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"etiology": "<p> В основе развития лежат ферментные нарушения в волосяных фолликулах, спастическое состояние сосудов, т. е. нарушение микроциркуляции крови в области дермы.Триггерными факторами заболевания могут являться стрессы, вакцинация, вирусные заболевания, инфекционные заболевания, прием антибактериальных препаратов, наркозы.</p>",
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"diagnostics": "<ul>\r\n<li>Диагноз ставится на основании клинической картины заболевания:</li>\r\n<li>■ наличия на коже очагов алопеции с четкими границами;</li>\r\n<li>■ наличия в очаге пеньков волос в виде восклицательного знака и зоны «расшатанных волос» на границе очага (активная стадия); ■</li>\r\n<li>обнаружения при микроскопическом исследовании эпилированных из очага волос дистрофичных проксимальных концов в виде «оборванного каната»;</li>\r\n<li>■ наличия в очаге роста светлых пушковых волос (в стадии регресса); иног- да по одному краю очага имеются обломки волос в виде восклицательно- го знака, а на противоположном — рост веллюса;</li>\r\n<li>■ обнаружения при осмотре ногтей признаков ониходистрофии: напер- стковидных вдавливаний, продольной исчерченности, изменений сво- бодного края в виде волнистых узур;</li>\r\n<li>■ выявления при трихоскопии (дерматоскопии волосистой части головы) «желтых точек», кадаверизированных волос, волос в виде восклицатель- ных знаков. При сомнительном диагнозе, а также перед назначением лечения реко- мендуется проведение лабораторных исследований:</li>\r\n<li>■ микроскопического исследования кожи и волос на наличие патогенных грибов;</li>\r\n<li>■ микроскопического исследования волос, эпилированных из краевой зоны очага (выявление дистрофичных концов волос — признака, пато- гномоничного для ГА);</li>\r\n<li>■ гистологического исследования фрагмента кожи волосистой части голо- вы. Гистологически ГА характеризуется состоящим в основном из Т-кле- ток воспалительным инфильтратом внутри и вокруг луковиц анагеновых волосяных фолликулов. Однако гистопатологические признаки ГА зави- сят от стадии заболевания, в случае хронического течения заболевания классические признаки могут отсутствовать;</li>\r\n<li>■ клинического анализа крови;</li>\r\n<li>■ серологических исследований для исключения красной волчанки и си- филиса;</li>\r\n<li>■ определения в крови уровня кортизола (при планировании лечения глю- кокортикоидными средствами системного действия — до лечения и спу- стя 4 недели после его окончания);</li>\r\n<li>■ биохимического анализа крови: АЛТ, АСТ, общий белок, билирубин, хо- лестерин, сахар крови, щелочная фосфатаза (при подозрении на токсиче- скую алопецию, а также перед назначением фотохимиотерапии с приме- нением фотосенсибилизаторов внутрь);</li>\r\n<li>■ обзорной рентгенографии черепа (для исключения объемных образова- ний области турецкого седла);</li>\r\n<li>■ анализа крови на гормоны щитовидной железы (Т3 свободного, Т4 сво- бодного, ТТГ, АТ к ТПО, АТ к ТГ) для исключения патологии щитовидной железы и пролактин для исключения геперпролактинемии. Реовазоэнцефалограмма (РЭГ) рекомендуется при распространенных формах ГА детям в возрасте до 12 лет с целью диагностики возможных нарушений кровообращения в системе церебральных сосудов. По показаниям назначаются консультации других специалистов: невро- лога, эндокринолога, психотерапевта.</li>\r\n</ul>",
"treatment": "<p>Лечение гнездовой алопеции проводится с помощью введения глюкокортекостероидов в патологические очаги, смысл этой терапии заключается в иммуносупрессивном действии препаратов. Если площадь поражения составляет более 50 % кожных покровов головы, на которых происходит рост волос, то лечение кортикостероидами не оказывает нужного эффекта.</p>\r\n<p>На сегодняшний день местное лечение препаратами, содержащими кортикостероиды, признано малоэффективным даже в сочетании с носителями, способствующими более глубокому проникновению гормональных препаратов.</p>\r\n<p>Топическая иммуносупрессивная терапия гнездной алопеции может проводиться с применением динитрохлорбензола, дибутилового эфира скваровой кислоты и дифенилциклопропенона.</p>\r\n<p>Правильно подобранное системное использование стероидов способно повернуть быстро прогрессирующую гнездную алопецию вспять.</p>\r\n<p>Подавить активные клоны лимфоцитов можно иммунотропными лекарственными средствами.