136例儿童斑秃发病相关因素分析

目的:了解影响斑秃发病的相关因素。方法:对广州市妇女儿童医疗中心皮肤科收治的136例儿童斑秃临床资料作回顾性分析,包括年龄、性别、既往病史、家族史,首次出现斑秃的年龄,脱发严重程度评分以及实验室结果。结果:136例患儿平均首次发病年龄为(4.66±3.12)岁,85例(62.5%)首次出现斑秃的年龄小于6岁。136例患儿中75例为轻症斑秃,平均发病年龄(4.76±2.02)岁,61例为重症斑秃,平均发病年龄(2.81±2.42)岁。26例(19.12%)患儿患有注意缺陷多动障碍,53例(39%)患有过敏性疾病及9例(6.62%)患有自身免疫性疾病。16例(11.76%)有斑秃家族史,27例(20.59%)有自身免疫性疾病家族史。结论:儿童斑秃可能与遗传、精神心理、自身免疫和变态反应有关。     

斑秃患者临床特征分析研究

目的调查斑秃患者的临床特征,分析影响斑秃病情轻重的相关因素,为临床诊治和预后判定提供依据。方法制作斑秃患者临床及流行病学调查表,通过对患者问诊填写相关项目,总结分析斑秃的临床特征,评价斑秃病情轻重的相关因素。结果283例斑秃患者入组,男性135例(47.70%),女性148例(52.30%),男女比例1︰1.10。发病年龄为9个月～74岁,中位数为29岁。29例S3～S4型斑秃、19例全秃、13例普秃定义为重型斑秃。重型斑秃患者较轻型斑秃患者发病年龄小、首发病情重、复发率高、多伴有家族史(P<0.01)。结论发病年龄小、首发病情严重、有斑秃家族史是重型斑秃的重要临床特征,可作为斑秃预后的评价指针之一。     

尘螨过敏可能是斑秃患者早发和重型的危险因素之一

【摘要】 目的 探讨232例斑秃患者的临床特征、伴发过敏性疾病的情况及血清中总IgE和特异性免疫球蛋白E（sIgE）的水平以及它们之间的相互关系。 方法 免疫比浊法和荧光酶联免疫吸附法分别检测232例斑秃患者血清中的总IgE及常见过敏原的sIgE。110例健康对照来自体检中心。 结果 232例斑秃患者中,男127例,女105例,平均（26.4 ± 13.8）岁,平均病程（25.3 ± 42.3）个月,89例（38.4%）为重型斑秃。67例（28.9%）除患斑秃外,还伴发至少1种过敏性疾病,但血清总IgE阳性率（30.6%）与健康对照组（21.8%）相比,差异无统计学意义。斑秃患者sIgE升高以户尘螨（34.1%）、 粉尘螨（31.9%）、蟑螂（22.5%）为主,均为常见过敏原,且三者sIgE的水平分别与总IgE水平呈正相关关系。户尘螨、蟑螂sIgE的阳性率和水平与健康对照组比较,差异无统计学意义。在重型、弥漫型斑秃中,户尘螨、蟑螂sIgE和儿童斑秃户尘螨sIgE的阳性率和水平均比健康对照组高,差异有统计学意义。重型患者户尘螨、蟑螂sIgE或儿童斑秃户尘螨sIgE阳性率和水平,各自比轻型或成人斑秃患者为高,差异有统计学意义。 结论 尘螨过敏是部分斑秃患者（重型、弥漫型及儿童斑秃）的发病因素之一,也是斑秃患者中发病早、脱发范围广的危险因素之一。     

76例重型斑秃的临床分析

目的 :探讨重型斑秃的临床特征。方法 :回顾分析了近 4年诊治的 76例重型斑秃病例。结果 :重型斑秃中女性患者的病程比男性患者长 (P <0 0 5 ) ,与重型斑秃中的斑秃相比 ,甲异常改变更多见于全秃和普秃患者 (P <0 0 5 ) ,有家族斑秃史患者与无家族斑秃史患者比较 ,两者的初次发病年龄有显著性差异 (P <0 0 5 ) ,发病前伴有精神神经因素诱发者比无伴有精神神经因素诱发者病程要短 (P <0 0 5 )。结论 :女性重型斑秃患者可能病程更容易持续延绵、迁移反复 ,重型斑秃中有家族斑秃史者 ,它的发病年龄更早 ,甲异常改变不但多见于病程较长、病情顽固、反复的患者 ,而且也多见于病情较重的患者 ,全秃和普秃患者甲异常改变更多见 ,重型斑秃的治疗应注意精神因素的影响及强调综合治疗。     

