Syphilitic hair loss

Introduction Syphilitic alopecia: About 10% of patients with secondary syphilis occur. This is caused by the infiltration of the hair follicle by syphilis, the microvascular congestion in the hair area, and the poor blood supply. It is characterized by syphilitic alopecia areata or diffuse alopecia. The former is a bald plaque of about 0.5 cm, which is worm-like. Diffuse hair loss, large area, sparse, hair length. It is common in the ankle, top and occipital, eyebrows, eyelashes, beards and pubic hair. There is a local syphilis spirochete in the second stage syphilis baldness. Moreover, the location of Treponema pallidum is basically consistent with the site of cell infiltration, so it is believed that syphilitic alopecia may be related to the invasion site of Treponema pallidum. Treponema pallidum does not invade the dermal papilla and invades the upper part of the hair follicle, so syphilitic baldness is dominated by incomplete alopecia patches. However, syphilitic hair loss is not permanent hair loss. If treatment is timely, hair can be regenerated within 6-8 weeks, and it can be regenerated even without treatment.

Cause

The hair follicle is caused by syphilis infiltration, and the tiny blood vessels in the hair area are blocked, resulting in poor blood supply.

The pathogen of syphilis is the subspecies of Treponema pallidum, also known as Treponema pallidum. It is a small and slender spiral microorganism with a length of 5-15 m, a diameter of about 0.2 m, a number of helices of 8 to 14, and a helical pitch of about 1 m; The spiral of the cells can expand and contract to produce motion. During exercise, the body keeps bending, and when it swings, it advances like a snake or stretches its spiral ring along the long axis and advances like a spring. Its movements are lively and regular, unlike the rapid and messy movements of other spirals.

Treponema pallidum has not been artificially cultured to date. However, it can remain viable for 7 days at 35 ° C in a suitable nutrient-rich suspension and 48 h at 37 ° C. Carbon dioxide contributes to the survival of Treponema pallidum. Treponema pallidum stored in whole blood or plasma at 4 ° C can remain viable for at least 24 h. The reproductive mode of Treponema pallidum is usually transverse fragmentation, and the generation time is 30-33h. Not easy to survive in vitro. Drying or a temperature of 42 ° C can quickly kill Treponema pallidum. Treponema pallidum is very sensitive to general disinfectants and soaps.

In addition to infecting humans, Treponema pallidum can also infect rabbits, causing experimental infections in the skin, testes, eyes, etc., and can produce hard chancre. However, experimental rabbits did not develop progressive lesions, but throughout the life, Treponema pallidum persisted in the lymph nodes, spleen and bone. Therefore, in addition to liquid nitrogen at -70 ° C, rabbits are the most common experimental animals for the preservation of Treponema pallidum.

an examination

Related inspection

Treponema pallidum antibody

It is characterized by syphilitic alopecia areata or diffuse alopecia. The former is a bald plaque of about 0.5 cm, which is worm-like. Diffuse hair loss, large area, sparse, hair length. It is common in the ankle, top and occipital, eyebrows, eyelashes, beards and pubic hair.

Laboratory inspection:

1. Dark-field microscopy of primary and secondary syphilis and early congenital syphilis should be performed using dark-field microscopy to detect Treponema pallidum in lesions. Positive persons should see pathogens with regular spiral motion. Dark field inspection is simple, fast and accurate. A skin lesion was found to be negative only after three consecutive examinations. Dark-field microscopy is not suitable for damage to the oral mucosa because the Treponema pallidum seen under the microscope cannot be distinguished from the non-pathogenic spirochetes in the mouth. It should be noted that no external antibiotics can be used for the examination of the anterior lesion, or physiological saline containing antibiotics should be used as the carrier liquid for the examination. Treponema pallidum that has died in the specimen can be identified by direct or indirect immunofluorescence staining or immunoperoxidase staining.

2. Serum tests: Divided into two categories depending on the antigen used.

(1) Non-treponema pallidum antigen serum test (lipid-like serum reaction): using cardiolipin of normal bovine myocardium as an antigen, combined with anti-cardiolipin antibodies (ie, responsive factors) in the serum of syphilis patients, and agglutination was found after binding. , the formation of flocs is a positive reaction. Used for syphilis diagnosis, efficacy observation, and monitoring of recurrence or reinfection. The methods are:

1Venereal Disease Research Laboratory test (also known as VDRL test): This test was established in 1946 by the American Sexually Transmitted Disease Research Laboratory, so it was named after the laboratory. The test was performed on a glass slide and can be qualitatively or semi-quantitatively observed with a low power microscope.

