梅毒性脱发合并HIV感染1例

  报告1例梅毒性脱发合并HIV感染。患者男,44岁,弥漫性斑状脱发伴白发增多11个月余。查体可见前额发际线“M型”上移,全头散在圆形、类圆形脱发斑,边界欠清,白发增多,拉发试验（-）,双手掌、足底红斑、鳞屑。头皮脱发斑处皮肤镜检查示：头皮无毛区内毛囊开口存在,毛干变细,少量黑点。实验室检查:TRUST定性（+）,TRUST定量（1: 128）,TPPA试验＞1:1 280,HIV抗体（+）。头皮脱发区病理组织活检示：真皮毛囊周围少量淋巴组织细胞,见休止期毛囊,周围纤维包绕,毛球部见浆细胞。诊断：梅毒性脱发合并HIV感染。经青霉素治疗5个月后,脱发斑消退,手足红斑、鳞屑消失,无再发脱发斑。     

Alopecia syphilitica with detection of Treponema pallidum in the hair follicle

Alopecia is one of the clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of alopecia areata. The main difference between these two entities is the detection of Treponema pallidum in syphilis. We present the case of a 24-year-old Hispanic man, human immunodeficiency virus seropositive in treatment, with tiny patches of non-cicatricial alopecia in the parieto-occipital regions of his scalp. The patient denied previous history of genital or other skin lesions. A biopsy from an alopecic patch was performed which showed an inflammatory non-scarring alopecia with a discrete lymphocytic type inflammatory infiltrate localized in the peribulbar region. There was lymphocyte exocytosis into the matrix, associated with vacuolar degeneration, and scattered apoptotic cells were observed. Plasma cells were scattered. Immunohistochemical studies showed the presence of T. pallidum limited to the peribulbar region and penetrating into the follicle matrix. To the authors' knowledge, this is the first time that spirochetes have been shown in the hair follicle in alopecia syphilitica, suggesting that the spirochetes may be pathogenetic and responsible for the alopecia.     

Unusual location of syphilitic alopecia: a case report.

A case of syphilitic alopecia on the legs of young man is described. Both positive serologic tests and the clinical response to treatment with penicillin suggest that this alopecia was due to syphilis. This report suggests that the physician should be aware of the possible unusual location of syphilitic alopecia at sites other than the scalp, eyebrows, and beard.     

Extensive annular verrucous late secondary syphilis

We report an illustrative case of an apparently healthy 38-year-old man with a past history of alopecia universalis who developed extensive, slightly pruritic, infiltrated annular verrucous lesions of the scalp, perioral, lumbar, perianal and genital areas over a 6-month period. The combination of an unusual clinical presentation, positive syphilis serology and rapid response to penicillin therapy was consistent with a diagnosis of extensive annular and verrucous late secondary syphilis. We present this case to illustrate a rare and potentially misleading clinical feature of late secondary syphilis, a disease considered to be of the past but still present in today's practice.     

Cicatricial marginal alopecia: is it all traction?

Background  In a specialized hair loss clinic, a group of patients was identified with focal or complete hair loss at the scalp periphery, with a normal scalp surface. Biopsy revealed complete loss of individual hair follicles, indicative of scarring alopecia. Not all patients had a history supportive of a diagnosis of traction alopecia.
Objectives  To identify and characterize further patients with scarring alopecia of the scalp margin using a retrospective review.
Methods  All biopsies of scarring alopecia carried out by a single clinician between 1 January 1999 and 29 September 2006 were reviewed. Patients in whom the hair loss was located at the periphery of the scalp were selected for retrospective chart review.
Results  A total of 15 patients met the study criteria, which included histological scarring alopecia and hair loss of the scalp margin. Six of the patients gave a history of relaxing or straightening their hair. Six denied hair care practices sufficient to cause traction alopecia. In three patients, the hair care history was unknown. Occipital hair loss was a common clinical finding, mimicking alopecia areata. The presence of scarring was often subtle histologically.
Conclusions  A group of patients with moderate to severe cicatricial alopecia of the scalp margin is described. The presence of scarring is difficult to diagnose both clinically and histologically. The lack of a history of severe traction or harsh styling practices in half the patients casts doubt on whether or not traction is the only pathogenic factor.     

