获得性结节性脆发症1例

<正>患者男,29岁。头顶断发1年余。患者1年前染发、烫发后头顶部出现片状断发,断发周边可见白色小颗粒及结节,此部位牵拉头发易在结节处折断,断发处毛发干枯无光泽。患者多次更换洗发水并勤剪发均未见明显改善。遂于2020年7月3日至我科就诊。患者既往体健,家族成员中未见类似病史。     

结节性脆发症1例

报道1例结节性脆发症.患者女,46岁,8年前多次烫染发后出现头发易折断,并伴有毛干白色颗粒物附着.显微镜下示:受累毛发毛干结节处毛皮质膨胀,毛小皮撕裂,呈典型的"扫帚嵌接样",部分毛小皮脱落,无结节处毛干基本正常.皮肤镜下示:受累毛发毛干多处膨大结节,呈竹节状,部分毛小皮撕裂、脱落.     

获得性结节性脆发症1例

报告少见获得性结节性脆发症1例。患者女,46岁。患者头发易断,起尘样颗粒10年,全发远端出现尘样颗粒损害,易断,确诊为获得性结节性脆发症。     

以虫蚀状脱发为唯一表现的二期梅毒1例北大核心CSCD

患者男,29岁。头顶断发1年余。患者1年前染发、烫发后头顶部出现片状断发,断发周边可见白色小颗粒及结节,此部位牵拉头发易在结节处折断,断发处毛发干枯无光泽。患者多次更换洗发水并勤剪发均未见明显改善。遂于2020年7月3日至我科就诊。患者既往体健,家族成员中未见类似病史。     

环状发合并结节状脆发1例

患者女,25岁,头发异常14年.皮肤科检查示自然光下,头发呈现黑白相间,外观如沙砾样.皮肤镜下可见皮肤镜下可见毛干上有规律的交替明暗带,存在多个像沙粒一样的白点.显微镜下可见毛干棕黑相间,毛干结节似一对扫帚相对嵌接.诊断:环状发合并结节状脆发.     

全身泛发结节性痒疹1例

1临床资料患者女,36岁。全身泛发痒性结节、进行加重4年。4年前患者到一贮存毛线仓库中工作后,双小腿伸侧始发绿豆大小之淡红色丘疹,继而变为半球形疣状结节,瘙痒甚,在当地诊所以“湿疹”治疗欠佳,以后皮损缓慢增多、增大。1月前突然加重,泛发全身。患者家族中无类似疾病史。体     

结节性脆发症一例

结节性脆发症(Trichorrhexis Nodosa)的结节,即毛发反层的破裂处短毛端对端相接,毛发在这些结节处折断,结节的数目在一根毛干上可有一个或数个,根据毛发的长度而定,病发大多见于头皮,笔者见到一例报告如下.     

妊娠诱发红斑狼疮性结节性粘蛋白症1例

患者女 ,31岁 ,已婚。 1995年 12月面、颈出现钱币大小红斑 ,伴疲乏 ,以多形红斑予以治疗 (用药不详 ) ,无明显疗效。患者当时已妊娠 2月 ,因服大量药物 ,要求终止妊娠 ,1月后 ,皮疹渐消退。 1年半后 ,患者再次妊娠 2月后 ,面、颈出现同样皮疹 ,日晒后加重 ,双上肢、躯干出现点状至钱币大小的浅白色丘疹及结节 ,伴瘙痒、乏力、脱发 ,肘、膝及双手指关节肿痛 ,唇粘膜糜烂 ,口腔颊粘膜有数个溃疡 ,自服牛黄解毒片无明显疗效。 3周后 ,病情加重 ,皮疹渐增多 ,来我院就医。既往体健。家族中无同类疾患。体检 :Ｔ 38℃ ,Ｐ82次/ｍｉｎ ,Ｒ 2 0次 …     

Netherton综合征1例

报告1例Netherton综合征。患者女,43岁患者自幼全身皮肤反复出现红斑、脱屑,严重时有渗出．伴有瘙痒。平时头发不易梳理、易断．幼时曾有哮喘史。皮损组织病理改变符合迂回线性鱼鳞病．毛发电镜检查示毛发呈竹节状,在竹节处有套叠。     

