A Case of Tufted Hair Folliculitis / 대한피부과학회지

Tufted hair folliculitis is an inflammatory disorder of the scalp characterized by a peculiar tufting of hair within areas of scarring alopecia. Histopathological studies reveal perifollicular inflammation around the upper portions of the follicles sparing the hair root level. Within areas of inflammation, several follicles converge toward a common follicular duct with a widely dilated opening. The cause of tufted hair folliculitis is unknown, and the therapeutic approach is problematic. We present herein a patient with a 28-year history of recurrent and progressive tufted hair folliculitis. A 33-year-old man was referred to our department for the treatment of chronic and relapsing inflammatory lesions of the scalp. The clinical examination revealed a circumscribed area of 15cm length and 10cm width on the occipital area of the scalp which was characterized by hair tufting and exudates. Histopathologic findings were typical for tufted hair folliculitis. We believe that hair tufting is a secondary phenomenon which may occur in several inflammatory diseases of the scalp.

A Clinical and Histopathologic Study of Pityriasis Rubra Pilaris / 대한피부과학회지

BACKGROUND: Pityriasis rubra pilaris (PRP)is a rare papulosquamous disorder of unknown etiology. Although the clinical and histopathologic features of PRP are relatively well known in western patients, there are few available studies in Korea. OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathologic features of pityriasis rubra pilaris(PRP) in Korea METHODS: The clinical charts, photographies and skin biopsy slides of patients clinically diagnosed as PRP at the initial visit were reviewed. Finally 30 patients were diagnosed as PRP. They were classified into 5 groups according to the Griffiths classification. And then the evaluation of age at onset, sex distribution, clinical feature of the skin lesion, associated symptoms, clinical course and histopathologic features were conducted. RESULTS: 1) The male to female ratio was 1:1.14. The age of onset was varied from 1 to 65 years with two peaks in first and fifth decades. The average ages of onset in adult type and juvenile type were 40.1 and 5.1 years respectively. 2) According to the Griffiths classification, 14(47%) of the patients had type I, 4(13%) had type III, 7(23%) had type IV, and 3(10%) had type V. However, 2(7%)patients could not be classified under any of these five types due to atypical clinical feature or insufficient follow-up periods. 3) The common clinical features during the disease course were follicular hyperkeratosis(83%), knee and/or elbow involvement(83%), palm and/or sole hyperkeratosis(80%). Erythroderma was present in 5 patients(17%) during the disease course. 4) There were no specific symptoms in most cases, but 9 patients had ben suffered from mild itching. 5) 3 patients had a positive family history, and were thought to have inherited autosomal dominant trait. 6) The frequent histopathologic findings were alternating parakeratosis and orthokeratosis (100%), superficial perivascular infiltration(100%), broad rete ridge(97%), acanthosis(93%), hypergranulosis (87%), follicular plugging(73%). CONCLUSION: We investigated the clinical and histopathological features of PRP in Korea. In our study, the clinical and histopathological features of PRP were not different from those observed in western patients.

A Case of Bilateral Nevus of Ota Associated with Bilateral Nevus of Ito / 대한피부과학회지

Benign pigmented lesions derived from dermal melanocytes include the Mongolian spot, the nevi of Ota and Ito, and the blue nevus. The nevus of Ito differs from the nevus of Ota by its location in the supraclavicular, scapular and deltoid regions. It occurs rarely in association with bilateral nevus of Ota. We present a 70 years old male, showing extensive involvement of dermal melanocytic nevi, so called bilateral nevus of Ota associated with bilateral nevus of Ito.

Diagnostic Trial of Epiluminescence Microscopy in Two Cases of Pigmented Basal Cell Carcinomas (PBCCs) / 대한피부과학회지

Basal cell carcinomas(BCCs) are the most common skin cancers in Korea and a proportion of BCCs contain pigment. Pigmented basal cell carcinomas(PBCCs) are included in the differential diagnosis of invasive melanoma and other benign pigmented skin lesions(PSLs) because of their growth patterns and asymmetry of pigmentation. Epiluminescence microscopy(ELM) describes the non-invasive in vivo examination of skin lesions with a microscope using incident light delivered from an acute angle and oil immersion. Many studies have shown that epiluminescence microscopy can improve the diagnostic accuracy of PSLs. Menzies et al analyzed the morphologic features of a large set of 142 pigmented BCCs and produced a simple ELM method for diagnosis that would allow differentiation from melanomas and benign pigmented lesions. We observed morphologic features of two PSLs with a handheld 10 epiluminescence microscopy (Episcope, Welch Allyn Inc, Skaneateles Falls, NY). After the ELM examination, two PSLs were excised and processed for histopathology. The ELM findings and histopathologic diagnosis were compared for each lesion. ELM permits the recognition of two PBCCs and the fact that it is a non-invasive in vivo method makes it even more attractive as a diagnostic tool in clinical practice.

A Case of Primary Essential Cutis Verticis Gyrata / 대한피부과학회지

Cutis verticis gyrata(CVG) is a descriptive term for a condition of the scalp in which deep furrows and convolutions are seen that resemble the outer surface of the cerebrum. The possible etiologies may be categorized as primary essential, primary nonessential, and secondary cutis verticis gyrata. This is based on history, physical examination, and histologic criteria with or without laboratory examinations. Herein we reported a case of primary essential cutis verticis gyrata with no associated disorders.

The Study of the Clinical, Histopathological and Pathogenetic Feature of Pilomatricoma / 대한피부과학회지

BACKGROUND: Pilomatricoma is a cystic neoplasm with differentiation toward hair cortex cells. Although it is characterized by several features such as cellular constitiuents, stromal change and inflammation, it is difficult to interpret the histopathogenesis of the lesions, and there is no comprehensive understanding about the evolution of the tumor. OBJECT: The purpose of this study was to characterize the clinical and histopathologic feature of pilomatricoma and to suggest the growth pattern and evolutional stage of this tumor. METHOD: Thirty-eight cases with pilomatricoma in 34 patients who had visited Korea University Hospital during the last 10 years have been collected. We studied the clinical and histopathological characteristics of the cases and tried to classify evolutional stages of them and to elucidate the growth pattern. RESULTS: Most of the tumors were solitary lesions except four patients, who showed two lesions simultaneously. The male to female ratio was 1:1.1. The average age was 16.25 years (9months to 43 years) and 35 cases(92%) were developed in the patients younger than 30 years old. The predilection sites were arm(61%), face(18.2%), neck(13%), thigh(5.2%), shoulder(2.6%) in order. The duration of lesions was from 10 days to 3 years in known cases, with mean duration of 9.8months. Histopathologically tumor size was from 0.3cm to 1.9cm in diameter, with average value of 0.89cm. 29 cases showed inflammatory reaction variably in its severity involving giant cells. Calcification was observed in 22 cases and two of them showed ossification. According to four stage system of previous study, we categorized our cases into the 3 early stage, 8 fully developed stage, 15 early regressive stage, and 12 late regressive stage. Peripheral basaloid epithelium surrounding the tumor was found in 17 cases. 3 cases were surrounded by epithelium perfectly, and 5cases were surrounded by half or more. CONCLUSION: Pilomatricoma is not a cyst but a cystic neoplasm that consists principally of rapidly growing basaloid cells that form well-defined lobular aggregations of diverse sizes and shapes. It shows variable features with differentiation. Since previous four staging system were not clearly differentiated in each stage, we divided pilomatricoma into three phases, developing phase, proliferative phase and regressive phase, according to the constituents of basaloid cells in the periphery.