Relationship of hair regrowth pattern in alopecia areata according to DIMT classification with treatment modalities and patch size

( Hanil Lee ),( Solam Lee ),( Jong Won Lee ),( Sang Hoon Lee ),( Won-soo Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: The morphology of hair regrowth in alopecia areata (AA) patches could be classified into four types, namely diffuse (d), irregular (i), marginal (m), and targetoid (t) patterns, according to the DIMT classification. However, factors affecting hair regrowth patterns have not been investigated. Objectives: Investigate whether the hair regrowth pattern in AA patches according to the DIMT classification is associated with the treatment modality used on the patches and their size. Methods: We retrospectively analyzed 152 AA patches with hair regrowth. The treatment modalities were classified into four types as follows: topical corticosteroid (TSC), diphenylcyclopropenone contact immunotherapy (DPCP), systemic and topical corticosteroid (SCS), and triamcinolone intralesional injection (TA ILI). The AA patches were classified into two groups according to sizes of ≤2 and >2 cm. Results: A total of 152 hair regrown AA patches were analyzed. The associations between the diffuse pattern and patch sizes of>2cm (OR: 0.36, 95% CI: 0.17-0.74), between the irregular pattern and triamcinolone intralesional injection (OR: 274.87, 95% CI: 25.75- 2933.56), between the marginal pattern and systemic corticosteroids (OR: 4.89, 95% CI: 1.31-18.27), and between the targetoid pattern and patch sizes of >2 cm (OR: 2.50, 95% CI: 1.10-5.68) showed statistical significance. Conclusion: Treatment modalities and sizes of AA patches are the factors that affect hair regrowth patterns in AA patches.

Morphological classification system of hair regrowth patterns in alopecia areata patches : DIMT classification

( Hanil Lee ),( Solam Lee ),( Won-soo Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Patches of alopecia areata show various morphological patterns of hair regrowth during recovering from hair loss. These hair regrowth patterns have rarely been systematically studied or classified. Objectives: To establish a classification system of the hair regrowth patterns found in alopecic patches in patients with alopecia areata based on the morphology. Methods: On the basis of morphology, we developed a classification system for the hair regrowth patterns, which included diffuse, marginal, targetoid and irregular patterns. It is named as DIMT classification using acronym of patterns included (diffuse, irregular, marginal, targetoid). We applied this classification system to the patients with alopecia areata who attended our outpatient clinic and showed hair regrowth from their alopecic patches. Results: 106 patches from 33 patients were analyzed. Of total, 36 (34.0%) showed diffuse pattern, 35 (33.0%) developed marginal pattern, 31 (29.2%) had targetoid pattern, and 4 (3.8%) showed irregular pattern. Conclusion: This is the first study to classify hair regrowth patterns in alopecia areata patches based on the morphology, into diffuse, marginal, targetoid, and irregular patterns. This study provides new insights that hair regrowth pattern might be an important outcome measure in monitoring alopecia areata patients. It is further to be investigated whether these hair regrowth patterns are related to its pathogenesis or patients’ clinical outcomes.

Post-GDC-coiling alopecia

( Hanil Lee ),( Young Bin Lee ),( Won-soo Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Postoperative alopecia is an uncommon complication of long anesthetic surgical procedures, typically affecting the occiput and resulting from pressure-induced tissue hypoxia. Guglielmi detachable coil (GDC) coiling is a procedure guided by fluoroscopy that fills an intracranial aneurysm. There were two cases of rectangular postoperative alopecia on the occipital area after GDC coiling, considered probably mainly radiation-induced. A 55-year-old male and a 49-year-old male patient visited our clinic for alopecic patches on occipital area which occurred 2 weeks after GDC coiling for cerebral aneurysms. The alopecic patches were evenly distributed reduction in hair density, not total loss of hair, and rectangular, sharply outlined from uninvolved area. The openings of hair follicles were remained, to be non-scarring alopecia. The patients were reassured that hair loss is temporary and topical minoxidil were prescribed. After about 5 months, the alopecic patches were fully restored in both patients. Both patients received GDC coiling under fluoroscopy which can cause significant amount of radiation exposure to penetrating skin and hair, resulting in temporary or permanent alopecia. The duration of operation of both patients were 3 hours, not long enough to cause pressure alopecia. In this point of view, these evenly distributed, circumscribed, rectangular and telogen-spared alopecic patches can be suggested radiation-induced.

