Tejapira Kasama, Sakpuwadol Nawara, Pomsoong Cherrin, Ratanapokasatit Yanisa, Suchonwanit Poonkiat
Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Clin Cosmet Investig Dermatol. 2023 Aug 17;16:2259-2269. doi: 10.2147/CCID.S424054. eCollection 2023.
Syphilitic alopecia (SA) and alopecia areata (AA) are two distinct conditions that frequently present diagnostic difficulties, especially when differentiating between them due to their similar clinical presentations. Trichoscopy may help in differential diagnosis, but a comparison between trichoscopic features of SA and AA is yet to be researched.
To compare trichoscopic features between SA and AA and determine their discriminative values.
Electronic medical records and trichoscopic images of patients diagnosed with SA or AA between January 2000 and February 2022 were retrieved. Trichoscopic features were statistically compared, and their discriminative values were demonstrated as sensitivity, specificity, predictive value, likelihood ratio, and area under the receiver operating characteristic curve (AUC).
A total of 69 patients were included: 23 SA and 46 AA cases were matched with a 1:2 ratio. Black dots, broken hairs, pigtail hairs, exclamation mark hairs, tapered hairs, angulated hairs, and non-pigmented regrowing hairs were significantly more prevalent in AA than in SA (all P<0.05), whereas erythematous background was more prevalent in SA than in AA patients (P=0.008). Among the aforementioned trichoscopic features, exclamation mark hairs and non-pigmented regrowing hairs had a high positive likelihood ratio for AA (16.17 and 8.34, respectively); however, only exclamation mark hairs revealed high AUC (AUC=0.816).
Despite the presence of several similar trichoscopic features between SA and AA, trichoscopy can aid in distinguishing between the two diseases. Exclamation mark hairs are the only trichoscopic feature that can be used to differentiate patients with clinically suspicious SA from those with AA.
梅毒性脱发（SA）和斑秃（AA）是两种不同的病症，常常在诊断上存在困难，尤其是当由于它们相似的临床表现而进行鉴别时。毛发镜检查可能有助于鉴别诊断，但SA和AA的毛发镜特征之间的比较尚未得到研究。
比较SA和AA的毛发镜特征，并确定它们的鉴别价值。
检索2000年1月至2022年2月期间被诊断为SA或AA的患者的电子病历和毛发镜图像。对毛发镜特征进行统计学比较，并将它们的鉴别价值表示为敏感性、特异性、预测值、似然比和受试者工作特征曲线下面积（AUC）。
共纳入69例患者：23例SA患者和46例AA患者按1:2的比例匹配。黑点、断发、辫子发、惊叹号样发、锥形发、成角发和无色素再生发在AA中比在SA中明显更常见（所有P<0.05），而红斑背景在SA患者中比在AA患者中更常见（P=0.008）。在上述毛发镜特征中，惊叹号样发和无色素再生发对AA具有较高的阳性似然比（分别为16.17和8.34）；然而，只有惊叹号样发显示出较高的AUC（AUC=0.816）。
尽管SA和AA之间存在一些相似的毛发镜特征，但毛发镜检查有助于区分这两种疾病。惊叹号样发是唯一可用于区分临床可疑SA患者和AA患者这两种疾病的毛发镜特征。
