Alopecia areata, nuevos hallazgos en histopatología y fisiopatología

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Artículo de revisión
Rev Asoc Colomb Dermatol. 2012; 20: 1 (enero-marzo), 41-53

Alopecia areata, nuevos hallazgos en histopatología y fisiopatología

Alopecia areata, new findings in histopathology and pathophysiology
Autor(es): 
Rodrigo Restrepo
rorestre@hotmail.com
Médico dermatopatólogo, Programa de Especialización en Dermatopatología, Facultad de Medicina, Universidad CES; instructor asociado de Patología y Dermatología, Universidad Pontificia Bolivariana; director, Laboratorio de Patología, Clínica Medellín, Med
Lucía Mercedes Niño
Médica, residente de Patología, Universidad de Cartagena, Cartagena de Indias, Colombia
Resumen: 

La alopecia areata es una enfermedad autoinmunitaria específica de órgano, dada por el colapso del privilegio inmunitario del folículo piloso. Constituye una causa muy común de alopecia no cicatricial. Las características histopatológicas dependen de la etapa de la enfermedad. La característica microscópica más frecuente corresponde al infiltrado inflamatorio linfocitario peribulbar; sin embargo, en ocasiones ni este ni otros hallazgos son visibles, dependiendo de la etapa en la que se toma la biopsia. En las etapas tempranas, se observa en los folículos un infiltrado inflamatorio linfocitario variable en la región peribulbar; luego este hallazgo disminuye y, en cambio, se observan numerosos folículos pilosos miniaturizados y en telógeno. En las fases tardías de la alopecia areata, la mayoría de los folículos pilosos se encuentran en catágeno y telógeno. Se debe sospechar alopecia areata cuando un alto porcentaje de los folículos pilosos están miniaturizados y se encuentran en telógeno, incluso en ausencia del infiltrado linfocitico peribulbar.

Palabras clave: 
Alopecia, Alopecia areata, no cicatricial, patología.

Summary: 

Alopecia areata is an organ-specific autoimmune disease thought to result from a collapse of the hair follicle immune privilege. It is a very common cause of nonscarring alopecia. The histopathological features depend on the stage of the disease. Although a peribulbar lymphocytic infiltrate is the most frequent histological feature, this inflammatory infiltrate is not always visible. The frequency with which this and other histological changes are observed depends on the stage of the illness when the biopsy is performed. In the early stages of the disease the follicles show a variable inflammatory lymphocytic infiltrate in the peribulbar region. In the late stage, inflammation decreases and numerous miniaturized hair follicles and telogen follicles are present. In longstanding alopecia areata the majority of the hair follicles are in catagen and telogen. Alopecia areata should be suspected when high percentages of miniaturized and telogen hairs are observed, even in the lack of a peribulbar lymphocytic infiltrate.

Key words: 
Alopecia, alopecia areata, nonscarring, pathology.
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