疤痕性脱发读书报告-潘卫利大夫
Scarring alopecias
瘢痕性脱发
A wide variety of follicular and nonfollicular scalp conditions including hereditary,王俪桥 developmental, and acquired disorders may result in scarring or permanent alopecia as a secondary phenomenon. Permanent alopecia may also take place in the late stages of some nonscarring alopecias such as andro- genetic alopecia, alopecia areata, and traction alopecia (‘transitional scarring or biphasic pattern’ alopecias)
多种毛囊性和非毛囊性头皮疾钟小江年龄病深湖巨兽 ，包括遗传性、发育性和获得性疾病，都可以继发瘢痕形成或永久性脱发。永久性脱发也可以出现在某些非瘢痕性脱发的后期，如雄激素性脱发、斑秃和牵拉性脱发（暂时性瘢痕形成或双相模式的脱发）
In this section, only those diseases that primarily affect the scalp or involve it secondarily with distinctive clinicopathological features will be described
本部分仅描述那些原发于头皮的疾病或具有特征性临床病理特点的继发病。
Scarring alopecia constitutes one of the most difficult and complex areas in the study of hair disease. It includes a wide variety of nosological entities with different etiologies and distinctive clinical features. However, the charac- teristic findings are usually only evident in the early stages and as the disease progresses the clinical and pathological features of different diseases overlap凰图 寐语者 , making categorization often impossible. The problem is further complicated by the fact that the majority of patients with scarring alopecia are asymptom- atic and do not seek medical attention until the disorder is at an advanced stage
瘢痕性脱发构成毛发性疾病研究中最为困难和复杂的部分之一。在疾病分类上是不同病因和临床特征的一大类疾病。然而通常在疾病的早期阶段有典型的特征，随着疾病的进展，不同疾病的临床和病理学特征相互重叠，导致分类困难。使问题更为复杂的是，大部分瘢痕性脱发的患者没有症状，直到疾病进入后期阶段才去寻求医学帮助。
Scarring alopecias are characterized by irreversible loss and destruction of hair follicles and hair shafts. There is frequently, but not always, associated dermal fibrosis. Clinical examination reveals absence of follicular ostia (usually in a focal distribution), induration or atrophy of the skin, pigmentary alterations, follicular plugging and, occasionally午夜杀生 , follicular pustules (Fig. 22.117). The histopathological hallmark is usually the presence of an inflammatory infiltrate surrounding the bulge and isthmus region and loss of sebaceous glands, later followed by the formation of a scar with the hair follicle being replaced by a scarring follicular stella (Fig. 22.118). Histochemical stains including elastic stain and trichrome are useful to define the scarring areas and in the differential diagnostic with discoid lupus erythematosus, lichen planopilaris, and pleudopélade of Brocq (Fig. 22.119).3 Sometimes the only structure left of the hair follicle are the arrector pili muscles (Fig. 22.120)
瘢痕性脱发的特征是毛囊和毛干不可逆的损失和破坏人造人8号 。经常会伴有真皮纤维化木乃七斤 。临床检查显示毛囊结构的缺失（通常是灶性分布）、皮肤的硬化或萎缩、色素改变、毛囊角栓和偶尔出现的毛囊性脓疱(Fig. 22.117)。组织病理学的特征性标志是经常可以看到毛球和峡部的炎症性浸润以及皮脂腺的缺失，继而瘢痕形成孙友田 ，毛囊被瘢痕性毛囊索取代(Fig. 22.118)。包括弹力纤维和三色法等免疫组化染色对于发现瘢痕区域，以及与盘状红斑狼疮、扁平苔藓、pleudopélade of Brocq 的鉴别诊断是很有帮助的（Fig. 22.119）。有时立毛肌是毛囊仅剩的结构(Fig. 22.120) 。
From the point of view of clinical management scarring alopecia represents a real ‘trichologic emergency’ because in a short period of time the hair follicles may be permanently destroyed. The resulting alopecia is irreversible and has a significant psychological impact. Therefore an early diagnostic and well-directed therapy are important to arrest the hair loss process. As the treatment is guided by the histopathologic findings, a scalp biopsy should be the first step in management.