2 Rapid plasma reagin (RPR) test: For the improved method of VDRL test, plasma can be used. The principle is to adsorb VDRL antigen with untreated activated carbon particles (3 to 5 m in diameter). If the particles are combined with the responsive elements in the serum to be tested, a black agglomerate is formed, which can be recognized by the naked eye without the need of low magnification observation. The test was carried out in a reaction ring (inner diameter 18 mm) of a special paper card. The test is highly sensitive, specific, and economical, convenient, and rapid, suitable for large-scale screening and can be qualitative or semi-quantitative.

(2) Treponema pallidum antigen serum test: Anti- Treponema pallidum antibodies are examined using live or dead Treponema pallidum or other components as antigens. This method is sensitive and specific, and is used to confirm the test, especially for advanced syphilis, but the blood and cerebrospinal fluid are negative for RPR test. Since this method detects anti- Treponema pallidum IgG antibodies, even if the patient has been adequately treated, the IgG antibody remains positive, so it cannot be used to observe efficacy, recurrence, and reinfection.

1 Fluorescent Treponema Antibody Absorption Test (FTA-ABS Test): In vivo immunofluorescence was used to examine anti- Treponema pallidum antibodies in serum.

2 Treponema pallidum antibody micro-hemagglutination test (MHA-TP): The corresponding anti- Treponema pallidum antibody was examined by micro-hemagglutination assay of erythrocyte sensitized with Treponema pallidum extract. When the titer is 1:80 or more, it can be judged that the antibody is positive. The specificity and sensitivity of this test are high, and the method is simpler than the FTA-ABS test, so it is widely used.

3 Treponema pallidum brake test (TPI): live Treponema pallidum is added to the patient's serum, and with the participation of complement, Treponema pallidum activity can be inhibited.

In addition to technical false positives, the syphilis serum test also has a biological false positive reaction. These reactions come from changes in the patient's physiological condition and other diseases. Some non-syphilitic infectious diseases can cause acute biological false positive reactions such as measles, rubella, chickenpox, vaccinia, viral hepatitis, infectious mononucleosis, upper respiratory tract infection, pneumococcal pneumonia, subacute Bacterial endocarditis, active tuberculosis, filariasis, malaria, trypanosomiasis, rat bite fever, relapsing fever, and leptospirosis, but the serum response titers of these diseases are low, and more than 6 Turned negative during the month. The results were negative by treponema hemagglutination test (TPHA), FTA-ABS or TPI. Other diseases that can cause chronic biological false positive reactions in non-helical antigen serum test are systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, rheumatic heart disease, leprosy, cirrhosis, nodular polyarteritis, Sjogren syndrome (sjogren's syndrome), autoimmune hemolytic anemia, Hashimoto's thyroiditis, chronic nephritis, systemic sclerosis, narcotics addiction (mainly intravenous heroin), a small number of pregnant women and the elderly.

Diseases that can cause chronic biological false positive reactions in spirochete antigen serum are systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, mixed connective tissue disease, scleroderma, lymphosarcoma, meningioma, cirrhosis, and itself. Immune hemolytic anemia, colon cancer, vaccination against vaccinia, genital herpes, diabetes, heroin addiction, pregnancy, etc. False positive reactions can last for months or years, or even life.

Non-helical antigen test in patients with 1% to 2% of secondary syphilis, such as VDRL test, showed weak positive, atypical or negative results, but the serum was diluted and then tested positive. This phenomenon is called prozone. The reason is that the anti-cardiolipin antibody in the serum is excessive, and the positive reaction is suppressed and the result of false negative is caused.

Some patients with syphilis appear to be serum-resistant, that is, after anti-syphilis treatment, the serum test of non-helicobacter antigen does not turn negative for a certain period of time. Except for some patients because of insufficient treatment, irregular treatment, recurrence, reinfection or neurosyphilis, which is an early antiserum resistant treatment, the remaining patients are of advanced serum tolerance, ie the patient has obtained enough anti-syphilis drugs and Adequate treatment, antibody titer does not decrease. If you continue to give more or even indefinite treatment, you can not reduce serum antibody titers. For this part of the patient should be detailed physical examination, after the exclusion of neurosyphilis, stop treatment, regular follow-up.

