Gershan L A, Esterly N B
Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
Arch Dis Child. 1993 May;68(5 Spec No):591-3. doi: 10.1136/adc.68.5_spec_no.591.
Scarring alopecia is relatively uncommon in infants and children and rarely discussed in the paediatric literature. It does not appear to have been previously documented as a consequence of compromised oxygenation and blood supply in the neonatal population or as a complication of extracorporeal membrane oxygenation (ECMO) treatment. During a six month period, we observed five patients who presented to our neonatal intensive care unit with pressure ulcers that eventuated in scarring alopecia. The patients were all > or = 2500 g at birth, had some disruption of the cardiac circulation, were hypoxaemic and acidotic, and required vasopressor treatment. Institution of a positioning schedule and use of a thermostable Spenco gel pad during the subsequent six month period eliminated the presence of pressure ulceration and scarring alopecia in this at-risk population. Although scarring alopecia is a permanent condition, skin changes preceding its development in this setting are recognisable and follow a predictable pattern and time course, and should therefore allow for intervention at an earlier stage. Neonatal ECMO patients, as well as those who suffer hypoxaemia-hypoperfusion, but do not require circulatory bypass, appear to be at increased risk for development of the pressure ulcers that precede scarring alopecia. Paediatricians should consider this possibility and seek the appropriate historical information when confronted with a case of scarring alopecia after the neonatal period.
瘢痕性秃发在婴幼儿中相对少见，儿科文献中也很少讨论。此前似乎没有文献记载其在新生儿群体中是因氧合和血液供应受损所致，或作为体外膜肺氧合（ECMO）治疗的并发症。在六个月的时间里，我们观察到五名新生儿重症监护病房的患者出现了压疮，最终导致瘢痕性秃发。这些患者出生时体重均≥2500克，有心脏循环的某些紊乱，存在低氧血症和酸中毒，且需要血管加压药物治疗。在随后的六个月里，制定了翻身计划并使用了热稳定的斯宾科凝胶垫，消除了这一高危人群中压疮和瘢痕性秃发的出现。尽管瘢痕性秃发是一种永久性疾病，但在这种情况下其发生前的皮肤变化是可识别的，且遵循可预测的模式和时间进程，因此应能在更早阶段进行干预。新生儿ECMO患者以及那些有低氧血症 - 低灌注但不需要循环旁路的患者，似乎发生瘢痕性秃发前压疮的风险增加。儿科医生在面对新生儿期后的瘢痕性秃发病例时应考虑这种可能性，并寻求适当的病史信息。
