago I started taking Eutyrox, because... TSH was 5.8, on eutyrox it dropped to normal 1.1. But the hair flew in 400 pieces and has been flying for 3 years. I thought it had to do with the thyroid gland, but why then, when TSH is normalized, does hair not stop falling out in huge quantities? All microelements and vitamins are normal, checked 4-5 times in different laboratories. What else should I check? Why does hair not stop falling out when TSH is normalized? 3 years of torment, a lot of doctors, trichologists, endocrinologists, but no one can help me stop it. I had an FTG done at your clinic, according to which I have diffuse prolapse. Was examined by E.V. Illarionova. But no amount of vitamins, expensive sprays, DSD ampoules, etc. reduced the hair loss one gram. What should I do??? I really need help! Read the answer

Hello. I am 24 years old. My hair started falling out quite a long time ago, at the age of 16. I was diagnosed with diffuse alopecia, it grows evenly all over my head. At times it gets better and the loss stops. But periodically everything resumes and is even more active. It gets worse every time. New hairs grow quite quickly, but they are very thin and soft, like guns. The skin is not oily, one might even say dry. There is dandruff, no itching. She was treated in different ways, took ferretab, as prescribed by a therapist, because... ferritin was low (8) iron was normal. I drank for half a year. Then the hematologist canceled it, explaining that iron accumulates in tissues and organs and then cannot be removed in any way. At one time I used genolone as prescribed by a trichologist, although I read that it is used for androgenism. I passed all the tests that could be taken. But the reason was never found out Read the answer

Good evening. I have stomach problems, gastritis and pancreatitis, my hair has been falling out profusely for 4 years without stopping, almost all of it has fallen out. New ones don't grow. Is it possible to restore my hair and the hair follicles are already all dead?(((Read answer

Good afternoon Please tell me exactly what parameters you calculate during the FTG procedure? I am interested in the whole spectrum: % anagen, % telogen, % terminal hair, vellus among anagen hair, vellus among telogen hair, average hair diameter, density per square cm, number of follicular units, anisotrichosis. Is it possible to do such FTG in your clinic? Read the answer

Good afternoon！I have a problem with hair loss. It started in winter. I thought it would go away in the summer, because of the sun, vegetables, fruits, but no... the loss continues... I was stressed in the spring, I took coke, but now I haven’t drunk anything for 2 months. I took the tests, those that are written on your website. Everything is okay. What should I do, please tell me？ Thanks in advance！ Read answer

Hello, a clump of short hair appeared on my head right on the top of my head, it’s a decent size and you can clearly see it, it’s not broken hair, no one cut it off for me, I just noticed it one day, and now that it’s grown it’s impossible to disguise it, before that I had this happen about 4 years ago, but lower in the area of the back of my head, it grew back later to this length, I cut off all my hair, I thought it wouldn’t appear again, but no. It is clear that this is new hair, why is this happening? Maybe this is some kind of disorder; none of my friends’ hair grows like that (in one place). Thanks in advance for your answer.

Hello, I was prescribed Revivogen 3 times a week and Rogaine. Will there be an effect if I apply Revivogen only for 3 months? Read the answer

Hello, I’m 16 years old, my hair started to fall out a lot, I assume it was after dyeing, but this has never happened before. I don’t know what to do Read answer

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Causes of diffuse hair loss at a young age

Gadzhigoroeva A.G., Egorova Yu.Yu., Markova Yu.A.

