羊毛状发痣

报告1例羊毛状发痣。患儿男,7岁。出生后即发现其左侧耳后及枕部头发异常。皮肤科检查:左侧耳后及枕部分别可见约6.0 cm×3.5 cm及6.5 cm×2.5 cm区域的毛发表现为淡黄色,卷曲呈波浪状,质地较正常毛发细软,头部其余部位均正常。皮肤镜检查:与正常区域毛发相比较,患处毛发弯曲、色黄,且粗细不一。扫描电镜检查:毛干粗细不一、弯曲,毛小皮边缘不整齐,有碎裂,部分区域毛干表面凹陷。诊断:羊毛状发痣。治疗:外用5%米诺地尔。     

地霉菌毛发穿孔试验研究及扫描电镜观察

目的 探讨地霉菌对毛发破坏的程度,比较林生地霉皮损株、林生地霉血液株和白地霉对不同年龄组毛发感染时间及程度的差异。方法 临床采集不同年龄组的健康人毛发,分别进行林生地霉皮损株、林生地霉血液株和白地霉的毛发穿孔试验及扫描电镜观察。结果 林生地霉皮损株、林生地霉血液株和白地霉均可致毛发破坏。在各个年龄组中,林生地霉血液株、林生地霉皮损株和白地霉的毛发穿孔时间差异有统计学意义（P < 0.05）;且感染毛发的时间均随着年龄的增长而延长（P < 0.05）。对不同菌株间的差异进行SNK-q检验,发现在各年龄组中,林生地霉血液株、皮损株和白地霉的毛发穿孔时间两两比较差异均有统计学意义（P < 0.05）,林生地霉血液株毛发穿孔时间最短,而白地霉毛发穿孔时间最长,其中林生地霉血液株的毛发穿孔时间范围在53 ~ 64 d,平均为（58.07 ± 3.15） d;林生地霉皮损株的毛发穿孔时间范围在57 ~ 66 d,平均为（61.05 ± 2.55） d;白地霉的毛发穿孔时间范围在61 ~ 74 d,平均为（67.11 ± 3.78） d;对不同年龄组间的差异进行SNK-q检验,发现除 < 2岁组与2 ～ 13 岁组之间比较差异无统计学意义外（P ＞ 0.05）,其余各年龄组的两两比较差异均有统计学意义（P < 0.05）。电镜显示,林生地霉和白地霉均能导致毛发破坏,且林生地霉较白地霉对毛发的破坏严重。结论 林生地霉较白地霉对毛发的破坏早且严重。年龄越小,毛发越易受破坏。     

31例成年男性头发生长特性的初步观察

目的 探讨中国成年男性头发的生长特性.方法 将31名志愿者头皮顶部及颞部各剃去约1.2 cm×1.2 cm范围内的头发;间隔7天后对上述部位微距照相,分析图像,得到头发密度及头发生长速度;拔取观察部位的头发,显微镜下测量头发尖端、中部及根部的直径.结果 31例成年男性头发密度为(132±42)根/cm²,顶部的头发密度显著高于颞部(P<0.001).头发生长速度为(461±44)μm/d,颞部的头发生长速度显著高于顶部(P<0.01).头发直径为(97±9)μm,顶部和颞部之间头发直径差异无统计学意义(P>0.05),头发尖端、中部及根部之间直径的差异亦无统计学意义(P>0.05).结论 与白人和非洲人相比,中国成年男性头发的密度较低,但头发生长速度较快.     

自体头皮与脱细胞异体真皮复合移植修复巨大色素痣北大核心CSCD

目的 探讨自体头皮与脱细胞异体真皮复合移植方法修复儿童巨大色素痣的效果.方法 采用自体刃厚头皮与脱细胞异体真皮复合移植的方法修复儿童巨大色素痣,并以自体薄中厚皮片移植方法作对照,观察移植皮片成活率、创面愈合时间及瘢痕增生状况.结果 供皮区实验组创面愈合时间为（5.31±1.45）d,对照组为（11.63±1.69）d,两组比较差异有统计学意义（P＜0.05）,实验组瘢痕评分为1.62±0.38,对照组为6.38±0.58,两组比较差异有统计学意义（P＜0.05）;受皮区实验组皮肤移植成活率为（94.44±2.56）％,对照组为（95.13±3.13）％,移植皮片成活率于两组间差异无统计学意义,实验组瘢痕评分为5.38±0.62,对照组瘢痕评分为8.40±0.41,两组差异有统计学意义（P＜0.05）.结论 自体头皮与脱细胞异体真皮复合移植修复儿童巨大色素痣,对供区损伤小,移植区形态及功能良好,值得应用.     