A case of nevus lipomatosus superficialis presented as a dome-shaped nodule, clinically resembling neurofibroma

( Hanil Lee ),( Jong Won Lee ),( Won-soo Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Nevus lipomatosus superficialis(NLS) is a fairly uncommon lesion characterized by ectopic adipose tissue in the dermis. It was classified into two clinical types: a multiple form and a solitary one. Pedunculated lipofibroma(PL) is a rare, solitary form of NLS. A 44-year-old male patient presented with a flesh-colored, well-circumscribed, small-coin-sized soft nodule on his left thigh which slowly grew up for 2 years. Histopathologic examination of the excisional biopsy specimen from the lesion showed a well-circumscribed, but not encapsulated mass of mature adipocytes embedded among the collagen bundles of the dermis. It was clinically first impressed with neurofibroma(NF) because of its dome-like shape and smooth surface of skin without any superficial changes. However, the histopathologic results were in favor of NLS, excluding the diagnosis of NF for the absence of wavy spindle-shaped cells. The term, pedunculated lipofibroma is proposed for the solitary form of NLS, which is slowly growing pedunculated tumor with similar histopathologic findings as NLS, often occurring over 4th decades. In this case, combining the clinical and histopathologic findings, it is mostly consistent with PL, except for its dome-like shape, lacking pedunculation.

Radiation-Induced Rectangular Alopecia after Endovascular Embolization of Cerebral Aneurysms: The Necessity of a Comprehensive Study on Its Incidence and Critical Radiation Doses

( Hanil Lee ),( Solam Lee ),( Young Bin Lee ),( Won-soo Lee ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.Suppl

Early malignant melanoma arising in dysplastic nevus

( Hanil Lee ),( Jong Won Lee ),( Won-soo Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Atypical nevi (AN) are melanocytic lesions with clinical features that may resemble malignant melanoma (MM) commonly representated as ‘ABCDE’ but are largely benign. The histologic correlate of the clinical atypical nevus is termed a dysplastic nevus (DN), which is believed to lie on the spectrum between a typical nevus and MM. A 43-year-old female patient presented with a dark mole on the right thigh which had been there since childhood, but recently enlarging about a year ago. The lesion was measured as 5mm in size and showed asymmetry, color variegation with darker center than margin. Excisional biopsy was done, and histologic examination revealed melanocytic proliferation along the elongated rete ridges. The melanocytes showed pleomorphic nuclei, intraepidermal upward growth, and focal invasion to papillary dermis, diagnosed with early MM arising in DN. The significance of AN and DN is complicated by the fact that whereas a small proportion of these have the potential to transform into MM, the majority remain stable. The annual risk of a DN to transform into MM was about 1/30000. However, 20% of MM arise out of DN, and the presence of 5 AN has an increased risk of MM compared to 0 (Relative risk (RR) 6.36). There are always risks of developing MM from the remaining lesions of biopsy-proven, margin-positive DN. So partial biopsies of pigmented lesions suspicious for melanoma may lead to delayed melanoma diagnosis.

Photographic assessment improves adherence to follow-up in patients with androgenetic alopecia and alopecia areata

( Solam Lee ),( Hanil Lee ),( Chung Hyeok Lee ),( Won-soo Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Treatment of androgenetic alopecia (AGA) and alopecia areata (AA) are not so favorable in many cases. Some institutions offer a detailed counseling and assessment including photographic evaluation to provide psychological satisfaction to patients for improving patients’ compliance to treatment. Objectives: To investigate the quantitative effect of photographic assessment on maintaining patients’ adherence to recommended follow-up. Methods: Medical records of patients with AGA or AA who visited our clinic from May 2003 to April 2017 were reviewed. Patients were considered to have undergone photographic assessment when they had photographing session during follow-up including the initial visit. A survival and Cox-regression analysis was performed for follow-up rate. Results: A total of 2999 patients were analyzed. The 1-year follow-up rate was 35.8% (95% CI, 31.6-40.6%) in AGA patients who underwent photographic assessment and 13.5% (95% CI, 11.7-15.6%) in those who did not. Likewise, in AA patients, the 1-year follow-up rate was 50.0% (95% CI, 44.2-56.5%) and 16.3% (95% CI, 14.0-18.9%), respectively. Patients who underwent photographic assessment had independently less risk of being lost to follow-up (adjusted hazard ratio of 0.51 in AGA, 0.41 in AA). Conclusion: To improve overall therapeutic outcome, it might be beneficial to provide photographic assessment to patients with AGA or AA.