Alopecia areata: Clinical presentation, diagnosis, and unusual cases

Alopecia areata (AA) is a nonscarring hair loss disorder with a 2% lifetime risk. Most patients are below 30 years old. Clinical types include patchy AA, AA reticularis, diffuse AA, AA ophiasis, AA sisiapho, and perinevoid AA. Besides scalp and body hair, the eyebrows, eyelashes, and nails can be affected. The disorder may be circumscribed, total (scalp hair loss), and universal (loss of all hairs). Atopy, autoimmune thyroid disease, and vitiligo are more commonly associated. The course of the disease is unpredictable. However, early, long‐lasting, and severe cases have a less favorable prognosis. The clinical diagnosis is made by the aspect of hairless patches with a normal skin and preserved follicular ostia. Exclamations mark hairs and a positive pull test signal activity. Dermoscopy may reveal yellow dots. White hairs may be spared; initial regrowth may also be nonpigmented. The differential diagnosis includes trichotillomania, scarring alopecia, and other nonscarring hair loss disorders such as tinea capitis and syphilis.     

Alopecia totalis incognito

We report an 11-year-old boy with a strong family history of alopecia areata who initially developed alopecia areata with a single circular patch of hair loss on the scalp with exclamation mark hairs at the periphery, which evolved over time into alopecia totalis and then into a novel pattern of hair growth with fine depigmented hair, uniformly 5 mm in length. The hair has not grown any longer over a 48-month follow-up period. Scalp biopsies from the occipital scalp demonstrate dense peribulbar lymphocytic infiltrate and uniform miniaturized secondary vellus hairs. This previously undescribed pattern of alopecia areata is remarkable for total lack of alopecia.     

Alopecia Neoplastica due to Gastric Adenocarcinoma Metastasis to the Scalp,Presenting as Alopecia: A Case Report and Literature Review

Alopecia neoplastica is defined as hair loss secondary to a visceral malignancy that has metastasized to the scalp. The scalp is a relatively common site of cutaneous metastasis, usually presenting as a single or multiple firm scalp nodules. Alopecia neoplastica is a well-recognized but rare presentation, and its pathogenesis is incompletely understood. Atrophy of the hair follicles due to tumor invasion of the scalp plays a role in the development of alopecia. Herein, we describe a 33-year-old woman with gastric adenocarcinoma who developed alopecia neoplastica while receiving cancer chemotherapy. Scalp biopsy revealed metastatic adenocarcinoma cells interspersed between collagen bundles and around hair follicles. Immunohistochemical analysis indicated that the tumor cells originated from the primary gastric adenocarcinoma. Therefore, she was diagnosed with alopecia neoplastica due to gastric adenocarcinoma. The findings from this report may be helpful for understanding the mechanism of alopecia neoplastica.     

Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness

Androgenetic alopecia affects both men and women. In men it produces male pattern hair loss with bitemporal recession and vertex baldness. In women it produces female pattern hair loss (FPHL) with diffuse alopecia over the mid-frontal scalp. FPHL occurs as a result of nonuniform hair follicle miniaturization within follicular units. Diffuse alopecia is produced by a reduction in the number of terminal fibres per follicular unit. Baldness occurs only when all hairs within the follicular units are miniaturized and is a relatively late event in women. The concepts of follicular units and primary and secondary hair follicles within follicular units are well established in comparative mammalian studies, particularly in sheep. However, discovery of these structures in the human scalp hair and investigation of the changes in follicular unit anatomy during the development of androgenetic alopecia have provided a clearer understanding of the early stages of androgenetic alopecia and how the male and female patterns of hair loss are related. FPHL is the most common cause of alopecia in women and approximately one-third of adult caucasian women experience hair loss. The impact of FPHL is predominantly psychological. While men anticipate age-related hair loss, hair loss in women is usually unexpected and unwelcome at any age. Treatment options to arrest hair loss progression and stimulate partial hair regrowth for FPHL include the androgen receptor antagonists spironolactone and cyproterone acetate, the 5α-reductase inhibitor finasteride and the androgen-independent hair growth stimulator minoxidil. These treatments appear to work best when initiated early. Hair transplantation should be considered in advanced FPHL that is resistant to medical treatments. Hair transplantation requires well-preserved hair growth over the occipital donor area. The psychological impact of FPHL may also be reduced by cosmetic products that improve the appearance of the hair. These agents work to minimize hair fibre breakage, improve hair volume or conceal visible bald scalp.     

Traction alopecia in children

Traction alopecia is traumatic hair loss secondary to the application of tensile forces to scalp hair. This condition can be classified as marginal or nonmarginal. In either case, the induced trauma, often the result of cultural, social, and cosmetic practices, is unintentional. Initially, hair loss is reversible; however, permanent alopecia may result from chronic traction.     

