Stewart M I, Smoller B R
Department of Dermatology, Stanford University Medical Center, California.
J Cutan Pathol. 1993 Apr;20(2):180-3. doi: 10.1111/j.1600-0560.1993.tb00239.x.
Alopecia universalis, a variant of alopecia areata, is a disease of unknown etiology, though evidence for an autoimmune etiology continues to mount. We report an HIV-positive patient with altered T-lymphocyte subsets in whom alopecia universalis developed. A skin biopsy of the patient's scalp demonstrated a classic perifollicular lymphocytic infiltrate, and immunophenotyping of the same specimen revealed that the majority of the cells were CD4+ lymphocytes. During the active loss of hair, the patient's CD4/CD8 ratio was decreased. This ratio normalized during the period of regrowth. Our data suggest that systemic immune dysfunction, as seen in HIV infection, may be more important in mediating alopecia areata than localized immune responses. Given the proposed mechanism of alopecia areata developing in this patient, i.e. influx of CD4+ lymphocytes to the perifollicular regions of skin when the CD4/CD8 ratio is low, it is surprising that alopecia areata is not seen more commonly in patients with HIV infection.
全秃是斑秃的一种变体，是一种病因不明的疾病，尽管自身免疫病因的证据不断增加。我们报告一例HIV阳性患者，其T淋巴细胞亚群发生改变，并出现了全秃。对该患者头皮进行的皮肤活检显示有典型的毛囊周围淋巴细胞浸润，对同一标本进行的免疫表型分析显示，大多数细胞为CD4 +淋巴细胞。在头发大量脱落期间，患者的CD4/CD8比值降低。在头发再生期间，该比值恢复正常。我们的数据表明，如在HIV感染中所见的全身免疫功能障碍，在介导斑秃方面可能比局部免疫反应更重要。鉴于该患者斑秃发生的推测机制，即当CD4/CD8比值较低时，CD4 +淋巴细胞流入皮肤毛囊周围区域，令人惊讶的是，HIV感染患者中斑秃并不更常见。