从临床处理的角度来看，瘢痕性脱发是一种真正的毛发学急性病症，因为在短时间内毛囊可能会受到永久性破坏北影三剑客 。产生的瘢痕是不可逆性的，会对心理造成极大的伤害。所以早期的诊断和精准的治疗对于阻止毛发脱失至关重要。由于治疗以组织病理特征为依托，所以应该首先进行头皮的活检爱经全书 。
Scalp biopsies in cicatricial alopecia
瘢痕性脱发的头皮活检
Scalp biopsy is the most important test to achieve the diagnosis. Biopsies must be taken in all cases of primary scarring alopecia. These should be taken from the active border. Multiple biopsies may be necessary to reach a definitive diagnosis. Ideally, vertical and horizontal sections should be examined stained with hematoxylin and eosin, PAS, and elastic tissue stains. The use of horizontal and vertical sections yields the higher results as it enables the pathologist to evaluate the type and location of the inflamma- tory infiltrate特雷门琴 , the presence or absence of fibrosis, the morphology of the hair follicles, and their stage in the cycle (Fig. 22.121). In advanced cases in which only a scar without inflammatory infiltrate or hair folli- cles is present华天韵, direct immunofluorescence evaluation may be of great help in the differential diagnosis of discoid lupus erythematosus, lichen plano- pilaris, and pseudopélade of Brocq. For immunofluorescence the second half of the punch biopsy submitted for vertical sections may be used (see Fig. 22.10).
头皮活检是确诊的重要方法。所有的原发性瘢痕性脱发必须进行活检。活检应该选择的活动性的边缘。为了达到明确的诊断，多部位的活检是有必要的独眼枭 。理论上，HE、PAS、弹力组织染色都应该有纵切面和横切面的检查。横切面和纵切面的运用产生更好的结果，因为它可以使病理医生评估验证浸润的类型和位置、是否存在纤维化、毛囊的形态和毛发周期的阶段(Fig. 22.121)。在一些晚期的病例中黄铃 ，无炎症性浸润和毛囊，仅有瘢痕存在，直接免疫荧光检查在与盘状红斑狼疮、扁平苔藓、pleudopélade of Brocq 的鉴别诊断中是有帮助的。可以使用钻孔取材的另一半来进行免疫荧光检查。
It is important not to forget that the evaluation of patients with scarring alopecia requires very close clinicopathological correlation, detailed clinical history, and laboratory tests including serology for syphilis, direct Gram and PAS stains瞿铭 , and culture of the lesions.
重要的是不要忘记，瘢痕性脱发患者的评估需要仔细的临床病理联系，详细的临床病史和实验室检查如梅毒血清学检查、直接革兰染色和PAS染色和皮损组织的培养。
Fig. 22.120
Scarring alopecia, central centrifugal cicatricial alopecia: the hair follicles have disappeared and been replaced by two vertical fibrous stellae in which an arrector pili muscle (red ) is inserted. Scarring is complete and there is no inflammatory infiltrate
瘢痕性脱发，中央离心性瘢痕性脱发：毛囊消失，被两条垂直的纤维索替代，可见立毛肌插入。瘢痕完全形成，无炎症性浸润。高清解码器
Fig. 22.118
Scarring alopecia, central centrifugal cicatricial alopecia: (left张效铭 , right) the perifollicular connective tissue shows onion skin fibrosis and an inflammatory cell infiltrate in the superior segment. There are sparse sebaceous glands. Some follicles are fused (trichrome stain).
瘢痕性脱发，中央离心性瘢痕性脱发：（左、右）毛囊周围结缔组织显示洋葱形皮肤纤维化和表层炎症细胞浸润。可见散在的皮脂腺。有些毛囊已溶解（trichrome stain）
Fig. 22.119
Scarring alopecia, end-stage lupus erythematosus:
(left) there are several fused follicles with an inflammatory cell infiltrate and absent sebaceous glands; (right) elastic stain shows absence of staining in the dermis that surrounds the superior section of the hair follicle due to extensive loss of elastic fibers and scarring
疤痕性脱发，晚期红斑狼疮。左：可见许多溶解的毛囊，伴有炎症性细胞浸润和皮脂腺缺失；右：弹力纤维染色可见围绕毛囊的真皮染色缺失，这是由于广泛的弹力纤维缺失和瘢痕所致。
Fig. 22.120
Scarring alopecia, central centrifugal cicatricial alopecia: the hair follicles have disappeared and been replaced by two vertical fibrous stellae
in which an arrector pili muscle (red ) is inserted. Scarring is complete and there is no inflammatory infiltrate.
瘢痕性脱发，中心离心性瘢痕性脱发：毛囊消失，被两条垂直的纤维索代替，可见立毛肌插入叶川的夏天 。瘢痕完全形成，无炎症性浸润。
Fig 22.121
Scarring alopecia, vertical and horizontal sections: this biopsy has been cut in two planes allowing a complementary view of tufted folliculitis (polytrichia) with follicle fusion into a single follicular structure which contains multiple hair stems which emerge at the surface through a single ostium
瘢痕性脱发，纵切面和横切面：活检以两种平面进行切割，以互补的视角来观察簇状毛囊炎（多毛症），毛囊融合成单一的毛囊样结构，这种结构包含多个毛干，他们通过同一个开口突出皮肤表面矮乐多 。
浙江省人民医院皮肤科 皇幼明大夫译文
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