Melanocyte-associated T cell epitopes can function as autoantigens for transfer of alopecia areata to human scalp explants on Prkdc(scid) mice

Alopecia areata is a tissue restricted autoimmune condition affecting the hair follicle, resulting in hair loss. The goal of this study was to test the hypothesis that the autoantigen of alopecia areata is melanocyte associated. Potential autoantigens were tested in the human scalp explant/Prkd(scid) CB-17 mouse transfer system. Scalp T cells from lesional (bald) alopecia areata scalp were cultured with antigen-presenting cells, and antigen, along with interleukin-2. The T cells were then injected into autologous lesional scalp grafts on SCID mice, and hair regrowth was measured. Hair follicle homogenate was used as an autoantigen control. T cells cultured with melanoma homogenate induced statistically significant reduction in hair growth (p <0.01 by ANOVA). HLA-A2-restricted melanocyte peptide epitopes were then tested with lesional scalp T cells from HLA-A2-positive alopecia areata patients. Melanocyte-peptide-activated T cells significantly reduced the number of hairs regrowing in two experiments with six patients (p <0.001 by ANOVA). Injected scalp grafts showed histologic and immunochemical changes of alopecia areata. The most consistent peptide autoantigens were the Gp100-derived G9-209 and G9-280 peptides, as well as MART-1 (27-35). Melanocyte peptide epitopes can function as autoantigens for alopecia areata. Multiple peptides were recognized, suggesting epitope spreading.     

幼儿肛周扁平湿疣误诊为尖锐湿疣1例

患儿,女,28个月。肛周扁平丘疹2月,无自觉症状,实验室检查:梅毒螺旋体凝集试验(TPPA)阳性,快速血浆反应素试验(RPR)1∶128,祖父祖母TPPA均为阳性,RPR均为1∶8,父母梅毒血清学检查结果均阴性,诊断为获得性二期梅毒(肛周扁平湿疣)。予苄星青霉素60万u/周治疗,3周后皮损基本消退,一月后患儿RPR降至1∶8。     

Alopecia areata universalis sparing nevus flammeus

Alopecia areata is a common form of nonscarring hair disorder of unclear etiology. Cases with alopecia areata sparing congenital melanocytic nevi have been described. It is explained by the Renb?k phenomenon or inverse K?bner phenomenon, which refers to normal hair growth in the psoriatic lesions observed in patients with psoriasis and alopecia areata. We report a 30-year-old man presenting with rapidly progressing alopecia areata universalis, which spared a large nevus flammeus on the left parietal scalp. Our case gives further evidence to the notion that nevus as genetic mosaic may show genetically determined resistance to alopecia areata.     

Histopathologic diagnosis of multifactorial alopecia

Establishing a definitive diagnosis for any form of alopecia can be challenging. Adding to the diagnostic complexity is the fact that many patients have more than one form of alopecia contributing to their hair loss. We conducted a review of 1360 consecutive scalp biopsy specimens submitted for the evaluation of scalp hair loss over a 16‐month period, demonstrating that 12.5% of cases had a combination of diagnoses (multifactorial alopecia) accounting for their hair loss. An approach to the histopathologic diagnosis of multifactorial alopecia, particularly multiple forms of alopecia found in a single biopsy, is here presented.     

BLACK DOT TINEA CAPITIS IN A MAN

A 52-year-old healthy man presented with scalp alopecia, which had progressed over a period of several weeks. The patient stated that he was unemployed and lived at home alone without pets. He recalled that a neighbor who routine-ly cut his hair in her home also cut the hair of many local children, some of whom had recently had scalp ringworm.
Physical examination revealed a patchy noncicatricial alopecia with numerous short hair stubs (i.e., black dots) in the frontal, parietal, and temporal areas of the scalp (Fig. 1). There was minimal scaling, but no pustulation, kerion forma-tion, or adenopathy. Glabrous skin and nails were normal. Potassium hydroxide (KOH) preparation of a black dot hair showed multiple arthroconidia within the hair shaft, typical of endothrix hair invasion. Fungal culture on Sabouraud's media later revealed growth consistent with Trichophyton tonsurans. In addition, a culture mount showed abundant microconidia of variable size and shape with occasional macroconidia and chlamydospores, characteristic of T. ton-surans (Figs. 2 and 3).
The patient was subsequently treated with 500 mg of griseofulvin par day for 2 months. At the completion of therapy, there was healthy regrowth of hair.     

