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Trichology and diseases of the annexes

In the context of the trichological clinic, pathologies involving the hair and its appendages are evaluated.

- MALE AND FEMALE ANDROGENETIC ALOPECIA 

- ANAGEN or TELOGEN EFFLUVIUM 

- ALOPECIA AREATA

- INFANTILE CONGENITAL ALOPECIA

- FRONTAL FIBROSANT ALOPECIA

- PLANOPILAR LICHEN  

Nail pathologies represent the other aspect of the trichology clinic and its appendages. The nails can be primarily affected by dermatological pathologies as well as they can be altered in the course of systemic pathologies.

Thanks to our modern technology, we perform the microscopic evaluation of the hair appendage as well as of the scalp.

The pathologies that most frequently affect the nail are:

- ONYCHOMYCOSIS

- LICHEN PLANUS

- NAIL PSORIASIS

- ALOPECIA AREATA WITH NAIL INTEREST

- LEUCONICHIA

- DISTAL ONYCHOLYSIS

- ONYCHOGRYPHOSIS

- PARONICHIA

- NAIL INFECTIONS

What is androgenetic alopecia?

 

Androgenetic alopecia, affecting  60% of men and 25% of women is the most common form of alopecia. The disease is related to the activity of an enzyme known as  Type II 5-alpha-reductase, an enzyme that transforms testosterone (inactive form on the hair) into dihydrotestosterone (active form).

The pathology is polygenic, with complete penetrance, and manifests itself in men much more than in women (who, generally, suffer from it even at an older age, as the disease generally develops after menopause, as a consequence of the increase androgen levels).

What is the cause of androgenetic alopecia?  ​

 

The phenomena that can be at the basis of this pathology are:

 

A) The fundamental pathological process consists in the acceleration, under androgenic stimulation, of the mitotic phase of the pilar cycle (anagen IV) and in the consequent reduction of the differentiation phase, which is normally very long. Since the latter is incomplete, the resulting shaft will be thinner and shorter (miniaturized hair). This  acceleration  it would be mediated by the 5-alpha-reductase enzyme. The enzyme is not expressed at the level of the entire scalp but mainly at the level of the frontal region and the vertex, a region in which an accentuated fall is noted.

B)  Hormonal vasoconstrictive action: it has been observed that in the course of androgenetic alopecia there is vascular suffering at the level of the hair follicle induced by a hormonal vasoconstricting action. Many drugs used during therapy (Minoxidil 2-5%, Aminexil) act exactly on this problematic, thus increasing blood flow in the hair)

C)  Increase of the kenogen phase. By kenogen we mean that transition phase between hair loss in  telogen  and regrowth of that in anagen.  It has been observed as ongoing androgenetic alopecia (probably due to  other factors) the kenogen phase is significantly increased.  

Clinical course

The thinning, which often begins at a very young age, progresses in a manner  more or less marked and more or less fast. In men, alopecia is localized in the frontotemporal area and / or in the cleric area, while in women it is almost always distributed over the entire upper part of the head. Generally the patient complains of increased hair loss.

Diagnosis

To diagnose this pathology, the following are used:

  • trichoscopy, trichoscopic examination in digital epiluminescence

  • stress test ( pula-test) : in which the drop induced by draft is evaluated

  • trichogram

  • laboratory test for differential diagnosis with other pathologies (see TSH; T3; T4; DHT; GH)

Pharmacological therapy

There are several drugs that allow you to slow down, block and even reverse in good responders  the process of hair miniaturization caused by androgenetic alopecia.

Surgical Therapy

An alternative or complementary to medical therapy is surgical, that is, the autotransplant. The intervention, if carried out by competent surgeons, always updated on new techniques, with proven experience and with various surgical interventions behind them, has almost always excellent results (also based on the starting state, the diameter of the patient's hair etc. .) as hair from the parietal and occipital region is used, not subject to miniaturization as it is resistant to the action of androgens.

The technique consists in "cutting" a strip of hair, which is then cut into much smaller parts and implanted in the area prone to baldness. The autograft technique has made significant progress over the past 50 years. The size of the implanted regions became smaller and smaller, until they reached the single hair.

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