Letters to the Editor
Development of terminal hairs following the treatment of pigmented nevus with vellus hairs by Q-switched alexandrite laser Dear Editor, Terminal hair growth after intense pulsed light source (IPLS) treatment was first described in 2002.1 This was followed by reports of hypertrichosis after long-pulsed alexandrite laser epilation2 and diode laser epilation.3 Herein, we describe a first case of terminal hair growth after Q-switched alexandrite laser treatment of a congenital pigmented nevus that was originally with vellus hairs. An 83-year-old Japanese female with Fitzpatrick skin type IV arrived at our hospital presenting a vitiliginous lesion with multiple white, hard, thick hairs on her right cheek (Fig. 1a). On this region, she had a congenital pigmented nevus that had been previously treated with five sessions of Q-switched alexandrite 755-nm laser at 6 J/cm,2 16 years prior at another hospital. The vitiliginous lesion with white hairs appeared after this laser treatment. She repeatedly shaved these hairs, but they continued to grow back. At our hospital, we resected the lesion at her request. We detected no histopathological abnormality in the epidermis, dermis or hair follicle, but the hair shaft was stuck in the lower level of adipose tissue (Fig. 1b). Vlachos and Kontoes1 reported two cases of hypertrichosis following IPLS therapy (one on a tattoo and the other on a port wine stain). They suggested that these cases must involve transformation of local vellus hair follicles into terminal hair follicles, and speculated that this transformation was induced by local inflammation. Alajlan et al.2 reported increased hair in three of 489 patients treated with long-pulsed alexandrite laser epilation. They proposed that the hypertrichosis is dependent on synchronization of hair cycling within the laser treatment sites. Additionally, Bernstein3 reported a case of a 24-year-old man who developed terminal hair growth resulting from diode 810-nm laser epilation. In these reports, hypertrichosis developed on the upper back,1–3 neck1 and cheek,2,4 namely, sunexposed regions. Although hypertrichosis has been reported following IPLS,1,4 long-pulsed alexandrite laser2 and diode laser3 treatment, the present report is the first description of terminal hair growth following Q-switched alexandrite laser treatment. As mentioned above, it has been proposed that hypertrichosis develops due to local inflammation and the synchronization of hair cycling. Additionally, Bouzari and Firooz5 hypothesized that hypertrichosis is associated with heat shock proteins (HSP), such as HSP27. However, the actual mechanism of
(a)
(b)
Figure 1. (a) Vitiliginous lesion with a few white, hard and thick hairs on the cheek. (b) Hair shaft is stuck in the middle of adipose tissue (hematoxylin–eosin, original magnification 920). hypertrichosis development following IPLS or any other laser treatment remains unknown. Although we could not obtain histopathological evidence of the transformation of vellus hair to terminal hair by laser therapy, the existence of terminal hair at the treated site was confirmed in our case. Skin type IV was reported for the previously described patients who developed terminal hair growth after IPLS treatment,1 and after long-pulsed alexandrite laser.2 Alajlan et al.2 mentioned a trend of this adverse effect occurring in individuals with darker skin types and with black hair. We conclude that the possibility of such an adverse reaction following IPLS or laser therapy should be noted, especially in skin type III–IV, which is common among Japanese people.
CONFLICT OF INTEREST:
The authors have no conflict of
interest to declare.
Koichi NAKAGAWA,1 Tomoko OSHIMO,1 Aya OKABAYASHI,1 Rie KINOSHITA,1 Megumi TATEBAYASHI,2 Akira KAWADA,2 Hisayoshi IMANISHI,3 Toshiyuki OZAWA,3 Daisuke TSURUTA3 1
Department of Dermatology, Saiseikai Tondabayashi Hospital, 2Department of Dermatology, Kinki University Faculty of Medicine, and 3Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan doi: 10.1111/1346-8138.12706
Correspondence: Koichi Nakagawa, M.D., Department of Dermatology, Saiseikai Tondabayashi Hospital, 1-3-36 Koyodai, Tondabayashi City, Osaka 584-0082, Japan. Email: [email protected]
© 2014 Japanese Dermatological Association
1115
Letters to the Editor
REFERENCES 1 Vlachos SP, Kontoes PP. Development of terminal hair following skin lesion treatments with an intense pulsed light source. Aesthetic Plast Surg 2002; 26: 303–307. 2 Alajlan A, Shapiro J, Rivers JK, MacDonald N, Wiggin J, Lui H. Paradoxical hypertrichosis after laser epilation. J Am Acad Dermatol 2005; 53: 85–88.
3 Bernstein EF. Hair growth induced by diode laser treatment. Dermatol Surg 2005; 31: 584–586. 4 Radmanesh M. Paradoxical hypertrichosis and terminal hair change after intense pulsed light hair removal therapy. J Dermatolog Treat 2009; 20: 52–54. 5 Bouzari N, Firooz AR. Lasers may induce terminal hair growth. Dermatol Surg 2006; 32: 460.
