Abreu-Velez Ana Maria, Girard Julia G, Howard Michael S
Georgia Dermatopathology Associates, Atlanta, GA, USA.
N Am J Med Sci. 2009 Sep;1(4):205-10.
Hair loss is one of the most striking clinical features of active systemic lupus erythematosus (SLE), however, very few studies have investigated the immunological features of this process.
We describe a 33 years old female who presented with scalp hair loss and arthralgias. Physical examination revealed erythematous plaques on the nose and scalp, with bitemporal hair loss. Scalp biopsies revealed epidermal hyperkeratosis, with a mild interface infiltrate of lymphocytes and histiocytes and a superficial and deep, perivascular and periadnexal infiltrate of mostly CD4 positive cells. Antibodies to HAM 56, CD68, CD1a, S-100, mast cell tryptase and c-kit/CD117 were strongly positive around the hair follicles, and in the adjacent sebaceous glands.
We present the first report showing a significant presence of several antigen presenting cells around the hair follicular units in a patient with alopecia in active SLE. Today, antigen presenting cells and dendritic cells (DC) are modeled as the master regulators of human immunity. One aspect that has become clearly appreciated is the great diversity of DC subtypes, each with considerable functional differences. Thus, we suggest that APC and DCs are equipped with Pattern Recognition Receptors (PRRs) to some hair follicular unit antigens; that these innate sensors recognize conserved molecular patterns on self- tissue, and play a significant role in the pathophysiology of alopecia in SLE patients.
脱发是活动性系统性红斑狼疮（SLE）最显著的临床特征之一，然而，很少有研究调查这一过程的免疫学特征。
我们描述了一名33岁女性，她出现头皮脱发和关节痛。体格检查发现鼻子和头皮有红斑，双侧颞部脱发。头皮活检显示表皮角化过度，淋巴细胞和组织细胞有轻度界面浸润，浅层和深层血管周围及腺周主要为CD4阳性细胞浸润。毛囊周围以及相邻皮脂腺中，针对HAM 56、CD68、CD1a、S-100、肥大细胞类胰蛋白酶和c-kit/CD117的抗体呈强阳性。
我们首次报告显示，在活动性SLE脱发患者的毛囊单位周围有大量几种抗原呈递细胞。如今，抗原呈递细胞和树突状细胞（DC）被视为人类免疫的主要调节因子。一个已被明确认识到的方面是DC亚型的巨大多样性，每种亚型都有相当大的功能差异。因此，我们认为抗原呈递细胞和树突状细胞配备了针对某些毛囊单位抗原的模式识别受体（PRR）；这些先天传感器识别自身组织上的保守分子模式，并在SLE患者脱发的病理生理学中发挥重要作用。
