男性雄激素性秃发患者的临床特征及治疗前后皮肤镜征象分析

A retrospective analysis of clinical,dermoscopic features of male patients with androgenic alopecia before and after treatment

目的：分析576例男性雄激素性秃发（AGA）患者的临床、皮肤镜特征及疗效。方法：对AGA患者进行问卷调查建立专科病历，对其中的391例进行皮损部位的皮肤镜观察并和118例正常人作对照，采用7级评分法进行疗效评价。结果：该研究中77．6％的患者发病年龄在21。40岁，89．1％病程在半年以上，61．3％有阳性家族史；95．3％的患者脱发表现为男性型，且82．4％的患者病情在Hamilton分级Ⅱ～Ⅳ级之间。皮肤镜下特征性的征象有〉20％的毛发直径变细、毛周征、毳毛增多、局部无毛征等，其中〉20％的毛发直径变细的发生率最高为87．5％，而对照组仅为3．4％。联合口服非那雄胺和外用米诺地尔治疗的有效率为75．2％，治疗3个月以上的有效率明显高于不足3个月者，疗程3个月以上的有效率达76．9％-86．7％，疗效与疗程成正相关关系。结论：AGA患者以轻中度脱发的青中年男性为主。皮肤镜在早期诊断AGA及评价疗效中有重要价值，〉20％的毛发直径变细为早期诊断的重要标准。联合口服非那雄胺和外用米诺地尔治疗AGA疗效确切，但至少需坚持3个月。

Objective： To analyze clinical, dermoscopic features and therapeutic efficacy of 576 male patients with androgenic alopecia （AGA）. Methods： Clinical data were collected with a questionnaire from 576 male AGA patients. Lesions in 391 AGA were examined with dermoscopy and 118 normal volunteers served as controls. The 7-level scoring method was employed to evaluate the therapeutic efficacy. Results： 77.6% male patients had AGA at ages of 21-40 years; 89.1% patients had AGA for more than six months; 61.3% had a family history of AGA. Among AGA patients, 95.3% patients were male pattern hair loss, and 82.4% were at Hamilton grade II-IV. Dermoscopic features included more than 20% hair diameter diversity （HDD）, peripilar signs, increased thinner hair shaft and focal atrichia. 87.5% patients had more than 20% HDD while only 3.4% normal controls had more than 20% HDD. The total effective rate after combination of oral finasteride and topical 5% minoxidil was 75.2%. The effective rates were 76.9%-86.7% following 3-month treatment. The effectiveness was positively correlated with the duration of treatment. Conclusions： Most of AGA patients are young to middle-aged males with mild to moderate hair loss. Demoscopy is a valuable tool for early diagnosis and evaluation of therapeutic efficacy of AGA. The presence of more than 20% HDD is an important criterion for early diagnosis of AGA. Combination of finasteride and minoxidil is effective in treating AGA, but at least 3-month treatment is required.