Hannah Hong

Comparison of hair shaft damage after chemical treatment in Asian, White European, and African hair

Diverse causes of extrinsic damage to the hair shaft have been documented and can be roughly divided into physical and chemical causes. Chemical causes of hair damage include bleaching, hair dyeing, and perming.

Reliability of the pattern hair loss classifications: a comparison of the basic and specific and Norwood-Hamilton classifications.

Pattern hair loss (PHL) is the most common form of baldness in both sexes. The Norwood–Hamilton classification is the most commonly used classification worldwide, but it has many limitations. The basic and specific (BASP) classification was introduced as an improvement over the Norwood–Hamilton classification. Previous research was done to estimate the reliability of the Norwood–Hamilton classification and the result was unsatisfactory. However, the reliability of the BASP and Norwood–Hamilton classifications has not yet been compared. Eight dermatological specialists, 17 dermatological residents and 15 general physicians classified PHL in 100 sets of photographs using both the BASP and Norwood–Hamilton classifications. Intergroup reproducibility was evaluated by examining the match rate of the individual data in each group and the match rate between hair specialist and the other examiners. Intragroup repeatability was determined by calculating the match rate between the first and second studies. In terms of intergroup reproducibility of the match rate for individual data in each group, the basic type had the best agreement, the specific type had the second best, and the Norwood–Hamilton classification had the lowest match rate. In comparison, hair specialist and intragroup repeatability showed the same patterns. The BASP classification not only distinguishes all kinds of hair loss patterns, but also has better reproducibility and repeatability than the Norwood–Hamilton classification.

Spontaneous Involution of Congenital Melanocytic Nevus With Halo Phenomenon

Abstract: Congenital melanocytic nevus (CMN) is a neural crest-derived hamartoma, which appear at or soon after birth. CMN has a dynamic course and may show variable changes over time, including spontaneous involution. Spontaneous involution of CMN is a rare phenomenon and is often reported in association with halo phenomenon or vitiligo. The mechanism of halo phenomenon is yet to be investigated but is suggested to be a destruction of melanocytes by immune responses of cytotoxic T cells or IgM autoantibodies. Here, the authors report an interesting case of spontaneously regressed medium-sized CMN with halo phenomenon and without vitiligo, which provides evidence that cytotoxic T cells account for the halo formation and pigmentary regression of CMN.

Eccrine Chromhidrosis Resembling Clinical Features of Pompholyx with Bile-Like Greenish Pigmentation on the Right Palm and Soles

Dear Editor: Chromhidrosis is a rare condition characterized by secretion of colored sweat from the eccrine or apocrine glands. Not only is this condition epidemiologically rare, but also its mimicry of eczematous clinical features may lead to misdiagnosis. A 55-year-old man was examined for abnormal pigmentation on right palm and soles, which lasted a week. He was a local farmer in an apple orchard and he had diabetes, alcoholic liver cirrhosis, and hepatic regenerative nodules as underlying diseases. He was hospitalized due to longstanding diarrhea and fever. On clinical examination, yellow and green papules were observed on his right palm and soles (Fig. 1) and levels of total (19.3 mg/dl) and direct (13.8 mg/dl) bilirubin were elevated. Histological findings revealed hyperkeratosis, diffuse acanthosis, and subcorneal vesicles in the epidermis (Fig. 2A). Homogenous eosinophilic materials were observed surrounding the vesicles and both the number and size of eccrine glands were increased (Fig. 2A, inset). Hence, the patient was diagnosed with eccrine chromhidrosis and treated with emollient. After three weeks, abnormal pigmentation was almost resolved, levels of total (2.18 mg/dl, normal range: 0.3~1.9 mg/dl) and direct (0.71 mg/dl, normal range: 0~0.3 mg/dl) bilirubin were lower and body temperature had decreased (Fig. 2B). Fig. 1 (A) Multiple yellow and green papules without symptoms on the right hand and (B) soles of both feet. Upper inset: yellow and green pigmentation on the sole. Fig. 2 (A) Upon histopathological examination of a yellow papule, the epidermis showed hyperkeratosis, diffuse acanthosis, and subcorneal vesicles (H&E, ×40). An increased number and size of eccrine glands (lower inset, ×200). Homogenous ... Green pigmentation on the palms and soles in patients with hyperbilirubinemia is a rare condition1. While our case presented with eczematous lesions on the right palm and soles (where sweat glands are most abundant), the patients clinical features resembled pompholyx, a primarily spongiotic dermatitis2,3. However, the yellow-green pigmentation in our case appeared to be bile-filled vesicles, which could not be explained by spongiotic changes alone. Two weeks of high fever led to increased sweating and high concentrations of bile components in the sweat may have acted as a sensitizer and induced eczematous lesions, exacerbating the inflammatory spongiosis. Eccrine chromhidrosis is a rare condition in which water-soluble pigments from certain dyes or drugs are excreted via the eccrine sweat glands-in our case, the bile components. It may be caused by chromogenic bacterial or fungal contamination or by extrinsic chemicals on the surface of the skin, which react with eccrine secretions and produce the color transformation. However, results of fungal and pseudomonal tests in this case were negative. Kanzaki and Tsuda4 reported two cases of eccrine chromhidrosis with liver disease. In hepatocytes associated with liver disease, bile may become pigmented with brown color; however, no bile pigmentation was observed in this case. The bile pigment may have been washed out during histological fixation if it was located within the spaces of the eccrine ducts and vesicles, and not in the cellular spaces2. Possible pathomechanisms of three essential factors that could contribute towards the development of pigmentation: (1) increased plasma level of water-soluble direct bilirubin, (2) high fever with sweating, and (3) a thick horny layer. The green color is attributable to the switch from brown-colored bilirubin to green-colored biliverdin by oxidative processes5. We report a case of eccrine chromhidrosis resembling the clinical features of pompholyx with explanation of probable pathomechanism.