3. Cerebrospinal fluid examination: used to check neurosyphilis. The number of cerebrospinal fluid cells increased, the number of white blood cells was 10×10 6 /L, the total protein increased, 2 lipoprotein, 2 macroglobulin, IgG, especially IgM increased. Positive for colloidal gold tests, including paralytic or first-belt type, syphilitic or intermediate type, meningitis type or end type. The anticardiolipin antibody test was positive, but some active neurosyphilis may be negative.

Other auxiliary inspections:

Histopathology: If the diagnostic evidence is insufficient, the pathological examination can be performed from the damage of the skin, mucous membrane or other tissues and organs. If the specific lesion of syphilis is found, it is helpful for diagnosis. The histopathology of each stage of syphilis damage is basically the same. Mainly manifested as small arteries and capillary endometritis and perivascular inflammation. Vascular endothelial cells swell and proliferate, eventually leading to vascular lumen obstruction. There are a large number of plasma cells, lymphocytes and monocytes infiltrating around the blood vessels. In addition to the above vascular changes, late syphilis is mainly a granuloma change, which may be infiltrated by epithelial-like cells and giant cells. Central vascular infarction may cause caseous necrosis. Fibroblasts appear upon healing, forming fibrosis and scar formation.

Differential diagnosis

Traditional Chinese medicine in the motherland believes that the cause of hair loss is mainly in the kidney. If the liver and kidney are both deficiencies, the blood circulation of the whole body is weak, and the nutrients are not able to transport the nutrients to the highest position of the human body. The hair follicles on the head are not nourished. , gradually shrinking, it will cause hair loss. "Kidney Tibetan essence, main reproduction, its Hua is in the hair", "being in the blood", that the kidney is the innate, hair is the product of blood. Kidney essence, liver blood, and blood homologous transformation, both are indispensable. At the same time, the way Chinese medicine treats hair loss is also based on these theories. In general, hair loss is related to several reasons:

Kidney deficiency: the essence of the kidneys, the internal organs, the deficiency of blood, the lack of blood, the lack of nutrients in the hair, causing hair loss. Kidney essence, its Hua is hair, kidney qi, hair loss.

Lung damage: the main fur of the lungs, the lungs are defeated. The lungs are the most important oxygen and waste exchange organs in the human body. The lung function is strong and weak, which directly affects oxygen inhalation, waste discharge, and nutrient supply in the body. Hair is the terminal organ of the body, and the lungs are numbed and hair loss.

Toxin accumulation: sorrow, pollution, bad habits, etc. will cause the body to absorb, produce and accumulate a large number of toxins. On the one hand, these toxins destroy various organs and systems of the body, and on the other hand affect the absorption of nutrients by various organs and hair of the body, so that various types Nourishing foods and drugs can't work, causing hair loss. Many methods for the treatment of hair loss are not effective because the toxins in the body have not been removed, and this is specifically proposed to cause full attention! Trace elements are closely related to hair: copper, calcium, magnesium, zinc, selenium have been studied by research. The trace elements are closely related to hair growth, and the lack of these trace elements in the body can cause hair loss.

Blood heat: Juveniles are early and white, because blood heat is too much. It is generally believed that blood deficiency and blood stasis, in fact, blood overheating is not anti-corrupt, blood and heat, wind and heat with the gas on the top of the head, hair roots can not be nourished by the blood, hair will suddenly fall off. Especially for people who work in different places, it is most likely to cause hair loss, which is most obvious to women. When I first arrived at a different place, my hair was thick and black. After a long time, I washed my hair and lost my hair. The hair began to decrease significantly. I didn't dare to wash my hair. Here, special reminders to go out to work, friends, take early measures to prevent hair loss can stop, and will grow out.

It is characterized by syphilitic alopecia areata or diffuse alopecia. The former is a bald plaque of about 0.5 cm, which is worm-like. Diffuse hair loss, large area, sparse, hair length. It is common in the ankle, top and occipital, eyebrows, eyelashes, beards and pubic hair.

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