以颞部受累为主的女性型脱发

报告1例以颞部受累为主的女性型秃发。患者女,66岁。双侧颞部脱发20余年。皮肤科检查:患者两侧颞部毛发稀疏明显,发质细软,头顶、额部及枕部毛发分布大致正常,拉发试验阴性。皮肤镜检查:患者两侧颞部可见毛干粗细不均,毛发直径异质性增加,毳毛样毛发的比例>50%,可见大量无毛干的毛囊开口,无断发、黑点征及惊叹号样发。患者的头顶部、额部及枕部毛发数量大致正常,毛发粗细一致,毛囊开口数量大致正常。诊断:女性型脱发。     

先天性三角形脱发1例

正患儿男,9岁。左侧颞部三角形脱发9年,于2018年8月27日来宁波市北仑区人民医院就诊。患儿出生时即发现左侧颞部三角形脱发区,无红肿,随年龄增大而增大,无自觉症状。既往体健,家族中无类似疾病患者。体格检查:一般情况好,各系统检查均正常。皮肤     

姐妹3人同患先天性秃发

先天性秃发临床较少见。笔者于门诊遇到同胞姐妹 3人同患本病 ,现报告如下。例 1　女 ,14岁。自 1周岁起 ,额顶部头发逐渐变细软 ,失去光泽。继之呈弥漫性脱落 ,至 9岁时基本完全脱落 ,趋于稳定 ,至今仍未恢复。脱发区边缘整齐 ,状似男性型脱发 ,中心残存少量细软毛发。颞部及枕部毛发正常。例 2　女 ,11岁。自 4岁起 ,枕部开始脱发 ,渐波及额顶部 ,至今未见缓解。枕部脱发区边缘较清晰 ,呈三角形 ,边长约 5ｃｍ。中央头皮光滑 ,无毛发存留 ,毛孔消失。额部及顶部脱发区呈小片状类似斑秃。周边毛发细软 ,但不易拔除 ,用力拔除可带有毛根及毛…     

前额纤维化性脱发二例

例1女,44岁,额颞部发际线后移4年,面部多发性肤色小丘疹2年.皮肤科检查:额颞部发际线后移,局部皮肤光滑菲薄,可见残存的细小毛发;眉毛、腋毛和阴毛部分脱落;额颞部、双下颌角处可见弥漫性分布许多粟粒大小的肤色小丘疹.皮肤镜下可见毛囊开口数减少,毛发直径不一,瘢痕性白斑和毛囊周围红斑.例2女,55岁,额颞部毛发稀少2年.皮肤科检查:双侧额颞部发际线后移,眉毛、腋毛和阴毛部分脱落.2例患者的组织病理检查均可见毛囊周围以淋巴细胞为主的浸润,基底细胞液化变性,毛囊周围有板层状纤维化.2例患者的临床和组织病理表现均符合前额纤维化性脱发的诊断.     

拉皮除皱术后急性休止期脱发一例

患者,女,拉皮除皱术后脱发2个月.顶部及颞部弥漫性脱发,起病急,进展快,全头皮轻拉试验阳性,皮肤镜下见大量休止期发.诊断为急性休止期脱发.予米诺地尔联合哈西奈德喷涂,复合维生素片、维D2磷酸氢钙片口服.毛发恢复良好.     

婴幼儿颞部三角形脱发皮肤镜和反射式共聚焦显微镜特征分析

目的 分析婴幼儿颞部三角形脱发(TTA)的皮肤镜和反射式共聚焦激光扫描显微镜(RCM)特征,探讨皮肤镜和RCM对TTA的辅助诊断价值.方法 收集2015年1月-2020年12月在天津市儿童医院皮肤科门诊就诊的TTA患儿10例,行皮肤镜和RCM检查,记录图像特点.结果 皮肤镜图像显示,皮肤颜色大致正常,毛囊开口数量大致正...     

