Lynch Michael C, Milchak Marissa A, Parnes Herbert, Ioffreda Michael D
*Department of Pathology, Penn State College of Medicine, The Penn State Hershey Medical Center, Hershey, PA; †Penn State College of Medicine, The Penn State Hershey Medical Center, Hershey, PA; and ‡Department of Dermatology, Penn State College of Medicine, The Penn State Hershey Medical Center, Hershey, PA.
Am J Dermatopathol. 2016 Nov;38(11):e150-e153. doi: 10.1097/DAD.0000000000000598.
Tick bites can cause a number of local inflammatory reactions, which are often difficult to differentiate from those induced by other arthropod bites or stings. These include erythematous nodular or pustular lesions, erosive plaques, annular lesions of erythema chronicum migrans, and both scarring and nonscarring inflammatory alopecia. We report a case of nonscarring alopecia in a 21-year-old male who reported a recent history of tick bite to the scalp. The biopsy demonstrated a dense pseudolymphomatous inflammatory infiltrate with numerous eosinophils associated with hair follicle miniaturization and an elevated catagen-telogen count. Signs of external rubbing, including lichen simplex chronicus and the "hamburger sign", were also visualized and are indicative of the associated pruritus. To the authors' knowledge, this is the fifth report of nonscarring tick bite alopecia in the literature and the first in an adult patient. This text will review the classic clinical presentation, histologic findings, and proposed mechanism of tick bite alopecia.
蜱虫叮咬可引起多种局部炎症反应，这些反应往往难以与其他节肢动物叮咬或蜇伤所引发的反应区分开来。这些反应包括红斑结节性或脓疱性损害、糜烂性斑块、慢性游走性红斑的环状损害，以及瘢痕性和非瘢痕性炎症性脱发。我们报告一例21岁男性非瘢痕性脱发病例，该患者自述近期头皮有蜱虫叮咬史。活检显示有密集的假淋巴瘤样炎性浸润，伴有大量嗜酸性粒细胞，与毛囊小型化及退行期-休止期毛囊计数升高有关。还可见到外部摩擦的迹象，包括慢性单纯性苔藓和“汉堡包征”，这表明存在相关瘙痒。据作者所知，这是文献中关于非瘢痕性蜱虫叮咬脱发的第五篇报道，也是首例成年患者病例。本文将回顾蜱虫叮咬脱发的经典临床表现、组织学发现及推测的发病机制。