中国汉族青年男性头发分布情况初探

目的:研究中国汉族青年男性头发正常分布的特点。方法:对500例健康青年男性志愿者的头皮毛发主要解剖标记部位进行测量定位,并分析头皮不同区域的毛发密度、毛囊单位密度及毛囊单位结构。结果:500例男性平均年龄(19.74±2.01)岁,前发际线类型主要以直线型为主(占53.04%),头皮各解剖部位毛发密度有明显差异,顶部密度最高[(175.98±15.25)根/cm2];前发际线及颞前区主要以1根毛发的毛囊单位为主(分别为75.92%及76.76%),顶部及枕部则以2根毛发的毛囊单位为主(67.45%及60.59%),≥3根毛发的毛囊单位较为罕见(10%)。结论:中国汉族青年男性头发密度低于白种人及黑种人,毛囊构成也存在差异。     

巨大晕痣合并白癜风2例

1临床资料例1女,6岁.右下颌及右枕部巨痣6年,周围皮肤、毛发变白1年余就诊.出生时,发现右侧枕部一黑色胎记,随年龄增长逐渐增大.1年前右下颌出现一小片色素脱失斑,同时发现右枕部巨痣周围皮肤及表面少数头发变白,此后,头顶和颞部头皮出现相同色素脱失斑伴部分头发变白（图1）,遂来本院就诊,诊断：巨大晕痣合并白癜风.……     

表没食子儿茶素没食子酸酯和补骨脂对莫诺苯宗诱导白癜风样小鼠的影响

目的 探讨表没食子儿茶素没食子酸酯（EGCG）和补骨脂对莫诺苯宗诱导的白癜风样小鼠的影响。 方法 C57BL/6小鼠40只,脱去背部2 cm × 2 cm区域毛,随机分为4组,每组10只。阴性对照组涂抹凡士林乳膏;模型组涂抹40%莫诺苯宗乳膏;EGCG组先后涂抹5% EGCG、40%莫诺苯宗乳膏;补骨脂组先后涂抹7%补骨脂、40%莫诺苯宗乳膏。观察小鼠皮肤和毛发脱色情况,组织病理检查观察淋巴细胞浸润,免疫荧光检测CD8+ T细胞表达量。 结果 阴性对照组小鼠皮肤和毛发无脱色现象。模型组小鼠在用药部位及非用药部位均有脱色现象,EGCG组和补骨脂组小鼠用药部位全部出现脱色,用药部位出现脱色斑的平均时间分别为16.7、29.3和19.9 d,脱色面积指数分别为4.00 ± 0.00、2.11 ± 0.54、2.84 ± 0.79,EGCG组、补骨脂组和模型组之间脱色面积指数差异有统计学意义（F = 14.17,P < 0.05）,EGCG组和补骨脂组分别与模型组比较,脱色面积指数差异均有统计学意义（均P < 0.05）;同时,EGCG组和补骨脂组非用药部位的脱色面积指数差异同样有统计学意义（P < 0.05）。EGCG组和补骨脂组CD8+ T细胞表达量均低于模型组,EGCG组和补骨脂组差异亦有统计学意义（P < 0.05）。 结论 EGCG和补骨脂对莫诺苯宗诱导的小鼠皮肤和毛发脱色均有干预作用,EGCG的干预作用比补骨脂的干预作用强,该动物模型与人类白癜风具有极高相似性。     