二苯环丙烯酮局部治疗斑秃的疗效分析

目的：分析斑秃患者局部外用二苯环丙烯酮（DPCP）疗效的影响因素。方法：对36例斑秃患者进行外用DPCP治疗,详细记录其临床资料及副作用;并对患者进行血清学检查、组织病理活检。结果：斑秃患者DPCP治疗总有效率为56.5%,复发率为23.1%。16.7%患者出现较明显副作用（严重接触性皮炎、白癜风）。副作用组患者在治疗前的血清IgE浓度明显高于有效组患者（P=0.03）。另外,患者年龄、发病年龄、病程、脱发面积、维持治疗浓度、自身免疫性疾病病史、异位性疾病病史和斑秃家族史、皮损病理改变与DPCP治疗的疗效无明显相关性。结论：外用DPCP治疗斑秃安全性较高,可避免长期使用皮质类固醇激素和免疫抑制剂的毒副作用,治愈率也较高。治疗前进行血清IgE测定可提前发现对治疗不耐受患者。     

毛发疾病

20 0 13346　 81例儿童斑秃发病相关因素分析 /熊春萍(广州医学院一附院皮肤科 )…∥华中医学杂志 .-2 0 0 1,2 5 (2 ) .- 6 9采用回顾分析法对近 3年诊治的 81例儿童斑秃病例的发病因素进行分析。≥ 7岁者占 79.0 %,初次发病年龄 <7岁者 81.5 %为男性 ;≥ 13岁者 76 .9%为女性。重型斑秃占 32 .1%,重型斑秃病程明显长于局限性斑秃 (P<0 .0 1) ,初次发病年龄较局限性斑秃早 (P<0 .0 5 )。17.4 %有家族斑秃史 ,其秃发严重程度、发病早晚和病程与无家族史者无显著性差异 (P>0 .0 5 )。5 6 .9%伴指 (趾 )甲改变 ,尤其是重型斑秃及病程长者(P<…     

斑秃的研究进展

斑秃是一种由T淋巴细胞介导的针对毛囊的器官特异性自身免疫性疾病,正常毛囊的免疫赦免作用的破坏在其发病过程中起着重要作用。精神心理因素可使病情加重或反复。目前通过全基因组关联分析至少发现了8个与斑秃发病有关的基因区域,为更好地认识斑秃的发病机制和寻求新的治疗方法提供了遗传学的理论基础。斑秃的发病机制尚不完全清楚,了解斑秃的流行病学、病因及治疗方法对斑秃的处理有指导意义     

斑秃患者血清TNFα水平观察

测定７０例斑秃患者血清肿瘤坏死因子－α水平。测定结果示斑秃患者ＴＮＦα明显高于对照组。活动期患者明显高表静止期。而单纯斑秃组与全，普秃组相比，则无明显差异。表明斑秃患者存在着免疫功能异常，并与斑秃的发病及病情活动有关。     

自身反应性T细胞与斑秃

斑秃的病因尚未完全清楚,但近年来多种研究表明,斑秃的发病与自身免疫有关,自身反应性T细胞在斑秃的发病中起着关键作用。综述自身反应性T细胞逃逸外周耐受、从外周血向毛囊迁移,及其介导斑秃发病的证据。研究斑秃自身反应性T细胞,有助于阐明斑秃的发病机制以及寻找有效及有针对性的治疗措施。     