Alopecia areata is a T-lymphocyte mediated autoimmune disease: lesional human T-lymphocytes transfer alopecia areata to human skin grafts on SCID mice

Much evidence suggests that alopecia areata is a tissue restricted autoimmune disease. Alopecia areata responds to immunosuppressive agents, and is associated with other tissue restricted autoimmune diseases, including autoimmune thyroiditis and vitiligo. Furthermore, hair regrows when involved scalp is transplanted to nude mice. This study was undertaken to determine whether alopecia areata is mediated by T lymphocytes. Involved scalp from alopecia areata patients was grafted onto SCID mice. Additional biopsies from lesional scalp of the same patients were used to isolate T lymphocytes. These T lymphocytes were cultured with hair follicle homogenate, as well as autologous antigen presenting cells. The T lymphocytes were then injected into autologous scalp grafts on the SCID mice, which had regrown hair. Injection of scalp T lymphocytes resulted in hair loss. Hair loss was associated with the histologic and immunochemical changes of alopecia areata, including perifollicular infiltrates of T cells, along with HLA-DR and ICAM-1 expression by the follicular epithelium. Scalp T lymphocytes that had not been cultured with hair follicle homogenate did not have this effect. Preliminary data suggests hair loss requires a collaboration between CD8+ and CD4+T cells. These studies have demonstrated that alopecia areata can be induced by the transfer of T cells that recognize a hair follicle autoantigen.     

Lipedematous Alopecia in an Asian Woman: Is It an Advanced Stage of Lipedematous Scalp?

Lipedematous alopecia (LA) is a rare disease entity that manifests as increased thickness of subcutaneous fatty tissue in the scalp with a variable degree of acquired, non-scarring alopecia. Although the pathogenesis of alopecia in LA is not clear, it is assumed that the increased thickness of subcutaneous fat retards hair growth by disturbing the peripheral microenvironment of the hair bulb. LA is clinically distinguishable from lipedematous scalp (LS) in that LS is not associated with any hair abnormalities, while LA is characterized by variable degree of hair loss. However, both LA and LS share increased scalp thickness. Here, we describe a rare case of LA on the frontal scalp of an Asian woman, further characterize the clinical and histologic features, and suggest applying an integrated diagnosis as lipedematous diseases of the scalp.     

Acute diffuse and total alopecia of the female scalp. A new subtype of diffuse alopecia areata that has a favorable prognosis

BACKGROUND: Although alopecia areata (AA) usually starts with focal lesions of hair loss and then presents several different clinical forms, AA may begin as diffuse hair loss. We examined 9 female patients who presented with acute, diffuse and total hair loss of the scalp and took a similar clinical course with a favorable prognosis. OBJECTIVE: To categorize such cases as a new subgroup of diffuse alopecia. METHODS: We studied 9 patients who showed acute, diffuse and total hair loss of the scalp within 1 month after their first visit to our hospital by comparing their clinical course, laboratory tests and histopathological findings with those of common, patchy AA, alopecia totalis or alopecia universalis. RESULTS: None of the patients had a background of systemic diseases or telogen effluvium. All the patients were female, and 8 of the 9 cases recovered cosmetically acceptable hair growth within 6 months regardless of steroid administration. The histology of he lesions was indistinguishable from that of AA except for a remarkable eosinophilic infiltrate. CONCLUSIONS: These cases can be categorized as a new subtype of inflammatory noncicatricial alopecia that is characterized by a marked female predominance, tissue eosinophilia and uniquely short clinical course. We suggest to name it 'acute diffuse and total alopecia of the female scalp (ADTAFS)'.     

An unusual presentation of secondary syphilis in a patient with human immunodeficiency virus infection. A case report and review of the literature.

BACKGROUND--Syphilis has been reported to assume unusual clinical appearances and to exhibit unusual courses in patients infected with the human immunodeficiency virus (HIV) type 1. We recently observed a distinct manifestation of syphilis in an HIV-infected patient with features not previously described. OBSERVATIONS--A 38-year-old HIV-seropositive homosexual man presented with fever, chills, malaise, and a cutaneous eruption consisting of indurated, shiny, erythematous plaques that were confluent on the face and scalp leading to alopecia and extreme tautness of the skin. Initial clinical diagnoses included lymphoreticular malignancy and infection. Although cultures yielded Staphylococcus aureus, a skin biopsy specimen was diagnostic of syphilis. CONCLUSIONS--This case demonstrates an unusual clinical manifestation of syphilis in a patient with HIV infection and emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of virtually any inflammatory cutaneous disorder in HIV-seropositive individuals.