A method for the diagnosis of alopecia areata

 

(57) Abstract:

The invention relates to medicine, namely to dermatology, and can be used in the diagnosis and treatment of hair loss, including alopecia areata. Visually assess the condition of skin and hair, additionally carry out immunological analysis of blood and violation of the cell component of the immune system mainly by the number of natural killer - PC (CD 16), exceeding the limit determined by immuno-reactive phase of development of the disease. The method provides a more accurate diagnosis. table 1.

The invention relates to medicine, namely to dermatology, and can be used in the diagnosis and treatment of alopecia hair loss (alopecia areata).

There are various theories of the origin of alopecia, for example, treponemataceae, neuroendocrine, infectious and theory of autoantibodies [bed, editor-in-chief B. C. Petrovsky, I. 1, ed. "Soviet encyclopedia", M,1974].

The etiology and pathogenesis of alopecia areata is not known. Hair loss associated with such factors as General intoxication, stress, bacterial and fungal damage, lack of vitamins and minerals, etc.

About the existing alopecia amid recent anamnestic welfare.

It is established that some of the negative factors is called a "trigger" (run), can potentiate the appearance of the first centers of baldness.

Such factors include acute and chronic stress,dysfunction of the ovaries, the damage of the scalp (hair pulling, prick the skin, the effect of chemical substances and so on), craniocerebral trauma, General anesthesia, some oral contraceptives, allergic and atopic reactions, various kinds of intoxication, vitamin and so on

In clinical practice, the identification of causes of disease are appointed, as a rule, analyses, not characteristic of alopecia, and to determine the comorbidity: a General analysis of blood and urine biochemical tests, hormone levels in the blood, bacteriological and virological investigations.

It is known that the diagnosis of alopecia areata are provided mostly by visual inspection of the skin and hair [in. A. Vladimirov, "Diagnosis and treatment of skin disease", ed. LLP Medtekhtorgsevis,1995;

C. Y. Arutyunov, "the Problem of alopecia," journal of dermatology and venereology, N 12, 1971].

The above diagnosis does not identify the root causes of alopecia and no ofdiagnosis alopecia areata ("rapid alopecia").

In this known method for the diagnosis of alopecia areata is characterized by visual inspection of the condition of the skin and hair, complement conducting immunological analysis of blood and violation of the cellular immune system, mainly by the number of natural killer cells - NK(CD16) in excess of absolute and relative indicators, identify immunoreactive phase in the development of alopecia.

Conducted by the authors in 1992-1998 medical Center "Blagovest" treatment of alopecia (,Moscow) showed that the development of alopecia areata is associated primarily with changes in the immunological status of the organism. While damage to the cells of the hair follicle is determined not only humoral and neural factors, but primarily strictly differentiated cells of the immune system.

In the pathogenesis of alopecia is a genetic predisposition. Genetic abnormalities of the immune system does not manifest at birth, it only intensifies the possibility of developing the disease.

Immunodeficiency is not universal, and exhibits strict specificity to a specific antigen. The introduction of the antigen is characterized by the absence of the " a defect in the recognition of a foreign agent antigen presenting cells.

Considered two etiological point: accidental invasion of the virus of low virulence (avirulence) and congenital deficiency of specific antiviral protection. Invalid "trihovirusom" hair follicle cells are the target cells, which after infection continue its vital cycles and prevent the natural growth of hair.

Langerhans cells (antigen skin macrophages) play a crucial role in the initiation of primary immune response. OK they are obliged to take the information from trichovirus and Express on their surface trichosanthin, starting thus a whole range of immune responses. When alopecia they do not, and antigen presenting cells are the target cells of the hair follicle, not capable of utilizing virus.

Trihovirus alters the DNA fragment of the sixth chromosome, responsible for the expression of antigens of the major histocompatibility complex. First of all it concerns antigens 1st class HLA-A9, B12, BW18. These antigens appear anomalous surface receptors brushed cells. Mutation of cells is point and do not run counter the nogo response with the formation of antibodies in the disease onset. It only makes recognizable affected cells to natural killer cells-NK ( CD16).

Studies have shown that the immunoreactive phase lymphocytosis due to the increased number of natural killer cells-NK(CD16), which are in contact with the mutated cells, Express tropic genotype receptors. This exposure leads killers in a state of excitement with the manifestation of cytotoxicity. Freed killer lymphotoxin violate membrane permeability of target cells and induce apoptosis (self-destruction of cells). Confirmation of apoptosis is the absence of inflammation and necrotic process in the areas of hair loss in Alopecia areata ("Swift alopecia").

