Tan Eileen, Tay Yong-Kwang, Goh Chee-Leok, Chin Giam Yoke
National Skin Center, Singapore.
Int J Dermatol. 2002 Nov;41(11):748-53. doi: 10.1046/j.1365-4362.2002.01357.x.
Alopecia areata is believed to be an autoimmune condition with a worldwide occurrence. It usually presents as patchy, nonscarring hair loss. There is a paucity of clinical data in Asians.
To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in an Asian population over a 1-year period.
Records of all newly diagnosed alopecia areata cases seen from May 1998 to April 1999 at the National Skin Center were collated with regard to the epidemiology, pattern of alopecia, and associations according to the investigational guidelines published by Oslen et al. The treatment and psychologic impact of alopecia areata were also assessed.
Two hundred and nineteen new case referrals of alopecia areata were seen from May 1998 to April 1999. The incidence of alopecia areata was 3.8%. There were 173 Chinese (79%), 35 Indians (16%), and 11 Malays (5.0%). The male to female ratio was 1 : 1.3. The median age at presentation was 25.2 years. The majority of patients (85.5%) had their first episode of alopecia areata before the age of 40 years. Of the patients with onset of alopecia areata before the age of 40 years, 36.5% presented with extensive alopecia, compared with 5.5% above the age of 40 years (P < 0.05). Nail changes, consisting of pitting, trachyonychia, and longitudinal ridging, were reported in 23 patients (10.5%). A significant percentage of patients had an associated personal and family history of atopy (60.7%). There was no significant association between a personal history of atopy and the extent of alopecia areata. The frequencies reported for the following associated diseases were: thyroid disease, 2.3%; vitiligo, 4.1%; diabetes mellitus, 3.2%; Down's syndrome, 1.4%; and rheumatic arthritis, 0.9%. A family history of alopecia areata was reported in 4.6%. Intralesional triamcinolone acetonide was the first-line treatment for limited alopecia areata, while squaric acid dibutyl ester was used for extensive involvement. The majority of patients with limited alopecia areata (82.1%) had more than 50% improvement with intralesional triamcinolone acetonide after 3 months. The majority of patients who received squaric acid dibutyl ester (87.5%) achieved more than 50% regrowth at the end of 6 months. Poor prognostic factors for alopecia areata were extensive involvement, early age of onset, and Down's syndrome. Thirteen out of 132 respondents (9.8%) recalled stressful events preceding hair loss. Patients with extensive alopecia areata experienced more psychologic adverse effects than those with limited alopecia areata (P < 0.05). Males with extensive alopecia areata experienced more severe psychologic ill-effects, such as depression and feelings of inability to improve hair loss.
Our findings are similar to those reported in the Western literature where alopecia areata is predominantly a disease of the young. A holistic approach is important in the management of alopecia areata as the disease can have a severe psychologic impact on an individual's well-being.
斑秃被认为是一种全球性的自身免疫性疾病。通常表现为片状、非瘢痕性脱发。亚洲人群的临床数据较少。
研究亚洲人群在1年期间斑秃的流行病学、临床特征、相关因素及治疗情况。
根据奥斯伦等人发表的研究指南，整理了1998年5月至1999年4月在国家皮肤中心新诊断的所有斑秃病例的记录，内容涉及流行病学、脱发模式及相关因素。还评估了斑秃的治疗及心理影响。
1998年5月至1999年4月共新收治219例斑秃转诊病例。斑秃发病率为3.8%。其中华人173例（79%），印度人35例（16%），马来人11例（5.0%）。男女比例为1∶1.3。就诊时的中位年龄为25.2岁。大多数患者（85.5%）在40岁之前首次出现斑秃。40岁之前发病的患者中，36.5%表现为广泛性脱发，40岁以上患者中这一比例为5.5%（P<0.05）。23例患者（10.5%）报告有指甲改变，包括甲凹点、粗糙甲和纵嵴。相当比例的患者有特应性个人史和家族史（60.7%）。特应性个人史与斑秃范围之间无显著相关性。以下相关疾病的报告发生率分别为：甲状腺疾病2.3%；白癜风4.1%；糖尿病3.2%；唐氏综合征1.4%；风湿性关节炎0.9%。有斑秃家族史的报告发生率为4.6%。曲安奈德皮损内注射是局限性斑秃的一线治疗方法，而二丁基二甲基丙烯酸酯用于广泛性斑秃。大多数局限性斑秃患者（82.1%）在3个月后接受曲安奈德皮损内注射治疗后改善超过50%。大多数接受二丁基二甲基丙烯酸酯治疗的患者（87.5%）在6个月末毛发再生超过50%。斑秃的不良预后因素为广泛性脱发、发病年龄早和唐氏综合征。132名受访者中有13名（9.8%）回忆起脱发前有应激事件。广泛性斑秃患者比局限性斑秃患者经历更多的心理不良反应（P<0.05）。广泛性斑秃男性经历更严重的心理不良影响，如抑郁和无法改善脱发的感觉。
我们的研究结果与西方文献报道相似，在西方文献中斑秃主要是年轻人的疾病。在斑秃的管理中采用整体方法很重要，因为该疾病会对个人的幸福感产生严重的心理影响。
