色素障碍性皮肤病

20101649白癜风患者406例临床调查分析/闫翠彦(天津医大研究生院),张峻岭,李丹凤∥中国皮肤性病学杂志.-2010,24(2).-123~125对406例白癜风门诊患者进行问卷调查,对各种涉及的因素及临床表现进行统计分析。结果白癜风患者以16~20岁为发病高峰,该年龄段占发病总数的16.34%。男女发病之比为1.16∶1,白癜风各型中散发型244例(60.10%),节段型8例(1.97%),有家族史者64例(15.76%)。伴晕痣28例(6.90%),伴发其他疾病者64例(15.76%)。认为白癜风发病高峰为青少年;有家庭史患者发病年龄早于无家族史患者;合并晕痣患者首发年龄早于无合并晕     

277例晕痣的临床回顾性分析

目的:总结晕痣的临床特点,初步探讨晕痣与白癜风的临床相关性。方法:对277例晕痣患者的临床特点进行分析,并对部分患者进行随访。结果:277例行晕痣切除术的患者中,皮损单发219例(79.06%),多发58例(20.94%)。好发于面颈部(54.86%)与躯干(37.03%)。106例患者(38.27%)并发白癜风,其平均发病年龄小于未并发白癜风者(P=0.041)。随访110例未并发白癜风的晕痣患者术后转归,17例继发白癜风,其中11例于半年内发生。比较未并发白癜风的晕痣患者与继发白癜风的晕痣患者,后者多发晕痣的比例高于前者(P=0.003)。结论:晕痣皮损以单发多见,面颈部好发。晕痣发病年龄小、皮损多发是白癜风发病的危险因素。手术切除是治疗晕痣的一种有效方法,晕痣切除术后半年可能是白癜风发生的高风险期,应密切随访。     

沈阳地区95例白癜风的临床研究及HLA-I抗原检测

本组95例白癜风是以10-20岁为发病高峰，其中65例（68.42%）发病前有诱发因素，以精神紧张及思虑过度占首位。6例（6.32%）伴发晕痣。有明确家族史者20例（21.05%),发生皮损早于无家族史者。白癜风与HLA-1类抗原相关。提示白癜风发病与免疫、遗传、神经精神因素有关。     

儿童白癜风临床及免疫学研究

目的 探讨儿童白癜风与免疫的关系.方法 采用统一设计的儿童白癜风临床特点调查表对本院门诊的14岁以下患儿及其家属进行调查.对270例患儿检测外周血免疫球蛋白、补体水平和T细胞亚群.结果 白癜风患儿620例中男302例(48.71%),女318例(51.29%),平均就诊年龄8.81岁,平均发病年龄7.57岁,平均病程8.14个月.累及头颈部453例,占73.06%.节段型160例,占25.81%.发病季节和疾病进展均以春夏季为多.73例患儿伴有晕痣,占11.77%,以散发型者居多.有家族史者84例,占13.55%.节段型患儿中,进展期的患儿血C3、c4水平明显低于稳定期患儿(P<0.05).寻常型患儿中,进展期的患儿血CD3+,CD4+细胞水平和CD4+/CD8+比值明显低于稳定期患儿(P<0.01).结论 白癜风患儿体内存在某些免疫指标的异常,可能与免疫紊乱有关.     

儿童白癜风260例临床分析

目的：研究儿童白癜风的临床特点,探讨其发病因素。方法：对前来我院就诊的260例白癜风患儿进行相关化验检查,采用问卷调查方式详细记录患者信息,运用SPSS 12.00统计学软件对资料进行统计学分析。结果：260例白癜风患者中,男女之间发病无统计学差异;患者以寻常型最为多见,多累及面部;有家族史者46例,占18.0%;合并慢性扁桃体炎者109例,咽后壁绿豆大小滤泡增生者198例,伴发晕痣者35例。患者就诊时多处于进展期,诱发以外伤为主,与正常组相比,白癜风患者进展期白细胞分类异常,但至稳定期后恢复正常。结论：儿童白癜风与遗传、外伤以及免疫性疾病如咽炎、扁桃体炎以及晕痣等因素相关。     

白癜风243例临床分析及与HLA-DQB1相关性研究

目的 总结和分析白癜风的临床特征及与两种HLA-DQB1等位基因的相关性,探讨白癜风的病因.方法 登记243例白癜风门诊患者的临床资料,利用聚合酶链反应-序列特异引物(PCR-SSP)法,对243例白癜风患者和250例健康人进行等位基因检测,对各项指标进行统计分析.结果 白癜风平均初发年龄男性为23.1岁,女性为23.7岁;首发类型以局限型为主,77%的节段型为儿童,家族史阳性患者发病年龄早于家族史阴性患者.白癜风与HLA-DQB1等位基因相关.结论 ①寻常型与节段型白癜风发病机制不同;②有阳性家族史者符合多基因遗传规律,有家族史和无家族史白癜风患者在其遗传背景上可能存在差异;③HLA-DQB1*0201可能是寻常型白癜风的易感基因或与易感基因相连锁.     