Know an immunological studies for the diagnosis of various diseases. For example, to determine the number of subpopulations and immune cells using monoclonal antibodies, a method of obtaining which developed During the Milshtein and, in 1975, köhler

For immunophenotyping (definitions) lymphocyte subpopulations using immunofluorescence assay (ELISA) blood, in which monoclonal antibodies labeled with fluorochrome binds to membrane antigens givine (for example, manufactured by Becton Dickinson Becton Dickinson, USA).

The principle of the phenotypic analysis of the cells is to determine the size of the cells and the identification associated with a cell specific monoclonal antibodies, which is reflected in the immunological

["Lymphocytes. Methods", J. Klaus, Moscow. Mir,1990 ].

The main lymphocytes defined by monoclonal antibodies, are: T-lymphocytes (CD3), b cells (CD19), T-helper cells (CD4), T-suppressor (CD8), natural killer cells - NK (CD16), and so on, the number of which and the mutual ratio may vary depending on the initial state of the immune system and its response to the result of the disease.

The number of lymphocytes taken as the norm, is given in the table at the end of the description.

As shown by the study authors, immunophenotypic analysis of blood of patients with alopecia areata identifies deviations in the immunological from the norm. Violation of the cellular immune system in alopecia primarily concerned with natural killer cells - NK(CD16). Excess of their numbers from the norm to 100% or more in absolute amounts, as well as the increase in the relative number of up to 70% of the upper limit of normal indicates excessive proliferation Nailable in the range of 0-15% in the relative amounts and 0-31% in absolute.

From the above we can conclude that alopecia (alopecia) areata - an autoimmune reaction of the body, aimed at the mutated cells of the hair follicle. In this autoimmune response is realized through the impact of natural killer cells NK(CD16) on target cells of the hair follicle, which triggered the mechanism of programmed cell death(apoptosis).

The following are examples of clinical studies of patients with alopecia areata, conducted in 1998, the medical Center "Blagovest" at the Institute of Immunology in Moscow) using immunograficheskogo analysis.

Example 1. Patient M. , aged 15, the detection of the first outbreak of alopecia for 2 months prior to the survey. Visual inspection indicated the continuation of the process of hair loss. In General, the analysis of blood was a small lymph and monocytosis, biochemical and hormonal parameters were within normal limits. Diagnosed with alopecia areata, Subtotal stage, 30% of the hair.

Immunological screening for cytometer (3-color flow cytometry laser, reagents and equipment from Becton Dickinson-Becton Dickinson, USA) revealed the content of T-lymphocytes CD3+, in absolute terms 1258 CL/what's amounts, respectively, 717 cells/ml and 33%.

Conclusion: the observed excess over the norm of absolute and relative indicators for natural killer cells and reduced T-lymphocytes, which shows a distinct immunoreactive phase of alopecia areata.

Example 2. Patient G.,28, is the first foci of alopecia observed in 7 years of age, 1 year scalp fully recovered. The recurrence of the disease started 5 months prior to the survey, with the hair on the head is lost completely. In General, the analysis of blood, a slight lymphopenia. Respiratory diseases are rarely sick, feels healthy. Diagnosed with alopecia areata, a total stage.

Immunological screening for cytometer (3-color flow cytometry laser, reagents and equipment from Becton Dickinson - Becton Dickinson, USA ) revealed the content of T-lymphocytes CD3+, in absolute terms 842 cells/ml and 59% in relative terms. The content of natural killer cells-NK(CD16) was in absolute and relative amounts, respectively, 463 cells/ml and 33%.

Conclusion: the observed excess over the norm of absolute and relative indicators for natural killer cells and reduced T-lymphocytes, which also SMI alopecia areata (alopecia, Subtotal, total, universal), which included 42 children from 5 to 13 years, 23 teenagers from 13 to 17 years and 13 adults. They were all in various stages of hair loss and in different phases of immunological activity (immunoreactive phase immunoindiffirentnaya phase).

A common feature of most patients was that the increased number of natural killer cells - NK(CD16) and the reduction in the number of T-lymphocytes (CD3) was accompanied by a rapid objective process of hair loss. This proves the involvement of natural killer cells in the pathogenesis of alopecia ("swift") alopecia.

The number of patients with impaired immune status during the period of active hair loss was 68.5% in natural killer cells and 39.6% of T-lymphocytes (CD3), which shows an immunoreactive in acute phase of the disease.

The results of the study confirmed the possibility of reliable identification of immunoreactive phase alopecia areata, which allows to form a new understanding of the etiology and pathogenesis of the disease.

The way to diagnose alopecia areata by conducting a visual inspection of the skin and hair, characterized in that DOPOLNITEL the number of natural killer cells-NK (CD 16), excessive, determine the immunoreactive phase of development of the disease.

 

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