الفهرس 
Anatomy of Hair FollicleOnly 14 pages are availabe for public view
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Abstract
Alopecia areata is a common, non-scaring, autoimmune disease that can affect any hair-bearing area and its characterized by patchy areas of hair loss without any signs of clinical inflammation. Various therapies have been proposed for treatment of this condition. None have been shown to alter the course of the disease. Histopathology is characterized by typical inflammatory lymphocytic infiltrates in peribulbar region.
Diagnosis of hair and scalp diseases was in recent years subjected to significant progress. One of the major developments was employing imaging techniques, including hair and scalp dermoscope. Although dermoscope is one of the non-invasive imaging techniques, it allows visualization and high magnification of hair and hair follicles.
One of the major developments in diagnosis of hair diseases was employing imaging techniques, including hair and scalp trichoscope that is one of the non-invasive imaging techniques; that allows visualization of hair magnification and the assessment of different hair structures.
The management of alopecia areata involves both psychological and pharmacological lines of treatment.
First-line treatment: Intralesional or topical corticosteroids are the initial treatment for the most patients with patchy alopecia areata. Topical immunotherapy can be used as first line treatment for patients with disease (greater than 50% scalp hair loss).
Second line option for treatment of alopecia areata includes: minoxidil 5% solution, anthralin and psoralen ultraviolet A (PUVA). It may be used alone or in combination with the first line interventions.
Systemic therapies are occasionally used for severe alopecia areata. They include oral corticosteroids, methotrexate, sulfasalazine, cyclosporine and biologic agents. A high likehood of relapse and potential adverse effects of these drugs limit their use to refractory cases.
Other therapies as excimer laser, topical bexarotene, capsaicin, platelet-rich plasma, recombinant interleukin 2, hydroxychloroquine, janus kinas (JAK) inhibitors, simvastatin/ezetimibe, fractional photothermolysis, and botulinum toxin has been reported.
Platelet-rich plasma is a volume of autologous plasma that has a high platelet concentration. Growth factors released from platelets may act on stem cells in the bulge area of the follicles, stimulating the development of new follicles and promoting neovascularization.
Platelet derived growth factors were proved to be biologically active in many key regenerative steps, such as the development of angiogenesis, the formation of hair matrix and the enhancement of the cell proliferation hence their use in many medical fields including sport medicine, orthopedic, plastic and aesthetic medicine. They aimed at both the delivery of biologically active substances such as growth factors, cytokines, and fibrin that help restoration of a healthy environment for the regenerating tissues.
Micro-needling of hair also relies on the principle of neocollagenesis and neovascularisation that occurs as a result of release of growth factors following needle piercing of the startum cornuem. These growth factors are believed to be responsible for the beneficial effects of the procedure in tissue regeneration.
The aim of the study was to investigate and compare the efficacy of intralesional injection of PRP and micro-needling by dermaroller in chronic, relapsing or resistant cases of alopecia areata.
The study recruited 40 cases attending outpatient clinic of dermatology of “El Hood El Marsoud” Hospital, during the period of April 2016 to August 2016, each patient had at least 3 areas of scalp alopecia areata, each patient‟s scalp divided into 3 areas; C-area wasn‟t receive any treatment acting as control area, D-area was treated by dermaroller and P-area was treated by PRP. All patients were subjected to detailed history taking and examination to detect pattern and severity of alopecia areata.
The cases were examined by dermoscope, the D-area was treated by 1.5 mm dermaroller, the P-area was treated by intralesional injection of PRP prepared by using single spin technique 1000 RPM for 20 minutes of 10 cm whole blood withdrawn from the alopecia areata patients, it was injected after addition of calcium chloride as growth factor activator. Injections were done once every month for 4 months for each patient. Each patient was digitally macro-photographed, measured and evaluated with dermoscopy for the detection of dystrophic hair markers for alopecia areata.
The obtained data was tabulated and statistically analyzed. The results revealed that significantly higher number of patients showed terminal hair regrowth in group treated by intralesional injection of PRP compared to group treated by dermaroller and other group compared to the control.
Moreover, both modalities increase the mean number of terminal hair evaluated to the dermoscope. This number was significantly higher in PRP group compared to dermaroller group which was higher than that compared to the control group. The average ratio between terminal to vellus hair after treatment was higher with PRP treatment.
In conclusion PRP is considered a promising, safe and effective treatment modality of alopecia areata that can combined with other therapeutic options for favorable results and also dermaroller is effective treatment modality that could be used in cases of milder alopecia areata.