Yoonseok Oh

A case of extragenital chancre on a nipple from a human bite during sexual intercourse

undergoes rapid hypertrophy. During a period of 2–3 weeks, hundreds of eggs are released, and involution of the lesion occurs as the flea dies. The most commonly affected area is the foot, particularly the periungual area of the toes, soles, and heels; however, infection may occur anywhere on the body. The typical lesions are 0.5–1-cm black nodules with a central dark focus, which may be painful and are often pruritic. Superinfected lesions may present with pustules, fissures, and ulcerations. Bullous lesions and white nodules have been reported as single cases. Tetanus may result in nonvaccinated persons. The diagnosis may be made clinically. The central brown– black spot examined under dermoscopy is a characteristic ring with a central pore, corresponding to the pigmented exoskeleton surrounding the posterior opening of the flea. Near this spot, a gray–blue blotch, resembling ovoid nests seen in pigmented basal cell carcinomas, may or may not be present. The gray–blue blotch is thought to represent developing eggs in the flea’s abdomen. If a biopsy is performed, the presence of the parasite, exoskeleton, or eggs is visualized under light microscopy. Visualization of a trachea may be helpful in distinguishing between tungiasis and helminthic infections. The clinical differential diagnosis includes plantar or subungual verrucae, melanoma, pyogenic granuloma, foreign body reaction, scabies infestation, and deep fungal infection. Treatment is by surgical excision of the flea. Care should be taken to remove the entire flea, as remaining parts can result in residual inflammation. Cauterization may assist in destroying invisible flea parts. Topical antimicrobial may be applied to the wound after removal, and, if necessary, tetanus immunization should be provided. It is important for dermatologists in nonendemic areas (such as the USA) to be aware of the clinical features of tungiasis, because travelers may present with this infestation without relating a supportive travel history.

Analysis of familial factors using the basic and specific (BASP) classification in Korean patients with androgenetic alopecia

BACKGROUND The mechanisms and inheritance of androgenetic alopecia (AGA) have yet to be elucidated. Several clinical studies suggest that a predisposition to AGA is affected by a variety of paternal and/or maternal hereditary factors. No previous study has addressed the association of AGA with family history based on the pattern of hair loss. OBJECTIVES The purpose of this study was to investigate paternal and/or maternal genetic influences in each type of hair loss pattern using the basic and specific (BASP) classification and to explore whether the morphology of AGA tends to be inherited in family members. METHODS Between October 2007 and September 2008, 1220 Korean participants, 998 male and 222 female, were classified according to the BASP classification at 13 university dermatologic centers. Information was collected using a standard questionnaire and BASP classification sheet. RESULTS Parental influences on anterior hairline shape in men were predominantly from the paternal side, whereas these effects were less notable in women. In the absence of a family history, statistical analysis showed a higher frequency for early-onset AGA than late-onset AGA (Pearson χ(2)P < .05). Basic types of hair loss had a higher degree of inheritance from the paternal side of the family, regardless of specific type. LIMITATIONS The evaluation of hair loss pattern and family history was done by the patients. CONCLUSIONS Familial factors affecting the morphology of AGA differ between male and female individuals, and for each type of BASP classification.

Co‐occurrence of nevus comedonicus with accessory breast tissue

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Does segmental lipodystrophy represent mosaicism of inherited lipodystrophy

To the Editor: Lipodystrophy is a rare, heterogeneous group of diseases characterized by the absence of subcutaneous fat over part of or the entire body surface. Lipodystrophy is classified into two main groups, acquiredor inherited,which in turn comprise four and three subgroups, respectively. Each type of lipodystrophy has a unique clinical appearance and underlying pathogenic mechanism (Table I). A 13-year-old female with a prominent loss of subcutaneous fat on the lateral side of her left lower limb presented to our dermatology clinic. The patient’s mother noticed the presence of a small, depressed area at the gluteal muscle region of the left lower limb since 6 months of age. As the patient grew, a further gradual loss of subcutaneous fat caused this depression to become more prominent and extend downward. The patient had no mental or physical developmental abnormalities or any remarkable medical history, such as febrile disease or abnormal medical or drug medication. In addition, there was no family history of lipodystrophy. Upon physical examination, the patient’s lipoatrophy extended from the gluteal fossa to the dorsal surface of her left foot without any other involvement. This skin distribution was segmental. The skin overlying the areas of lipoatrophy was brown, thin, smooth, and not sclerotic. Superficial veins and muscularity were prominent because of the loss of