202205271031COVID-19 疫苗-病毒感染-圓禿

2022-05-27 10:33AM
剛剛評估民眾是否可施打疫苗. 聽到民眾說打BNT疫苗之後掉頭髮. 回想之前好像沒看過相關新聞報導. 於是上網搜尋一下

AA 圓禿(Alopecia Areata)又稱、班禿、鬼剃頭、油風,是皮膚科常見疾病
99年台灣醫學會教育演講16:禿頭面面觀Global Assessment of Alopecia
時 間:民國99年11月14日(星期日)下午14:00~17:00
地 點:台北國際會議中心101A會議室
圓禿的診斷及治療The Diagnosis and Treatment of Alopecia Areata
楊朝鈞 成大醫院皮膚科
  圓禿在門診並不少見,其特徵為區域狀掉髮,在急性期掉髮速度通常很快,輕拉頭髮測試通常會偵測到大量的掉髮。其餘特徵包括掉髮區域出現斷髮髮根、驚嘆號狀頭髮。病理組織學下的特徵為淋巴球浸潤在毛囊周圍。圓禿影響範圍並不侷限在頭皮,身上任何毛髮都可能因為這個疾病而脫落。
  圓禿是一種器官特異性自體免疫疾病,帶有某些HLA基因的人具有易感性,目前對於誘發圓禿發生的原因未有定論,一般認為與感染、藥物以及生理上或心理上的壓力可能有關。
根據嚴重度以及發病時間的長短,圓禿的治療有不同選擇。治療主要以類固醇使用為主,輔佐以其他免疫調節的方法。類固醇的使用方式包括局部塗抹、病灶內注射、口服以及脈衝式療法(pulse therapy)。其他免疫調節法包括接觸性免疫療法(contact immunotherapy)及紫外線治療等。局部Minoxidil使用可以做為輔佐性治療。短期來說,這些治療能讓禿髮達到某個程度或完全的再生,但長期的效果還有待確認,所以必須權衡治療的副作用及能給病人的真正效益。
  復發在圓禿病人很常見,越嚴重的圓禿越容易復發。對程度輕微的圓禿病人來說,疾病在一兩年內會穩定或完全恢復,對程度嚴重的病人來說,疾病通常是慢性的。圓禿對病人的心理層面衝擊是極大的,面對圓禿病人除了提供適當治療之外,要讓病患對疾病有正確的認識及期待。

與掉髮有關的新聞報導還不少. 但查詢文獻. 目前不管是疫苗或感染是否引起掉髮, 仍有爭議. 證據不是很夠. 
下面這篇是加拿大斑禿基金會的文章, 簡單說. 疫苗是否導致圓禿目前證據不足
COVID-19 Vaccines and Alopecia Areata: What is the Relationship?
COVID-19 疫苗會導致圓禿嗎?
對這個問題的簡短回答是,我們沒有任何數據表明疫苗會導致 AA 或加重 AA 患者的脫髮。
Can the COVID-19 vaccine cause Alopecia Areata?
The short answer to this question is that we do not have any data to suggest that the vaccine causes AA or worsens hair loss in people with AA.
Some people have referenced a case report by Rossi et al. (2021) which described the recurrence of AA in 3 people after the first dose of the vaccine. In this specific case, all 3 people had a history of AA, meaning they already had AA but did not have any active hair loss at the time. 2-3 weeks after the first dose, these people noticed an increase in their hair loss.
The important thing to consider in this case is that this is only 3 out of the hundreds of thousands of people with AA who received their COVID-19 vaccine without issue, thus this information cannot be generalized to the public. The most likely explanation in this case is that the autoimmunity causing AA was exacerbated, but not caused by the healthy immune response to the vaccine. It is imperative to note that this can theoretically happen with any vaccine – not just the COVID-19 vaccine, but this does not routinely happen and should not be a reason to avoid vaccination. The risk of severe illness and death caused by the infection is much worse than the low risk of AA worsening after vaccination.
AA is very unpredictable and is known to come and go in cycles. Therefore, try as we might, we cannot fully attribute any activity, vaccination or otherwise, to worsening hair loss as there is always the possibility that it would happen on its own. Think of it like shaking a tree in the fall. You may cause some leaves to fall off, but this was likely to happen any way given the change of season.
In short, the COVID-19 vaccine has been proven to be safe and effective in reducing the transmission of the virus as well as severe illness or death caused by the infection. People considering the vaccine are encouraged to speak with their healthcare providers and critically review any information they receive from the internet or by word-of-mouth. For specific concerns regarding the COVID-19 vaccine and AA, you are encouraged to speak with your dermatologist or dermatology nurse practitioner.


下面這篇發表於美國皮膚科學會期刊, 最後結論是圓禿可能是COVID-19感染的的皮膚表現
Association between alopecia areata and COVID-19: A systematic review 
Rachel E. Christensen, BS; Mohammad Jafferany, MD
Open AccessPublished:February 09, 2022
Background
COVID-19 may play a role in various immune-related dermatologic conditions. The relationship between COVID-19 and alopecia areata remains unclear.
Objective
To review the existing literature for clinical studies and reports investigating the association between new-onset alopecia areata or the exacerbation of preexisting alopecia areata following infection with SARS-CoV-2.
Methods
A systematic review of the literature was performed using PubMed, Embase, and MEDLINE databases from inception to October 2021. Included articles assessed alopecia areata following infection with SARS-CoV-2.
Results
Of 402 total articles, 9 were identified as meeting the inclusion criteria. Six articles described case reports of 7 patients with new-onset alopecia areata following confirmed infection with SARS-CoV-2, and 3 articles reported on alopecia areata recurrence or exacerbation following SARS-CoV-2 infection in patients with preexisting disease. Studies investigating the exacerbation or recurrence of alopecia areata following infection reported mixed findings.
Limitations
A majority of the included studies were case reports. The heterogeneity of articles precluded data synthesis.
Conclusion
Alopecia areata may be a dermatologic manifestation of COVID-19, with cases most often appearing 1 to 2 months following infection. Additional research is necessary to better elucidate the relationship and draw conclusions.


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