2 English references cicatricial alopecia
3 overview cicatricial alopecia is a localized alopecia that suddenly occurs in any long-haired part of the body. Refers to the destruction of hair follicles caused by various reasons to form scars, leading to permanent hair loss. The incidence of alopecia areata is roughly equal to that of men and women, but it is more common in children and young people. After a long-term investigation and study, Iktda in Japan classified alopecia areata into four types according to the age of onset, clinical manifestations and prognosis, which is helpful to guide treatment and judge prognosis. Type I: hereditary allergic type, accounting for 10%. Generally, the onset of childhood, the course of disease is more than 10 years, single alopecia areata often lasts more than 1 year, there are hereditary allergic diseases, and 75% have total alopecia. Type Ⅱ: autoimmune type, accounting for 5%. It often occurs after the age of 40 and the course of disease is prolonged. Only 10% people lose their hair completely. Often accompanied by autoimmune diseases, such as pernicious anemia, vitiligo, Hashimoto's thyroiditis and so on. Type ⅲ: prehypertension, accounting for 4%. Mainly seen in young people, parents or one of them has hypertension, which progresses rapidly, and 39% is completely bald. Type ⅳ: common type, accounting for 83%. Those who do not belong to type ⅰ ~ ⅲ are more common in adults aged 20 ~ 40. The total course of disease is less than 3 years. A single alopecia areata can grow hair within 6 months, and 6% has total baldness.
This disease is called "ghost licking head" and "oil wind" in Chinese medicine. For example, in On Etiology, it is recorded that ghosts lick their heads: "People have common cold, which lies in their heads. If they are weak, they will lose their hair, lose their muscles, or be as big as money or fingers. It is neither born nor itchy, so it is called ghost licking. " "Surgical Success" records: "The oil wind causes the hair to fall off in pieces, the skin is bald, and it itches like a worm. For the wind and heat, the deficiency is attacked, and the blood cannot nourish the glory."
It is feasible to treat with drugs, physics and traditional Chinese medicine. Patients with lesions less than 25% have a high self-healing rate. The wider the lesion, the worse the prognosis.
4 disease name cicatricial alopecia
5 English name cicatricial alopecia
6. alias Mylabris; Used for cicatricial alopecia; Scar alopecia; Scar alopecia; Scar alopecia; Alopecia areata; Ghost head; Localized alopecia; Oil wind
7 classification dermatology > hair follicle diseases
8 ICD number L66.9
Epidemic cicatricial alopecia accounts for about 2% of the total number of newly diagnosed patients in dermatology outpatient department. It can occur at any age, but most of them are between 5 and 40 years old. Both men and women can participate.
10 etiology There are many reasons for hair follicle destruction, which can be roughly divided into the following five categories:
1. developmental defects, such as skin hypoplasia, Conrdi disease, epidermal nevus, sweat duct keratosis, ichthyosis, rounded hair, etc.
2. Curly hair, burns, radiation dermatitis and other physical factors.
3. Infections such as tinea capitis, pyogenic tinea, furuncle, carbuncle, folliculitis, lupus erythematosus and leprosy.
4. Tumors such as syringoma.
5. Skin diseases with unknown etiology, such as lichen planus, lupus erythematosus, scleroderma, sarcoidosis, hair follicle mucinosis, etc.
The pathogenesis of 1 1 is still unknown. Many reasons lead to the destruction of hair follicles and the formation of scars, leading to permanent baldness. In recent years, alopecia areata is more prone to autoimmune diseases. The changes of humoral immunity include non-organ specific autoantibodies and organ specific autoantibodies. Anti-smooth muscle antibody, anti-nuclear antibody (mainly spot antibody), anti-mitochondrial antibody, anti-basement membrane antibody and rheumatoid factor have been reported. The reported organ-specific autoantibodies include anti-thyroid antibodies, anti-gastric parietal cell antibodies and anti-adrenal antibodies. The positive rate of autoantibodies is related to sex, age and severity of illness. The change of cellular immunity is that there are a lot of lymphocytes infiltrating around the blood vessels and hair balls of alopecia areata. The study also found that hair follicles in alopecia areata area have strong HLA class ⅰ and ⅱ immunoreactivity, and the expression of adhesion molecules involved in hematopoietic cell migration is abnormal. These changes may be caused by the release of cytokines caused by some factors such as trauma, neuroinflammation or infection. Cytokines can participate in a variety of immune response processes, leading to the occurrence of immune response to the unique antigen of hair follicles. In recent years, the study of cytokines related to immune regulation of alopecia areata has attracted people's attention. Although the above mechanism is popular, the exact cause is not clear, and the exact autoantigen and pathogenic gene have not been confirmed. The genetic type of alopecia is still unknown. The polygenic genetic model with different penetrance and expression seems reasonable, but it is still affected by external hormones and immunity.
