斑秃患者不但有毛发的改变，也会有甲的损害。同时斑秃也会和很多疾病和药物等多因素有关，在临床诊断时要多注意问病史，做相应检查。（译者注）

Nail changes may be present in patients with alopecia areata and include pitting, spotted lunula, and red lunula. Changes may be seen in one, several, or all of the nails. Trachyonychia (twenty-nail dystrophy) occurs in up to 3% of patients (Fig. 22.64). The dystrophy may precede, coincide with, or occur after resolution of the episode of alopecia.

Alopecia areata has been associated with many other diseases. Some of these have an autoimmune etiology such as Hashimoto's thyroiditis, type I (insulin dependent) diabetes,Addison's disease, vitiligo, hereditary thrombocytopenia (pseudo-von Willebrand disease),myasthenia gravis, polymorphism in the interleukin-1 receptor antagonist gene, lupus erythematosus, autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia syndrome(autoimmune polyglandular syndrome-1), common variable immunodeficiency, relapsing polychondritis, kidney-pancreas transplant recipients taking ciclosporin and after allogeneic bone marrow transplantation. 

Other associations include lichen planus, atopy, human immunodeficiency virus (HIV)infection, twenty-nail dystrophy, Down's syndrome, cytomegalovirus and Epstein-Barr virus infection, celiac disease in children, chemotherapy, interferon-alpha (IFN-a ), ribavirin,ciclosporin A, rifampicin, borderline tuberculoid leprosy, and ocular alterations (keratoconus,symptomless punctate lens opacities). 

Alopecia areata has also developed in a patient with pili annulati. There appears to be an increased incidence of nuchal nevus flammeus in patients with severe alopecia areata.

甲改变可以在斑秃患者中表现出来。主要改变是凹点、半月斑点和红半月。甲改变可以累积单个甲，多个甲，或者所有甲。（早期改变时要跟真菌感染甲病鉴别，所有甲板都累及了，与真菌感染的鉴别就简单了，因为真菌感染很少引起全部甲受累，虽然极少数情况下也会有。译者注）二十甲营养不良发生在3%以上的病人中。

斑秃跟很多其它疾病相关。者其中有一些是自身免疫病因，如桥本甲状腺炎、I型糖尿病（胰岛素依赖型）、爱迪森病、白癜风、遗传性血小板减少症（假性von Willebrand 病），重症肌无力、多态性白介素-1受体拮抗基因、红斑狼疮、自身免疫性多内分泌病-念珠菌病-外胚层发育不良综合症（自身免疫性多腺体综合症-1型）、寻常性变量免疫缺陷、复发性多软骨炎、服用环孢菌素多肾-胰移植受体、同源骨髓移植后。

其它相关疾病或原因包括扁平苔癣、异位性、人类免疫缺陷病毒感染、二十甲营养不良、唐氏综合征、巨细胞病毒和E-B病毒感染、儿童腹腔疾病、化疗、肿瘤坏死因子-alpha、病毒唑、环孢菌素、利福平、界线结核风样麻和眼改变（圆锥形角膜、无症状点状浑浊晶状体）。

在环状发患者中也会发生斑秃。在严重的斑秃患者中，颈部鲜红斑痣的发生率似乎也增加了。

Fig. 22.64 

Alopecia areata: (A, B) in this patient there is severe involvement of all 20 nails (trachyonychia). Courtesy of L.M. Gómez,MD, Universidad Pontificia Bolivariana, Medellín, Colombia. 

在这个病人中，有严重的20甲累及。

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（浙江省人民医院皮肤科 潘卫利译），2017-11-13