柳佳 李丽 郭书萍

[摘要]目的：观察斑秃患者的皮肤镜征象并研究其对临床诊断的意义。方法：收集85例斑秃患者，45例健康对照者及40例雄激素性秃发患者的皮肤镜征象及相关临床资料，并进行分析。结果：斑秃的皮肤镜征象发生率依次为黄点征、短毳毛增多、断发、黑点征、感叹号发、毛细血管扩张、圈状发/螺旋状发、毛发尖端变细等，其中黄点征发生率最高。黄点征、黑点征、断发、圈状发/螺旋状发、感叹号发、短毳毛增多、毛细血管扩张及毛发尖端变细的发生率在斑秃患者明显高于健康对照者；毛干直径差异>20%、褐色毛周征、蜂窝状色素沉着、毛细血管扩张的发生率斑秃患者则低于雄激素性秃发患者。短毳毛增多的发生率与脱发面积呈负相关。白点征、黄点征、黑点征、毛发尖端变细的发生率与脱发面积呈正相关。结论：黄点征、断发、黑点征、短毳毛增多对斑秃诊断较敏感，感叹号发对斑秃具有一定特异性。各皮肤镜征象在不同分型的斑秃患者之间的差异较小。短毳毛增多可用于判断疾病恢复。毛发尖端变细、黄点征、黑点征可作为观察斑秃患者病情进展的指标。

[关键词]斑秃；皮肤镜；皮肤镜表现

[中图分类号]R758.71 [文献标志码]B [文章编号]1008-6455（2018）06-0081-04

Abstract： Objective To observe the features of alopecia areata（AA） with dermoscopy and study its significance for clinical diagnosis. Methods A handheld dermoscope was used to observe the balding scalp of 85 patients with ，aAA，40 patients with androgenetic alopecia （AGA），as well as normal scalp of 45 human controls without hair loss.climical information was also collected from these subjects.Then the data were analyzed. Results The most common dermoscopic features was yellow dots，followed by broken hairs， short vellus hairs ， black dots， exclamation mark hairs， telangiectasia， coiled hair/spiral hair， hair tapering.The incidence rate of yellow dots， black dots， broken hairs， hair ring/spiral hairs， short vellus hairs， exclamation mark hairs， telangiectasia， coiled hair/spiral hair， hair tapering were significantly higher，in AA patients than controls. The incidence rate of hair diameter diversity>20%， brown peripilar sign，scalp pigmentation and telangiectasia was lower in patients with AA than in patients with androgenetic alopecia.The prevalence of short vellus hairs was negatively correlated with the area of AA.While yellow dots，black dots，white dots and hair tapering was positively correlated with the area of hair loss. Conclusion The yellow dots， broken hair， black dots， short vellus hair are more sensitive for AA， exclamation mark hairs is highly sensitive for the confirmation of diagnosis of AA. The differences between the dermoscopic features and the different types of AA were small. Short vellus hair can be used to determine the recovery of the disease. The yellow dots，black dots and hair tapering may be used as an indicator of the progress of the patients with AA.

Key words： alopecia areata； dermoscopy； dermoscopic features

皮膚镜是一种可放大10～30倍的皮肤显微镜。它具有偏振光源，其偏振光可以减少皮肤角质层对光线的折射，从而有助于我们观察体表皮肤细微结构、毛囊单位在皮面开口处、毛细血管及毛干结构等信息。皮肤镜用于脱发疾病的诊断及鉴别诊断具有无创性和快捷性的优点。