The Effect of Rhus verniciflua Stokes Extracts on Photo-Aged Mouse Skin

Background Rhus verniciflua Stokes (RV) has traditionally been used in Korea as an indigenous food (Rhus chicken soup) and as an herbal medicinal plant. While the anticancer, antimicrobial, and anti-inflammatory properties of RV have been actively studied in the medical field, its antioxidant effects in the skin that resist the reactive oxygen species in keratinocytes and fibroblasts is less understood. Objective We designed to evaluate the effects of R. verniciflua Stokes extract (RVE) on the photo-aged skin by an in vitro experiment using human fibroblasts and an in vivo experiment using a photo-aged murine model. Methods For the in vitro experiments, human fibroblasts irradiated with ultraviolet (UV) B were treated with RVE or vehicle, and the growth levels and the expression level of type 1 procollagen were compared. For the in vivo experiment, photo-aged mice irradiated with UVB and UVA were administered drinking water with or without RVE, and histological changes and the expression level of type 1 procollagen and matrix metalloprotease (MMP)-13 were compared. Results In vitro experiments using fibroblasts irradiated with UVB showed that RVE promoted growth and significantly increased the expression of type 1 procollagen as compared to the control group. In the photo-aged mice, RVE increased collagen content in the dermis and promoted the synthesis of type 1 procollagen without any visible decrease in MMP-13 as compared to control group. Conclusion In addition to the previously reported antioxidant effects of RVE, oral intake of RVE effectively inhibited photo-aging in hairless mice by enhancing collagen synthesis.

Woolly Hair Nevus Involving Entire Occipital and Temporal Scalp

Dear Editor: Woolly hair is an abnormal variant of the fine, curled hair on the scalps of non-Black people. These abnormal hairs are curly, short, thin and sparse. Woolly hair nevus is a rare condition that is characterized by curly hair in a circumscribed area of the scalp1. A 20-year-old woman visited our hospital complaining of sparse and curled hair on her scalp. On clinical examination, we observed a well-defined patch of abnormal hairs over the occipital and lower temporal area. The abnormal hairs were curly, short, and appeared thinner and lighter than the other hairs on the scalp. The scalp surface on the lesion showed mild erythematous macules and patches (Fig. 1A, B). The patient reported that these findings have been present since she was 1 year old. She had a known past history of pectus excavatum but no other skin problems or visual abnormalities and no medical or family history. On histopathologic examination, hair follicles revealed a wavy appearance with perifollicular infiltration of the inflammatory cells (Fig. 1C). The diameter of five woolly hairs and five normal hairs on vertex area were measured by phototrichogram (Folliscope 2.8; LeedM, Seoul, Korea). The mean diameters of the normal vertex area hairs and the woolly hairs were 0.086 mm (Fig. 2A) and 0.041 mm (Fig. 2B), respectively. Chest X-ray showed right heart border obliteration, and left atrial enlargement was shown on electrocardiography. We consulted with the department of cardiology for diagnosis of this abnormal finding, but no abnormalities were found in complete medical checkups. Other laboratory tests results were within normal ranges. These findings were consistent with a diagnosis of woolly hair nevus. Fig. 1 Well-defined patch of abnormal curly hair over the occipital and lower temporal area. (A) Right 90° side view. (B) Posterior view

Interferon-γ Release Assay and Reverse Blot Hybridization Assay: Diagnostic Role in Cutaneous Tuberculosis.

Cutaneous tuberculosis (TB) is traditionally diagnosed via histopathological findings of granuloma with caseous necrosis and positive acid-fast bacilli (AFB) staining or culture. Tuberculids, such as erythema induratum (EI), which are associated with TB, may demonstrate atypical characteristics of TB, including negative TB culture or staining and, histologically, non-caseating, non-granulomatous features. EI and erythema nodosum are difficult to distinguish clinically and histopathologically; therefore, making a correct diagnosis is difficult (1). The gold standard for a definite diagnosis of TB is detection of Mycobaterium tuberculosis on culture; however, this method is time-consuming, resulting in a delayed diagnosis (2). The interferon-γ (IFN-γ) release assay estimates the ability to produce IFN-γ, using Mycobacterium antigens to stimulate T cells. This assay has a low false-positive rate, regardless of BCG vaccination, and high specificity, and can therefore be used to diagnose both latent and active TB (3). The aim of our report was to examine the diagnostic usefulness of the interferon-γ release assay and the reverse blot hybridization assay (REBA) in 7 patients suspicious of having cutaneous TB not identified by conventional methods including TB-PCR.

Myxofibrosarcoma arising in a burn scar.

metastasis (25% of cases) and a poor 5-year survival (59%). EHE mainly occur at muscles of extremities, soft tissues and visceral organs such as the liver and lung. Primary cutaneous EHE is extremely rare and EHE of breast soft tissue has been reported only once previously. To our knowledge, this is the first cutaneous EHE appearing on the areola (Fig. 1). Tumor cells in EHE have abundant eosinophilic cytoplasm and show an infiltrative growth pattern. Intracytoplasmic vacuole is the most prominent feature of EHE. The mass can ulcerate sometimes. From its histological features, EHE must be differentiated from epithelioid hemangioma and epithelioid hemangiosarcoma. Clinically, when the lesion is on the breast, common neoplasm on the breast such as intraductal adenocarcinoma should be considered as well. EHE can be ruled out from them by a wide range of vascular antigens that are not seen in breast carcinomas. Complete surgical excision is the treatment of choice. Due to its indistinct clinical features and rarity, EHE is prone to be overlooked. EHE should be considered as a differential diagnosis of cutaneous mesenchymal tumor and attention to its recurrence is vital for both clinician and patient.