Samrao Aman, Fu Jennifer M, Harris Steven T, Price Vera H
Department of Dermatology, University of California, San Francisco, CA , USA.
J Drugs Dermatol. 2013 Feb;12(2):e36-40.
Intralesional corticosteroid injections are a common treatment for patchy alopecia areata, the most prevalent subtype of this autoimmune hair disorder. To date, no studies have examined the potential adverse effects of this therapy on bone mineral density (BMD).
In this retrospective, cross-sectional case series, 18 patients with patchy alopecia areata treated at 4- to 8-week intervals with intralesional triamcinolone acetonide for at least 20 months were evaluated for BMD using dual-energy x-ray absorptiometry (DXA). Follow-up DXA measurements were obtained in those with abnormal findings.
Nine out of 18 patients (50%) had abnormal DXA results. Patients with the following risk factors were more likely to have abnormal BMD: age older than 50 years, body mass index less than 18.5 kg/m2, lack of weight-bearing exercise, smoking history, postmenopausal status, past stress fracture, family history of osteopenia or osteoporosis, and a cumulative intralesional triamcinolone acetonide dose of greater than 500 mg.
Patients with patchy alopecia areata who receive chronic intralesional triamcinolone acetonide therapy should be counseled on preventive measures for osteoporosis and monitored for effects on BMD.
病灶内注射皮质类固醇是斑秃（这种自身免疫性毛发疾病最常见的亚型）的一种常见治疗方法。迄今为止，尚无研究探讨该疗法对骨密度（BMD）的潜在不良影响。
在这个回顾性横断面病例系列中，对18例斑秃患者进行了评估，这些患者每隔4至8周接受病灶内注射曲安奈德治疗至少20个月，使用双能X线吸收法（DXA）测量骨密度。对检查结果异常的患者进行了后续DXA测量。
18例患者中有9例（50%）DXA结果异常。具有以下危险因素的患者骨密度异常的可能性更大：年龄超过50岁、体重指数低于18.5kg/m²、缺乏负重运动、吸烟史、绝经后状态、既往应力性骨折、骨质疏松症或骨质减少症家族史以及病灶内曲安奈德累积剂量大于500mg。
对于接受慢性病灶内注射曲安奈德治疗的斑秃患者，应就骨质疏松的预防措施提供咨询，并监测其对骨密度的影响。