12 The clinical manifestations of cicatricial alopecia include scar, hair follicle destruction and permanent alopecia. We can also see the clinical manifestations corresponding to various causes. Such as lupus erythematosus caused by other skin manifestations, histopathology and laboratory examination changes. Alopecia areata often occurs suddenly, showing round or oval alopecia spots on the scalp. Because there are no conscious symptoms, it is often found by others unintentionally, and a large number of hair falls off when combing hair. The disease can be divided into three stages, namely, progressive stage, static stage and recovery stage. In the progressive stage, new hair loss spots appear, and the original hair loss spots expand, but the number and size of hair loss spots are different, mostly from fingernail to coin size, and adjacent hair loss spots can be quickly merged. The detached hair shaft is atrophied at the proximal end, and the end is dull and thick. The hair around the alopecia spot is loose and easy to pull out, and the hair roots are in the shape of exclamation mark (), that is, the hair pulling test is positive (Figure 1, 2). This is a feature that the disease is in the progressive stage. The scalp in the alopecia area is normal, without inflammatory swelling, scales and scars. At rest, the hair on the edge of the hair loss area is no longer loose, and no new hair loss spots appear. Most patients enter the recovery period after 3 ~ 4 months of rest. In the recovery period, new hair grows, which is soft and light-colored fluff at first, similar to mane, gradually thickens and turns black with time, and then returns to normal.
The incidence of alopecia areata is roughly equal to that of men and women, but it is more common in children and young people. Alopecia areata can also be seen in eyebrows, eyelashes, armpit hair, * * and beard, which may be the only disease site. Most alopecia areata patients only have 1 or several alopecia areas, and the course of the disease lasts for several months. But there are also a few patients who can repeatedly occur or fall off along the long side. In severe cases, hair loss continues, and the hair loss areas merge with each other, gradually becoming a large area of hair loss, and the course of disease can last for several years. If all the hair falls off, it is called alopecia (Figure 3). If hair, eyebrows, eyelashes, beard, armpit hair, * * and mane all fall off, it is called generalized alopecia. Band-like alopecia along the scalp is called crawling alopecia.
After a long-term investigation and study, Iktda in Japan classified alopecia areata into four types according to the age of onset, clinical manifestations and prognosis, which is helpful to guide treatment and judge prognosis. Type I: hereditary allergic type, accounting for 10%. Generally, the onset of childhood, the course of disease is more than 10 years, single alopecia areata often lasts more than 1 year, there are hereditary allergic diseases, and 75% have total alopecia. Type Ⅱ: autoimmune type, accounting for 5%. It often occurs after the age of 40 and the course of disease is prolonged. Only 10% people lose their hair completely. Often accompanied by autoimmune diseases, such as pernicious anemia, vitiligo, Hashimoto's thyroiditis and so on. Type ⅲ: prehypertension, accounting for 4%. Mainly seen in young people, parents or one of them has hypertension, which progresses rapidly, and 39% is completely bald. Type ⅳ: common type, accounting for 83%. Those who do not belong to type ⅰ ~ ⅲ are more common in adults aged 20 ~ 40. The total course of disease is less than 3 years. A single alopecia areata can grow hair within 6 months, and 6% has total baldness.
13 The complications of cicatricial alopecia may be accompanied by the following diseases:
1. Nail lesions such as punctate pits, longitudinal ridges, irregular thickening and obvious nail malnutrition, especially for alopecia totalis and alopecia universalis.
2. Hereditary allergic diseases.
3. Autoimmune diseases.
4. Eye diseases, such as drooping mydriasis, enophthalmos, vascular and pigment malformation, lens opacity and cataract.
5. The incidence of alopecia areata is 5. Down syndrome is 6%.
14 histopathological laboratory examination: generally, biopsy is not needed, unless it is diffuse alopecia, hair loss in growth period and rest period should be considered. The typical changes are the infiltration of monocytes around the hair bulb, around the blood vessels and in the outer hair root sheath, mainly T cells and macrophages. Hair follicle atrophy, abnormal pigment and hair matrix degeneration can also be seen.