斑秃655例伴发疾病分析

目的探讨斑秃发病的临床特点及伴发疾病分析。方法收集本科门诊2006年1月-2008年5月确诊的斑秃患者,以调查表的形式收集患者临床资料及伴发疾病情况,包括斑秃发病年龄、病程、严重程度、家族史和复发情况等,用SPSS13.0软件分析。结果 655例斑秃患者,男320例,女335例,平均年龄(38.4±12.4)岁,平均病程(14.8±35.7)个月,88例(13.44%)为全秃/普秃,84例(12.82%)家族史阳性,195例(29.77%)斑秃反复发作。655例患者中,190例(29.01%)除斑秃外,还伴发至少1种过敏性疾病或自身免疫性疾病,仅伴过敏性疾病者123例(18.78%)。未发现伴发疾病与性别、发病年龄、病程、斑秃类型、既往史及家族史相关联(P>0.05)。全秃/普秃更易伴发过敏性疾病,包括湿疹、荨麻疹、哮喘和药物过敏(P=0.004),与无伴发过敏性疾病的斑秃患者相比,伴发者发病更早(P=0.033)。结论斑秃与伴发的其他疾病可能有着相同的遗传学、免疫学基础,不同的伴发疾病可能对斑秃的发生、发展和预后产生不同的影响。     

Late‐onset alopecia areata: A retrospective study of 73 patients from Taiwan

Background Alopecia areata (AA) is regarded to be mediated by autoimmune process, and manifests as patchy non‐scarring hair loss with occult onset. Little is known about AA occurring later in life. Objective To define the characteristics of late‐onset AA. Methods Patients with first onset of AA at age 50 years and above were retrospectively recruited from two separate institutes in southern and northern Taiwan. The onset age, patterns, severity, past history, serological findings and therapeutic responses were reviewed. Results Seventy‐three AA patients were enrolled, including 49 females (67%) and 24 males (33%). The onset age ranged from 50–78 years with the median age of 57 years. Multifocal lesions (41%) constituted the most common pattern and 55% of the recruited patients had a hair loss of less than 10%. Seventeen patients (23%) had co‐existent dermatological or systemic diseases while six patients (8%) had a history of malignancy. Among 27 patients (37%) with available laboratory data, positive anti‐nuclear antibody, anti‐microsomal antibody and anti‐thyroglobulin antibody was demonstrated in 26%, 40% and 30% of them, respectively. Association with personal or family history of atopy was absent. In 15 patients of follow‐up longer than 6 months, a complete hair regrowth was found in three patients with mild disease severity. Conclusion Late‐onset AA is characterized by marked female predominance and milder disease activity with increasing age. The link to cancer in the old age remains to be determined. The influence of aging on the pathogenesis and prognosis of AA deserves further studies.     

Alopecia areata in children: a clinical profile

Alopecia areata (AA) is prevalent among children in Kuwait. In this prospective survey we studied 215 children with AA to determine their clinical and epidemiologic features. Ninety-seven percent of the children were of Arab ancestry. Girls outnumbered boys by a 2.5:1 ratio. The peak age of onset was seen between 2 and 6 years of age with a mean age of onset at 5.7 +/- 2.8 years. A majority of the patients (80.5%) had mild disease and extensive disease (more than 50% hair loss) was seen in 13% of the children. A positive family history of AA was obtained in 51.6% of cases and nail changes were seen in 26.5% of the children. The age of onset, a positive family history of AA, and associated atopic disorders were observed to have no influence on the extent and severity of the disease. The results were compared with those reported elsewhere for this age group.     

A clinical study of childhood alopecia areata in Singapore

Alopecia areata (AA) is a common cause of nonscarring alopecia. The aim of this epidemiologic study is to review the clinical characteristics and treatment of childhood alopecia areata in a mixed ethnic population. The study population consisted of a total of 392 children seen over a 4-year period with AA diagnosed before the age of 16 years. The female:male ratio was 1:1.4. There were 309 Chinese (78.8%), 51 Malays (13.0%), and 32 Indians (8.2%). The mean age at the time of diagnosis was 11.2 years. The majority of patients (71.7%) had alopecia of less than 6-months duration and 6% had previous episodes of AA. Females appeared to have more severe involvement. A familial history of AA was observed in 33 patients (8.4%). Associated atopy was found in 26.6% of patients and in 32.3% of their first-degree relatives. Other associations such as vitiligo or Down syndrome were rare. For limited AA, topical and/or intralesional corticosteroid was the first-line treatment used and squaric acid dibutyl ester was the choice of treatment for patients with extensive involvement. The profile of the poor respondents to therapy included young age of onset, past history of AA, Down syndrome, and extensive involvement.     

