Morais Karina Lopes, Secchin Pedro, Anzai Alessandra, Verussa Maria Júlia Miquelão Canuto, Munck Andréia, Fechine Carolina Oliveira Costa, Valente Neusa Yuriko Sakai, Romiti Ricardo
Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Skin Appendage Disord. 2022 Jul;8(4):322-327. doi: 10.1159/000521549. Epub 2022 Feb 14.
Lupus erythematosus (LE) is a chronic autoimmune disease that frequently causes hair loss and scalp lesions. Hair loss can be scarring and nonscarring, diffuse, or patchy. The nonscarring patchy alopecia is usually related to systemic LE (SLE) and may simulate alopecia areata (AA), reason why it is named areata-like lupus. Our case was diagnosed with areata-like lupus but did not meet criteria for SLE.
A 63-year-old woman presented with irregular nonscarring patchy alopecia in the temporal and frontoparietal scalp. Trichoscopy showed exclamation mark hairs, vellus hairs, and sparse yellow dots. Histology revealed epidermal vacuolar interface dermatitis, lymphohistiocytic infiltrate around the bulbs of anagen follicles, and eccrine glands. Direct immunofluorescence showed deposits of C3, IgA, and IgG in the basement membrane zone.
Patients with cutaneous LE can also manifest as nonscarring patchy alopecia that is clinically similar to AA, despite the absence of systemic manifestations. Areata-like lupus is secondary to the lupus autoimmune infiltrate that affects the skin including the hair follicles. Trichoscopy, histology, and direct immunofluorescence are important to differentiate this form of alopecia from AA, which is believed to have a higher incidence in lupus patients.
红斑狼疮（LE）是一种慢性自身免疫性疾病，常导致脱发和头皮病变。脱发可为瘢痕性和非瘢痕性、弥漫性或斑片状。非瘢痕性斑片状脱发通常与系统性红斑狼疮（SLE）有关，可能类似斑秃（AA），因此被命名为斑秃样狼疮。我们的病例被诊断为斑秃样狼疮，但不符合SLE的标准。
一名63岁女性，颞部和额顶部头皮出现不规则非瘢痕性斑片状脱发。皮肤镜检查显示惊叹号样毛发、毳毛和稀疏的黄点。组织学检查显示表皮空泡状界面性皮炎、生长期毛囊球周围淋巴细胞和组织细胞浸润以及汗腺。直接免疫荧光检查显示基底膜带C3、IgA和IgG沉积。
皮肤型红斑狼疮患者也可表现为临床上与斑秃相似的非瘢痕性斑片状脱发，尽管没有全身表现。斑秃样狼疮继发于影响包括毛囊在内的皮肤的狼疮自身免疫浸润。皮肤镜检查、组织学检查和直接免疫荧光检查对于区分这种脱发形式与斑秃很重要，据信斑秃在狼疮患者中的发病率较高。
