Clinicopathological Observation in Trichotillomania and Pathologs after Hair Plucking in Rabbits / 대한피부과학회지

BACKGROUND: Trichotillomania appears as incomplete alopecia due to patients own repeated manipulations of the hair. But there are few available clinicopathologic data in Korea. OBJECTIVE: The purpose of this study was to evaluate the clinicopathological feature of trichotillomania and the experimental pathologic findings after hair plucking in rabbits. METHOD: Through retrospective study on patients who were diagnosed as trichotillomania from 1988 to 1997 at the Department of Dermatology in Pusan National University Hospital, we observed the clinical and histopathological findings in 20 cases of trichotillomania as well as histopathologic changes of hair follicle and associated structure after hair plucking in rabbits with 4 days interval. RESULTS: 1. The mean age of onset was 15.7 years and female were 12 cases(60%). 2. The school age(between 7 and 18 years) was most common as 15cases(75%) 3. Among initial sites of involvement, parietal region was the most common(10 cases, 55%), followed by frontal(5 cases, 25%), temporal(2 cases, 10%), and occipital(2 cases, 10%) region. 4. Some patients complained pruritus(25%), chronic headache(10%) and had onychophagia (20%), trichophagia(5%) and thumb sucking(5%). 5. Many patients were not typical in history, and 14 cases(70%) denied hair-plucking history. 6. Results of twelve patients with psychiatric consultation revealed obsessive disorder(4 cases, 33%), social phobia(2 cases, 17%) and dysmorphic disorder(1 case, S%). 7. The most common presumptive triggering factor was mental stress related to school work(5 cases, 25%). 8. The characteristic findings of histopathologic examination in 20 cases were empty hair follicles without perifollicular infiltration(100%) and increased catagen hair(90%) with normal anagen hair(85%), trichomalacia(40%). 9. In experimental hair plucking of rabbit, soon after hair plucking, dilated empty root sheaths, perifollicular hemorrhage were observed. These findings are similar in trichotillomania. Catagen evolution, sebaceous proliferation and hyperplasia at 4th day, prominent bulge region at 8th day, growing epithelial sheaths into deep dermis at 12th day, many anagen hair at 20th day were observed. CONCLUSION: Trichotillomania was more frequent in young than adolescent and female than male. Histopathologically, the most characteristic finding was increased catagen hair without perifollicular inflammation. In hair follicle regeneration of rabbit after plucking, all hair follicles changed into catagen and telogen stage simultaneously and new hair growth was observed.

A Case of Multiple Histiocytomas in a Healthy Person / 대한피부과학회지

Epidermolysis bullosa acquisita(EBA) is a rare chronic subepidermal bullous disease wit,h autoantibodies to type VII collagen. Clinically, EBA usually begins after the age of 50 with pruritic vesicle and blister formation often on traumatized skin and leaves atrophic scars and milia. A 48-year-old woman visited our department with a 5 month history of a generalized pruritic blistering eruption that began on the scalp and spread to the face, trunk, extremities, and lip. The biopsy specimen revealed dermoepidermal separation, infiltration of perivascular mononuclear cells. Direct immunofluorescence(DIF) showed positive linear deposition of IgG at the BMZ. Bullous pemphigoid was diagnosed and treated with prednisolone 20-40mg daily. The skin lesions were improved after 2 week. During follow-up, trauma-induced vesicles occurred frequently and healed with remaining malia and scars. The biopsy specimen of trauma induced vesicles revealed subepidermal blisters and inflammatory cell infiltration in the dermis. DIF of perilesional skin showed positive linear deposition of IgG at the BMZ. DIF of salt split skin showed linear IgG deposits on the dermal floor. EBA was confirmed.

A Case of Generalized Annular Lichen Planus Controlled by Erythromycin / 대한피부과학회지

A 69-year-old man presented with annular lichen planus involving both forearms, hand dorsa, wrists, inner sides of the thighs, knees and ankles. He was treated initially with systemic corticosteroids and etretinate, but rernission and recurr ence of the skin lesions were observed. During the follow-up, we found erythrasma on all his toewebs and both soles. After administration of erythromycin for the treatment of erythrasma, lesions of the lichen planus rapidly improved. Five months later, some lesions of lihen planus and erythrasma had recurred. After administration of erythromycin, the lesions of lichen planus improved again. No recurrence was observed for the following 8 months. We suspect that eradication of the chronic focus of infection and the anti-inflammatory effect, of erythromycin may lead to supression of abnormal immunological reactions and resolution of lichen planus.

Significance of Peanut Agglutinin in the Differentiation between Basal Cell Carcinoma and Trichoepithelioma / 대한피부과학회지

Great difficulty may be encountered in the differentiation of basal cell carcinoma from trichoepithelioma snd, in some cases, it may even be irnpossible. Immunohistochemical methods using peanut agglutinin(PNA) which is glycoprotein of non-immune origin selectively binding to galactose-N-acetyl-galactosa-mine are increasingly used in dermatopathology to improve the diagnosis and differential diagnosis. Using PNA, anti-PNA antibody, and peroxidase antiperoxi-dase(PAP) technique, normal skin specimens, basal cell carcinomas, trichoepitheliiomas, and a variety of different skin tumors were studied, and different PNA Ibinding sites between basal cell carcinomas and trichoepitheliomas were observed. The results were as follows : l. In normal skin, except the basement membrane, epidermis and hair follicle epithelium showed a cell membrane staining of PNA, which stained weakly in the Ibssal cell layer. Sebaceous glands revealed membranous and cytoplasmic staining of PNA, but sweat ducts and duct coi1s were mostly negative. 2. 34 of 36(94.4%) basal cell carcinoma sections demonstrated peritumorous PNA-positive bands, and none of 5 trichoepithelioma sections showed peritumorous PNA-binding. 3. Peritumorous PNA-positive bands were strongly positive in solid and keratotic basal cell carcinomas, but decreased or absent in the vicinity of the ulceration or the dense inflammatory infiltration. 4. None of the other skin tumors(squamous cell carcinoms, keratoscanthoma, Bowens disesse and actinic keratosis} showed a periturnorous PNA-positive band. Therefore, we believe that the PNA staining on paraffin-embedded sections using PAP technique can be a useful probe for the differentiation of basal cell carcinoma from trichoepithelioma.