Jui-Hung Ko

Hair Counts from Normal Scalp Biopsy in Taiwan

BACKGROUND Horizontal scalp biopsy is a better method to use when evaluating hair disorders, but an accurate diagnosis requires quantitative data regarding normal hair counts to be used as a control, which are currently available only for Caucasians, African Americans, Koreans, and Iranians. OBJECTIVES To evaluate scalp hair counts in the Taiwanese population. METHODS Two 4‐mm punch biopsies were taken from clinically normal‐looking scalp skin of 31 patients who underwent scalp surgery for non‐hair‐loss disorders. Punch biopsy specimens were sectioned horizontally at the sebaceous gland level and the number of follicular units, terminal hairs including anagen and telogen hairs, and vellus hairs were counted and compared with other published data. The numbers of hairs were also compared between the sexes, different age groups, and different anatomical locations of the scalp. RESULTS The average counts of total hairs, terminal hairs, vellus hairs, and follicular units per 4‐mm punch scalp skin were 21.3, 20.5, 0.8, and 9.4, respectively. The mean ratio of anagen hair to telogen hair was 91.6:8.4 and of terminal hair to vellus hair was 25.3:1. The average density of hair follicles was 1.69 mm2. The mean counts of terminal hairs, total hairs, follicular units, and hair follicles/mm2 were significantly different between different age groups. CONCLUSION Differences in hair count parameters were recognized between different ethnic groups. Parameters of hair density established in the Taiwanese population will provide clinicians with useful reference data for the evaluation of hair disorders in Asians.

Acute tuberculosis cutis miliaris disseminata in a patient with systemic lupus erythematosus

Cutaneous tuberculosis accounts for about 1.5% of all cases with extrapulmonary tuberculsosis. Acute tuberculosis cutis miliaris disseminata is an uncommon form of tuberculosis in the skin. Disseminated miliary tuberculosis was affected by the transmission of Mycobacteria tuberculosis to a variety of organs via hematogenous spreading from the primary focus of lung or meninges. Common risk factors of miliary tuberculosis include immunocompromised status, alcoholism, and acquired immunodeficiency syndrome. We herein report a rare case of acute tuberculosis cutis miliaris disseminata in a systemic lupus erythematosus (SLE) patient.

Acute generalized exanthematous pustulosis induced by levetiracetam.

tion included chemotherapy-induced inflammation of actinically damaged skin, as seen in actinic keratoses following exposure to 5-fluorouracil, and TEC. While the distribution of her eruption within a photo-exposed site argues for chemotherapy-induced inflammation of actinically damaged skin, the lack of involvement of other photo-distributed skin, such as face and dorsal hands, as well as the lack of characteristic histopathological findings, including basal keratinocyte atypia and lymphocytic infiltrate, exclude the possibility of chemotherapy-induced inflammation of actinically damaged skin. Instead, the histopathological findings, combined with the recurrence of lesions with subsequent infusions of paclitaxel, a drug associated with acral erythema (an entity within the spectrum of TEC), are characteristic of TEC. However, the distribution of the patient’s lesions is interesting and, to our knowledge, has not been previously reported in TEC. When the as yet unproven pathophysiology of TEC is elucidated, we look forward to a better understanding of how this unusual distribution can be explained. Kerith E. Spicknall, MD Diya F. Mutasim, MD Department of Dermatology, University of Cincinnati, Cincinnati, OH, USA E-mail: kerith.spicknall@uc.edu

Brachioradial pruritus in a young man presenting with transverse myelitis

Abstract Pruritus with unknown origin is a common complaint and secondary causes should be investigated. We report a 22-year-old man with intractable localized pruritus and painful burning, stinging sensations in the bilateral arms, shoulders, neck and upper back for 3 weeks. A dermatologist was consulted in the emergency department. On physical examination, there were multiple excoriated erythematous macules and depigmented scars in a linear distribution over the dermatome from C4 to C6. Decreased muscle power in bilateral upper limbs was also noted. A consultant dermatologist strongly suggested that an image survey on the cervical spine was necessary. Surprisingly, a magnetic resonance image (MRI) of the cervical spine revealed a lesion with T1 hypointensity and T2 hyperintensity occupying two-thirds of the intramedullary region at the C2-C5 levels, consistent with transverse myelitis. Brachioradial pruritus with transverse myelitis was diagnosed. It is important for clinicians to be aware that bra-chioradial pruritus should be a differential diagnosis of pruritus of unknown origin and that the disease entity is not responsive to systemic corticosteroids and antihistamines; however, it is dependent on treatment of the underlying process. Once the diagnosis of brachioradial pruritus is made, plain film or MRI of the cervical spine should be arranged to determine the presence of possible nerve compression lesions.

Hyperimmunoglobulin E syndrome presenting as eosinophilic pustular folliculitis: a case report

Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency disorder characterized by high serum IgE levels, eosinophilia, eczema, and recurrent cutaneous and sino-pulmonary infections. It was first described as Job’s syndrome in 1966 in two girls with recurrent skin abscesses, pneumonia, and chronic eczema. In 1972, hyperimmunoglobulin E syndrome (HIES) was named after the associated feature of greatly elevated serum IgE. Three genetic mutations of HIES have been found successively since 2006: tyrosinase kinase 2 (TYK2), signal transducer and activator of transcription 3 (STAT3), and dedicator of cytokinesis 8 (DOCK8). Skin findings of HIES similar to atopic dermatitis or eczema were described in previous literatures. Herein is a case of STAT3-mutated HIES manifesting with eosinophilic pustular folliculitis (EPF)-like symptoms. The cutaneous manifestations of HIES have also been reviewed.

Acute generalized exanthematous pustulosis induced by levetiracetam: Correspondence

tion included chemotherapy-induced inflammation of actinically damaged skin, as seen in actinic keratoses following exposure to 5-fluorouracil, and TEC. While the distribution of her eruption within a photo-exposed site argues for chemotherapy-induced inflammation of actinically damaged skin, the lack of involvement of other photo-distributed skin, such as face and dorsal hands, as well as the lack of characteristic histopathological findings, including basal keratinocyte atypia and lymphocytic infiltrate, exclude the possibility of chemotherapy-induced inflammation of actinically damaged skin. Instead, the histopathological findings, combined with the recurrence of lesions with subsequent infusions of paclitaxel, a drug associated with acral erythema (an entity within the spectrum of TEC), are characteristic of TEC. However, the distribution of the patient’s lesions is interesting and, to our knowledge, has not been previously reported in TEC. When the as yet unproven pathophysiology of TEC is elucidated, we look forward to a better understanding of how this unusual distribution can be explained. Kerith E. Spicknall, MD Diya F. Mutasim, MD Department of Dermatology, University of Cincinnati, Cincinnati, OH, USA E-mail: kerith.spicknall@uc.edu