这是一种很重要的假性斑秃读书报告

PseudopéladeofBroc

Brocq假性斑秃

Clinicalfeatures

临床特征

In,Brocqdescribedaformofprogressive,idiopathic,noninflammatoryscarringalopecia,whichhenamedpseudopélade.Thisisaverycontroversialentitythathasbeenthesubjectofheateddebateformorethanyears.Presently,manyofthecasesdescribedaspseudopéladeareconsideredtorepresentfinalstagesofdiversescarringalopeciasincludingdiscoidlupuserythematosus,lichenplanopilaris,andcentralcentrifugalscarringalopecia.3,4ThetermpseudopéladeofBrocqshouldberestrictedtothosepatientsinwhomexhaustiveclinicalandhistologicalexaminationandpertinentlaboratorytestshaveexcludedallotherformsofscarringalopecia.

年，Brocq描述了一种进行性、特发性、非炎症性的疤痕性脱发，被其命名为假性斑秃。由于这种疾病非常有争议，因此多年来一直存在激烈的争论。至今，许多曾被描述的Brocq假性斑秃其实是不同瘢痕性脱发的终末阶段，包括盘状红斑狼疮、扁平毛发苔癣、中央离心性瘢痕性脱发。所谓的Brocq假性斑秃应该限于那些经过详细的临床、病理检查以及相关实验室检查后排除所有其他类型瘢痕性脱发的患者。

Patientsaregenerallywhiteadultfemaleswithnoprevioussymptomswhopresentwithdiscreteasymptomaticareasofalopecia.Thesevaryinshapeandlocationandtendnottoinvolvetheperipheralhairlineregionofthescalp(Fig.22.).Lesionsprogressslowlywithalternatingperiodsofinactivityandexacerbation.Whenthediseasestabilizes,confluentplaquesofalopeciawithashinywhiteporcelain-likesurfaceareseen(Fig.22.).Thereislossoffollicularostiabutafewfolliclessometimessurvivewithintheplaque.Milderythemamaybedetectedbutingeneralthereislittleornoinflammation.Somelesionsarehypopigmentedandevendepressed.Frequentlytheyareirregularandhaveageometricform.Suchfocihavebeenclassicallydescribedas‘footprintsinthesnow’,implyingthattheatrophyisvisualizedasafocaldepressionwithintheplaque.7However,manycasesofpseudopéladeofBrocqdonotshowatrophyorthe‘footprintsinthesnow’sign.8NocasesinindividualsofblackAfricandescenthavebeenreportedsofarintheliterature.

患者通常是成年女性白种人，没有前驱症状，主要表现出散在非对称性的区域性脱发。皮损的形状及分布多种多样，但不累及头皮周边的发际线。(Fig.22.).皮损进展缓慢，静止期与活化期交替。当病情稳定时，可见脱发斑呈白色有光泽的瓷样外观。(Fig.22.).毛囊口缺失但病变区域有时可见残存毛囊。皮损处有时可见轻度红斑，但通常病变处仅有少许或无炎症。部分皮损处了见色素减退甚至凹陷。皮损表现通常不规则呈几何图样。这样的病灶表现被称为“雪地上的脚印”，来形容斑块中可见的灶性萎缩。但是许多Brocq假性斑秃并不会表现出萎缩或者“雪地上的脚印”。目前为止，非洲黑种人后裔患病在文献中未见报道。

Fig.22.

PseudopéladeofBrocq:therearemultiplefociofsmallatrophicplaquescontainingisolated,scatteredresidualhairs.CourtesyofP.Reygagne,MD,CentreSabouraud,Paris,France

Brocq假性斑秃：多灶性萎缩性脱发斑，期间有孤立、散在的残留毛发。

Fig.22.

PseudopéladeofBrocq,latelesion:thisexampleshowsthecharacteristicporcelain-whitehypopigmentedplaque.CourtesyofA.M.Aristizábal,MD,InstitutodeCienciasdelaSalud,Medellín,Colombia.

Brocq假性斑秃：特征性的瓷白色斑块。

Thediagnosisofpseudopéladeisoneofexclusionsinceanidenticalclinicalandhistologicalpicturemaybeseenintheendstagesofotherformsofscarringalopecia.Ingeneral,inflammationisminimaland,ifitisprominent,thediseaseismostunlikelytorepresentpseudopélade.Casesparticularlyaffectingthecrownorvertexthatarethoughttorepresentpseudopéladeareprobablybestclassifiedascentralcentrifugalscarringalopecia.

其他的瘢痕形成性脱发的晚期也可以与有相同的临床和病理表现，因此假性斑秃的诊断是一种排除性诊断。一般炎症浸润轻微的，如果炎症浸润显著，就不像假性斑秃。对于累及冠状区或顶部的类似假性斑秃的病例最好归类于中央远心性疤痕性脱发。

Althoughpseudopéladeclassicallyaffectsthescalp,acasewithcon







































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