Cassano N, Amerio P, D'Ovidio R, Vena G A
Dermatology and Venereology Private Practice Bari and Barletta, Italy -
G Ital Dermatol Venereol. 2014 Oct;149(5):555-65. Epub 2014 Jun 30.
Hair disorders are frequently observed in various systemic diseases, including autoimmune connective tissue diseases (CTDs), with predilection of lupus erythematosus (LE), followed by dermatomyositis (DM) and scleroderma. Hair disorders in CTDs may manifest as various clinical patterns, such as telogen hair loss, diffuse thinning or fragility of hair, and scarring alopecia. Less common hair disorders include anagen effluvium, alopecia areata, and trichomegaly. Some drugs used to treat CTDs may cause hair loss in a drug-related manner or hyperthrichosis. In the assessment of common hair loss patterns, such as telogen effluvium, the possible association with CTDs must be borne in mind and should not be overlooked. Alopecia appears to be a significant sign in the course of LE and especially systemic LE. In DM, the involvement of the scalp is common, and is often characterized by a diffuse, violaceous, scaly, non-scarring and symptomatic hair loss. Linear scleroderma en coup de sabre is an uncommon localized form of morphea with involvement of the paramedian forehead and frontal scalp, where it is associated with cicatricial alopecia. The most important variant of scarring alopecia in the context of CTDs is that associated with discoid lupus erythematosus (DLE). In the diagnostic work-up of DLE-related cicatrical alopecia, histopathological and immunopathological studies are useful, and a relevant role has been attributed to dermatoscopy (trichoscopy) over the last years. Hair loss has been reported in several other CTDs, including mixed and undifferentiated CTDs, and primary Sjögren's syndrome, although it is likely to be underestimated in such diseases.
毛发疾病在各种全身性疾病中很常见，包括自身免疫性结缔组织病（CTD），其中红斑狼疮（LE）最为常见，其次是皮肌炎（DM）和硬皮病。CTD中的毛发疾病可能表现为多种临床类型，如休止期脱发、头发弥漫性稀疏或脆弱以及瘢痕性脱发。不太常见的毛发疾病包括生长期脱发、斑秃和毛发过长。一些用于治疗CTD的药物可能会以药物相关的方式导致脱发或多毛症。在评估常见的脱发类型，如休止期脱发时，必须牢记其与CTD的可能关联，不应忽视。脱发似乎是LE尤其是系统性LE病程中的一个重要体征。在DM中，头皮受累很常见，其特征通常是弥漫性、紫红色、鳞屑性、非瘢痕性且有症状的脱发。线性硬皮病军刀状瘢痕是硬斑病的一种罕见局部形式，累及额旁正中及额部头皮，伴有瘢痕性脱发。CTD背景下瘢痕性脱发最重要的变体是与盘状红斑狼疮（DLE）相关的那种。在DLE相关瘢痕性脱发的诊断检查中，组织病理学和免疫病理学研究很有用，并且在过去几年中皮肤镜检查（毛发镜检查）也发挥了相关作用。在其他几种CTD中也有脱发的报道，包括混合性和未分化CTD以及原发性干燥综合征，尽管在这些疾病中脱发可能被低估。