PROFILE OF ALOPECIA AREATA: A QUESTIONNAIRE ANALYSIS OF PATIENT AND FAMILY

Eight hundred patients with alopecia areata (AA) responded to a detailed questionnaire that was compiled, distributed, and analyzed by Help Alopecia International Research, Inc. (HAIR). Among those responding, 28% were men and 72% were women. Fifty percent had localized alopecia, 30% had alopecia totalis, and 20% had alopecia universalis. Forty-eight percent developed their initial onset before the age of 20. A very strong family history of 42% was found. There were 333 additional family members with AA. Many patients and relatives had concurrent atopic diseases (seasonal rhinitis, bronchial asthma, and atopic dermatitis). Associated autoimmune diseases including vitiligo, thyroid disease, and collagen vascular disease in patients and relatives appeared consistent with previous reports. Insulin dependent diabetes mellitus (IDDM) was not increased in patients but greatly increased in relatives. Additional analysis suggests a genetic association between the two diseases where expression of AA may prevent the development of IDDM.     

Efficacy and safety of diphenylcyclopropenone among Chinese patients with steroid resistant and extensive alopecia areata

Background Topical immunotherapy has recently been found useful in the treatment of chronic and extensive Alopecia Areata (AA). Objective To evaluate the efficacy and safety of diphenylcyclopropenone (DPCP) use among Chinese patients with steroid resistant and extensive AA in our institute. Methods The medical records of 31 Chinese patients treated with DPCP were analysed retrospectively. The efficacy, adverse effects, and relapse rate of DPCP treatment were reviewed. Results Thirty‐one (16 male, 15 female) Chinese patients with extensive, steroid resistant Alopecia Areata and a mean age of 28.9 years (SE 10.4) were treated. The mean age of onset was 17.8 years (SE 8.8) with an average disease duration of 11.2 years (SE 7.7). Ten patients had a history of atopy and 4 had a history of thyroid disease. Nail changes were found in 14 patients and a family history of AA was found in 2 patients. Thirteen patients (41.9%) had experienced total hair loss. Two patients abandoned the treatment due to severe side effects. Of the remaining 29 patients, 4 (13.8%), 7 (24.1%), 5 (17.2%), and 13 (44.8%) achieved >90% complete response, >50–90% partial response, >10–50% minimal response, and <10% no response hair regrowth, respectively. Adverse effects included pruritus, erythema, vesiculation, scaling, cervical lymphadenopathy, dyspigmentation and urticarial reactions. Relapse occurred (>25% hair loss) in 69.23% of patients after 18 months of follow up. Conclusions DPCP is an effective and tolerable treatment for Chinese patients with extensive, steroid resistant AA.     

A case series of alopecia areata in children: impact of personal and family history of stress and autoimmunity

BACKGROUND: The epidemiology of alopecia areata (AA) is well documented in adults but has not been studied adequately in children. OBJECTIVE: To evaluate the clinical and epidemiological profile of AA in children and assess the significance of thyroid screening. METHODS: One hundred and fifty-seven children (83 boys, 74 girls, aged 1-16 years) who visited our clinic with a first episode of AA from 1996 to 2000 were retrospectively studied. One hundred children served as clinical controls. RESULTS: The age of peak incidence of AA was 0-5 years. The youngest child was 1 year old. In the majority of the cases (131/157, 83.4%) the disease was mild or moderate (less than 50% hair loss). In 15 patients (9.5%), AA was preceded by a stressful event. Five patients had a personal history of autoimmune disease (3.2 vs. 5% of the controls, (P = not significant [NS]) while 18 patients had a personal history of atopy (11.4 vs. 18% of the controls, P = NS). Twenty-one patients had a family history of autoimmune disease other than thyroiditis (13.4 vs. 5% of the controls, P = 0.04), while 23 patients had a family history of thyroid disorder (14.6 vs. 3% of the controls, P = 0.006). In eight patients (5%) subclinical hypothyroidism of autoimmune aetiology (Hashimoto's thyroiditis) was revealed at the time of investigation. Six out of the eight patients with Hashimoto's thyroiditis had a family history of thyroid disorder, which was statistically significant when compared to AA patients without thyroiditis (P < 0.001). The severity of AA was associated with early age of onset of the disease (P = 0.02). CONCLUSION: The age of peak incidence of AA in children is 0-5 years. Children with AA have an increased family history of autoimmunity, and, among children with a first episode and short duration of AA (< 6 months), thyroid screening might be restricted in those with a positive family history of thyroid disorder. Thyroid screening should be routinely performed in all children with long-standing AA.     

