Lux-Battistelli Christine
Polyclinique des 3 Frontières, Saint-Louis, France.
Dermatol Ther. 2015 Jul-Aug;28(4):235-8. doi: 10.1111/dth.12215. Epub 2015 Mar 5.
Spontaneous remission occurs in less than 10% of patients suffering from alopecia areata (AA) totalis for more than 2 years. The efficacy of PUVA therapy is controversial due to recurrence of hair loss after cessation. We report two cases presenting with AA totalis and AA universalis. After hair regrowth, relapse of hair loss occurred upon cessation of PUVA and zinc gluconate combination therapy. However, hair regrowth was noted upon the reintroduction of zinc gluconate and sulfur amino acids without PUVA in the first case and with episodic PUVA in the second case. The chronology of events appears to support the notion that zinc has a significant effect. Our findings suggest the possibility of a subgroup of zinc-responsive patients, but the identification of these patients remains difficult. Metallothioneins and zinc transporters regulating the entrance and exit of zinc in cells might play a key role. Combination therapy with immunomodulators may be administered to facilitate enhanced zinc-targeted action. Taking into account the safety profile of zinc, 30-40 mg/day of zinc metal may be used during at least 1 year, although we recommend to monitor its serum and hair levels. Studies with a larger number of patients are required to further investigate the therapeutic effect of zinc.
斑秃全秃患者病程超过2年者，自发缓解率低于10%。由于停用补骨脂素紫外线A（PUVA）疗法后脱发会复发，其疗效存在争议。我们报告了2例斑秃全秃和普秃患者。在毛发再生后，停用PUVA和葡萄糖酸锌联合治疗后出现脱发复发。然而，在第一例患者中，重新引入葡萄糖酸锌和含硫氨基酸（未使用PUVA）后，毛发再次生长；在第二例患者中，间歇性使用PUVA后毛发也再次生长。事件的先后顺序似乎支持锌具有显著作用这一观点。我们的研究结果提示可能存在一个对锌有反应的患者亚组，但识别这些患者仍然困难。金属硫蛋白和调节锌进出细胞的锌转运蛋白可能起关键作用。可联合使用免疫调节剂以促进增强针对锌的作用。考虑到锌的安全性，尽管我们建议监测血清和毛发中的锌水平，但至少1年内可使用30 - 40毫克/天的金属锌。需要对更多患者进行研究以进一步探究锌的治疗效果。
