Pirov Eitan, Ramot Yuval
The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel.
Skin Appendage Disord. 2025 May 28:1-10. doi: 10.1159/000545835.
Psoriatic alopecia is a distinct but underrecognized manifestation of psoriasis, leading to both non-scarring and scarring hair loss. While scalp involvement is common in psoriasis, the mechanisms underlying follicular damage and hair loss remain poorly understood. Diagnosis is challenging due to clinical and histopathological overlap with other alopecias, and treatment responses are often variable.
This review examines the clinical presentation, pathogenesis, and management of psoriatic alopecia. The inflammatory process, primarily driven by the Th17/IL-23 axis, contributes to hair follicle disruption, sebaceous gland atrophy, and in severe cases, permanent alopecia. Trichoscopy and histopathology aid in diagnosis, but standardized criteria are lacking. Treatment strategies include topical corticosteroids, vitamin D analogs, and systemic biologics, but some patients remain refractory to conventional therapies. Paradoxical psoriatic alopecia induced by TNF inhibitors further complicates management, necessitating individualized treatment approaches.
Psoriatic alopecia requires greater clinical recognition and research to improve diagnosis and treatment. A deeper understanding of its pathogenesis, particularly immune-mediated follicular damage, could lead to more effective therapies. Personalized treatment approaches, including novel biologics, hold promise for improving patient outcomes, but further studies are needed to optimize long-term management strategies.
银屑病性脱发是银屑病一种独特但未得到充分认识的表现形式，可导致非瘢痕性和瘢痕性脱发。虽然头皮受累在银屑病中很常见，但毛囊损伤和脱发的潜在机制仍知之甚少。由于与其他脱发疾病在临床和组织病理学上存在重叠，诊断具有挑战性，且治疗反应往往各不相同。
本综述探讨了银屑病性脱发的临床表现、发病机制和管理方法。主要由Th17/IL - 23轴驱动的炎症过程会导致毛囊破坏、皮脂腺萎缩，严重时会导致永久性脱发。皮肤镜检查和组织病理学有助于诊断，但缺乏标准化标准。治疗策略包括外用皮质类固醇、维生素D类似物和全身性生物制剂，但一些患者对传统疗法仍有抵抗。由肿瘤坏死因子抑制剂引起的矛盾性银屑病性脱发使管理更加复杂，需要个体化的治疗方法。
银屑病性脱发需要更多的临床认识和研究以改善诊断和治疗。对其发病机制，尤其是免疫介导的毛囊损伤有更深入的了解可能会带来更有效的治疗方法。包括新型生物制剂在内的个体化治疗方法有望改善患者预后，但需要进一步研究以优化长期管理策略。