LLC "Institute of Beautiful Hair"

In the wild, full plumage and shiny fur of birds and animals perform a number of functions important for survival (heat exchange, protection) and allow us to indirectly judge the health of individuals. For people, beautiful, well-groomed hair is, first of all, an important component of external attractiveness. And if seasonal molting for animals is an evolutionary physiological process aimed at the survival of the species, then increased hair loss for humans is an unpleasant situation that every person faces at least once in their life. The majority of patients consulted by trichologists are women and men of young reproductive age. Hair loss can be a manifestation of a wide range of transient or long-term conditions, as well as the implementation of a genetic predisposition. Often problems begin gradually and do not immediately force you to contact a specialist. The patient usually associates periodic increases in hair loss with seasonality, stress, poor-quality haircuts, coloring, shampoo, and lack of vitamins. The most common type of hair loss is reactionary hair loss; As a rule, hair growth is restored on its own after 4-6 months, so people with this type of hair loss do not often consult a doctor. Mostly, patients who turn to a specialist are concerned about the intensity of hair loss, the duration of hair loss, the ineffectiveness of self-taken measures aimed at stopping hair loss, as well as a noticeable decrease in hair density.

Normally, the duration of the hair growth phase on the head is 3 - 8 years. This is the time of active division and differentiation of the matrix cells of the hair follicle, which ensures rapid hair growth in length, keratinization and hair pigmentation. These processes are carried out due to high rates of metabolic reactions and energy exchange, which makes actively dividing matrix cells especially sensitive to various external influences and disturbances of homeostasis. The follicle receives the nutrients necessary for the synthesis processes through the network of capillaries of the hair papilla, reproducing the main product - the sulfur-containing protein keratin. At the same time, failures in the supply of “raw materials” and violations of technological conditions and keratinization processes can lead to a violation of the quality of the final product and interruptions in the operation of the entire keratin production factory. The mechanisms that can disrupt the normal hair growth cycle are not always clear, since they are realized in the process of a complex of intercellular and intracellular biochemical interactions. It is also difficult to assess the impact of certain factors on the hair follicle under conditions of the whole organism.

The most common type of hair loss in young people is reactionary diffuse hair loss, which can be acute or chronic, lasting more than 6 months. As a rule, such loss is a response to a wide range of unfavorable trigger factors, including stress, endocrine disorders (hypo- and hyperthyroidism, hyperprolactinemia), fever of various origins, taking certain medications, and nutritional deficiency. The consequence of this effect is the premature interruption of anagen and the simultaneous entry into the telogen phase of many hair follicles. In this case, diffuse telogen hair loss is not an independent diagnosis, but represents one of the symptoms of a pathological condition. Reactionary hair loss occurs 2-3 months after exposure to a factor that provokes interruption of the growth phase. The delay in loss is determined by the sum of the catagen and rest periods, which average 2-4 weeks and 2-3 months, respectively.

One of the proven and common causes of reactionary hair loss is nutrient and general protein-energy malnutrition. Most often, these are the consequences of an unbalanced diet that the patient maintains in order to lose weight. For normal hair growth, nutrition must be energetically complete, balanced in macronutrients (proteins, fats, carbohydrates), and also ensure the supply of necessary micronutrients (vitamins, microelements). Various diseases of the gastrointestinal tract, leading to disturbances in the digestion and absorption of nutrients, can also cause the development of deficiency conditions.

One of the important components of the diet that promotes normal hair growth is sufficient protein. It is known that hair shafts consist of 15.9% of the sulfur-containing amino acid cysteine. The formation of disulfide bonds plays an important role in the formation of the spatial structure of keratin, the main protein of hair. Insufficient dietary intake of amino acids, especially sulfur-containing ones (cysteine, methionine), can lead to hair loss and deterioration in hair quality.

One of the common causes of diffuse telogen hair loss in women of young reproductive age is iron deficiency. This microelement is involved in many important metabolic processes in the body, and therefore, iron deficiency negatively affects the functions of many organs and systems. In addition to hair loss and deterioration in hair quality, patients may develop and experience general weakness, lethargy, shortness of breath, tachycardia, dry skin, changes in taste, smell, nail dystrophy and other disorders. The development of iron deficiency in women can be associated with heavy menstruation, as well as with an increased need for iron during special periods of pregnancy and lactation. Insufficient intake of iron is observed, as a rule, with dieting for the purpose of weight loss, as well as with eating behavior with restriction of animal protein (for vegetarians). In such cases, in order to compensate for the intake of the microelement, it is recommended to take iron supplements, sometimes on an ongoing basis. When prescribing iron supplements, the initial level of hemoglobin, ferritin and serum iron should be taken into account, and these indicators should be periodically monitored. It is worth remembering that with long-term use of iron supplements, it is possible to develop zinc deficiency - a microelement no less important for normal hair growth. Parenteral nutrition and various diseases of the gastrointestinal tract that contribute to malabsorption also lead to zinc deficiency. To determine zinc deficiency, its level in the blood is determined.