局限型获得性结节性脆发症一例

患者男,22岁。因双耳后头发出现白色结节样改变2个月就诊。患者数年来坚持每日洗发,头发逐渐干枯、毛糙,2个月前发现双耳后头发出现白色结节样改变,头皮处无明显瘙痒、疼痛及红肿。患者曾怀疑患头虱,但未行特殊治疗,密切接触者及家族中无类似病史出现。体检：未见明显异常。血常规、肝功能、肾功能、血糖均正常。皮肤科情况：双耳后头发见沿发干排列的小米粒大小白色结节,结节粗糙,与头发粘连（图1）。头部皮肤无异常,其余部位头发及全身毛发未见明显异常改变。取患处头发光镜下检查：见结节发干皮质膨胀,部分断裂、蓬松,犹如两支画笔相对嵌接,无结节处毛发正常（图2）。根据患者病史、临床表现及光镜检查结果,诊断为局限型获得性结节性脆发症（trichorrhexis nodosa,TN）,嘱患者定期洗发、护发,减少头发刺激……     

皮肤型结节性多动脉炎1例

报告1例皮肤型结节性多动脉炎。患者女．57岁，躯干四肢出现水肿性红斑．伴疼痛6年．在病程进展中出观双下肢结节、溃疡和高血压，不能排除其病情向系统发展。皮损组织病理示：真皮及皮下脂肪组织中动脉血管壁增厚，纤维蛋白样变性．血管周围肉芽肿胜炎性细胞浸润。     

A Case of Trichorrhexis Nodosa Developed in Winter

A young Japanese man developed localized trichorrhexis nodosa (LTN) of the scalp hair in the winter season. To investigate the roles of shampoo, severe sunlight exposure and/or mechanical injuries, we performed the following studies. Hair was collected from the patient and from a control. The study was performed in two steps. In the first step, hair was put into shampoo, rinsed with saline water, and then exposed to ultraviolet B (UVB) radiation once a day for one week. In the second step, the hair was similarly treated, but each shaft was bent gently with forceps before UVB exposure. Scanning electron microscopic studies revealed cuticular changes when the hair was treated only with shampoo and UVB. When it was treated with shampoo, UVB, and mechanical bending, the patient's hair developed longitudinal and transverse fractures of the hair shafts, while the control hair showed only partial damage to the hair shaft. On the basis on the above findings, we conclude that mechanical bending may damage the hair shaft.     

Cutaneous polyarteritis nodosa

The term polyarteritis nodosa (PAN) presently includes classic systemic PAN, cutaneous PAN, and microscopic PAN (microscopic polyangeiitis). Cutaneous PAN involves the deep dermis and the panniculus, with anatomopathological findings diagnostic for arteritis. The most frequent clinical manifestation of cutaneous PAN is the presence of nodules on the lower legs, which frequently are found at different stages of development. At times, they may not leave residual changes, but generally a violaceous livedoid color or pigmentation with retiform appearance persists for months and even years. Ulceration also is a frequent complication of cutaneous PAN. Pain, arthralgias, malaise, and moderate fever are frequently associated symptoms. Histopathologically, cutaneous PAN shows a single artery involved with diagnostic inflammatory changes. The involved artery is always located in the deep dermis or in the panniculus. Inflammatory active skin nodules show a necrotizing arteritis with variable amounts of fibrinoid necrosis and leukocytoclasia, edema and inflammatory cells. The presence of focal panniculitis surrounding the involved artery is characteristic, in contrast with the more diffuse panniculitis usually found in other nodular diseases. Cutaneous PAN has a variable course, with repeated exacerbations. Salicilates relieve the pain in most instances and may be the only treatment required to improve the symptoms in patients with moderate flare-ups. A short course of corticosteroids therapy at a moderate dose is the most effective treatment to relieve the symptoms and to reduce the inflammation. Patients with an increased ASO titer should always be treated with penicillin.     

