Kossard S, Lee M S, Wilkinson B
Skin and Cancer Foundation Australia, NSW, Australia.
J Am Acad Dermatol. 1997 Jan;36(1):59-66. doi: 10.1016/s0190-9622(97)70326-8.
Lichen planopilaris usually produces multifocal areas of scarring alopecia. Recently, a condition in postmenopausal women characterized by progressive frontal hairline recession associated with scarring has been described.
Our purpose was to study the clinical and histopathologic features and results of treatment in a group of women with the frontal variant of lichen planopilaris and to compare the immunohistochemical profile of scalp biopsy specimens from this subset with that found in the multifocal variant of lichen planopilaris.
The clinical data as well as the histopathologic findings in 16 women with frontal fibrosing alopecia were collated. The immunohistochemical profile of six scalp biopsy specimens from the frontal hairline were compared with six specimens from women with multifocal lichen planopilaris.
In addition to the progressive frontal fibrosing alopecia in all 16 women, total loss or a marked decrease of the eyebrows was observed in 13. No evidence of lichen planus was observed at other sites. In one patient multifocal areas of lichen planopilaris developed in the scalp. The frontal fibrosing alopecia was slowly progressive but has stabilized in five patients. Biopsy specimens from the frontal hairline showed histologic changes identical to lichen planopilaris. Immunophenotyping failed to reveal any significant differences between the frontal and multifocal variants. No effective treatments emerged although oral steroids and antimalarials may temporarily slow the course. Hormone replacement therapy did not appear to influence the course of the alopecia.
Progressive frontal fibrosing alopecia is a clinically distinct variant of lichen planopilaris that affects in particular elderly women and frequently involves the eyebrows. The basis for this lichenoid tissue reaction targeting frontal scalp follicles and eyebrows is unknown.
扁平苔藓性毛发角化病通常会导致瘢痕性脱发的多灶性区域。最近，一种在绝经后女性中出现的疾病被描述出来，其特征为伴有瘢痕形成的额部发际线进行性后退。
我们的目的是研究一组患有扁平苔藓性毛发角化病额部变异型的女性的临床和组织病理学特征及治疗结果，并将该亚组头皮活检标本的免疫组化特征与扁平苔藓性毛发角化病多灶性变异型的特征进行比较。
整理了16例患有额部纤维性脱发女性的临床资料以及组织病理学检查结果。将来自额部发际线的6例头皮活检标本的免疫组化特征与6例多灶性扁平苔藓性毛发角化病女性的标本进行比较。
除了所有16例女性均出现的进行性额部纤维性脱发外，13例患者出现眉毛全部脱落或明显稀疏。在其他部位未观察到扁平苔藓的迹象。1例患者头皮出现多灶性扁平苔藓性毛发角化病区域。额部纤维性脱发进展缓慢，但5例患者病情已稳定。额部发际线的活检标本显示出与扁平苔藓性毛发角化病相同的组织学变化。免疫表型分析未能揭示额部和多灶性变异型之间的任何显著差异。尽管口服类固醇和抗疟药可能会暂时减缓病程，但未出现有效的治疗方法。激素替代疗法似乎并未影响脱发的病程。
进行性额部纤维性脱发是扁平苔藓性毛发角化病的一种临床上独特的变异型，尤其影响老年女性，且常累及眉毛。这种针对额部头皮毛囊和眉毛的苔藓样组织反应的基础尚不清楚。
