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Alopecia areata Cos'è l'Alopecia Areata?

 L'Alopecia areata (AA) è una patologia di tipo infiammatorio e non cicatriziale che si manifesta attraverso la caduta dei capelli negli uomini, nelle donne e nei bambini. L'Alopecia Areata si presenta solitamente sotto forma di chiazze di perdita completa di capelli o peli nello scalpo o in altre parti del corpo. Nei casi più gravi l'alopecia areata può progredire fino alla perdita totale di tutti i peli del corpo.  Sebbene non si tratti di una patologia che minaccia direttamente la sopravvivenza, l'Alopecia areata costituisce senza dubbio un problema serio soprattutto per gli effetti psicologici e sociali che la caduta dei capelli può provocare nei soggetti che ne sono affetti.

Le caratteristiche del disturbo che oggi conosciamo come alopecia areata furono descritte per la prima volta nel 30 A.C da Cornelio Celso. Quest'ultimo descrisse due forme di alopecia, utilizzando il termine greco alopekia, tradiotto letteralmente come "scabbia della volpe". All' Alopecia areata sono stati dati differenti nomi nel corso della storia. Il termine attuale "alopecia areata" tuttavia fu utilizzato per la prima volta da Sauvages nella sua opera "Nosologica Medica" , pubblicata per la prima volta nel diciottesimo secolo. In passato si riteneva che l'alopecia areata fosse causata da stress, agenti infettivi o disfunzioni ormani. L'ipotesi che questa malattia fosse di natura autoimmune e che colpisse soggetti che manifestavano una predisposizione genetica alla stessa fu avanzata per la prima volta alla metà del ventesimo secolo.

Solitamente ciascun follicolo pilifero segue un ciclo di vita. Ci sono tre fasi principali nel ciclo di vita del capello: Anagen, Catagen e Telogen.  L'Anagen è la fase di crescita attiva in cui la fibra del capello viene prodotta. Segue la fase del Catagen caratterizzata da una progressiva e controllata regressione del follicolo pilifero. Infine il bulbo entra nella fase telogen in cui si trova in un cosidetto stato di riposo.

L'Alopecia areata colpisce principalmente i follicoli che si trovano in stato di anagen. Numerosi studi indicano che il primo segnale nello sviluppo della malattia è il prematuro passaggio dei follicoli che si trovano in fase anagen a fase telogen vale a dire in stadio di riposo. Più comunemente i follicoli escono dalla fase anagen, entrano in catagen, e rilasciano il capello, che cade, una volta entrati in catagen.  I follicoli possono poi ritornare nello stadio di crescita anagen ma, a causa della continua azione dell'alopecia areata, produrre capelli di qualità scarsa.  Questi follicoli si troveranno in uno stato descritto come anagen distrofico. Alcuni ricercatori ritengono che i follicoli continuino ad oscillare indefinitamente tra rapidi cicli di anagen distrofico e telogen. Altri studiosi sostengono invece che i follicoli colpiti da alopecia areata permangano in uno stato telogen. 

 

I fattori che innescano lo sviluppo dell'alopecia areata e i meccanismi del suo sviluppo sono ancora avvolti nel mistero. Alcune delle ipotesi più accreditate sono:

  • Disordine autoimmune: Dati raccolti attraverso osservazioni dirette de indirette sottolineano come sia possibile che una patogenesi di natura autoimmune possa essere coinvolta nello sviluppo iniziale dell'alopecia areata. Il sistema immunitario disegnato per proteggere l'uomo da virus e batteri, improvvisamente ed in maniera erronea si scaglia contro i follicoli provocando la caduta dei capelli. 
  • Predisposizione genetica: Studi condotti su soggetti affetti da questa patologia hanno mostrato che ci sono persone geneticamente predisposte allo sviluppo della malattia. Tali ricerche hanno mostrato che vi era più frequentemene una storia familiare di parenti colpiti da alopecia areata nelle persone che soffrivano di questa malattia.at
  • Fattori scatenanti ambientali: Vaccini, iniezioni per ridurre la sensibilità, esposizione a sostanze chimiche sono tutti fattori che possono produrre lo sviluppo di alopecia areata. Alcuni dermatologi sostengono che infezioni virali o battericge possano spingere il sistema immunitario a dare una risposta inappropriata contro i follicoli piliferi in alcuni soggetti predisposti.
  • Stress e ansia: Vi sono state numerose segnalazioni di casi in cui singoli individui che hanno vissuto situazioni particolarmente stressanti sono stati colpiti da una perdita anormale di capelli
  • Cheratonociti anormali: alcuni studiosi sostengono che questi siano gli obiettivi potenziali nei follicoli colpiti da alopecia areata.

