毛发疾病诊断技术和方法北大核心CSCD

毛发是机体健康的外表重要标志之一,涉及毛发的疾病直接影响心理健康和生活质量。毛发分布的密度和毛干直径是决定毛发是否能够正常地覆盖头皮的重要因素。毛囊是生成毛发的器官,由来源于不同胚层的多种细胞组成,具有生长期、退行期和休止期的周期性循环,毛干的产生和延长仅限于生长期。从毛囊的长轴来看,自表皮至皮下组织,毛囊分为永久和次级毛囊即暂时性毛囊,分水岭在立毛肌的附着点附近。次级毛囊经历生长期、退行期和休止期的周期性改变,它的最下端是毛囊的球囊部,是毛干形成的部位,由真皮结缔组织形成的毛乳头供给营养。     

毛发疾病诊断技术和方法

毛发是机体健康的外表重要标志之一,涉及毛发的疾病直接影响心理健康和生活质量.毛发分布的密度和毛干直径是决定毛发是否能够正常地覆盖头皮的重要因素.毛囊是生成毛发的器官,由来源于不同胚层的多种细胞组成,具有生长期、退行期和休止期的周期性循环,毛干的产生和延长仅限于生长期.从毛囊的长轴来看,自表皮至皮下组织,毛囊分为永久和次级毛囊即暂时性毛囊,分水岭在立毛肌的附着点附近.次级毛囊经历生长期、退行期和休止期的周期性改变,它的最下端是毛囊的球囊部,是毛干形成的部位,由真皮结缔组织形成的毛乳头供给营养.     

毛发疾病皮肤镜诊断专家共识

正毛发疾病的皮肤镜诊断具有无创性和快捷性,能够提供毛囊单位在皮面开口处、皮表微细结构、毛干形态、毛细血管和发根形态的信息。而且常见的脱发疾病具有与病理改变相关联的特征性皮肤镜征象,可用于脱发疾病的诊断和鉴别诊断工作,在一定程度上减少活检和病理检查的机率。本共识详细阐述了常见脱发疾病的皮肤镜征象,重点在于提供瘢痕性和非瘢痕性脱发诊断和鉴别诊断的依据。     

毛发老化

毛发老化包括毛干的剥蚀作用以及毛囊的老化。前者包括整个毛干纤维逐渐退化，后者表现为头发变白，或者头发生长缓慢。内在因素和外在因素均会导致毛发老化。外用抗毛发老化的药物包括护发素、光防护剂和抗氧化剂。染发是治疗灰发症的主要手段。目前用于治疗雄激素源性脱发的方法包括外用米诺地尔、口服非那雄胺以及自体毛发移植术。生物工程技术将在抗毛发老化方面发挥作用。     

雌激素对毛囊作用的研究进展

毛发疾病中仅少部分患者是由于毛干生长紊乱引起，绝大多数还是因为毛发周期变更导致的。雌激素可调节毛发生长，在多数生物中抑制其生长。目前对毛囊中雌激素靶细胞和准确信号通路了解甚少。雌激素还和一些酶及细胞因子间存在复杂的相互作用，形成一个网络，发挥生物学效应。     

雄激素性秃发的皮肤镜特点及其与临床的关系

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。     

硫缺乏性脆毛病

硫缺乏性脆毛病(Trichothiodystrophy)是一种罕见的毛发疾病.系常染色体隐性遗传(仅有1例提示和X-性联遗传有关).临床表现为毛发干燥稀疏,毛干损伤时容易折断,而毛发颜色无明显异常,目前尚无有效的治疗方法.此病常伴有严重的神经外胚叶病变,但此并非为恒定的特征.     

生长期毛发松动综合征二例毛发形态学观察

目的 探讨2例生长期毛发松动综合征患者毛发形态。方法 普通显微镜、扫描电镜、透射电镜观察患者的毛干及毛囊。结果 光学显微镜下见毛球变形,发干扭曲、损伤、断裂,远端明显尖细。扫描电镜下见患者毛球变形扭曲,毛护膜边缘呈波浪状等。透射电镜下见病变主要在内毛根鞘,内外毛根鞘细胞均见多数空泡化改变,细胞间黏附减低,桥粒结构减少或消失等。结论 生长期毛发松动综合征患者病变主要在内毛根鞘。     

常见脱发疾病皮肤镜征象与病理的联系

在毛发领域,皮肤镜主要用于观察毛干和毛囊单位形态、皮肤表面结构的颜色、血管形态和病原体等.常见的脱发疾病有其特殊的皮肤镜征象,可用于诊断、鉴别诊断及疾病活动程度和治疗结果的评判,例如瘢痕性和非瘢痕性脱发的鉴别诊断、急性弥漫性脱发的病因判断等.     

