Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Eur Acad Dermatol Venereol. 2019 Apr;33(4):774-780. doi: 10.1111/jdv.15421. Epub 2019 Feb 18.
Hair and scalp involvement in systemic lupus erythematosus (SLE) can manifest as scarring alopecia, non-scarring alopecia or scalp/hair shaft changes without apparent hair loss. While trichoscopic signs in chronic cutaneous lupus are well established, data on SLE patients with normal-looking or non-scarring scalp are limited.
To investigate trichoscopic features of SLE patients without chronic cutaneous scalp lesions and compare the findings with normal controls, as well as determine which feature associates with systemic disease. Furthermore, we aim to explore different clinical presentations of the scalp in SLE patients and their association with disease activity.
Trichoscopic photographs were taken from patients and healthy controls and evaluated by one blinded hair specialist. For SLE patients, their clinical presentations and evaluations for cutaneous, extracutaneous involvement; SLE Activity Index 2000 (SLEDAI-2K) score were documented.
Of 109 SLE patients and 305 healthy controls were included. Hair shaft changes were significantly more common in SLE and associated with higher SLEDAI-2K (P < 0.05). The most common feature was prominent arborizing blood vessels (60.6% vs. 18.4%, P < 0.001), followed by thick arborizing blood vessels (57.8% vs. 10.2%, P < 0.001), black dots (47.7% vs. 2%, P < 0.001), brown scattered pigmentation (5.5% vs. 0.7%, P = 0.005) and blue-grey speckled pigmentation (44% vs.0.3%, P < 0.001). When hair loss is diffuse and severe, there were associations with haematologic (P = 0.002) and renal involvement (P = 0.027 for proteinuria > 500 mg/day, P = 0.004 for proteinuria > 1 g/day).
Trichoscopic examination is a valuable tool for SLE diagnosis and monitoring. Severe diffuse non-scarring alopecia most likely indicates active disease.
系统性红斑狼疮（SLE）可累及头皮和毛发，表现为瘢痕性脱发、非瘢痕性脱发或无明显脱发的头皮/毛发改变。虽然慢性皮肤狼疮的毛发镜下表现已得到充分证实，但关于头皮外观正常或无瘢痕的 SLE 患者的数据有限。
探讨无慢性皮肤头皮病变的 SLE 患者的毛发镜特征，并将这些发现与正常对照进行比较，以及确定哪些特征与系统性疾病相关。此外，我们旨在探索 SLE 患者头皮的不同临床表现及其与疾病活动的关系。
对患者和健康对照者进行毛发镜拍照，并由一位盲法毛发专家进行评估。对于 SLE 患者，记录其皮肤、皮肤外受累的临床表现和评估；SLE 活动指数 2000（SLEDAI-2K）评分。
共纳入 109 例 SLE 患者和 305 例健康对照者。毛发改变在 SLE 患者中更为常见，且与 SLEDAI-2K 评分更高相关（P<0.05）。最常见的特征是突出的树枝状血管（60.6%比 18.4%，P<0.001），其次是粗大的树枝状血管（57.8%比 10.2%，P<0.001）、黑色小点（47.7%比 2%，P<0.001）、棕色散在色素沉着（5.5%比 0.7%，P=0.005）和蓝灰色斑片状色素沉着（44%比 0.3%，P<0.001）。当脱发弥漫且严重时，与血液学异常（P=0.002）和肾脏受累（蛋白尿>500mg/天，P=0.027；蛋白尿>1g/天，P=0.004）相关。
毛发镜检查是 SLE 诊断和监测的有价值工具。弥漫性严重非瘢痕性脱发很可能表明疾病活动。