绝经后女性头发变化与雌激素受体β基因多态性的关系

目的探讨绝经后女性头发生长特征的变化,对其与雌激素受体β基因多态性的关系进行分析。方法选择健康中老年绝经后女性作为受试对象,使用毛发检测仪对顶部和颞部受试区头发进行拍照,图像分析软件计算头发生长速度、密度和白发率;同时采集受试者抗凝静脉血,应用聚合酶链反应-限制性片段长度多态性技术,对受试人群的雌激素受体β基因RsaⅠ和AluⅠ酶切多态性进行分析。结果 131名绝经后女性基因型频率分布符合Hardy-Weinberg平衡定律(P0.05)。受试者顶部和颞部白发率与RsaⅠ酶切位点有相关性,差异有显著性(P=0.040,P=0.008)。头发密度、生长速度在各组间有一定差异,但无显著性(P0.05)。结论雌激素受体β基因RsaⅠ酶切多态性与绝经后女性白发的发生有关。     

儿童、青少年拔毛癖24例临床分析

目的探讨儿童、青少年拔毛癖患者的临床特点及相关因素。方法回顾分析8年来在我院就诊的24例拔毛癖患者的临床资料。结果发病年龄以青春期前3～10岁为多(79.16%),女性占(83.33%),男性占(16.66%),男:女为1:5。拔发部位最常见受累部位:颞部、额、其次为枕、顶部。脱发情况为脱发斑及毛发稀松斑,18例承认有拔发行为,2例合并注意缺陷(多动障碍);1例合并舔唇癖;2例合并咬甲癖,1例拔毛后吃毛发,6例合并焦虑症,5例合并忧郁症。22例的发病与心理因素或诱因有关,以家庭环境及压力等应激因素为多。结论拔毛癖以儿童和女性多见,最常见受累部位是手比较容易伸及的颞部、额,其次为枕、顶部。儿童、青少年拔毛癖作为一个行为方面的精神症状,也常伴抑郁症、焦虑症等其他心理问题及精神障碍,其家庭、环境及生化等因素与其发生有相关性。从分类学上这类疾病仍然归属精神疾病,但部分患者和家人对到精神科治疗不易接受,绝大多数首先到皮肤科就诊和治疗因此,皮肤科医生应加强心理咨询技巧,承担起拔毛癖诊疗中的主要作用。     

经皮水分丢失与健康人性别、年龄、解剖部位的关系

通过经皮水分丢失（TEWL）来评价皮肤的屏障功能，并研究经皮水分丢失与性别，年龄，解剖部位的关系，参加本次实验的为健康志愿者共104名，其中女性53名，男性51名，分为5个不同年龄组，用与计算机相连的蒸发测定仪Darmalab TEWL探头测量。结果发现不同年龄组男女性别之间TEWL值均无显著性差异（P＞0．05），新生儿组TEWL值明显高于其他各年龄组（P＜0．05），老年组TEWL值低于其他年龄组。在8个不同部位测量中，经统计得到TEWL值顺序为：手掌＞额部＞颊部＝手背＞小腿＝背部＞前臂＝胸部。说明TEWL与性别无明显相关性，而与年龄相关，以新生儿最高，老年人最低，在身体各部位的测量中，四肢末端和暴露部位经皮水分丢失较高。     

斑秃共聚焦激光扫描显微镜影像学特征分析

目的 通过在体共聚焦激光扫描显微镜（CLSM）采集斑秃的微解剖图像,研究斑秃的CLSM影像学特征。方法 2010年1月至2011年5月,临床诊断斑秃患者46例。选定患处皮损及31例皮损附近正常皮肤行CLSM检查,并与斑秃的组织病理象作比较。结果 CLSM显示,单位面积内毛囊数目斑秃进展期［（134.856 ± 18.301）/cm2］及静止期［（147.159 ± 17.536）/ cm2］均显著低于正常对照组［（301.613 ± 35.317）/cm2,P值均 < 0.05］,毛囊内毛干缺失,毛囊周围、毛囊及真皮浅层毛细血管周围可见炎细胞浸润,静止期炎细胞浸润程度较进展期减轻;恢复期［（227.778 ± 16.861）/cm2］毛囊数目较进展期增加,但仍少于正常对照（P < 0.05）,可见毳毛及终毛生长,炎细胞浸润进一步减少。结论 斑秃CLSM图像与常规组织病理表现相符合,CLSM描述斑秃细胞水平的成像特点,可用于斑秃的临床观察及动态随访。     

Significant relationship between temporal hair loss and other scalp areas in female pattern hair loss