白癜风2 008例临床分析

目的：总结及分析白癜风患者的临床特点及意义，探讨白癜风发病机理。方法：对2008例白癜风门诊患者进行认真填写问卷调查表，对各种可能涉及的因素进行统计分析。结果：白癜风主要发生于青少年，5－10岁为发病高峰，该年龄段占发病总数的近18．4％。泛发者占34．4％，神经节段型占7．0％，有阳性家族史者占7．4％，合并自身免疫性疾病者占11．2％，晕痣占6．3％。结论：（1）目前的观察尚未能提出有意义的诱发因素；（2）有阳性家族史者符合多基因遗传规律；（3）白癜风并非完全后天发病，少数出生时即可发生。     

81例未成年人白癜风分析

目的 探讨未成年人白癜风患者临床特点及疗效。方法 从81例未成年人白癜风患者的性别构成、年龄分布、发病年龄、皮损分布部位、皮损分期及分型、家族史、免疫功能、病理及免疫病理、疗效等方面进行分析。结果81例未成年人白癜风患者男女性别构成约为1∶1.6。发病年龄最小6个月。各年龄段均可发病。皮损可累及人体多个部位包括黏膜,但以躯干及面部为多。寻常型明显较节段型多,寻常型者中又以局限型者为多。稳定期者较进行期者为多。不完全型较完全型者多。12例有家族史,但无明显家族遗传特征。3例白癜风患者免疫病理显示：基底膜带IgG沉积。在各型白癜风中局限性白癜风疗效最佳,肢端性及节段型次之而散发性、泛发性白癜风疗效较差。治疗起效时间最短2w,最长1m。治疗3m后痊愈14例（17.28%）,显效23例（28.40%）,有效率45.68%。结论 未成年人白癜风患者发病年龄小,病因不清,部分患者有家族史或免疫功能异常,疗效有待提高。     

节段型与非节段型白癜风临床特征比较及治疗现状初步调查

目的:了解白癜风不同临床类型的相关特征和常用治疗方法的临床应用情况.方法:采用问卷调查方法,收集临床资料,输入EPIDATA 3.1数据库,应用STATA软件对数据进行统计学分析.结果:调查的1 025例白癜风患者中,男女比例为0.83:1,临床类型中节段型占19.0%,非节段型占81.0%;局限型占总人数的18.3%,散发型占56.4%,肢端型占5.3%,而泛发型只占1%.平均发病年龄(23.2±12.5)岁,主要集中在11～20岁(40.2%),疾病平均病程为38个月(中位数),复发率为6.7%.同形反应、伴有晕痣各占16.9%和7.8%,且非节段型患者发生的概率皆高于节段型患者.通过比较各种治疗方法,光疗及自体表皮移植的治疗有效率较高,分别为80.3%和92.7%,但临床应用率较低,仅为16.6%和20.5%.结论:白癜风病程长,复发率低,非节段型患者出现同形反应、晕痣的比率高于节段型.临床上应大力推广光疗,对于稳定期的患者,可行自体表皮移植治疗.     

153例儿童白癜风临床分析

分析了１５３例儿童白癜风的临床资料。结果显示儿童白癜风发病年龄早，以５－７岁娄病高峰平均发病年龄６、７岁，伴晕痣患儿病情发展快。其中节段性白癜风占１７．６５％。其临床表现不同于非节段性白癜风。     

不同治疗方法对晕痣疗效的影响因素分析

目的 探讨晕痣临床特征及疗效影响因素。方法 对2016年2 - 11月门诊晕痣患者临床资料进行前瞻性研究,分析影响晕痣疗效相关因素。结果 250例患者共293处皮损,单发219例（87.6%）,多发31例（12.4%）;皮损位于躯干部154处（52.6%）、面颈部127处（43.3%）,直径5 ~ 20 mm。248例（99.2%）晕痣在自然病程中未完全自发消退。122例（48.8%）患者伴发白癜风。单因素分析显示,年龄、皮损数目、伴发白癜风和治疗方法是晕痣疗效的影响因素,多因素logistic回归分析显示年龄 ≤ 19岁或 ≥ 40岁、病程 > 1年、皮损单发、不伴发白癜风、接受祛痣治疗是晕痣治疗有效的独立影响因素。结论 大部分晕痣不能完全自发性消退。CO2激光或手术祛痣联合外用药是治疗晕痣的有效方法,未伴发白癜风晕痣患者可优先祛痣,伴白癜风者可在白癜风稳定后祛痣。多发晕痣或白癜风面积较大者更易复发,应密切随访。     

