Mesotherapy treatment of alopecia

Yulia Zlotnitskaya , certified training doctor of the company “European Aesthetics - Ukraine” (Ukraine, Kiev).

Forms of the disease

Alopecia (synonym: baldness; from Greek - “baldness”) is pathological hair loss on the scalp, face, and less commonly, the torso and limbs, resulting from damage to the hair follicles. Alopecia can be total (alopecia totalis - complete absence of hair), diffuse (alopecia diffusa - hair thinning) and focal (alopecia areata - absence of hair in limited areas). You can also distinguish cicatricial alopecia (when hair follicles are destroyed due to inflammation, skin atrophy or scarring) and non-scarring alopecia (passing without previous damage to the skin). Non-scarring alopecia includes diffuse alopecia (alopecia diffusa), alopecia areata (alopecia areata) and androgenetic alopecia (alopecia androgenetica).

Scarring alopecia is a general term used to define the process that accompanies hair loss and destruction of follicles, and the pathological process does not always primarily affect the follicles themselves. May result from long-term chronic skin diseases, injuries, burns, inflammatory and autoimmune diseases. Depending on the etiological factor, rough scars appear on the skin of the scalp, like after a carbuncle, or cicatricial atrophy of the skin. Hair follicles die, and it is impossible to restore them in the scar connective tissue of the skin using therapeutic methods. There are separate forms of scar post-traumatic alopecia: traction (“gymnast hairstyle”), massage, postoperative (after plastic surgery on the face), burn, etc.

Diffuse alopecia is characterized by hair loss over the entire scalp with unaffected skin. The degree of hair thinning depends on the duration and intensity of the provoking factors. Depending on the main causes that led to the disease, the following forms can be distinguished:

• alopecia in chronic diseases (diabetes mellitus, hypothyroidism, autoimmune diseases);
• alopecia due to infections (for example, syphilis);
• postpubertal alopecia;
• postpartum alopecia;
• menopausal alopecia;
• psychosomatic alopecia;
• Sulzberger's diffuse alopecia (in women);
• premature alopecia, senile (due to progressive atrophy of hair follicles in old age;
• Seborrheic alopecia.

Alopecia areata

Alopecia areata (areas) is characterized by pathological hair loss and the formation of lesions with a complete absence of hair on the scalp, in the beard, eyebrows, eyelashes and on the torso. The lesions may coalesce to form large, hairless areas. Factors that provoke the appearance of alopecia areata can be: endocrine disorders, mental stress, physical trauma, infection, genetic predisposition, which can lead to autoimmune changes in the body. In this case, the hair follicle does not die, but simply stops reproducing hair.

There are 3 types of alopecia areata:

Type 1 – hair loss occurs in small areas of the head, which is why the disease received its name – alopecia areata. This type of alopecia areata is the most common;

Type 2 – a more serious stage of the disease, at which the fusion of foci of baldness occurs and almost complete hair loss on the head can be observed;

Type 3 - this degree of baldness is manifested by complete loss of hair, both on the head and throughout the body. Some authors call this stage “universal” alopecia.

Androgenetic alopecia

Androgenetic alopecia is a progressive baldness caused by the action of androgens on hair follicles. The term "androgenetic alopecia" was first coined by Norman Orentreich in 1988 to refer to a disease caused by the action of male sex hormones. Under the influence of androgens (testosterone and its more active metabolite - dihydrotestosterone), hair follicles on the frontal, occipital, parietal areas of the head undergo significant changes: the hair growth phase - anagen - is shortened, the latent period of the hair life cycle is extended, and its “follicular miniaturization” occurs. This term refers to a significant reduction in the size of the pilosebaceous apparatus, in which the terminal long hair is gradually reduced in volume to the level of vellus hair with a possible length of only one centimeter. Inheritance in men is polygenic or autosomal dominant; in women it is autosomal recessive. The initial stages of androgenetic alopecia may appear after puberty. Baldness of this type tends to occur seasonally and is often extended over time. The cause of hair loss is the symbiotic influence of two factors: heredity and hormonal activity. The presence of only one of the two factors does not lead to baldness. With androgenetic alopecia, a crown of hair always remains on the head - in the occipital and temporal regions. The essence of the phenomenon is that the hair follicles in these areas do not have receptors capable of perceiving the action of androgens. Therefore, one of the obligatory causes of androgenetic alopecia – hormonal activity – is excluded, and hair in these areas is genetically “insured” from loss.

Androgenetic alopecia accounts for almost 95% of all cases of hair loss in men and over 90% in women.

The characteristic signs of this type of alopecia are as follows:

- in men (male-pattern baldness): hair loss in the frontoparietal region; thinning, shortening of hair; the appearance of vellus hair; In bald areas, the skin is smooth and shiny. Hamilton (1951), and later Norwood, identified seven stages during androgenetic alopecia in men:

• Stages 1–3 – “bald patches” at the temples;
• Stage 4 – formation of a focus of baldness on the crown of the head;
• Stages 5–6 – fusion of foci of baldness on the temples and crown;
• Stage 7 – complete fusion of all foci of baldness;

- in women (female-pattern hair loss): progressive thinning and diffuse hair loss in the parietal region, the presence of acne, hypersecretion of the sebaceous glands, signs of hirsutism. Female pattern baldness is likely during hormonal changes, i.e., when using contraceptives, after childbirth, during menopause and after it. The hairline at the temples is less likely to recede than in men; usually the hairline remains unchanged. Androgenetic alopecia in women begins with thinning hair in the parting area and spreads in all directions. Ludwig (1977) divided hair loss in women into three stages (most women who experience baldness fall into the first category):

• Stage 1 – hair thinning in the frontoparietal region;
• Stage 2 – moderately severe thinning and thinning of hair in the same area;
• Stage 3 – pronounced thinning of hair in the frontoparietal region. In the border areas, the hair is preserved, but thinned.

