Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, China.
Australas J Dermatol. 2013 Aug;54(3):184-91. doi: 10.1111/ajd.12065. Epub 2013 Jun 28.
BACKGROUND/OBJECTIVES: Alopecia areata (AA) is a non-scarring inflammatory hair loss disease. We investigated the early pathological changes of AA to identify possible factors participating in its pathogenesis.
Clinical, laboratory and pathological features of 87 AA patients were investigated.
Anti-nuclear antibody was found in 11 of 85 patients tested (13%), with a higher percentage in women (21%) than men (5%) (P = 0.026). In early AA lesions, inflammatory infiltration in the upper dermis and epithelial cell damage of the hair follicle infundibulum, just above the sebaceous gland, was observed. Liquefaction and disarrangement of peripheral infundibular epithelial cells coexisted with T-lymphocytic invasion and regression of the lower follicle. The latter findings positively correlated with the presence of eosinophils and perivascular mononuclear cell infiltration in the upper dermis. Eosinophilic infiltration was found in 35 patients (40%) and was positively correlated to elevated serum IgE levels (r = 0.21, P = 0.044), a more severe perivascular lymphocytic inflammation in the upper dermis (r = 0.24, P = 0.026), as well as a prominent swarm of bees-like peri-follicular infiltration (r = 0.41, P < 0.001). Mast cells were abundant in the upper dermis, especially around blood vessels, and positively correlated with eosinophil presence (r = 0.30, P = 0.027).
Damage to the hair follicle infundibulum in the upper dermis might be an important component of early changes in AA lesions, possibly caused by lymphocyte cell infiltration in the same area. AA may involve damage of the upper hair follicle as well as the bulb, possibly involving hypersensitivity and autoimmunity.
背景/目的：斑秃（AA）是一种非瘢痕性炎症性脱发疾病。我们研究了 AA 的早期病理变化，以确定可能参与其发病机制的因素。
对 87 例 AA 患者的临床、实验室和病理特征进行了调查。
在 85 例接受检测的患者中，有 11 例（13%）发现抗核抗体，女性（21%）高于男性（5%）（P=0.026）。在早期 AA 病变中，在上皮细胞损伤的毛囊漏斗部和上真皮炎症浸润，就在皮脂腺上方，观察到。液化和周围滤泡上皮细胞排列紊乱与 T 淋巴细胞浸润和下毛囊退行性变并存。后者的发现与上真皮中嗜酸性粒细胞和血管周围单核细胞浸润呈正相关。在 35 例患者（40%）中发现嗜酸性粒细胞浸润，并与血清 IgE 水平升高呈正相关（r=0.21，P=0.044），上真皮中血管周围淋巴细胞炎症更严重（r=0.24，P=0.026），以及明显的毛囊周围群蜂样浸润（r=0.41，P<0.001）。在上真皮中，肥大细胞丰富，特别是在血管周围，并与嗜酸性粒细胞存在呈正相关（r=0.30，P=0.027）。
上真皮毛囊漏斗部的损伤可能是 AA 病变早期变化的一个重要组成部分，可能是由同一部位的淋巴细胞细胞浸润引起的。AA 可能涉及上毛囊和毛囊球的损伤，可能涉及过敏和自身免疫。