衰老性脱发

衰老性脱发常发生在50岁及以上人群,是一种毛囊的衰老表型,主要表现为一定年龄以后的毛干直径、毛发密度、毛囊生长期/休止期比率的逐年下降,并由此带来相应的生理和心理影响。但衰老性脱发的独立诊断仍存在争议,其发生的病理生理机制也不清楚,预防和减缓衰老性脱发的发生在当前还缺乏有效办法。本文旨在阐述当前有关衰老性脱发在定义、临床特征、与其他常见毛发疾病之间的关系、病理机制及预防治疗方法等方面的研究进展,以提高人们对该疾病的认知,并对未来的研究提供一些借鉴。     

Hair shaft abnormalities--clues to diagnosis and treatment

Hair dysplasias are congenital or acquired alterations which often involve the hair shaft. Hair shaft abnormalities are characterized by changes in color, density, length and structure. Hair shaft alterations often result from structural changes within the hair fibers and cuticles which may lead to brittle and uncombable hair. The hair of patients with hair shaft diseases feels dry and looks lusterless. Hair shaft diseases may occur as localized or generalized disorders. Genetic predisposition or exogenous factors produce and maintain hair shaft abnormalities. Hair shaft diseases are separated into those with and those without increased hair fragility. In general, optic microscopy and polarized light microscopy of hair shafts provide important clues to the diagnosis of isolated hair shaft abnormalities or complex syndromes. To establish an exact diagnosis of dysplastic hair shafts, a structured history and physical examination of the whole patient are needed which emphasizes other skin appendages such as the nails, sweat and sebaceous glands. Profound knowledge on hair biology and embryology is necessary to understand the different symptom complexes. Therapy of hair shaft disorders should focus on the cause. In addition, minimizing traumatic influences to hair shafts, such as drying hair with an electric dryer or permanent waves and dyes, is important. A short hairstyle is more suitable for patients with hair shaft disorders.     

[Translated article] Keys to the Diagnosis of Hair Shaft Disorders: Part I

Hair shaft disorders, involving dysplastic abnormalities in the shaft, may be either congenital or acquired. Two large categories have been defined according to the presence or not of hair fragility. A diagnosis can usually be made after taking a thorough medical history and performing a physical examination. Trichoscopy has become a useful, cost-effective tool in recent years, particularly for examining the hair of children, because it facilitates inspection without removal of hairs. Structural abnormalities in the hair shaft are sometimes clues to the diagnosis of more complex diseases in which early treatment can improve prognosis. This review describes key features that enable the diagnosis of the most common hair shaft disorders and discusses the various treatments currently available.     

Claves diagnósticas en displasias pilosas I

Hair shaft disorders, involving dysplastic abnormalities in the shaft, may be either congenital or acquired. Two large categories have been defined according to the presence or not of hair fragility. A diagnosis can usually be made after taking a thorough medical history and performing a physical examination. Trichoscopy has become a useful, cost-effective tool in recent years, particularly for examining the hair of children, because it facilitates inspection without removal of hairs. Structural abnormalities in the hair shaft are sometimes clues to the diagnosis of more complex diseases in which early treatment can improve prognosis. This review describes key features that enable the diagnosis of the most common hair shaft disorders and discusses the various treatments currently available.     

[Translated article] Keys to the Diagnosis of Hair Shaft Disorders: Part II

Hair shaft disorders, involving dysplastic abnormalities in the shaft, may be caused by genetic mutations or acquired through environmental exposures. The second part of this review presents these disorders classified according to the degree of hair fragility. It is important to take a thorough medical history and examine the hair to detect changes in texture, density, quality, and whether fragility is observed or not. Trichoscopy is a useful, noninvasive tool that can suggest a diagnosis in most cases. Specific treatments for hair shaft disorders are not available at present. We recommend general care practices to prevent hair damage; examples are avoiding excessive brushing, chemical products, hairstyles that introduce tension, and exposure to excessive heat. Some hair shaft disorders improve with puberty. Others may respond to treatments such as topical applications of minoxidil.     