儿童颞部三角形脱发合并斑秃1例

1临床资料患儿男,8岁,右侧颞部局限性脱发6年余,头顶部小片脱发2个月。患儿家长在其2岁时即发现右侧颞部有约蚕豆大小脱发区,至当地医院就诊,诊断“斑秃”,予补充微量元素,外用中药生发液等治疗无效。此后6年,患儿曾至多家医院就诊,均诊断为“斑秃”,具体治疗不详,效果不佳。2个月前患儿头顶部出现新的蚕豆大小脱发区,遂至本院皮肤科就诊。患儿既往体健,发育正常。体检:系统查体无异常。皮肤科情况:右侧颞部见蚕豆大小卵圆形脱发区,可见较多毳毛;头顶部见蚕豆大小脱发区,边界清楚,见少许断发;两处脱发区均未见红斑,脱屑,萎缩,脓疱(图1)。两处脱发区拉发试验、真菌镜检及Wood灯检查均阴性。     

先天性胎毛性多毛症一例

3岁6月龄男性患儿,全身皮肤多毛3年6个月。皮肤科检查:眉毛粗黑,额部、四肢及臀部皮肤可见大量浓密黑色毛发,胸腹及背部毛发稍多但细软,面颊部、下颌部毛发正常;牙齿有龋齿,门牙间隙增宽。诊断为先天性胎毛性多毛症。     

颞三角形脱发一例

患者男,29岁,出生时右颞侧即有一斑秃样秃发区。出生后不久在此秃发区前方长一蚕豆大小结节,手术切除后形成瘢痕。平素身体健康,无家族性遗传病史。多年来两处一直未长头发,无自觉症状,未予治疗。2014年6月来我院就诊,检查：右颞侧两个秃发区（图1）,分别是类圆形手术瘢痕（2 cm ×2 cm）和长条形秃发区（1 cm ×4 cm）。两处秃发区头皮均无发红、脱屑等。切取两处秃发区头皮行组织病理检查。病理表现：瘢痕处部分真皮纤维组织增生,附属器减少,可见毛囊索（图2）,符合瘢痕。脱发处表皮、真皮未见明显异常,毛囊数量正常,但毛囊毳毛化,无炎症浸润（图3）,结合病史,考虑颞三角形脱发可能。1个月后加测毛发镜：两处偏振光下均可见毛细血管扩张,表明尚有一些炎症（手术取材引起）。瘢痕区油脂分泌正常,未见毛囊开口,并可见数个黑点（图4）。秃发区油脂分泌正常,可见一些细而软的毳毛,无黄点征、黑点征、惊叹号样发等（图5）。结合病史、组织病理及毛发镜检查,秃发区诊断为颞三角形脱发,另一处为手术瘢痕。     

斑驳病1例

患儿,男,5个月。因额部、胸腹部白斑于1999年5月19日来诊。患儿自出生时额部、胸腹部即有不规则白斑,并且白斑随年龄及体表面积增大而扩大。否认家族史。体检一般情况好,各系统检查无异常。皮肤科所见：额部正中三角形白斑,上窄上宽,白斑向上从额至头顶、头后方呈锥形延伸,越来越细,终止于枕部以上,整个头部的白斑区毛发稀疏且白,白发区毛发呈网眼状,此即“白色额发”（图1）。胸腹部正中可见形状不规则,双侧不对称的白斑,似地图状（图对。额部、胸腹部白斑境界清楚,周围无色素增生,白斑区内可见岛屿状正常色素斑点。四肢及…     

雄秃样纤维性秃发一例

【摘要】 报道1例雄秃样纤维性秃发（FAPD）及其临床病理、皮肤镜和TrichoScan特征,以提高对FAPD的认识。患者男,23岁,前额及头顶部进行性脱发10年,伴局部头发变细、软,偶有头皮瘙痒。皮肤科检查：前额至头顶部头发弥漫性稀疏,前额发际线后移,局部发质细软,脱发区可见部分毛囊角化性丘疹、毛囊周围红斑,未见明显鳞屑。TrichoScan检查：毛发密度明显降低,毳毛比例增加。皮肤镜检查：部分毛囊开口消失,融合性白点征。头皮组织病理检查：毛囊漏斗部、峡部淋巴细胞苔藓样浸润,毛囊周围同心层状纤维化,毛囊结构破坏,毛囊性微瘢痕形成,残留毛囊直径变异度明显增加,可见部分毳毛。诊断：FAPD。FAPD临床易误诊为雄激素性秃发,需及早诊断并治疗。     