Vitamins are important participants in the processes of cell growth and differentiation. Insufficiency of B vitamins (biotin, pantothenic acid) can cause hypoenergetic conditions and contribute to disruption of the hair growth cycle, since vitamins of this group are important participants in metabolic reactions and the respiratory chain as coenzymes. The role of vitamin A - retinol - in regulating the hair growth cycle is twofold. It is known that this vitamin is necessary for normal proliferation and differentiation of keratinocytes and is involved in antioxidant protection and immune response. However, the use of high doses of retinoids in the treatment of acne inhibits the proliferation of keratinocytes, induces apoptosis of hair follicle matrix cells and causes premature onset of catagen, which is manifested by diffuse telogen hair loss in the 2-3rd month of taking drugs of this group. Due to the widespread use of isotretinoin drugs in the treatment of acne and the need for its long-term course use, this fact should be taken into account when collecting anamnesis in young people

Recent studies have shown the important role of vitamin D for the cyclic proliferation of hair follicle cells and the prevention of hair loss. Vitamin D deficiency is a common phenomenon in the general population, especially when living in an area of low insolation and insufficient intake of the vitamin from food. The suboptimal level of vitamin D in the body is 30-50 ng/ml, the optimal level is 50-80 ng/ml. In order to exclude its deficiency, the level of 25-hydroxy-cholecalciferol in the blood serum is determined. The presence of receptors for vitamin D on the cells of the hair follicle determines the possibility of developing alopecia due to its deficiency. In order to correct its deficiency, Vigantol or Aquadetrim is prescribed in the appropriate dosage.

True diffuse telogen effluvium hair loss is a process of hair loss without a noticeable decrease in density in different areas of the scalp. In this case, thinning of hair in the temporal zones is possible with the replacement of normal hair with short hair, 3-6 cm long. Typically, such a transformation is observed with long-term telogen hair loss. Dermatoscopy cannot identify any specific signs. The exception is the presence of seborrhea of the scalp, the signs of which are revealed in the form of yellow peripillary dots. The diagnosis is made on the basis of a pull test (manual hair removal). With a positive test, the researcher is left with up to 6 or more hairs with light, dense proximal ends - this is the telogen hair follicle. To confirm the diagnosis, a phototrichogram is performed - quantitative determination of hair in the telogen and anagen phase with a study of hair diameter.

Diffuse telogen effluvium hair loss can manifest itself as an independent disease, or it can represent the initial signs of androgenetic alopecia, which is characterized by a more specific type of hair loss with a predominant reduction in the crown area and, necessarily, thinning. Comparative characteristics of the physical parameters of hair in the area of the back of the head and crown, obtained as a result of a phototrichogram, will make it possible to establish the diagnosis of androgenetic alopecia in the early stages of its development. Dermatoscopic signs of female pattern hair loss (syn. androgenetic alopecia) are signs of thinning hair in the crown and crown area, yellow peripillary dots (not always), as well as empty follicle openings. Detection of such signs allows timely prescribing etiopathogenetic treatment aimed at maintaining active hair growth and preventing follicle miniaturization.

In case of reactive telogen effluvium hair loss, treatment should be aimed at eliminating the cause of hair loss, as well as improving nutrition of the hair follicle. It is important to eliminate factors that provoke stressful situations, and also, in case of increased nervous excitability, prescribe sedatives. It is recommended to take multivitamins, amino acids, microelements and vascular medications.