15 can be diagnosed according to clinical manifestations, skin lesions and histopathological features.
Traditional Chinese medicine believes that besides blood, hair is mainly kidney, and sparse or dry hair is mostly a syndrome of insufficient essence and blood. This disease is mostly caused by deficiency of liver and kidney, deficiency of yin and blood, and instability of reason, while common cold took advantage of it, and the wind was strong and the blood was dry, which led to malnutrition. In addition, frustration and disharmony between qi and blood are also related to the occurrence of this disease. Yin deficiency of liver and kidney and disharmony of heart and kidney are common types.
16 differential diagnosis 16. 1 pseudoalopecia areata is similar to alopecia areata, but the affected skin is atrophied, the hair can not regenerate, there are island-like normal hair bundles on the surface, there is a narrow red band on the damaged edge, and the hair is not loose, which is more common in women aged 30-50.
16.2 tinea capitis is a gray-white scaly plaque, with hair broken 2 ~ 4 mm away from the scalp, surrounded by a white fungal sheath, which is positive for fungi, and is more common in children. Tinea and scalp damage are similar to tinea capitis, but the damage is small and many, often accompanied by different degrees of inflammatory reaction. The disease often occurs when the scalp is exposed, not hair loss, and the fungal test is positive. The alopecia of chloasma is atrophic scar with residual hair scattered sparsely on it, which is a typical chloasma.
16.3 patients with trichotillomania are mentally abnormal and often pluck their hair unconsciously, which can be distinguished according to their medical history and clinical manifestations.
16.4 Leprosy alopecia starts from hairline and gradually spreads upward. In severe cases, only flaky or linear hairs remain along the vascular path. All the hair in other places falls off, and there are other leprosy damages and sensory abnormalities besides hair loss.
16.5 alopecia folliculitis first develops into suppurative inflammation of hair follicle, and then atrophic scar appears, which is easy to recur.
16.6 Syphilitic alopecia has a history of syphilis or impurity. Hair loss is insect-eroded, with irregular distribution and incomplete hair loss in the hair loss area. More common in occipital temporal side, syphilis serological test is positive.
17 Treatment of cicatricial alopecia 17. 1 General therapy (1) Find the cause, give corresponding treatment and reduce mental burden. You can wear a wig to relieve mental stress.
(2) For those with obvious mental factors, sedatives such as diazepam and bromide are given.
(3) Vitamin B 1, B6, oryzanol or cystine (50 mg/time, 2-3 times/day) were given.
17.2 western medicine treatment 17.2. 1 (1) internal treatment ① glucocorticoid: oral or intramuscular injection is often effective, but long-term treatment has great side effects, and it will recur after drug withdrawal. It is not suitable for routine treatment, and it is only used for alopecia totalis, alopecia universalis and alopecia with rapid progress, and the short-term effect is obvious after use. For example, prednisone 20 ~ 40 mg/d, taken orally several times, 1 ~ 2 months later, reduced according to the condition. Low dose (10mg/d) lasts for 6 months or is combined with other drugs (such as minoxidil). Dexamethasone, methylprednisolone or diprospan can be selected according to the situation.
② Cyclosporine: 6mg/kg orally every day, taking effect for 2-4 weeks, and it can recur after stopping taking medicine. Pay attention to its hypertension and nephrotoxic side effects.
③ Thymosin: The mechanism of treating alopecia areata may be mediated by * * * inhibitory cytotoxic T cells and abnormal T cells that correct alopecia areata. 50mg/ time, intramuscular injection, every other day 1 time, lasting 1 month.
④ Others: Isopropylinosine, dapsone, minoxidil and thyroxine can be used as appropriate.
17.2.2 (2) Most of the external treatments are * * * agents, which cause local moderate contact inflammation, make local congestion and promote hair regeneration.
① Glucocorticoid preparations such as 0.05% betamethasone cream or 0. 1% triamcinolone acetonide cream combined with 5% minoxidil are more effective. You can also inject a small dose of triamcinolone acetonide suspension (2.5 ~ 10 mg/ml) into the skin lesions, each time 0. 1ml, once a week, 1 0 times as a course of treatment.