Differences in Comorbidity Profiles between Early-Onset and Late-Onset Alopecia Areata Patients: A Retrospective Study of 871 Korean Patients

Background

Alopecia areata (AA) is a common dermatologic condition with a broad spectrum of clinical features and age of onset, classically characterized by nonscarring patches of hair loss. In the past, early-onset (before adolescence) AA has been associated with various autoimmune diseases, especially atopic diseases and lupus erythematosus and demonstrates a worse prognosis compared with late onset AA.

Objective

To evaluate the differences in the comorbidity profile of AA with regard to age at onset.

Methods

We completed a retrospective study of 871 Korean AA patients seen at our department within the last 10 years. After these patients were subdivided according to onset before or after age 13 years, the two groups were compared on the basis of their comorbid disorders, family history of AA, and hematologic test results.

Results

Our results demonstrate that significantly more patients in the early-onset group had a personal history of atopic dermatitis or family history of AA. These findings are consistent with previous reports associating early-onset AA with autoimmune diseases and a family history of AA in different ethnic populations. Most of the serologic test values showed no significant differences between the groups and the results were considerably affected by age.

Conclusion

This study is significant because it is a large group study in Korean AA patients, and Korean AA patients with an onset age before adolescence show similar clinical manifestations to other ethnic populations.     

The genetic epidemiology of alopecia areata in China

BACKGROUND: Alopecia areata (AA) is hypothesized to be an organ-specific autoimmune disease with genetic predisposition and an environmental trigger. There are few clinical data in Asians. OBJECTIVES: To describe the genetic epidemiological features of AA patients in China and to determine the possible genetic model for AA. METHODS: Data for 1032 patients with AA were obtained by questionnaire in the Institute of Dermatology of Anhui Medical University in China from 2001 to 2003. Complex segregation analysis and heritability analysis were performed using Falconer's method, EPI INFO 6.0 and SAGE-REGTL programs. RESULTS: In total, 1032 AA patients (male/female ratio 1.1 : 1) were enrolled, representing 0.94% of the total number of cases seen in our outpatient clinic during that time. The mean +/- SD age of onset was 28.98 +/- 13.43 years. The difference between the mean age of onset in males and females was not significant. Most patients (82.6%) experienced their first episode of AA within the first four decades of life. A positive family history of AA was obtained in 87 patients (8.4%). The prevalence of AA in first-, second- and third-degree relatives of the proband with AA was 1.6%, 0.19% and 0.03%, respectively. These figures were higher than those in controls. A greater severity and longer duration of AA were seen in the early onset group than in the late-onset group. The early onset group also had more affected first- and second-degree relatives. The heritability of AA in first-, second- and third-degree relatives was 47.16%, 42.53% and 22.29%, respectively. Based on the REGTL results, the best model was a polygenic additive model for AA. CONCLUSIONS: The effect of genetic factors is strong in AA, but environmental factors such as infection and psychological stress may still play an important role. Our findings on the genetics of AA are consistent with a polygenic additive mode of inheritance.     

The R620W polymorphism in PTPN22 confers general susceptibility for the development of alopecia areata

BACKGROUND: The functional R620W (c.1858C>T) variant of the protein tyrosine phosphatase nonreceptor 22 gene (PTPN22) has been associated with a variety of autoimmune disorders. A recent study has suggested that R620W also contributes to the severe form of alopecia areata (AA). OBJECTIVES: We sought to replicate the finding of an association between PTPN22 and severe AA. In addition, we wanted to study the effect of PTPN22 on the general risk to develop AA and on other subtypes of AA (mild AA, early/late age at onset, positive/negative family history). METHODS: The R620W variant was genotyped in a large case-control sample of Belgian-German origin with 435 patients and 628 controls. RESULTS: Significant results were obtained for the overall collective of patients with AA (P=0.007). Subdividing the sample according to severity of AA, family history and age at onset, we detected lowest P-values for patients with the severe form of AA (Pcorr=0.036), with a positive family history (Pcorr=0.042) and with an age at onset相似文献