Medical complex

Treatment of alopecia is due to the complexity of its pathogenesis and is always complex, starting with the correction of the patient’s eating behavior, his lifestyle and a combination of local and general therapy. The initial stage is a thorough clinical and laboratory diagnosis, including laboratory tests (thyroid hormones, female sex hormones, androgens, etc.), instrumental studies of the structure of hair, hair follicles and scalp. Perhaps, for a reliable diagnosis, consultations with related specialists will be required - a dermatologist, gynecologist, therapist, endocrinologist, etc. To treat baldness, it is recommended to follow a special diet rich in vitamins and microelements. For the normal functioning of the scalp and hair, a whole complex of vitamins and microelements is necessary. The most valuable foods for treating alopecia are apples, almonds, spinach, sprouted wheat, salmon, blueberries, broccoli, red beans, sweet potatoes and any vegetable juices. It is advisable to exclude alcohol, coffee, smoked meats, pickles, seasonings, marinades from the diet, and limit the intake of fats and carbohydrates.

General treatment is most often individualized. It depends on the nosological form of the disease, etiological factors and requires correction of hormonal imbalance, elimination of dysfunctions of the nervous system, digestive tract, liver, kidneys, foci of chronic infection, helminthic infestation and is largely determined by the results of laboratory diagnostics. Of course, it is prescribed by a trichologist.

Psychotropic and nootropic drugs (Sibazon, Azafen, Nootropil), vitamins (A, E, multivitamins, including those containing microelements), immunocorrective drugs (Dekaris, Methyluracil, T-activin) are widely used "), photosensitizers (Ammifurin, Beroxan), angioprotectors (Doxium), drugs that improve microcirculation (Trental) and specific drugs (Pantovigar, Minoxidil). In severe cases, corticosteroid therapy may be used.

The effectiveness of mesotherapy

Local therapy depends on the form of alopecia and necessarily includes special preparations for external use, adequate home care, and physiotherapy. The goal of external therapy is to improve microcirculation, activate redox processes and nourish the hair follicles. At this moment, a cosmetologist who knows an effective method for treating baldness - mesotherapy - comes to the fore. Gone are the days when our patients, in order to stimulate blood circulation, were forced to rub tinctures of onion, pepper, naphthalan oil extract, etc. into the scalp. The purpose of the mesotherapy procedure is to stop hair loss and lengthen the anagen phase by normalizing the functioning of the microcirculatory system (circulatory and lymphatic systems), sebaceous glands, metabolic processes in hair follicles and supplying the scalp with necessary nutrients, vitamins and elements.

One of the most important issues in the treatment of alopecia is the choice of cocktail for mesotherapy administration. To carry out this procedure, a complex drug is required that is capable of influencing all parts of the pathological process and regulating the cycle of a mature hair follicle, which exhibits a decrease in vascularization when entering the catagen phase and restoration of vascularization at the early stage of anagen. To achieve this goal, the concentration of vascular endothelial growth factor (VEGF) must be increased. This factor is synthesized by various cells, including keratinocytes and fibroblasts. VEGF has been proven to be a growth factor in dermal papilla and hair follicle cell cultures. In mature hair follicles, VEGF is found in the inner and outer epithelial hair root sheaths and the dermal papilla. This means that VEGF is a molecule that plays a key role in ensuring adequate capillary blood flow in the skin papillae and stimulating hair growth.

Thus, the meso cocktail should contain:

• venotonics – normalize blood and lymph flow and thereby ensure sufficient trophism and oxygenation of the scalp;
• bioflavonoids – have an angioprotective effect, neutralize free radicals, stabilize the cell membrane;
• micro- and macroelements (zinc, selenium, sulfur, copper, magnesium) are coenzymes of all synthesis and catabolism reactions, have antioxidant properties, and their role in enzymatic reactions stimulates hair restoration and growth.
• amino acids – help restore the concentration of essential amino acids present in healthy hair, improve the production of keratin proteins. Thus, the amino acid cysteine is involved in the metabolism of sulfur in the body. The breakdown of cysteine under the influence of disulfohydrase leads to the formation of disulfide bonds, which determine the natural strength of hair;
• vitamins . For example, B vitamins in combination with zinc prevent hair loss and regulate the secretion of the sebaceous glands, prevent the formation of dandruff, eliminating dead cells that compress the hair follicle. Vitamin A is a precursor to melanin and reduces graying of hair.

The mesotherapy procedure for the scalp is carried out according to the protocol and necessarily includes a vascular stage with elements of capillary mesotherapy for the cervical spine. When carrying out such injections, the pharmacological effect of drugs and the effect of physical stimulation are combined. In addition, there are almost no systemic effects. Mesopreparations have high bioavailability and low toxicity, since they are administered in microdoses. A course of mesotherapy, as a rule, is individual and consists of 10–12 procedures performed at intervals of 7–14 days. After the main stage of treatment, maintenance procedures are carried out - once every 3-4 weeks until the next course. The interval between courses is on average 3–8 months.

Complex therapy and coordinated actions of general practitioners, trichologists and cosmetologists will restore damaged hair follicles and create a healthy, favorable environment for new hair growth.

First published: KOSMETIK international journal, No. 1(39), 2010, pp. 52-55