Claves diagnósticas en displasias pilosas II

Hair shaft disorders, involving dysplastic abnormalities in the shaft, may be caused by genetic mutations or acquired through environmental exposures. The second part of this review presents these disorders classified according to the degree of hair fragility. It is important to take a thorough medical history and examine the hair to detect changes in texture, density, quality, and whether fragility is observed or not. Trichoscopy is a useful, noninvasive tool that can suggest a diagnosis in most cases. Specific treatments for hair shaft disorders are not available at present. We recommend general care practices to prevent hair damage; examples are avoiding excessive brushing, chemical products, hairstyles that introduce tension, and exposure to excessive heat. Some hair shaft disorders improve with puberty. Others may respond to treatments such as topical applications of minoxidil.     

Hair loss: an overview

Hair loss is a common problem in men and women. Correct diagnosis of hair disorders is complex and requires evaluation of clinical presentation, history, physical examination, and laboratory tests. Hair loss may be categorized as hair shaft abnormalities, permanent alopecia, or nonpermanent alopecia. Nonpermanent alopecia, the most common type, includes androgenetic alopecia, telogen effluvium, alopecia areata, and traction alopecia. The hallmark of this group is the possibility of complete regrowth with adequate treatment.     

Office diagnosis of hair shaft defects

Hair shaft abnormalities are fascinating and can provide a diagnostic challenge. Current knowledge of structural changes in hair has been amplified by scanning and transmission electron microscopy (SEM and TEM). Dermatologists using the light microscope and polarization in the office can diagnose the great majority of hair shaft defects. A number of these defects are illustrated here.     

Hair and systemic disease.

Hair loss (alopecia) occurs as a manifestation of numerous systemic diseases, but usually can be categorized into one of five general groups: telogen effluvium, anagen arrest, follicular destruction, hair miniaturization, and hair shaft defects. An excess of hair also can be evidence of internal disease, and there are two general categories of increased hair density: hypertrichosis and hirsutism. The basic categories of hair disease and the systemic conditions associated with them are discussed. The history, physical examination, and histopathologic data usually are sufficient to categorize the form of hair disorder and may provide a clue to the nature of the underlying systemic disease.     

Prognosis and Management of Congenital Hair Shaft Disorders with Fragility—Part I

Hair shaft disorders are characterized by congenital or acquired abnormalities of the hair shaft. The objective was to review the literature regarding the prognosis and treatment options of hair shaft disorders. We used keywords in the search engines PubMed and Medline to identify all publications in the English language related to the prognosis and management of hair shaft disorders. Data were extracted from 96 articles that met search criteria. Findings were limited to case reports and small case series, as no studies were found. Disorders that improve in childhood include pili torti, trichorrhexis invaginata, wooly hair, and pili trianguli et canaliculi. Others, such as trichorrhexis nodosa, monilethrix, pili annulati, and pili bifurcati improve with minoxidil. Oral retinoids have improved hair abnormalities in trichorrhexis invaginata and monilethrix. There is no specific treatment for congenital hair shaft abnormalities. Gentle hair care is the mainstay of care for hair shaft disorders associated with fragility. Practices for gentle care include no brushing, backcombing, chemical products, tight braids, heat exposure, or mechanical grooming. Any inherited or congenital disorder requires genetic counseling as part of management.     

Prognosis and Management of Congenital Hair Shaft Disorders without Fragility—Part II

Hair shaft disorders are characterized by congenital or acquired abnormalities of the hair shaft. The objective of this study was to review the literature regarding the prognosis and treatment options for hair shaft disorders. We used keywords in the search engines PubMed and Medline to identify all publications in English related to the prognosis and management of hair shaft disorders. Data were extracted from 96 articles that met search criteria. Findings were limited to case reports and small case series, as no studies were found. Disorders that improve in childhood include pili torti, trichorrhexis invaginata, woolly hair, and pili trianguli et canaliculi. Others, such as trichorrhexis nodosa, monilethrix, pili annulati, and pili bifurcati, improve with minoxidil. Oral retinoids have been found to improve hair abnormalities in trichorrhexis invaginata and monilethrix. There is no specific treatment for congenital hair shaft abnormalities. Gentle hair care is the mainstay of care for hair shaft disorders associated with fragility. Practices for gentle care include no brushing, backcombing, chemical products, tight braids, heat exposure, or mechanical grooming. Furthermore, any inherited or congenital disorder requires genetic counseling as part of management.