Quantification of hair follicle parameters using computer image analysis: A comparison of androgenetic alopecia with normal scalp biopsies

Computer image analysis enables large numbers of hairs to be measured in an automated fashion. In this study, we examined horizontal scalp biopsies from 10 patients with a histological diagnosis of androgenetic alopecia and 10 normal control subjects. The density of hair follicles and the ratio of terminal to vellus hairs were determined. Hair shaft, hair canal and hair follicle diameter, inner root sheath width and outer root sheath area were measured using the Chromatic Colour Image Analysis program. This study showed a statistically significant progressive decrease in size of hair canal diameters from normal terminal hairs (85.93 ± 10.07 μm) through to androgenetic alopecia terminal (68.83 ± 13.60 μm) and vellus hairs (28.67 ± 5.60 μm). This pattern is also seen with hair follicle diameters; normal terminal (268.41 ± 24.88 μm), androgenetic alopecia terminal (236.34 ± 17.23 μm), and vellus hairs (130.88 ± 19.96 μm). Outer root sheath areas, hair shaft diameters and ratio of terminal to vellus hairs were significantly larger in normal (18500 ± 4222 μm²; 82.71 ± 13.79 μm; 36:1; respectively) compared with androgenetic alopecia scalp biopsies (8403 ± 3322 μm²; 61.11 ± 14.42 μm; 3:1; respectively), whereas inner root sheath width and density did not vary significantly. Computer image analysis can be adapted for use in clinical trials where large numbers and objectivity are critical in determining the efficacy of hair growth promoters.     

Use of dermoscopy in the diagnosis of temporal triangular alopecia

Temporal triangular alopecia, also referred as congenital triangular alopecia, is an uncommon dermatosis of unknown etiology. It is characterized by a non-scarring, circumscribed alopecia often located unilaterally in the frontotemporal region. It usually emerges at ages 2-9 years. Alopecia areata is the main differential diagnosis, especially in atypical cases. Dermoscopy is a noninvasive procedure that helps distinguish temporal triangular alopecia from aloepecia areata. Such procedure prevents invasive diagnostic methods as well as ineffective treatments.     

Case for diagnosis

A 6 year-old patient began to experience localized hairloss in the right temporal region three years ago. During the first appointment, diagnoses of alopecia areata and congenital triangular alopecia were made. After one year, there was no change. Upon dermatological examination, non-scarring alopecia was noted in the right temporal region, revealing extremely fine and fair hair follicles. A dermoscopy revealed only thin vellus-type hairs. Congenital triangular alopecia is a condition commonly confused with alopecia areata and is thus underdiagnosed. However, well-established clinical parameters and dermoscopic criteria can be used to distinguish skin diseases that affect hair and define the diagnosis.     

Hair counts from scalp biopsy specimens in Asians.

BACKGROUND: Differences in hair density have been described according to the ethnic background in whites and blacks. Asians are known to have fewer hairs than whites. OBJECTIVE: We performed this study to assess the normal values of hair counts in scalp biopsy specimens from Koreans. METHODS: A total of 35 subjects with clinically normal occipital scalps (13 patients with androgenetic alopecia, 20 with patchy alopecia areata, and 2 healthy volunteers) were included. Horizontal sections of 4-mm punch biopsy specimens from clinically normal occipital scalps were examined at various levels from the papillary dermis to the subcutis, and follicular counts of terminal/vellus hairs and anagen/telogen hairs were obtained. RESULTS: The numbers of total hairs, terminal and vellus hairs, and terminal anagen hairs were significantly lower (P <.05) in Koreans compared with the published data of whites and blacks. Percent ratio of terminal anagen and telogen hairs were similar to whites and blacks. Follicular density was significantly lower (P <.05) in Koreans than in whites and blacks. In Koreans, female subjects had a significantly higher number of terminal hairs than male subjects (P <.05). CONCLUSION: Hair density is significantly lower in Koreans than in whites or blacks. Slight sexual difference exists in follicular counts in Koreans. Our data could be used as a guideline for determining normalcy in interpreting horizontal sections of scalp biopsy specimens from Asians.     

