弥漫性斑秃11例临床及组织病理研究

Clinical and histopathologic analysis of 11 cases of diffuse alopecia areata

目的:探讨弥漫性斑秃的临床、实验室检查、组织病理特点及与其他弥漫性脱发性疾病的鉴别。方法:回顾性分析11例弥漫性斑秃患者的临床表现、实验室检查和头皮组织病理、免疫组化等检查结果。结果:11例患者中8例为女性,春夏季急性发作,表现为数月内毛发弥漫性大量脱落,致使短期内出现毛发明显稀疏,但在毛发完全脱落之前,已有新生毛发长出。部分患者有特应性体质及血清IgE增高。组织病理检查显示退行期及休止期毛囊数量明显增多,毛乳头及毛囊索条周围中到大量以单个核细胞为主的炎性细胞浸润。治疗中发现多数患者需要系统使用糖皮质激素方能遏制脱发及诱导新发生长,患者预后良好。结论:弥漫性斑秃多累及青年女性,病程较短,组织病理示典型的斑秃改变,即有毛乳头周围特征性淋巴细胞浸润。其临床经过良好,提示变态反应在发病中起一定的作用。建议早期对患者系统性使用糖皮质激素治疗,以期尽快控制患者的脱发进程。

Objective： To explore the characteristics of diffuse type of alopecia areata by analyzing the data from clinical observa tions, histopathological and serological tests, as well as its differential diagnosis from other diseases. Methods：Clinical data including pathological findings of 11 patients with diffuse alopecia areata were analyzed retrospectively. Results： 8 female patients had acute onsets in spring or summer and lasted for a few months, hair regrowth started before complete hair shedding, and recovered fully within 6 months. Some patient had a history of atopie dermatitis, and elevated serum level of IgE. Histopathological study of scalp biopsy showed high per- centages of catagen or telogen hairs, with moderate to intense lymphocytic infiltration around the terminal hair bulb. Most of the patients markedly improved after administration of systemic corticosteroids. Conclusion： diffuse type of alopecia areata was more commonly seen in young female. Histopathologieally, it showed typical changes of acute or subacute phase of alopecia areata. The diffuse subtype has a benign clinical course which indiates hypersensitivity plays a role in the pathogenesis of the disease. An early and correct diagnosis with proper treatment using systemic corticosteroids warrants quick recovery and lowers relapsing possibilities of the disease.