Pattern Alopecia during Hormonal Anticancer Therapy in Patients with Breast Cancer.

We report five cases of pattern alopecia in female patients who are undergoing hormonal anticancer therapy for the prevention of recurrence of breast cancer after surgery. Three patients demonstrated male pattern alopecia with receding frontal hairlines, and two patients demonstrated female pattern alopecia without receding hairlines. The detailed clinical history showed that the pattern alopecia of the patients developed after the full recovery of global hair loss of the entire scalp due to previous cytotoxic chemotherapy. All of the adjuvant hormonal anticancer drugs that were used in the patients are antiestrogenic agents, either aromatase inhibitors or selective estrogen receptor modulators. Considering androgen effect on the hair follicles of the fronto-parietal scalp, the androgen-estrogen imbalance caused by the drugs was thought to be the reason for the onset of pattern alopecia in the patients. In general, alopecia that develops during cytotoxic chemotherapy is well known to both physicians and patients; however, the diagnosis of pattern alopecia during hormonal anticancer therapy in breast cancer patients seems to be overlooked.

Phototrichogram analysis of normal scalp hair characteristics with aging.

BACKGROUND: Phototrichogram analysis of normal scalp hair characteristics in Asian populations is not well characterized. OBJECTIVE: To investigate the normal hair characteristics of South Koreans using a phototrichogram. METHODS: We enrolled 674 males and 683 females between the ages of 10 and 69. Hair density, thickness and the white hair percentage were measured via phototrichogram. Six scalp sites, including front, top, the peak between top and back, back, and the right and left sides were targeted. RESULTS: The mean hair density, hair thickness, and the white hair percentages were not significantly different between genders at any scalp site. The mean hair density and thickness were significantly different according to scalp sites. Hair density declined with age, especially at the peak between the top and back. Males and females showed different patterns of aging in hair density. Hair thickness changed little with age. Mean hair thickness generally tended to increase until the 20s, reach a plateau between the 20s and 50s, and decrease after the 50s. The mean white hair percentages were 1.84 ± 4.24% in males and 1.66 ± 4.21% in females. The mean white hair percentages were significantly increased in subjects over 40 years of age. CONCLUSION: We described the normal characteristics and aging patterns of scalp hair in a Korean population.

Retrospective analysis of 12 Korean patients with paraneoplastic pemphigus.

Paraneoplastic pemphigus (PNP) is a rare, life-threatening, autoimmune, mucocutaneous blistering disease associated with neoplasia. Both humoral and cellular immunity are involved in the pathogenesis of PNP. Characteristically, PNP has a diverse spectrum of clinical and immunopathological features. We retrospectively analyzed 12 Korean patients with PNP who were diagnosed between 1993 and 2011. We performed analysis of the clinical features, clinical outcomes, underlying neoplasia, histological features and laboratory findings. All of the patients except one had severe mucosal involvement. Two patients had only mucosal lesions but no cutaneous involvement was observed. Erythema multiforme or lichen planus-like eruptions rather than bullous lesions were more commonly observed skin rashes. The most common histological features were interface dermatitis and apoptotic keratinocytes. There were associated hematological-related neoplasms in 11 patients, with Castleman's disease (n = 4) as the most frequent. Twelve patients were followed for 5-148 months (mean, 43.0). The prognosis depended on the nature of the underlying neoplasm. Six patients died due to respiratory failure (n = 3), postoperative septicemia (n = 1), lymphoma (n = 1) and sarcomatosis (n = 1). The 2-year survival rate was 50.0%, and the median survival period after diagnosis was 21.0 months. Immunoblotting was performed in 12 patients and autoantibodies to plakins were detected in 11 patients. The results of this study demonstrated the clinical, histological and immunological diversity of PNP. Widely accepted diagnostic criteria that account for the diversity of PNP are needed.

The three dimensional conformal radiotherapy for hyperkeratotic plantar mycosis fungoides.

The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.

Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea.

BACKGROUND: Generalized granuloma annulare (GGA) is a benign skin disorder of an unknown etiology. Though some cases of GGA have been reported, few systemic reviews of the clinical and pathological features of GGA have been performed. OBJECTIVE: The purpose of this study is to analyze and correlate the clinical and pathological characteristics of GGA in Korean patients. METHODS: We conducted a retrospective study that included 54 biopsy specimens of Korean GGA patients, and the clinical and pathological features of GGA were reviewed and analyzed for their correlation. RESULTS: The cutaneous lesions could be divided into the annular (24, 44%) and nonannular types (30, 56%), and the lesions were more common in males than in females (29 males and 25 females). The incidence of GGA showed a bimodal age distribution. The number of patients who presented within the first decade was 24 cases (44%), and 24 cases (44%) were over the fifth decade. Eight patients (15%) had systemic diseases. Especially, diabetes mellitus (DM) occurred only in the adult GGA patients over forty years old. The pathological findings showed dermal granulomatous lesions that consisted of either a palisading pattern (28, 52%) or an interstitial pattern (26, 48%). CONCLUSION: In contrast to the previously reported studies, the age of GGA onset showed a bimodal distribution, and GGA was observed more often in males. The prevalence of DM in the GGA affected individuals was higher than that found in the general Korean population. Therefore, it is recommended to perform a work-up for DM in the GGA affected patients who are over forty years old.

Two cases of linear alopecia on the occipital scalp.