</p>\r\n<p>В ряде случаев эффективна фотохимиотерапия, а также некоторые адъювантные методы воздействия на очаги поражения.</p>\r\n<p>При выборе методов лечения гнездовой алопеции принимают во внимание особенности конституции пациентов, фоновые заболевания.</p>\r\n<p>Использование биогенных стимуляторов позволяет ускорить процессы восстановления тканей. Для коррекции некоторых показателей крови могут быть рекомендованы препараты, содержащие экстракт слюны пиявок. При некоторых формах гнездовой алопеции могут быть показаны препараты цинка.</p>\r\n<p>К наружным средствам сопутствующей терапии относят широкий спектр раздражающих средств (скипидарную мазь, эфкамон), стимуляторы процессов пролиферации креатиноцитов, препараты, улучшающие питание тканей, а также способствующие улучшению микроциркуляции тканей. Наружно могут также использоваться лекарственные средства, содержащие кремний, которые позволяют улучшить структуру волоса, или же препараты, терапевтический эффект которых обусловлен воздействием на пораженные участки кожи вытяжки из плаценты.</p>",
"prevention": "<p>Методов профилактики не существует.</p>",
"clinical_picture": "<p>Заболевание начинается внезапно с появлением очага выпадения волос на волосистой части головы. Как правило, очаги круглые или овальные с неизменной по цвету и консистенции кожей величиной от 1,5 см до размера ладони ребенка. Очаги могут сливаться, образуя обширные участки облысения. Субъективные признаки отсутствуют. Существуют следующие клинические разновидности:</p>\r\n<p>1) мелкоочаговая алопеция (чаще встречаются у детей);</p>\r\n<p>2) лентовидные очаги облысения затылочной части головы, распространяющиеся к вискам, нередко изъязвляющиеся. При регрессии остаются рубцы. Эта форма резистентна к терапии;</p>\r\n<p>3) стригущая форма – в очаге облысения определяются обломанные волосы;</p>\r\n<p>4) субтотальная – почти полное или полное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a> на голове;</p>\r\n<p>5) тотальная (злокачественная) алопеция – полное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a> на голове, туловище, конечностях, включая ресницы и брови.</p>",
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"etiology": "<p> В основе развития лежат ферментные нарушения в волосяных фолликулах, спастическое состояние сосудов, т. е. нарушение микроциркуляции крови в области дермы.Триггерными факторами заболевания могут являться стрессы, вакцинация, вирусные заболевания, инфекционные заболевания, прием антибактериальных препаратов, наркозы.</p>",
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"diagnostics": "<ul>\r\n<li>Диагноз ставится на основании клинической картины заболевания:</li>\r\n<li>■ наличия на коже очагов алопеции с четкими границами;</li>\r\n<li>■ наличия в очаге пеньков волос в виде восклицательного знака и зоны «расшатанных волос» на границе очага (активная стадия); ■</li>\r\n<li>обнаружения при микроскопическом исследовании эпилированных из очага волос дистрофичных проксимальных концов в виде «оборванного каната»;</li>\r\n<li>■ наличия в очаге роста светлых пушковых волос (в стадии регресса); иног- да по одному краю очага имеются обломки волос в виде восклицательно- го знака, а на противоположном — рост веллюса;</li>\r\n<li>■ обнаружения при осмотре ногтей признаков ониходистрофии: напер- стковидных вдавливаний, продольной исчерченности, изменений сво- бодного края в виде волнистых узур;</li>\r\n<li>■ выявления при трихоскопии (дерматоскопии волосистой части головы) «желтых точек», кадаверизированных волос, волос в виде восклицатель- ных знаков. При сомнительном диагнозе, а также перед назначением лечения реко- мендуется проведение лабораторных исследований:</li>\r\n<li>■ микроскопического исследования кожи и волос на наличие патогенных грибов;</li>\r\n<li>■ микроскопического исследования волос, эпилированных из краевой зоны очага (выявление дистрофичных концов волос — признака, пато- гномоничного для ГА);</li>\r\n<li>■ гистологического исследования фрагмента кожи волосистой части голо- вы. Гистологически ГА характеризуется состоящим в основном из Т-кле- ток воспалительным инфильтратом внутри и вокруг луковиц анагеновых волосяных фолликулов. Однако гистопатологические признаки ГА зави- сят от стадии заболевания, в случае хронического течения заболевания классические признаки могут отсутствовать;</li>\r\n<li>■ клинического анализа крови;</li>\r\n<li>■ серологических исследований для исключения красной волчанки и си- филиса;</li>\r\n<li>■ определения в крови уровня кортизола (при планировании лечения глю- кокортикоидными средствами системного действия — до лечения и спу- стя 4 недели после его окончания);</li>\r\n<li>■ биохимического анализа крови: АЛТ, АСТ, общий белок, билирубин, хо- лестерин, сахар крови, щелочная фосфатаза (при подозрении на токсиче- скую алопецию, а также перед назначением фотохимиотерапии с приме- нением фотосенсибилизаторов внутрь);</li>\r\n<li>■ обзорной рентгенографии черепа (для исключения объемных образова- ний области турецкого седла);</li>\r\n<li>■ анализа крови на гормоны щитовидной железы (Т3 свободного, Т4 сво- бодного, ТТГ, АТ к ТПО, АТ к ТГ) для исключения патологии щитовидной железы и пролактин для исключения геперпролактинемии. Реовазоэнцефалограмма (РЭГ) рекомендуется при распространенных формах ГА детям в возрасте до 12 лет с целью диагностики возможных нарушений кровообращения в системе церебральных сосудов. По показаниям назначаются консультации других специалистов: невро- лога, эндокринолога, психотерапевта.</li>\r\n</ul>",
"treatment": "<p>Лечение гнездовой алопеции проводится с помощью введения глюкокортекостероидов в патологические очаги, смысл этой терапии заключается в иммуносупрессивном действии препаратов. Если площадь поражения составляет более 50 % кожных покровов головы, на которых происходит рост волос, то лечение кортикостероидами не оказывает нужного эффекта.</p>\r\n<p>На сегодняшний день местное лечение препаратами, содержащими кортикостероиды, признано малоэффективным даже в сочетании с носителями, способствующими более глубокому проникновению гормональных препаратов.</p>\r\n<p>Топическая иммуносупрессивная терапия гнездной алопеции может проводиться с применением динитрохлорбензола, дибутилового эфира скваровой кислоты и дифенилциклопропенона.</p>\r\n<p>Правильно подобранное системное использование стероидов способно повернуть быстро прогрессирующую гнездную алопецию вспять.</p>\r\n<p>Подавить активные клоны лимфоцитов можно иммунотропными лекарственными средствами.</p>\r\n<p>В ряде случаев эффективна фотохимиотерапия, а также некоторые адъювантные методы воздействия на очаги поражения.</p>\r\n<p>При выборе методов лечения гнездовой алопеции принимают во внимание особенности конституции пациентов, фоновые заболевания.</p>\r\n<p>Использование биогенных стимуляторов позволяет ускорить процессы восстановления тканей. Для коррекции некоторых показателей крови могут быть рекомендованы препараты, содержащие экстракт слюны пиявок. При некоторых формах гнездовой алопеции могут быть показаны препараты цинка.</p>\r\n<p>К наружным средствам сопутствующей терапии относят широкий спектр раздражающих средств (скипидарную мазь, эфкамон), стимуляторы процессов пролиферации креатиноцитов, препараты, улучшающие питание тканей, а также способствующие улучшению микроциркуляции тканей. Наружно могут также использоваться лекарственные средства, содержащие кремний, которые позволяют улучшить структуру волоса, или же препараты, терапевтический эффект которых обусловлен воздействием на пораженные участки кожи вытяжки из плаценты.</p>",
"prevention": "<p>Методов профилактики не существует.</p>",
"clinical_picture": "<p>Заболевание начинается внезапно с появлением очага выпадения волос на волосистой части головы. Как правило, очаги круглые или овальные с неизменной по цвету и консистенции кожей величиной от 1,5 см до размера ладони ребенка. Очаги могут сливаться, образуя обширные участки облысения. Субъективные признаки отсутствуют. Существуют следующие клинические разновидности:</p>\r\n<p>1) мелкоочаговая алопеция (чаще встречаются у детей);</p>\r\n<p>2) лентовидные очаги облысения затылочной части головы, распространяющиеся к вискам, нередко изъязвляющиеся. При регрессии остаются рубцы. Эта форма резистентна к терапии;</p>\r\n<p>3) стригущая форма – в очаге облысения определяются обломанные волосы;</p>\r\n<p>4) субтотальная – почти полное или полное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a> на голове;</p>\r\n<p>5) тотальная (злокачественная) алопеция – полное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a> на голове, туловище, конечностях, включая ресницы и брови.</p>",
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