Female pattern hair loss affects the central scalp, sparing the frontal hairline. The temporal area can also be affected by hair loss. We investigated the degree of temporal hair loss and correlation of other sites of scalp hair loss in Korean female pattern hair loss patients. A total of 109 women with female pattern hair loss were enrolled in this retrospective analysis. We measured hair density and thickness in five scalp sites including the frontal, vertex, occipital and bilateral temporal areas by phototrichogram. Frontal and vertex area hair loss were classified according to the Basic and Specific (BASP) classification, and temporal scalp and occiput areas were also assessed. Eighty-nine patients showed temporal hair loss. The mean of the hair density was lowest in the temporal area among all scalp areas. Total and thick hair densities of the frontal scalp were correlated with those of the vertex, temporal scalp and occiput in descending order, and hair thickness of the frontal scalp was more related with that of the temporal scalp than the vertex. In this study, temporal involvement is evident in female pattern hair loss. We suggest that temporal involvement should be added to pattern hair loss classification, especially BASP classification.     

Hair shaft abnormalities in alopecia areata evaluated by optical coherence tomography

Background/purpose: Optical coherence tomography (OCT) is able to provide highly reproducible measurements of hair shaft thickness, including hair shaft diameter, cross‐sectional surface area and hair shape, similar to histology but in vivo. Variations in the caliber of hair shafts have been described in patchy hair loss like alopecia areata (AA) using electron microscopy. The aim of this study was to evaluate whether OCT is useful for the evaluation of hair shaft abnormalities in AA. Methods: The measurements were performed on patients with AA (n=9), aged 2–66 years. Fifty hairs from the border of an alopecic area and 50 hairs from an unaffected area without hair loss were examined using the OCT technique. The hair parameters were characterized by the cross‐section (CS) and the form factor. The ratio of the maximal and minimal diameters of the hair at a fixed measuring distance from the scalp surface determined the form factor (d_max/d_min). Results: In all cases, the CS of hairs from an AA patch was significantly lower compared with hairs of an unaffected area. However, the form factor did not indicate any disturbances in hair growth. Conclusions: The results demonstrate that structural abnormalities of hair shafts are found in active lesions of AA, but not in clinically unaffected hairs. The OCT technique is a promising method to gain more insight into the pathogenesis of AA in a non‐invasive way.     

不同年龄成人头发的变化

目的 观察不同年龄成人头发的变化,探讨反映人老化的参照指标.方法 根据入选标准和排除标准征集志愿者,并依据年龄分为4组.头顶指定区域拍照后利用图像分析软件检测头发密度以及黑发率.该区域内随机拔取10根头发,利用目镜测微尺测量发干直径和毛球直径.同时,根据毛囊形态计算不同生长时期毛囊率.结果 共有96名志愿者加入本研究,男44例,女52例,年龄30~78岁.头顶头发密度、毛干直径、毛球直径、生长期毛囊率和黑发率随着年龄的增加逐渐减小,休止期毛囊率及白发率增多,并且60岁以上组明显减小,与其他3个年龄组差异有统计学意义,各组内部分指标存在性别差异.相关分析发现,毛干直径与毛球直径呈显著正相关.结论 头发的一些变化可能作为评价人老化程度的参照指标.     

Ultrastructural study of acquired pili torti-like hair defects accompanying pseudopelade

Acquired structural hair defects are caused by various physical and chemical manipulations. Plucked hairs and hair follicle biopsy specimens of pili torti-like hairs that arose from pseudopelade scalp were studied. In scanning electron microscopy, the hair shafts had a segmental pili torti-like appearance, accompanied by oblique or longitudinal grooves and ridges. In light microscopy, the hair follicles showed an asymmetric hair bulb and inner root sheath, and a shortened keratogenous zone within sclerosing fibrous connective tissue. In transmission electron microscopy, the numbers and thickness of the hair cuticle cells were different on the opposite sides of the hair shaft. The hair cuticle was irregularly shaped and formed asymmetric waves. The tonofilaments in the hair cortex ran almost parallel to the hair axis. From these findings, it was clear that the grooves and ridges were produced by the deformed hair cuticle and cortex, whose shapes were modulated by the asymmetric inner root sheath. This asymmetry most likely resulted from a dysfunctional dermal papilla, which was affected by fibrosis. The pili torti-like appearance appeared to be caused by the grooves and ridges that ran obliquely on the hair shaft surface.     

