斑秃的皮肤镜表现及对治疗的反应  

Dermoscopic Features of Alopecia Areata Before and After the Treatments

作　　者：曹慧[1] 杨雨清[1] 李水凤[1] 戚世玲[1] 张小婷[1] 杨建[1] 章星琪[1] 

机构地区：[1]中山大学附属第一医院,广州510080

出　　处：《中国中西医结合皮肤性病学杂志》2014年第4期223-227,共5页Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine

摘　　要：目的探讨斑秃患者皮肤镜征象表现及其在不同治疗方法治疗后消失的情况。方法回顾性分析80例初诊或复发后初诊斑秃患者的初始皮肤镜征象以及在不同治疗方法治疗后消失的顺序,并分析其原因。结果斑秃发病男女比例相近,平均发病年龄为26.5岁,平均病程为32.6个月,临床类型以斑片型多见;斑秃患者皮肤镜征象出现率由高到低依次为黄点(87.5%)、黑点(82.5%)、断发(77.5%)、短毳毛(76.25%)、感叹号发(45.0%),黄点、断发、短毳毛与斑秃病程呈负相关,感叹号发与轻拉发实验呈正相关,黑点、断发、感叹号发两两之间亦呈显著正相关。二苯环丙烯酮(DPCP)组患者随访期间内均未见明显新生毛发,而另外3组有1种或以上皮肤镜征象消失的患者均伴有新生毛发增多。复方甘草酸苷组、复方倍他米松组、口服激素组中4种征象(黄点、黑点、断发、感叹号发)均有。患者治疗后征象最先消失比例最高的为感叹号发,平均时间为治疗后7.3周,第二消失比例最高的为黑点,平均时间为7.6周,第三消失比例较高的为断发,平均时间为8.2周,最后消失的为黄点,平均时间为8.4周,组间差异无统计学意义。结论感叹号发与病情活动度呈正相关,DPCP组患者病程长,病情活动度少,以重型及难治型患者占大多数,治疗起效慢。治疗后皮肤镜征象的消失与治疗方法无关,与治疗起效时间有关,开始起效时间约在7.3周左右。超过随访时间所有征象均未消失的患者,说明病情活动未得到控制,需调整治疗方案。治疗起效后毛囊重新进入生长期,引起感叹号发首先消失,随之黑点、断发亦消失。Objective To observe the features of alopecia areata （AA） with dermoscopy and evaluate their disappearance orderafter different treatments. Methods A non-contact polarized dermoscope （Dermlite, USA） was performed in the area ofalopeeia of 80 first visit or the first visit after recurrence patients with AA. Analyzing the disappearance order of these featuresafter treatment and presuming the reason. Results The male to female ratio was similar in the incidence of AA. The mean ageof the patients was 26.5 years. The mean duration of AA was 32.6 months. Most common AA in our study was patchy type. Themost common dermoseopie feature was yellow dots （87.5%）, followed by black dots （82.5%）, broken hairs （77.5%）, short vellushairs （76.25%） and exclamation mark hairs （45.0%）. The prevalence of yellow dots, broken hairs and short vellus hairs wasnegatively correlated with the duration of AA while exclamation mark hairs was positively correlated with hair-pull test. Andthe prevalence of black dots, broken hairs and exclamation mark hairs was positively correlated with each other. None of theDPCP group was seen significantly growing of short vellus hairs, but everyone of the other three groups who had at least onefeatures disappearance after treatment was seen significantly growing of short vellus hairs. Among the patients who had all ofthe four signs （yellow dots, black dots, broken hairs and exclamation mark hairs） in these three groups, the first disappearancesign was exclamation mark hairs and the mean disappearance time was 7.3 weeks, followed by black dots （7.6 weeks）, brokenhairs （8.2 weeks） and yellow dots （8.4 weeks）. Conclusion The prevalence of exclamation mark hairs is positively correlatedwith the disease activity. Most patients in DPCP group are the heavy types and hard to treat, who have longer duration andlower disease activity. The disappearance of the dermoscopic features are possibly related with the effect time of treatments butnot with the kinds of treatment. Th

关 键 词：斑秃 皮肤镜 感叹号发 治疗 

分 类 号：R758.71[医药卫生—皮肤病学与性病学]