Hair shaft abnormalities: Part I

The light microscopic and electron microscopic appearances of the normal hair are briefly described. The major hair shaft abnormalities are reviewed in two parts, discussing clinical characteristics, light and electron microscopy and, where information is available, the pathogenesis of these rare conditions. Part I describes monilethrix, pili torti and trichorrhexis nodosa.     

Cutaneous polyarteritis nodosa

Classic polyarteritis nodosa (PAN) is a segmentary leucocytoclastic vasculitis that affects small- and medium-sized arteries. In 1931, Lindberg (Acta Med Scand 1931; 76: 183-225) described the existence of a cutaneous variant of PAN, without visceral involvement and with a more favourable prognosis. We present four patients diagnosed with cutaneous PAN in our hospital between 1987 and 1998. The study group was composed of three women and one child, whose ages ranged from 11 to 70 years old. The follow-up period was between 2 and 13 years. Each patient was submitted for an initial clinical, histological and laboratory evaluation and subsequent follow-up. The presence of nodules was the most frequent cutaneous lesion, preferentially located in the lower limbs. The erythrocyte sedimentation rate was the only parameter that was altered in all patients. Cutaneous biopsies from all patients showed a segmentary leucocytoclastic vasculitis in the arteries of the deep dermis and/or hypodermis. Direct immunofluorescence was positive in just one patient. No visceral involvement was found in any patient. There is confusion about the correct definition of cutaneous PAN. Some clinical findings, such as nodules or livedo reticularis, typical of cutaneous PAN suggest a good prognosis; however, we consider that it is necessary to evaluate these patients for systemic involvement for the possibility of arteritis in other organs as the term polyarteritis suggests.     

Cutaneous polyarteritis nodosa: a clinical and histopathological study of 20 cases

Twenty cases diagnosed as cutaneous polyarteritis nodosa (CPN) and confirmed by skin biopsy over the last 17 years were reviewed in our department. Based upon their clinical features, laboratory findings, and long-term observation of the disease course, they were divided into three groups. 1) Group 1 comprised 16 cases which were classified as the mild cutaneous form. The disease was confined to the skin with occasional involvement of peripheral nerves and skeletal muscles of the affected extremity. They generally followed a benign course. 2) Group 2 comprised 2 cases classified as the severe form. Despite severe clinical manifestations and several abnormal laboratory findings, the disease was limited to the skin, muscles, and peripheral nerves without any visceral involvement over follow-up periods of 11 years and 5 years, respectively. 3) Group 3 comprised 2 cases of the progressive form; in these the disease had begun with a cutaneous lesion and progressed to the systemic form after 19 and 18 year periods of recurrent episodes of cutaneous lesions, respectively. One died of gastrointestinal bleeding. In group 3, serum antinuclear antibodies and rheumatoid factor were positive. The autoimmune mechanism seems to play a role in this group. It is clear from the results of this study that not all patients whose vasculitic lesions are apparently limited to the skin remain in a benign course. Long-term follow-up is essential.     

Hypotrichosis and nail dysplasia: a novel hidrotic ectodermal dysplasia

We report a unique isolated hair and nail ectodermal dysplasia in a 3-year-old girl. Clinical examination revealed short, sparse scalp hair, absent eyebrows, short eyelashes and nail dystrophy in all digits. Nail changes included shortened nail plate with distal onycholysis and loss of the cuticle. Sweating and teeth were normal. Development was normal. Scanning electron microscopy of the hair only demonstrated trichorrhexis nodosa. There was no pili torti. Vertically sectioned scalp biopsy revealed hypoplastic hair follicles and a horizontally sectioned biopsy showed a decrease in the overall number of hair follicles present. Treatment with topical minoxidil 5% 1 mL twice each day massaged into the scalp led to only minimal improvement and was discontinued after 12 months.     

皮肤镜诊断获得性结节性脆发症二例

例1 女,12岁。因头发远端起串珠样白点,开叉易断1年就诊。患儿1年前无明显诱因出现头发远端干枯,起串珠样白点,开叉,轻拉即断,未予重视和处理,否认有染发、烫发史。既往体健,家族成员中无类似疾病史。体检：发育正常,智力正常,各系统检查未见异常……