Topical minoxidil therapy for hereditary male pattern alopecia

Minoxidil solution 2.8 percent applied topically produced new hair growth in patients with male pattern alopecia. An open trial involving 777 male patients was conducted over thirty-two months. Of these patients, 133 were followed for six months or longer. Forty-five percent noted growth that varied from a few vellus hairs to terminal hair. Better response was seen in patients who underwent longer treatment and who had type I or type II alopecia. Subjective evaluations by the patients were better than objective evaluations. No serious systemic effects of minoxidil were encountered; however, in one patient allergic contact dermatitis occurred. The mechanism of this growth is presently unknown but may be related to a vasodilatory effect or direct cell stimulation.     

Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts in horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men and postmenopausal women

Hair regrowth was evaluated by histologic analysis in men and women treated for androgenetic alopecia, by counting follicles in horizontal sections of scalp biopsies. Serial 4mm punch biopsies were taken at baseline and after 12mo of treatment from the transitional area of hair thinning between normal hair and vertex balding in men, and in an area of frontal/parietal thinning in women. Horizontal sections of reticular and papillary dermis were read by one observer, blinded to patient, treatment, and time. All terminal hair bulbs, terminal anagen and telogen hairs, and vellus and vellus-like miniaturized hairs were counted. Twenty-six men aged 18-41y, comprising 14 on finasteride 1 mg daily and 12 on placebo, and 94 postmenopausal women, aged 41-60y, comprising 44 on finasteride 1 mg daily and 50 on placebo, were evaluated. In the male study, the terminal hairs increased from a mean baseline count of 15.5-20.9 after 12mo of finasteride, versus 17.3-18.3 in the placebo patients. The miniaturized hairs decreased from 26.7 to 23.6 with finasteride versus 21.3-20.3 with placebo. The terminal-to-vellus ratio increased more in the finasteride than in the placebo patients, suggesting some reversal of the miniaturization process with finasteride. In the female study, no significant differences in follicular counts were found between the finasteride and placebo groups after 12mo of treatment. Follicular counts in horizontal sections provide an informative adjunct to noninvasive measures used in hair growth studies. Finasteride appears to be capable of reversing hair miniaturization in androgenetic alopecia in young to middle-aged men, but not in postmenopausal women.     

Kenogen in female androgenetic alopecia. A longitudinal study

BACKGROUND: Kenogen indicates the physiological interval of the hair cycle in which the hair follicle remains empty after the telogen hair has been extruded and before a new anagen hair emerges. Kenogen frequency and duration are greater in men and women with androgenetic alopecia (AGA). OBJECTIVE: To study the relationship of kenogen with female AGA. METHODS: A woman with AGA, studied 14 years before, was re-examined for 2 years by the phototrichogram technique. Kenogen was identified when telogen lasted 3 months and shedding left the follicle empty. RESULTS: Kenogen lasted 1-5 months, the longest duration affecting cycles of vellus hairs, and involved more hair follicles (16 vs. 8%) than in the first observation. Cycles of vellus hairs increased in number from 4 to 13%, and cycles with a normal succession of phases decreased from 60 to 32%. CONCLUSIONS: The number of kenogen phases increased in parallel with vellus hairs and the diminished number of normal hair cycles, features that mark AGA aggravation. Kenogen seems to be related also to the progression of female AGA.     

Temporal triangular alopecia and a review of 52 past cases

Temporal triangular alopecia (TTA) is a circumscribed, non‐cicatricial form of alopecia confined to the frontotemporal region. The patient, a 15‐year‐old boy, was noticed at birth to have an alopecial area, sized 1.5 cm × 2.5 cm, in the right temporal region. Microscopic examination revealed miniaturized hair follicles accompanied by differentiated sebaceous glands. We have provided a synopsis of the past 52 cases. Of the 53 cases of TTA including our case, more than half (55.8%) were detected in childhood between the ages of 2 and 9 years, while 36.5% were detected at birth and only 3.8% (only two cases) in adulthood. There were three familial cases. Several congenital diseases were associated with the condition, for example, phakomatosis pigmentovascularis, Down syndrome and Dandy–Walker malformation. This information suggests that TTA can be recognized as a hamartomatous mosaic disease.