Alopecia of a scalp shows various shapes and extents of hair loss, from a small round patch to polymorphous patches or total global alopecia. But alopecia of a linear shape is very rare. Only a few such cases have currently been reported in the medical literature. We recently had the chance to observe and treat two cases of linear alopecia that developed on the occipital scalp. The lesions themselves were like alopecia areata that shows a smooth bald area without any abnormality except the hair loss, but histopathologically, the lesions were compatible with lupus erythematosus profundus.

A new classification of pattern hair loss that is universal for men and women: basic and specific (BASP) classification.

BACKGROUND: Pattern hair loss (PHL) can be classified into several patterns. Currently, the Hamilton-Norwood classification system for men and the Ludwig grade system for women are commonly used to describe patterns of hair loss. However, these pre-existing classifications have some limitations. OBJECTIVE: To establish an acceptable, universal, and accurate standard of both male and female pattern hair loss and to report its use in determining the incidence of PHL. METHODS: We developed a new classification system (BASP classification) and then applied this system to classify the types of PHL. The BASP classification was based on observed patterns of hair loss. The basic (BA) types represent the shape of the anterior hairline, and the specific types (SP) represent the density of hair on distinct areas (frontal and vertex). There are four basic types (L, M, C, and U) and two specific types (F and V). The final type is decided by the combination of the assigned basic and specific types. Between November 2004 and June 2005, 2213 Korean subjects, comprised of 1768 males and 445 females, were classified according to the BASP classification at 13 university dermatologic centers nationwide throughout South Korea, as a multicenter study of the Korean Hair Research Society. RESULTS: For both sexes, the majority of patients enrolled in the study were in the third and fourth decade of life (65.1% of males and 56.68% of females). In males, the older group as well as the younger group in the study were more likely to have little recession of the frontal hairline (classified as type M1 approximately 2) and diffuse thinning over the top of scalp (type F1 approximately 2). The women in the study developed typical female PHL. LIMITATIONS: The subjects of our study were mostly outpatients and some inpatients who complained about hair loss, not the general population of Korea. CONCLUSION: The BASP classification is a new stepwise, systematic, and universal classification system for PHL, regardless of sex.

Squamous eddies in irritated seborrheic keratosis.

Seborrheic keratosis is related to the intraepidermal hair follicle in its morphogenesis. Squamous eddies in irritated seborrheic keratosis (ISK) are known to develop by focal maturation of basaloid cells, but the significance of squamous eddies is not understood. The purpose of this study was to elucidate the nature of squamous eddies in ISK. Serial sections of paraffin blocks of 20 cases of ISK were examined. We tracked each squamous eddy through the serial sections to observe the different shapes and positions of the same squamous eddy. In 4 cases, squamous eddies revealed hair shafts at their centers in different sections. In 14 cases, squamous eddies contained acrotrichial canals. In 13 cases, squamous eddies were connected to keratotic invaginations we thought to be follicular infundibula. Eighteen of the 20 cases of ISK showed at least 1 of the morphological features of intraepidermal hair follicle structures. We have found that the squamous eddies of ISK are anatomically related to acrotrichia.

Acute alopecia totalis.

From a group of 1,189 AA patients seen in our dermatology unit, thirteen (3 males, 10 females) experienced hair shedding that started profusely and diffusely over the entire scalp. They were under observation for about 5 years, histopathology and trichograms being performed in all instances. The mean age of the patients was 26.7 years. It took only 2.3 months on average from the onset of hair shedding to total denudation of the scalp. The trichogram at the time of diffuse shedding showed that about 80% had dystrophic roots and the remaining 20% had telogen roots. Histopathological findings and exclamation mark hairs were compatible with alopecia areata. Regrowth of hair was noted 3.2 month after the onset of hair shedding and recovery observed in 4.8 months. All patients were treated by methylprednisolone pulse therapy. During the follow-up period, 53 months on average after recovery, 8 of the 13 patients (61.5%) showed normal scalp hair without recurrence, in 4 patients the recovery was cosmetically acceptable in spite of focal recurrences and only 1 patient showed a severe relapse after recovery. Considering all of the above findings, this group of the patients should be delineated by the term acute alopecia totalis.

Histopathological pictures of the initial changes of the hair bulbs in alopecia areata.

A biopsy of the seemingly normal scalp of a patient who had just begun to develop alopecia areata showed distinctive changes in bulbar morphology, in addition to peribulbar lymphocytic infiltrates. One of these changes was a loss of structural integrity of the centrally located supramatrical upper bulbar region. The other was the shrinkage of hair bulbs in the direction of club shape. Uninvolved intact anagen follicles were also present among these involved follicles.

Lupus tumidus involving facial skin nasal cavity throat and eye

A case of tuberculosis involving facial skin, nasal cavity throat and eyes was found in a yong korean girl. We report the case because of its unusual clinical picture and to recall the morbidity of cutaneos tuberculosis in the present dermatological field.Skin tuberculosis is one of the oldest diseases in dermatology. But the invasion of the skin by tubercle bacilli still seen and all the types of so called reinfection tuberculosis of the skin are being found sporadically all over the world.Generally patients with skin tuberculosis adapt themselves to their disorder during the long course of the disease actually, mostof the tuberculous skin lesions do not cause great troubles to the patient allowing him or her to lead a normal life. Recently we found a case which was quite unusual and seriosly treatened the patients normal activity because of naasal obstruction and facial disfiguration.