② Anthracene ointment and 0.5% ~ 1% anthracene cream were applied externally for 30min every day, and then the action time was gradually prolonged, and hair regrowth occurred within 3 months. Alternating use of 5% chlorhexidine cream (night) and 5% minoxidil (day) has synergistic effect on most refractory cases.
③0.002% nitrogen mustard hydrochloride solution, 5% minoxidil (minoxidil) solution, dibutylsqualene ester and diphenylpropenone can all be selected as appropriate.
④ Vitamin E 5 ~ 75 mg each time, atropine 0. 1mg each time, anisodamine (6542), etc. It can be injected intradermally locally, every week 1 ~ 2 times, and 8 ~ 10 times is a course of treatment.
17.2.3 (3) Physiotherapy ① Freezing: Cryopreservation with liquid nitrogen at low temperature, once a week, usually 1 ~ 2 times.
② Laser: He-Ne laser irradiation, each lesion 10min, 1 time every day, and 1 time after 6 times.
③ Photochemical therapy (PUVA): It may play a role by inhibiting the local immune attack of Langerhans cells on hair follicles. 1% 8- methoxysalicylic acid ointment or solution for external use, or 8 MOP(0.6mg/kg)65438+2 ~ 3 times/week 0 ~ 2 hours after UVA irradiation, and gradually increase the light quantity. The curative effect on alopecia universalis is not good.
④ Hematoporphyrin (Hp) and UVA: 0.5% HP was used externally, and UVA was irradiated locally 2 hours later, with a dose of 4J/cm2 each time, three times a week, with a total dose of 96 ~ 120J/cm2.
⑤ Other therapies: such as ultraviolet radiation, * * lighting, * * *, wax therapy, etc. , you can choose.
17.3 TCM treatment (1) Systemic medication: it is advisable to nourish liver and kidney, nourish blood and dispel wind. Prescription: Radix Rehmanniae Preparata 10g, Fructus Lycii 15g, Semen Cuscutae 15g, Mulberry 15g, Eclipta prostrata 10g, Caulis Polygoni Multiflori 15g and Radix Angelicae Sinensis 10g.
(2) External treatment: pepper tincture, ginger tincture, mustard tincture, cantharis tincture, etc.
Patients with 18 prognosis lesions less than 25% have a high self-healing rate. The wider the lesion, the worse the prognosis. The factors influencing the prognosis are: concomitant atopic dermatitis, early onset, widespread alopecia, crawling alopecia, 5 years' course of disease and nail malnutrition.
19 to prevent cicatricial alopecia. Keep a good mood, ensure adequate sleep, and avoid or eliminate possible reasons.
2. Early diagnosis and early treatment.
Related drugs: diazepam, oryzanol, cystine, prednisone, minoxidil, dexamethasone, methylprednisolone, cyclosporine, isopropylidene, inosine, dapsone, betamethasone, triamcinolone acetonide, nitrogen mustard, squalene, vitamin E, atropine, anisodamine, oxygen, methoxysarin, hematoporphyrin and kidney-yang deficiency.
2 1 correlation tests of anti-smooth muscle antibody, anti-mitochondrial antibody, rheumatoid factor, anti-thyroid antibody, anti-gastric parietal cell antibody, cystine and vitamin e.
The acupoints for treating cicatricial alopecia are Tang Qiwen acupuncture for 5-7 weeks and moxa stick moxibustion 10-20 minutes. Note: Scar moxibustion should not be used, so as not to affect elbow joint activity due to scar. Compatibility: Ikezawa uses less. ...
Chi Zewen's acupuncture is 5 ~ 7 strong, and moxa stick moxibustion 10 ~ 20 minutes. Note: Scar moxibustion should not be used, so as not to affect elbow joint activity due to scar. Compatibility: Ikezawa uses less. ...
People who are afraid of dumb doors are not suitable, so press and knead for three uses. Moxibustion can be used, but it is not suitable for scar moxibustion. Compatibility of Yamen Point: Yamen Point and Li Anquan, Ermen, Tinggong and Tinghui. ...
Yangchi moxa cone moxibustion or warm acupuncture is 3 ~ 5 strong, and moxa stick moxibustion lasts for 5 10 minutes. Scar moxibustion is not suitable. Compatibility of Yangchi point: Yangchi point is matched with Fengchi, Dazhui, Quchi and Hegu. ...
Natural bone