Vitiligo is associated with HLA-DR4 in black patients. A preliminary report

We have determined the HLA-DR and HLA-DQ phenotypes of 24 black patients with vitiligo and compared these with phenotypes of 143 local black controls. HLA-DR4 was significantly increased in patients, 38% vs 11% for controls. HLA-DQw3 was also increased in patients, 58% vs 32% for controls and may be explained in part by linkage disequilibrium with HLA-DR4. When patients were subgrouped according to family history of autoimmune disease and compared with controls, the increase in HLA-DR4 and HLA-DQw3 segregated with a positive family history. HLA-DRw6 in patients with a negative family history of autoimmune disease (64%) was significantly greater than the 10% in patients with a positive family history. When patients were subgrouped according to age at onset of disease, HLA-DR4 was increased in those with early onset of disease (younger than 20 years) while HLA-DRw6 was greater in patients who were older at onset of disease. These findings support the hypothesis of an immunogenetic influence on the expression of vitiligo in black patients with vitiligo.     

Clinical differences between segmental nevus depigmentosus and segmental vitiligo

Segmental nevus depigmentosus and segmental vitiligo can be difficult to differentiate from each other. Differential diagnosis of these two diseases is important because they have significantly different prognoses and psychological effects. The purpose of this study is to identify clinical clues that may be helpful in differentiating these two diseases. We enrolled 63 patients with segmental nevus depigmentosus and 149 patients with segmental vitiligo. Sex, age of onset, sites involved, dermatomal distribution, margin of lesion and presence of poliosis were evaluated in both groups. The age of onset was less than 10 years in 96.8% of segmental nevus depigmentosus and 28.9% of segmental vitiligo cases. Trunk (36.5%) and cervical (38.1%) dermatomes were the most commonly involved in segmental nevus depigmentosus and face (67.1%) and trigeminal (64.4%) dermatomes in segmental vitiligo. The average number of dermatomes involved in truncal lesions was different in segmental nevus depigmentosus and segmental vitiligo (2.71 vs 1.62, P = 0.001). Segmental vitiligo on the face, neck and trunk appeared closer to the axis than segmental nevus depigmentosus (P < 0.001). Segmental nevus depigmentosus and segmental vitiligo showed significantly different margins (90.5% and 41.6% serrated, respectively; P < 0.001). We observed clinical differences between patients with segmental nevus depigmentosus and those with segmental vitiligo. Distribution (site, distance to axis, dermatome), vertical width, margin of lesion and presence of poliosis can be helpful in differentiating segmental nevus depigmentosus and segmental vitiligo.     

Association of giant congenital melanocytic nevus, halo nevus and vitiligo in a 75-year-old patient

A giant congenital melanocytic nevus represents a rare condition. The halo phenomenon may be seen in congenital or acquired melanocytic nevi. In the literature, association of halo nevus and giant congenital melanocytic nevus is rare and the association of both with vitiligo even more rare. A 75-yearold woman at first consultation complained of a hyperchromic bluish-brown hairy macula on the lower back, buttocks and thighs present since birth and an achromic halo of onset three years ago. The histological features were consistent with congenital melanocytic nevus and halo nevus, respectively. After two years the patient developed achromic areas in normal skin, histologically consistent with vitiligo. The authors emphasize the rarity of this triple combination, the patient's age and the absence of malignant degeneration to date.     

Profile of childhood vitiligo in China: an analysis of 541 patients

From July to December 2002, we collected data from 2247 vitiligo patients in order to establish the clinical and epidemiologic profile of vitiligo in China. Of these patients, 541 (24.1%) were children aged equal to or less than 12 years. Of the 541 children, 274 (50.6%) were boys and 267 (49.4%) were girls, with a mean age of 8.87 years and a mean onset age of 7.28 years. Similar to adult patients, boys and girls were affected by vitiligo with equal frequency. The most frequent age of onset was between 4 and 8 years (42.5%). The mean duration of vitiligo was 19.71 months (range: 0-132 months). The most common type of vitiligo was vitiligo vulgaris, the frequency of which was 38.1%, followed by focal vitiligo (34.6%), segmental vitiligo (19.4%), acrofacial vitiligo (7.6%), and universal vitiligo (0.4%). Segmental vitiligo had an earlier the other types. Of the 541 children with vitiligo, 60 (11.1%) had a family history, and 3 (0.6%) had more than one family member who was affected. Forty-one (7.6%) children had an associated autoimmune disease: halo nevi and alopecia areata, which were observed in 39 (7.2%) and 2 (0.4%) children, respectively.     

