53例瘢痕性秃发的临床和病理特点分析

Cliulcopathological analysis of 53 cases of cicatricial alopecia

目的探讨瘢痕性脱发的临床、组织病理与皮肤镜特点，以及治疗和预后的特征。方法回顾性分析53例瘢痕性脱发患者的临床资料，分析其组织病理、皮肤镜征象、治疗和预后的特点。结果瘢痕性脱发以脱发、毛囊开口消失、毛囊皮脂腺单位数目减少或消失为共同特征。基底细胞局灶液化变性、毛囊角栓、毛细血管分支状扩张、免疫荧光阳性提示盘状红斑狼疮；界面皮炎提示毛发扁平苔藓；炎症和弹力纤维轻微破坏提示假性斑秃；毛囊问黏蛋白沉积及毛囊口下陷为黏蛋白性脱发的特点；脓疱可见于脱发性毛囊炎和分割性蜂窝织炎或毛囊炎，前者多伴有簇状发，窦道形成则仅见于后者。治疗对淋巴细胞性患者使用免疫抑制剂，对中性粒细胞性患者使用抗生素和维A酸。结论组织病理检查对诊断起决定性作用。瘢痕性脱发造成不可逆的毛囊损害，治疗周期长。早期诊断及早期合理用药可控制疾病发展，减少永久性脱发损害。

Objective To investigate the clinical, histopathological and dermoscopic features as well as treatment and prognosis of cicatricial alopecia. Methods Clinical data on 53 patients with cicatricial alopecia were retrospectively collected and studied. Pathological and dermoscopie characteristics, as well as treatment modality and prognosis of cicatricial alopecia were analyzed. Results Cicatricial alopecia was characterized by alopecia, disappearance of follicular ostia, and absence or decrease in the number of polisebaceous gland units. Pathologically, focal liquefactive degeneration of basal cells, follicular keratotic plugs, arborising telangiectasia together with a positive immunofluorescence test were usually suggestive of discoid lupus erythematosus, interface dermatitis suggestive of lichen planopilaris, inflammation and mild disruption of elastic fibers suggestive of classic pseudopelade of Brocq. Muein deposition between hair follicles and sinking of follicular ostia were pathological and dermoscopic characteristics of alopecia mueinosa. Pustules could be visible in both folliculitis decalvans and dissecting cellulitis/folliculitis, with tufted hairs usually seen in the former, and sinus formation in the later. Lymphocytic disorders were treated with immunosuppressors, and neutrophile disorders with antibiotics and retinoids. Conclusions Histopathological examination plays a determinant role in the diagnosis of cicatricial alopecia, which can cause irreducible damage to hair follicles, and require long term treatment. Early diagnosis and appropriate use of drugs may control the development of cicatricial alopeeia, and reduce the occurrence of permanent hair loss.