An effective treatment method applicable in outpatient settings is mesotherapy. Indications for mesotherapy are both acute and chronic telogen hair loss. The method is based on the targeted delivery of substances necessary for hair growth into the skin of the scalp to a depth of 3-4 mm, to the location of the hair follicles. Activation mechanism: reflexology (tonication of biologically active points of the scalp), pharmacopuncture, neurohumoral. When the skin is damaged by a needle, active inflammatory mediators (histamine, catecholamines, lysosomal enzymes, etc.) are released; macrophage and fibroblastic stages of the inflammatory process lead to the proliferation of epidermal cells of the cambial zone and closure of the tissue defect. At the site of the defect, young connective tissue is formed, which is then rebuilt with the help of fibroblasts in accordance with the characteristics of the dermis of this tissue area. The aseptic inflammatory process lasts from 3 to 6 days, so the procedure should not be done more than once a week. The course of treatment is 6-10 procedures once a week. Mesotherapy improves microcirculation, trophism and lymphatic drainage of the scalp, improves hair structure, accelerates hair growth, increases hair thickness, heals the scalp and normalizes sebum secretion. The composition of the meso cocktail should include substances that improve microcirculation (Lofton, procaine, buflomedil), trophism (D-panthenol, pyridoxine, biotin, B vitamins, amino acids). Lympholytics and drugs with antioxidant effects (rutin-melito and gingo-biloba, vit E), oligoelements (zinc, selenium, silicon). In the presence of androgenetic alopecia, substances that block the action of 5a-reductase (finasteride), as well as hair growth stimulants (ATP, minoxidil).

The prognosis of treatment for telogen effluvium hair loss depends on the cause that caused the hair loss and the possible connection with androgenetic alopecia. Timely started therapy gives satisfactory results and allows you to control the progress of androgenetic alopecia in the case of combined forms of hair loss.

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What is a phototrichogram

Phototrichogram is one of the most modern, highly accurate, accessible and most generally accepted diagnostic methods for hair loss in clinical trichological practice. Using this method, the initial forms of androgenetic alopecia are identified at an early stage, differential diagnostics is carried out between androgen-dependent and diffuse hair loss, and the effectiveness of alopecia treatment is assessed over time.

Phototrichogram allows you to:

Count the number of hairs per square centimeter of scalp. (Separately, anagen hair (being in the growth stage) and telogen hair (being in the loss stage), dysplastic (too thin) and shaft hair are considered).
Determine the average hair growth rate.
Determine the percentage of vellus (vellus hair) among anagen (in the stage of dew) and telogen (in the stage of loss) hair.
Determine the activity of the hair loss process.
Determine the diameter of the hair in microns.
Diagnose androgenetic alopecia and/or diffuse hair loss in the early stages.
Monitor the effectiveness of treatment over time.

There are no contraindications to phototrichogram

Preparation for phototrichogram

Phototrichogram technique

To carry out a phototrichogram, it is necessary to correctly select the area in which subsequent measurements will be taken. In selected areas, in the area 5-10 mm. Hair is shaved off using a trimmer (hair removal device). The areas of cut hair are invisible to others, so the procedure does not cause psychological discomfort. After 2-3 days, when among the shaved hair it will be possible to detect hair that has grown by approximately 1 mm. hair, areas are tinted with hair dye, and with the help of a trichoscope connected to a computer, they are entered into a specialized computer program (Trichoscience) with magnification. Using the program, the total number of hairs per square cm, the percentage of vellus-like (vellus hair), anagen (in the growth phase) and telogen (in the loss phase) hair are calculated. The count is carried out in different places of the scalp and is displayed in the form of graphs. This information is compared with the norm for each hair type.

(on the left is a photograph of the area under study, on the right is the same area after processing by a computer program).

A control phototrichogram is performed

after 2-3 days, when regrown hair can be detected and assessed among the shaved hair.
after the therapy to evaluate the results of the treatment

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