31例晕痣的临床分析及光电镜观察

本文对31例晕痣的临床资料进行了分析,并作了7例光镜和4例电镜观察.结果表明:31例晕痣患者中伴发白癜风14例(45.1%).晕痣痣细胞周围有密集的淋巴细胞浸润.痣细胞有受损,最后则消失.晕痣的皮肤内郎格罕细胞增多.晕部表皮中黑素细胞消失.结果提示:晕痣的组织学特征符合免疫学改变.此外,本文实验还观察到晕痣组织中一种较为特殊的细胞,推测可能是郎格罕细胞在皮肤内行有丝分裂.     

1005例白癜风患者遗传因素的调查

目的 探讨白癜风患者发病过程中遗传因素所起的作用。方法 采用问卷调查方法收集1997年9月至2009年3月于我科门诊就诊的1005例白癜风确诊患者的临床资料,应用SPSS 13.0软件对所得数据进行统计学分析。结果 本调查的1005例白癜风先证者中,有家族史者206例,占20.5%。家族史阳性者的平均发病年龄（24.45 ± 15.87岁）比家族史阴性者（28.12 ± 16.88岁）小（P < 0.05）。家族史阳性者皮损双侧分布的比例比家族史阴性者高（71.3%比60.8%）（P < 0.05）。家族史阳性者以B型血居多（19.9%）,家族史阴性者以O型血居多（16.8%）（P > 0.05）。结论 ①白癜风的发病符合多基因遗传规律,具有家族聚集性,且血缘关系愈近,其发病率愈高。②白癜风的发病与性别无关。③家族史阳性者的平均发病年龄较家族史阴性者小,父系或母系遗传对发病年龄无影响。④家族史阳性者皮损双侧分布的比例较家族史阴性者高,而对其他临床表现无影响。     

Association of halo nevus/i and vitiligo in childhood: a retrospective observational study

Background Although halo nevus (HN) is frequently observed, the relationship between vitiligo and HN in children has rarely been investigated. Objectives To investigate the association between HN and vitiligo in children and understand if HN/HNi might be a risk factor for vitiligo. Methods Ninety‐eight patients with only HN/HNi and 27 with HN/HNi and vitiligo were investigated for number and localization of HN/HNi, family history for HN/HNi and vitiligo and personal and family history for autoimmune or other diseases. A follow‐up telephone interview was performed to investigate the evolution of HN/HNi and the possible onset of vitiligo and/or other diseases. Results In the HN/HNi and vitiligo group, HN/HNi and vitiligo had started almost simultaneously in 11 children; in nine, the onset of HN/HNi was followed by vitiligo after 6 months to 5 years; seven patients presented vitiligo first and HN/HNi after 3–9 years. Patients with associated vitiligo had, significantly more often, multiple HNi and a positive personal and/or family history of autoimmune thyroiditis compared with those with only HN/HNi. Follow‐up longer than 5 years was available in 54/98 patients with only HN/HNi; two of them, both with multiple HNi, developed vitiligo. After follow‐up, multiple HNi were noticed in 18/52 patients without vitiligo and in 9/11 of those in whom HN/HNi heralded vitiligo (s.s.). Conclusions In patients with multiple HNi, the risk of vitiligo and other autoimmune diseases seems to be higher than in pediatric patients with a single HN; clinicians should pay particular attention to children with multiple HNi and personal or family history of autoimmune diseases.     

白癜风患者215例临床分析

目的：总结白癜风患者的临床特点和发病诱因.方法：对确诊的白癜风患者进行问卷设计和调查,用SPSS 11.5软件包进行统计分析.结果：资料完整的215例白癜风患者中男98例,女117例;平均发病年龄18.76±7.43岁;最常见的受累部位为上肢（54.42%）;伴发疾病中以甲状腺疾病最常见（5.58%）;有家族史者占13.02%,有家族史患者发病年龄为14.6±4.31岁,无家族史为25.09±5.45岁（P〈0.001）,两者间有显著性差异;春夏季发病最常见;25.58%的患者可发现诱因,其中常见的诱因包括精神因素 （43.64%）和皮肤损伤（56.36%）.结论：本地区白癜风好发于青少年,有家族史患者发病年龄早于无家族史患者,上肢为最常见的好发部位,可能与精神因素和皮肤外伤、日晒伤有关.