A herpes simplex virus infection secondary to acupuncture and cupping.

Acupuncture and cupping have a public reputation as being safe even though these practices can lead to complications such as trauma or infection. We report here on a case of herpes simplex virus (HSV) infection secondary to acupuncture and cupping in a 56-year-old woman. The patient, who had a history of acupuncture and cupping on her left forearm for treating her myalgia, developed painful papules. Histologically, the biopsy specimen showed characteristic ballooning degeneration and inclusion bodies in the epidermis and mid-dermis. These clinical and histological findings were consistent with the diagnosis of HSV infection.

Expression of antimicrobial peptides such as LL-37 and hBD-2 in nonlesional skin of atopic individuals.

Recurrent skin infection is one of the major complications of atopic dermatitis and can be partly explained by decreased expression of antimicrobial peptides such as human beta-defensin-2 and cathelicidin (LL-37). In the human epidermis, human beta-defensin-2 is packed in the lamellar body and LL-37 is co-localized with intercellular lipid lamellae of the stratum corneum; together, these antimicrobial peptides constitute the primary defense system. IL-1alpha, a potent inducer of LL-37 and human beta-defensin-2, is also secreted from the disrupted epidermis for barrier homeostasis. In this study, we investigated whether expression of human beta-defensin-2 and LL-37 is constitutively decreased in the skin of atopic individuals. Nonlesional foreskins from atopic (n=7) and nonatopic (n=7) individuals were analyzed. The expression of LL-37, human beta-defensin-2 and IL-1alpha was analyzed using immunohistochemical staining, Western blot, and real-time polymerase chain reaction. Lamellar body density and secretion were evaluated by electron microscope. Quantitative analysis showed that the expression of each parameter was not significantly different between groups. Thus, basal expression of LL-37 and human beta-defensin-2 was not changed in atopic individuals. These results indicate that the expression of antimicrobial peptides at baseline was not different between nonlesional skin of atopic individuals and normal skin of nonatopic individuals.

Development of a classification system for extrinsic hair damage: standard grading of electron microscopic findings of damaged hairs.

Human hairs experience damage and restoration processes consistently because of various external and internal factors. To analyze degrees of hair damage, morphological studies based on electron microscopy (EM), and biochemical studies based on protein and lipid analysis have been proposed and are widely used. Among them, morphological analysis through EM is a fundamental method in understanding the degree of damage and restoration. EM has been very useful in assessing extrinsic and intrinsic damage of hair and various pathological alopecias and also in estimating the efficacy of various kinds of products related to hair care. However, morphological studies have some limitations because they have been described using varying terms and subjective descriptions by different researchers. To establish an objective classification of damaged hair using uniform terms and standardizations. We analyzed over 2000 scanning electron microscopic and transmission electron microscopic findings of normal and of various kinds of damaged hairs to develop a standard grading system for the damaged hairs. After reviewing the results of the electron microscopic pictures, we proposed a standard grading system based on scanning electron microscope and transmission electron microscope. We developed and proposed an easy, objective, and useful standard grading system of damaged hairs.

Epidemiology of complex regional pain syndrome: a retrospective chart review of 150 Korean patients.

Complex regional pain syndrome (CRPS) is a chronically painful and disabling disorder. However, no data are available even on the epidemiology of CRPS in Korea. This study was undertaken to retrospectively assess the epidemiologic characteristics of CRPS in 150 consecutive patients at a tertiary chronic pain center from March 2002 to February 2006. Information was obtained regarding patients' demographics, nature of injury, and treatment modalities. Seventy-one percent of patients had CRPS type I. The mean 11-point verbal numerical rating scale score at initial examinations and at the time of study were 8.0 and 5.7, respectively. Thirty-two percent of patients showed no change or increase in pain intensity during follow-up at our pain center. The mean duration of CRPS symptoms prior to our pain center evaluation and prior to the time of study were 27 months and 50 months, respectively. These patients had seen on average 5 different physicians before being referred to our center. This study shows that the majority of CRPS patients were referred to our center after more than 2 yr of symptoms. The clinical implication of such delayed transfer and strategies to avoid this problem are discussed.

A new method for investigation of the hair shaft: hard X-ray microscopy with a 90-nm spatial resolution.

Various methods have been used to investigate the hair shaft. In the ultrastructural hair field, scanning and transmission electron microscopies are widely used investigative methods, but they have some technical limitations. Recently, X-ray microscopes with sub-micron spatial resolution have emerged as useful instruments because they offer a unique opportunity to observe the interior of an undamaged sample in greater detail. In this report, we examined damaged hair shaft tips using hard X-ray microscopy with a 90 nm spatial resolution. The results of this study suggest that hard X-ray microscopy is an alternative investigative method for hair morphology studies.

Comparison of hair shaft damage after UVA and UVB irradiation.

Sunlight, especially ultraviolet (UV) light-induced hair damage is difficult to avoid during daily life. Concerns about the effects of ultraviolet light on hair are emerging recently. These photochemical changes mainly come from damage to hair proteins and melanins. In this study, we performed experiments to find the patterns of morphological and biochemical changes in UV-light-induced damage to hair by scanning and transmission electron microscopy and hair protein analysis. In our results, morphological damage is significant in UVB-irradiated hairs, while biochemical changes are greater in UVA-irradiated hairs.

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.

Integral lipid in human hair follicle.

On the hair surface, cells are covered with a thin lipid layer (LL) covalently bonded to hair proteins. This integral hair lipid is different from sebaceus lipid. We conducted this study to examine the lipid distribution in human hair follicle. Transmission electron microscopy was performed to observe the ultrastructure of the LL. Hair follicles were cut and observed longitudinally along the hair axis. For transmission electron microscopy, new fixative (Lee's fixative: composed of OsO4 and RuO4) was designed as the conventional fixatives such as OsO4 or RuO4 alone were not appropriate for staining for hair follicle lipid. In addition, we measured the chemical composition of integral hair lipid by high-performance thin-layer chromatography. From the above experimental procedure, it was discovered that the lipid in the hair follicle was mainly distributed in hair cuticle and keratinized inner root sheath. A multitude of lamellar granule is observed in the vicinity of the above LL. The chemical composition of integral hair lipid was different from those of epidermal or sebaceous lipids. It is assumed that the LL in the hair follicle is similar to the epidermal LL playing an important role as a skin barrier in the stratum corneum. We proposed here the new terminology "hair barrier" from this point of view.

Unilateral xanthelasma forming a kissing-like lesion.

Xanthelasma is a common cutaneous xanthomatosis which occurs usually on the medial canthus in the upper or inferior palpebra. We describe a rare case of kissing xanthelasma which was unilateral at early onset.