斑秃（1）-读书报告5

Alopecia areata斑秃

Clinical features临床特征

Alopecia areata is an organ-specific autoimmunedisease in which large numbers

of hair follicles undergo progression intocatagen and telogen while smaller numbers enter an abnormal anagen stage.

斑秃是一种器官特异性自身免疫性疾病，表现为大量毛囊进入退行期和静止期，而少数进入异常的生长期。

The condition is quite common, affecting up to 1%of the population. The frequency of a family history is very high, ranging from10% up to 42% of cases. It is more common in individuals between 15 and 40years of age and about 60% of cases occur before the age of 20.1 The disease is very rare in newborns and youngchildren.2 Exceptionally, however, congenital cases may occur.3 There appears to be a higher incidence in Kuwaitichildren.

这个疾病非常常见，累及1%的人群。家族史的出现频率非常高，从10%到高达42%。15～40岁的人更常见，并且大约60%的病例在20岁前发病。新生儿和幼儿罕见。先天性病例罕见。有资料显示科威特儿童的发生率相对较高。

图A Alopecia areata: typical annularnoninflammatory foci of alopecia.

斑秃：典型表现为环状的非炎性的局部脱发。

The degree of involvement is very variable andcan range from verymild disease where the hair loss is difficult to detect through to veryseverecases with diffuse hair lossaffecting the entire scalp or even the whole body(Fig. 22.57). Any hair-bearing surface may be affected (Fig. 22.58). A typicalpatient presents with an abrupt development ofpatches of nonscarring alopeciain different patterns: circumscribed, bandlike inthe temporo-occipitalregion (ophiasic), bandlike in the frontoparietalregion in a ‘sisaipho’ pattern(ophiasis inversus); (Fig. 22.59),5 and reticular. When these patches extendand become confluent, involving the entire scalp,the appearance is known asalopecia totalis (Fig. 22.60). If there is hair loss on the entire body the conditionis referred to as alopecia universalis (Fig. 22.61).6,7 Even in the most

severe forms of alopecia totalis and universalisone can observe isolated small

groups of unaffected hair follicles, allowingdistinction from telogen effluvium.

疾病受累程度变化范围很大。极轻的斑秃，可能难以发现脱发；极重度的累及整个头皮甚至全身弥漫性脱发（图22.57）。任何毛发被覆的部位都可受累（图22.58）。典型的表现为突发的非瘢痕性脱发斑，可以为局限性的，在颞枕区发生带状（匍行性），额顶部带状马蹄形（逆蛇形斑秃）（图22.59）和网状。当这些脱发斑扩大和融合时累及整个头皮，被称为全秃（图22.60）。当全身毛发脱落时称为普秃（图22.61）。即使在最严重的全秃和普秃中，也可观察到孤立、未受累的小群毛囊，可以与静止期脱发相鉴别。

fig B  Alopecia areata: typical annularnoninflammatory foci of alopecia.

斑秃：典型表现为环状的非炎性的局部脱发。

Fig. 22.58

Alopecia areata: note the loss of eyelashesin the middle third of the upper eyelid.

斑秃：注意上眼皮中间三分之一的睫毛的缺失。

AFig. 22.59

B Fig.22.59

Alopecia areata: this broad band of alopeciin the occipital region is known as ophiasis (A). In the frontoparietal region it is knownas ophiasis inversus, or a ‘sisaipho’pattern (B).

斑秃：这种在枕部宽带状的脱发被称为匍行性脱发（A）。在额顶部的这种脱发被称为逆蛇形斑秃，或‘马蹄形’型脱发。

Fig. 22.60

Alopecia areata totalis:in this patientthere is complete loss of scalp hair.

全秃：这个病人所有的头皮头发都脱光了。

Fig. 22.61

Alopecia areatauniversalis: in its most extreme form there is loss of hair affecting the wholebody. There is loss of eyebrows in addition to scalp involvement.

普秃：在最极端的形式中，头发的丧失影响了整个身体。除了头皮受累，眉毛也有缺失。

Alopecia areata may occasionally present with apattern mimicking

androgenetic alopecia.8 The proportion of patients who eventually develop

alopecia totalis and universalis varies but isaround 7%.9 Alopecia totalis is

more frequent in children.

偶尔斑秃可表现为与雄激素源性脱发相似的模式。最终发展为全秃和普秃的患者比例不定，大约占7%。全秃在儿童更常见。

Examination of the involved scalp generallyreveals that except for the

absence of hair, the skin appears normal,follicular openings are preserved,

and there is no evidence of scarring (Fig. 22.62). In occasional cases, however,

edema and erythema are observed. Hair color mayappear normal or it

may show mild lightening and loss of sheen. Inthe periphery of the patches

of alopecia one typically finds exclamation markhairs, which are short and

become thinner as they gradually approach thescalp (Fig. 22.63). They are

a very characteristic feature but may also beseen in trichotillomania.11 The

process usually affects pigmented hairs. Nonpigmented hairs appear to be

more resistant, at least temporarily.

对受累头皮进行检查，可以发现局部没有毛发，但皮肤外观正常，毛囊开口保留，且没有疤痕的表现（图22.62）。然而偶有病例可出现水肿和红斑。毛发颜色可以正常或轻度变淡及失去光泽。脱发斑边缘头发松动，易于拔起，可为典型的惊叹号状发，表现为发干短，并且越接近头皮越细（图22.63）。这是非常特征性的表现，但也可见于拔毛癖。该病通常累及色素性毛发，而无色素性毛发较少累及，至少病程短。