雄激素性脱发的分类进展

雄激素性脱发因性别、年龄及种族不同表现为不同的类型，随着其病因、发病机制和治疗的研究进展，其分类已得到多次修订与完善，现广泛采用Ebling分类法(男性)和Ludwig分类法(女性)。该文就雄激素性脱发的分类方法及进展作一介绍。     

50例女性型脱发的临床研究

目的：研究女性型脱发的临床、实验室结果及皮肤镜表现的特点。方法：对比分析50例女性型脱发患者及20例慢性休止期脱发患者的临床及实验室资料和皮肤镜表现,同时采集20例年龄相同、无脱发表现健康女性的头皮皮肤镜表现作为对照。结果：与慢性休止期脱发相比,女性型脱发患者中具有雄激素性脱发家族史者较常见,且其发病年龄较早。≤25岁女性型脱发患者的雄激素性脱发家族史阳性率最高、雌激素水平及E2/T值相对最低;25～40岁女性型脱发患者的血清铁蛋白水平最低;〉40岁女性型脱发患者严重脱发的发生率最高。女性型脱发患者的皮肤镜表现特点如头皮色素沉着、局部无毛征、棕色毛周征、白色毛周征和白点征与健康对照组相比有显著统计学差异。结论：遗传因素和低雌激素水平可能参与早发型女性型脱发的发病;低血清铁蛋白可能是中青年人发病的诱因之一;性激素水平的改变可能是中老年女性患者出现严重女性型脱发的原因之一。毛周征、头皮色素沉着、局部无毛征和白点征是女性型脱发的常见皮肤镜表现特点,其中白色毛周征不仅是严重脱发的表现,还可能是治疗预后不好的指标之一。     

雄激素性秃发的分类和分级方法

雄激素性秃发根据性别、种族、病情严重程度等可表现为不同的脱发模式,Hamilton-Norwood分类法通常用于男性型脱发,Ludwig法则适用于女性型脱发.BASP分类法涵盖种族、性别的差异,易于记忆和掌握.     

女性型脱发

1998年Kaufman等用口服非那雄胺治疗男性型脱发获得成功，女性型脱发引起重视。女性型脱发与雄激素分泌过多有关，流行病学发生率为87％，Olsen首次对女性型脱发作了分类又分了型，女性型脱发诊断尚无明确标准，治疗可外用5％米诺地尔，口服非那雄胺可能有效，也可用抗雄激素药治疗。     

女性型脱发的临床进展

女性型脱发(female pattern hair loss,FPHL)是成年女性脱发的主要原因,临床表现具有特征性,发病机制尚不完全清楚,可对患者生活质量造成影响[1].最初,该病被泛称为女性弥漫性脱发.1942年,Hamilton证实了雄激素在男性型脱发(male pattern alopecia,MPA)中的作用后,开始使用雄激素性脱发这一术语,以强调激素和遗传因素的作用.由于女性弥漫性脱发曾被认为是与MPA为同一疾病的不同亚型,人们开始改称女性雄激素性脱发.尽管男女两型脱发的毛囊改变相似,但其临床表现和对抗雄激素治疗的反应有差异,而雄激素在女性型脱发中的致病作用尚未完全阐明,故FPHL的命名比女性雄激素性脱发更合适[2].     

男性雄激素性脱发的激素参数

血浆激素水平的测定对依赖激素治疗的皮肤病是有用的诊断方法,也是激素治疗剂量是否恰当的依据。女性脱发常常是雄激素过高的指征,男性脱发则提示与多基因遗传有关,而雄激素性脱发是由于在脱发区雄激素代谢增强所致。5α—还原酶活力升高,将睾丸酮转成有活性的双氢睾丸酮,增加了结合在脱发区头皮皮脂腺中的雄激素受体,通过其靶器官—皮肤本身来调整血浆雄激素。在男子型脱发的女性病人中雄激素受体结合部位也增高。然而在男女性雄激素脱发中,很少有文献反映激素情     

SAHA综合征研究进展

SAHA综合征是女性患者雄激素功能过强而引起的一组皮肤症候群,主要临床特征为皮脂溢、痤疮、多毛及雄激素脱发.该综合征可在一系列疾病导致的外周雄激素水平增高基础上发生,也可由毛囊皮脂腺组织对正常循环雄激素水平过于敏感的应答导致.临床分为特发型,卵巢型,肾上腺型,高催乳素型和高雄激素-胰岛素抵抗-黑棘皮型.应在明确病因和临床类型的基础上个体化治疗.     

雄激素源性脱发与血液流变学变化的关系探讨

检测57例雄激素源性脱发患者的血液流变学变化,其中男性患者(男性型脱发)35例,女性患者(女性弥漫性脱发)22例,并与健康体检者进行对照,结果显示:男性患者全血黏度、红细胞压积、全血高切相对指数等均高于正常对照组,全血黏度以高切变率增高为主;女性患者红细胞压积高于正常对照组。提示:雄激素源性脱发与血液流变学变化存在相关性,血液黏度增高、血瘀可能是本病发病机制之一;雄激素源性脱发患者存在红细胞变形能力下降。     

雄激素性秃发治疗进展

雄激素性秃发是最常见的一种脱发,在基因易感的女性也同样常见。该文总结了针对男性和女性雄激素性秃发的内服药物（如非那雄胺、异维A酸、氟他胺、激素疗法等）、外用药物（如米诺地尔、非那雄胺凝胶等）、毛发移植和物理治疗（高压氧及激光）等治疗方法的原理、用法、不良反应等最新进展。     

螺内酯联合米诺地尔搽剂治疗女性雄激素源性脱发的疗效观察

目的:探讨螺内酯联合米诺地尔搽剂治疗女性雄激素源性脱发的临床疗效。方法:将84例女性雄激素源性脱发患者随机分成对照组(40例)和治疗组(44例)。对照组仅给予外用米诺地尔搽剂治疗;治疗组在外用米诺地尔搽剂治疗基础上给予口服螺内酯60 mg/d,连续服用6个月。治疗1、3、6个月后观察两组治疗效果及不良反应。结果:6个月后,治疗组有效率为59.09%,对照组有效率为37.50%,两组差异有统计学意义(2=3.91,P<0.05)。结论:螺内酯联合米诺地尔搽剂治疗女性雄激素源性脱发有效、安全,值得临床推广使用。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.