Alopecia areata: Caratteristiche cliniche

L'Alopecia areata si può presentare in molte forme differenti. Solitamente si sviluppa come una singola chiazza calva di uno o due centimetri di diametro che può apparire sia nel corpo sia sullo scalpo. Le prime chiazza possono espandersi ed altre chiazze glabre possono conseguentemente manifestarsi. L'alopecia areata si può presentare in diverse forme:

  • Chiazze circolari od ovali di perdita dei capelli
  • Perdita di tutti i capelli
  • Perdita di tutti i capelli e i peli corporei (alopecia universalis)
  • Ofiasi: una perdita di capelli a bande orizzontali

L'Alopecia areata si può sviluppare in alcune zone anche come un nevo della pelle. I nei sono piccole zone di pelle con caratteristiche differente dalle zone di pelle circostanti e l'alopecia areata perinevoide è caratterizzata da zone glabre che si producono attorno a nei pigmentati. 

Nell' Alopecia Areata in fase attiva, il ciclo del capello è modificato e vi è un anormale scostamento nella media dei capelli che normalmente dovrebbero essere in fase anagen, telogen e catagen. I capelli che cadono sembrano avere delle "radici" e appaiono come capelli in fase telogen una volta esaminati al microscopio.

Dei capelli molto corti (1-2 mm) e spezzati possono sovente essere scorti ai margini delle chiazze di alopecia areata. Questi capelli sono definiti dai dottori come a forma di punto esclamativo. I capelli che sono meno severamente danneggiati possono continuare ad avere fasi anagen ma produrranno capelli distrofici come descritto precedentemente.

L'Alopecia areata colpisce comunemente i capelli pigmentati ed è meno in grado di attaccare capelli bianchi o poco sub pigmentati. L'alopecia areata ha un corso imprevedibile e può tardare alcuni anni senza che vi sia alcuna ricrescita di capelli o oscillare tra fasi di manifestazione della patologia e scomparsa della stessa. In alcuni casi può durare solo per un breve periodo ed il normale ciclo di crescita del capello si ristabilisce dopo pochi mesi dal manifestarsi della malattia. Dovuto alla conversion da telogen ad anagen dei capelli che ricrescono, una volta cessati gli effetti dell'alopecia areata, la ricrescita iniziale si caratterizza per il comparire di capelli corti bianchi e crespi. 

Alcune persone che soffrono di alopecia areata possono sperimentare un cambio del colore dei capelli durante o successivamente ad un episodio di alopecia areta e talvolta queste mutazioni cromatiche possono essere permanenti. La ragione per cui i capelli pigmentati sono più frequentemente colpiti da alopecia areata e i meccanismi per cui i capelli che ricrescono sono iniziamente bianchi sono ad oggi inspiegabili.

Una percentuale tra il 10 ed il 65% delle persone colpite da alopecia areata può sperimentare altresì problemi alle unghie tra cui il più comune sono delle irregolarità puntiformi nella struttura della stessa. Altre anormalità tipiche sono strisce longitudinali, fragilità, macchie nella zona della lunula (l'area alla base dell'unghia che ha spesso la forma di mezza luna crescente), coilonochiasi (una deformità caratterizzata dalla concavità della superficie esterna dell'unghia) onicolisi (la separazione o la perdita parziale dell'unghia del piede o della mano) ed onicomadesi (perdita completa dell'unghia). I problemi alle unghie possono precedere seguire o verificarsi in contemporanea alla caduta dei capelli. 

 

 

 

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