Cheveux incoiffables—diagnostic, clinical and hair microscopic findings, and pathogenic studies

Three possible mechanisms of the hair shaft abnormality in cheveux incoiffables have been investigated in nine patients. Cheveux incoiffables hairs were found to exhibit a normal distribution of cystine-rich protein within both the cuticle and the cortex, as determined by silver methenamine ultrastructural cytochemistry. Resistance to stretching, at 65% relative humidity and constant temperature, was similar to normal controls. Resistance to bending forces was also assessed, and was equivalent in both groups. On scanning electron microscopy, all patients with cheveux incoiffables demonstrated longitudinal grooving of the hair shaft, and the hairs were triangular or heart-shaped in cross-section. In addition, there appeared to be minimal cuticular weathering. Even hairs of 20–30 cm length showed only minimal cuticular and cortical weathering, compared with normal hair shafts of similar length and diameter. It is possible that the reduced progressive weathering renders the hair shaft more rigid, and could serve to explain the ‘stand on end’ appearance of the hair which is typical of this condition. However, the characteristic cross-sectional shape of the hair shaft in cheveux incoiffables may render it more rigid and resistant to bending forces. This latter theory has yet to be fully investigated.     

甘草酸二铵对人毛囊生长作用及对Wnt/β连环蛋白信号通路的影响

目的 探讨甘草提取物甘草酸二铵对体外培养人毛囊生长的作用并检测Wnt/β连环蛋白信号通路相关分子的表达。方法 分别将体外分离人毛囊培养于0.1、0.01、0.001、0.000 1 μmol/L浓度的甘草酸二铵中10 d,并设置不添加甘草酸二铵Williams E培养基组为对照组,显微镜下每日测量并记录其生长长度,观察毛囊形态改变并拍照。用免疫荧光评估毛母质细胞增殖情况及毛母质细胞中Wnt/β连环蛋白信号通路各主要分子β连环蛋白、GSK3β、p?GSK3β、Lef1表达情况。采用重复测量方差分析及单因素方差分析进行统计学分析。结果 重复测量方差分析显示,与对照组相比,仅0.01 μmol/L甘草酸二铵对毛囊生长的促进作用有统计学意义（P < 0.05）,其余各组与对照组相比差异无统计学意义（均P > 0.05）。与对照组相比,0.01 μmol/L甘草酸二铵组毛囊进入退行期时间推迟,而其余各组与对照组相比均无明显变化。免疫荧光显示,与对照组相比,0.1、0.01、0.001 μmol/L浓度组毛母质细胞中ki67阳性细胞较多,而0.000 1 μmol/L浓度组无明显区别。单因素方差分析显示,β连环蛋白、p?GSK3β、Lef1在各组中的表达量差异有统计学意义（F =12.604、16.65、15.266,均P < 0.05）,而GSK3β在各组中的表达差异无统计学意义（F =1.472,P > 0.05）。LSD?t检验显示,与对照组相比,0.1、0.01、0.001 μmol/L浓度组毛母质细胞中β连环蛋白、p?GSK3β、Lef1表达量较多（均P < 0.05）,而0.000 1 μmol/L浓度组与对照组差异无统计学意义（P > 0.05）。结论 0.01 μmol/L甘草酸二铵具有明显促进人毛囊生长的作用,可增强毛母质细胞增殖活性,延迟毛囊进入退行期,该作用可能与其激活Wnt/β连环蛋白信号通路相关。     

Hyperplasia of the subcutaneous adipose tissue is the primary histopathologic abnormality in lipedematous scalp

