雄激素性秃发的皮肤镜特点及其与临床的关系

Dermoscopic features of androgenetic alopecia and their clinical implications

目的 探讨雄激素性秃发（AGA）的皮肤镜特点及其与临床的相关性.方法 用皮肤镜观察比较200例男性AGA（MAGA）患者和80例女性AGA（FAGA）患者以及50例健康对照者的头皮区域皮损特点,并收集相关临床资料.结果 毛发直径差异＞20.0％,见于所有MAGA和88.8％ FAGA患者的脱发区域;褐色毛周征可见于47.0％ MAGA和41.3％ FAGA患者;白色毛周征可见于23.5％ MAGA和17.5％ FAGA患者;黄点征见于22.5％ MAGA和31.3％ FAGA患者及14.0％对照者;白点征见于24.0％ MAGA和23.8％ FAGA患者及18％对照者;局部毛干缺失见于28.5％ MAGA、67.5％ FAGA患者及2％对照者;头皮色素沉着见于35.0％MAGA和38.8％ FAGA患者;鳞屑见于49.0％ MAGA和56.3％ FAGA患者及50.0％对照者.FAGA患者的毛发直径差异＞20％的阳性率低于MAGA患者（P＜0.01）,而局部毛干缺失的阳性率则高于MAGA患者（P＜0.01）.毛发直径差异＞20％见于所有晚期FAGA患者（P＜0.05）,而褐色毛周征多见于早期MAGA患者（P＜0.05）,白色毛周征、头皮色素沉着、局部毛干缺失则与AGA的疾病严重程度呈正相关（P＜0.05）.结论 毛发直径差异、褐色毛周征、白色毛周征、黄点征、白点征、局部毛干缺失、头皮色素沉着及鳞屑均为AGA患者皮肤镜下的常见征象,其中毛发直径差异＞20％、褐色毛周征、局部毛干缺失具有特征性.

Objective To investigate the dermoscopic features of androgenetic alopecia （AGA） and to assess their clinical implications.Methods A handheld dermoscope was used to observe the balding scalp of 200 male patients with AGA （MAGA）,80 female patients with AGA （FAGA）,as well as normal scalp of 50 human controls without hair loss.Clinical information was also collected from these subjects.Results Of the male and female AGA patients,100.0% and 88.8% showed hair diameter diversity （HDD） 〉 20% in the balding areas respectively,47.0% and 41.3% showed brown peripilar sign respectively,and 23.5% and 17.5% showed white peripilar sign respectively,35.0% and 38.8% showed scalp pigmentation respectively.Yellow dots were observed in 22.5%,31.3% and 14.0% of the male AGA patients,female AGA patients and controls respectively,pinpoint white dots in 24.0%,23.8% and 18% respectively,focal atrichia in 28.5%,67.5% and 2.0% respectively,and scaling in 49.0%,56.3% and 50.0% respectively.The incidence rate of HDD 〉 20% was significantly lower,but that of focal atrichia was significantly higher,in female AGA patients than in male AGA patients （both P 〈 0.01）.All the female patients with advanced AGA showed HDD 〉 20% with significant differences between female patients with AGA of grade F1 and those with AGA of grade F2-F3 （P 〈 0.05）,whereas white brown peripilar sign was mainly observed in male patients with early AGA with significant differences between male patients with AGA of grade Ⅱ-Ⅲ and those with AGA of grade Ⅳ-Ⅶ （P 〈 0.05）.The presence of white peripilar sign,scalp pigmentation and focal atrichia was positively correlated with the severity of AGA （all P 〈 0.05）.Conclusions Common dermoscopic findings in AGA include HDD 〉 20%,brown peripilar sign,white peripilar sign,yellow dots,pinpoint white dots,focal atrichia,scalp pigmentation and scaling,among which,HDD 〉 20%,brown peripilar sign and focal atrichia seem to be characteristics of AGA.