JEADV:不仅仅有脂溢性脱发,还有纤维性脱发

2021-11-11 医路坦克 MedSci原创

纤维性脱发是一种罕见的瘢痕性脱发,2000年由Zinkernagel和Trüeb.首次报道。FAPD目前被一些人认为是扁平苔藓(LPP)的一个亚型。

    纤维性脱发是一种罕见的瘢痕性脱发,2000年由Zinkernagel和Trüeb.首次报道。FAPD目前被一些人认为是扁平苔藓(LPP)的一个亚型,具有LPP和雄激素性脱发(AGA)的临床和组织病理学特征。LPP和FFA的潜在致病过程是毛囊(HF)隆起免疫豁免权的崩溃,导致细胞毒性淋巴细胞介导的HF破坏并与纤维组织取代。对HF上皮干细胞的不可逆转损害是LPP和FFA等瘢痕秃发的核心,并导致永久性脱发。相反,AGA的特点是渐进性小型化,导致终末期HFs的牛皮状转化。最初论文的作者承认,很难确定FAPD代表的是具有苔藓样组织反应的AGA还是图案化的LPP。

    该文描述了26例FAPD患者的临床、毛镜和组织病理学特征,以及治疗反应。扁平苔藓活动指数(Lichen Planopilaris Activity Index)平均为1.50分,辛克莱评分中位数为3分。12例患者中央顶区弥漫性变薄,4例额叶突出,8例头顶突出脱发。其中8人面部毛发脱落。主要的三镜检查特征包括毛干直径变异性(100%),滤泡周围红斑和/或鳞屑(95%)和滤泡口损失(95%)。FAPD的组织病理学在同一活检标本中典型地显示了LPP和AGA的特征,包括涉及毛囊上皮和围绕HF的淋巴细胞浸润的界面改变,同心性板层纤维化,皮脂腺减少和HF小型化。用促进毛发生长,抗炎和抗雄激素药物治疗阻止了14名患者的疾病进展,并导致两名患者的毛发再生。尽管接受了治疗,但仍有6名患者脱发加重。

 

   FAPD是原发性瘢痕性脱发的变种,在史蒂文·科萨德于1994.9首次报告6例绝经后妇女的FFA后6年首次被描述,就像FFA一样,这提出了一个问题,即FAPD在2000年之前是不存在的,还是根本没有被认识到。FAPD的病因仍不清楚,不断上升的发病率将引发人们对环境诱因的猜测。虽然防晒霜、落叶化妆品、接触性过敏原、化学暴露和食物等因素在FFA中的作用仍然存在争议。

   我们建议用抗炎和促进毛发生长的药物联合治疗FAPD是最好的。局部或病灶内的皮质类固醇应该被认为是一线治疗,同时增加局部或小剂量口服米诺地尔和抗雄激素治疗,如非那雄胺。

    FAPD的临床、毛镜和组织病理学特征使其被归入以淋巴细胞为主的原发性瘢痕性脱发的亚群是合理的。对早期FAPD患者进行及时的诊断和干预可以获得更有利的结果。

文献来源:Jerjen R,  Pinczewski J,  Sinclair R,Clinicopathological characteristics and treatment outcomes of fibrosing alopecia in a pattern distribution: A retrospective cohort study.J Eur Acad Dermatol Venereol 2021 Aug 20

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    2021-12-03 zhanguwe

    感谢分享,学习到了,翻译有点不准。皮肤镜,毛干直径异质性,毛囊周围,毛囊口缺失

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    2021-11-11 ms8000002139912783

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    2021-11-11 屋顶瞄爱赏月

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