A 51-year-old white woman presented with thickening of the scalp located at the vertex and left lateral occiput without hair abnormalities or alopecia. Skin biopsies of the thickened scalp showed thickening of the subcutaneous tissue with proliferation of mature subcutaneous fat cells but no signs of inflammation or hair abnormalities. During 2.5 years of follow-up, scalp thickening progressed over the entire hair-bearing scalp and persisted without signs of further progression at 3.5 year follow-up. Lipedematous scalp is an extremely rare diagnosis. It is defined by a thickening of the subcutaneous layer of the scalp and can be distinguished from lipedematous alopecia, in which subcutaneous thickening is associated with diffuse alopecia and shortening of scalp hairs. A total of seven cases of lipedematous alopecia and two cases of lipedematous scalp have been reported. We report the third case of lipedematous scalp in a 51-year-old white woman associated with early symptoms of meningitis. Additional features described in the literature include pruritus, pain, and paresthesia of the scalp as well as associated medical problems such as hyperelasticity of skin and laxity of joints, renal failure, and diabetes mellitus. This sporadic disorder is predominantly located at the vertex and occiput. The etiology and pathogenesis of lipedematous scalp and alopecia remain unclear. The treatment is symptomatic.     

环丙沙星对博来霉素诱导小鼠真皮纤维化的抑制作用

目的 观察环丙沙星对博来霉素诱导实验性硬皮病小鼠模型真皮胶原合成及致纤维化基因表达的影响。 方法 用博来霉素连续4周皮下注射BALB/c小鼠背部建立实验性硬皮病小鼠模型,随后分为3组,分别给予1%环丙沙星乳膏（环丙沙星组）、2.5%积雪草苷乳膏（积雪草苷组）以及乳膏基质（模型组）连续外擦5周,另外,于小鼠背部皮下注射磷酸盐缓冲液后外擦乳膏基质设立空白对照（对照组）。连续治疗5周后取各组皮肤标本行HE染色、Masson染色、Ⅰ型胶原蛋白以及基质金属蛋白酶1（MMP1）和金属蛋白酶组织抑制因子1（TIMP1）免疫组化分析;同时用半定量逆转录PCR技术测定结缔组织生长因子（CTGF）、转化生长因子 1（TGFβ1）和Smad3基因的表达水平,碱水解-分光光度法测定皮肤羟脯氨酸含量。各组间比较采用单因素方差分析,模型组和各处理组间两两比较采用LSD检验。 结果 博来霉素模型组小鼠注射区真皮厚度［（432.76 ± 93.74） μm］较对照组［（301.69 ± 79.47） μm］明显增厚（P < 0.01）,Masson染色可见真皮胶原纤维束粗大致密,排列错乱,符合硬皮病真皮纤维化表现。环丙沙星和积雪草苷组小鼠皮肤胶原总含量、Ⅰ型胶原、TIMP1、MMP1染色强度比模型组明显减少（F值分别为1628.54、33.29、84.82、224.81,均P < 0.01）,但真皮厚度改变不明显（均P > 0.05）。与模型组比较,积雪草苷不同程度下调CTGF、TGFβ1和Smad3基因表达水平（均P < 0.05）,而环丙沙星仅抑制TGFβ1（P < 0.05）和Smad3（P < 0.05）的表达,对CTGF基因表达作用不明显（P > 0.05）。 结论 环丙沙星可抑制TGFβ1/Smad3通路,改变失衡的MMP1和TIMP1表达,显示抗真皮纤维化作用。     

RNA干扰神经突起导向因子 Netrin-1表达下调对鳞状细胞癌SCL-1细胞的影响

目的 探讨神经突起导向因子 Netrin-1表达下调对皮肤鳞状细胞癌（鳞癌）SCL-1细胞增殖、凋亡和迁移的影响。方法 脂质体2000将Netrin-1 siRNA和对照siRNA转染皮肤鳞癌SCL-1细胞。将细胞分为对照1组（未处理组）、对照2组（siRNA对照组）、实验组（Netrin-1 siRNA组）。Western印迹检测转染Netrin-1 siRNA后SCL-1细胞Netrin-1蛋白的表达。人胆囊收缩素/缩胆囊素8肽（CCK-8）ELISA试剂盒分析细胞增殖的变化,流式细胞仪检测细胞凋亡情况。Western 印迹检测caspase-3、caspase-9及MMP-2的表达。结果 Netrin-1 siRNA明显下调SCL-1细胞中Netrin-1蛋白的表达。Netrin-1表达下调明显抑制SCL-1细胞的增殖和诱导细胞凋亡,增加caspase-3和caspase-9的表达,同时可显著抑制MMP-2的表达。结论 Netrin-1表达下调可介导鳞癌细胞增殖抑制、增高细胞凋亡率和降低细胞迁移能力。