淋巴细胞性原发性瘢痕性脱发2例

Primary lymphocytic cicatricial alopecia: two case reports

报告2例淋巴细胞性原发性瘢痕性脱发。例1.患者男,53岁。头皮多发红斑及脱发1年。皮肤科检查:头部多发椭圆形花生米大脱发斑,局部头皮萎缩。皮损组织病理检查:表皮角化过度,毛囊角栓,棘层灶性变薄,毛囊上皮基底细胞液化,真皮浅层血管附属器周围大量淋巴细胞浸润。直接免疫荧光(DIF)示真、表皮交界处,真皮与毛囊上皮交界处线状及颗粒状C3(+)、IgM(±)、IgG(-)及Ig A(-)。免疫组化:抗核抗体(ANA)(+)1∶40、抗SSA抗体(++)及抗线粒体抗体(+)。例2.患者女,48岁。头皮多发红斑伴脱发和瘙痒2年。皮肤科检查:头皮多发形状不规则的脱发斑片,部分融合,局部头皮萎缩。皮损组织病理检查:表皮角化过度,毛囊角栓,毛囊上皮基底细胞液化,附属器周围大量炎性细胞浸润。DIF(-)。免疫组化:ANA(-)。2例患者均诊断为淋巴细胞性瘢痕性脱发。

Two cases of primary lymphocytic cicatricial alopecia are reported. Case 1. A 53-year-old male presented with erythemas and alopecia on the scalp for 1 year. Physical examination showed multiple oval peanut-sized, atrophic alopecia patches on the scalp. Histopathological examination showed hyperkeratosis, keratin plugs of the hair follicles, focal thinning of the stratum spinosum, liquefaction of the basal cells of follicular epithelium, and perivascular and periappendiceal infiltration of a large number of lymphocytes in the superficial dermis. Direct immunofluorescence(DIF) showed linear and granular deposition of C3(+), IgM(±), Ig G(-) and IgA(-) along the dermal-epidermal junction and the dermal-follicular epithelial junction. Immunohistochemistry revealed ANA(+) 1 ∶ 40, anti SSA antibody(++) and anti mitochondrial antibody(+). Case 2. A 48-year-old female had a 2-years history of scalp erythemas with alopecia and pruritus. Dermatological examination showed irregular atrophic alopecia patches with partial merging on the scalp. Histopathological examination revealed hyperkeratosis, keratin plugs of the hair follicles, liquefaction of basal cells of follicular epithelium and periappendiceal infiltration of inflammatory cells. Both DIF and ANA were negative. Diagnosis of primary lymphocytic cicatricial alopecia was made in both patients.