A new classification of alopecia areata based on risk stratification by subtype and extent of hair loss: lee classification

( Sung Jay Choe ),( Solam Lee ),( Chung Hyeok Lee ),( Hanil Lee ),( Won-soo Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Alopecia areata (AA) could manifest various patterns and degree, some of which are known to be associated with prognosis of disease. There are several classifications in AA, however they reflected the various prognostic factors insufficiently. Objectives: We aimed to establish a classification that reflects the prognostic factors affecting the treatment response. Methods: 94 AA patients were enrolled. We assessed correlation between treatment response and disease-related factors, including pattern and extent of scalp lesion, and presence of lesions on the body hair using multivariate logistic regression. In patients with extrascalp lesion, we assessed the correlation between treatment response and affected site and extent of extrascalp lesions separately. Results: There was a poorer response to scalp involvement with increasing extent. Furthermore, there was a significant difference in treatment response according to the pattern of scalp lesion. Besides, in patients with lesions on the extrascalp hair, there was a tendency to show worse results when involved wider areas and more sites of body hair lesions. Conclusion: We applied these results and developed a new classification based on combination of the pattern and extent of scalp hair lesion and the affected body hair site and extent. It is a new systematic, and evidence-based classification that reflects disease-associated prognostic factors.

Relationship of Hair Regrowth Pattern in Alopecia Areata Patches According to DIMT Classification with Treatment Modalities and Patch Size: A Retrospective Cross-Sectional Analysis

( Sung Ha Lim ),( Hanil Lee ),( Solam Lee ),( Jong Won Lee ),( Sang-hoon Lee ),( Won-soo Lee ) 대한피부과학회 2022 Annals of Dermatology Vol.34 No.1

Background: The morphology of hair regrowth in alopecia areata (AA) patches could be classified into four types, namely diffuse, irregular, marginal, and targetoid patterns, according to the DIMT classification. However, factors affecting hair regrowth patterns have not been investigated. Objective: We investigated whether the DIMT-classified hair regrowth patterns of AA patches are associated with treatment modality and patch size. Methods: We conducted a retrospective, cross-sectional study of 152 AA patches with hair regrowth. Results: The associations between the diffuse pattern and patch size >2 cm (p=0.006; odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.17~0.74), between the irregular pattern and triamcinolone acetonide intralesional injection (p< 0.001; OR: 274.87, 95% CI: 25.75~2,933.56), between the marginal pattern and systemic and topical corticosteroid (p=0.018; OR: 4.89, 95% CI: 1.31~18.27), and between the targetoid pattern and patch size >2 cm (p=0.028; OR: 2.50, 95% CI: 1.10~5.68) were statistically significant. Conclusion: Treatment modalities and patch size are the factors affecting hair regrowth patterns in AA patches.

[P405] A nail-extracting behavior in a patient with adjustment disorder, confused with onychotillomania

( Hanil Lee ),( Won-soo Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A nail-picking behavior is a common presentation in a patient with psychocutaneous diseases. Onychotillomania, first described by Alkiewicz in 1934, is a condition that patients repetitively and neurotically pick their nails with their teeth or hands or even using instruments. A 29-year-old male patient visited our department complaining of an oozing and painful wound on the nailbed of his right first toe after extracting the toenail by himself watching Youtube. He had been suffered from ingrowing nail for 2 years and that made him have difficulties in concentrating on the public official exam. At first visit, antibiotics was prescribed. After a week, he re-visited after extracting the remaining 9 toenails and apologized to us for what he had done. Then, we referred him to the department of psychiatry, and he was diagnosed as adjustment disorder. In this case presented with a nail-extracting behavior, we first considered whether it is onychotillomania or not. However, we concluded that it is different from onychotillomania because unlike the onychotillomania usually presented with repetitive nail-picking behaviors, the patient`s behavior ended as a single episode, and is beyond common sense. We observed an extremely rare nail-extracting behavior which is considered to be very bizarre. Herein, we report the case of a patient with adjustment disorder presented with a nail-extracting behavior, confused with onychotillomania.