Bilateral linear nevus sebaceous: An unusual case Dear Editor, Nevus sebaceous (NS) is a well-known congenital epidermal hamartoma of the skin. The condition is most commonly found on the head and face.1 NS consists of a circumscribed, slightly raised plaque, and usually appears unilaterally. Linearly arranged NS is often accompanied by other systemic abnormalities. Herein, we report a case of bilateral and linear NS on the neck in a young, healthy man. A 19-year-old man presented with multiple asymptomatic skin lesions on the right side of his neck that had been present since birth. Over time, these lesions increased in number and became more prominent and pigmented. During puberty, similar cutaneous lesions appeared on the left side of his neck. He had no previous relevant medical history, including local trauma or surgery. Upon examination, multiple, symmetrical, linearly distributed, flesh-colored and/or brownish small verrucous papules 2–4 mm in diameter were found on both lateral sides of his neck. Crusty areas and erythema as a result of unconscious scratching were present (Fig. 1a,b). Because the lesions had characteristic distribution and verrucous features, it was initially thought that the patient had inflammatory, linear, verrucous, epidermal nevus or verruca vulgaris. The most discrete papules were completely excised to obtain a diagnosis. Each specimen had the same histopathological findings, including hyperkeratosis, acanthosis, prominent papillomatosis in the epidermis and the sebaceous glands, and hyperplasia of the apocrine glands in the dermis (Fig. 1c,d). Finally, the diagnosis of bilateral linear NS was made. We recommended total excision of the remaining lesions, but the patient refused and wanted careful observation of the lesions. The published work review concluded that NS commonly occurs in a single location, rarely on multiple locations.2 One author stated that cases of multiple NS never cross the midline.3 A case of multiple NS located on both sides of the body, although extremely rare, has been reported in the English-language published work. Chi et al.4 described a case of multiple NS occurring on the scalp and the contralateral side of the face. However, interestingly, the NS lesions in our patient occurred symmetrically on both lateral sides of the neck. NS is not usually accompanied by any other abnormalities. When linearly arranged NS is accompanied by other systemic abnormalities, it is called linear NS syndrome. NS syndrome encompasses a
(a)
(b)
(c)
(d)
Figure 1. (a,b) Bilateral, linear, discrete papules on both lateral aspects of the neck. Close-up view shows flesh-colored to brown, verrucous papules. Some papules have crusts and surrounding erythema (insets). (c,d) Acanthosis, hyperkeratosis with marked papillomatosis in the epidermis and sebaceous glands hyperplasia in the dermis. Hyperplastic ectopic apocrine glands in the lower dermis (hematoxylin–eosin, original magnification 940).
broad spectrum of abnormalities that may affect every organ system, including the central nervous system, cardiovascular, skeletal, ophthalmologic and urogenital systems.5
Correspondence: Joong Sun Lee, M.D., Ph.D., Department of Dermatology, Eulji University School of Medicine, Eulji University Hospital, 95 Dunsanseo-ro, Seo-gu, Daejeon 302-799, Korea. Email: [email protected]
1116
© 2014 Japanese Dermatological Association
Development of terminal hairs following the treatment of pigmented nevus with vellus hairs by Q-switched alexandrite laser Dear Editor, Terminal hair growth after intense pulsed light source (IPLS) treatment was first described in 2002.1 This was followed by reports of hypertrichosis after long-pulsed alexandrite laser epilation2 and diode laser epilation.3 Herein, we describe a first case of terminal hair growth after Q-switched alexandrite laser treatment of a congenital pigmented nevus that was originally with vellus hairs. An 83-year-old Japanese female with Fitzpatrick skin type IV arrived at our hospital presenting a vitiliginous lesion with multiple white, hard, thick hairs on her right cheek (Fig. 1a). On this region, she had a congenital pigmented nevus that had been previously treated with five sessions of Q-switched alexandrite 755-nm laser at 6 J/cm,2 16 years prior at another hospital. The vitiliginous lesion with white hairs appeared after this laser treatment. She repeatedly shaved these hairs, but they continued to grow back. At our hospital, we resected the lesion at her request. We detected no histopathological abnormality in the epidermis, dermis or hair follicle, but the hair shaft was stuck in the lower level of adipose tissue (Fig. 1b). Vlachos and Kontoes1 reported two cases of hypertrichosis following IPLS therapy (one on a tattoo and the other on a port wine stain). They suggested that these cases must involve transformation of local vellus hair follicles into terminal hair follicles, and speculated that this transformation was induced by local inflammation. Alajlan et al.2 reported increased hair in three of 489 patients treated with long-pulsed alexandrite laser epilation. They proposed that the hypertrichosis is dependent on synchronization of hair cycling within the laser treatment sites. Additionally, Bernstein3 reported a case of a 24-year-old man who developed terminal hair growth resulting from diode 810-nm laser epilation. In these reports, hypertrichosis developed on the upper back,1–3 neck1 and cheek,2,4 namely, sunexposed regions. Although hypertrichosis has been reported following IPLS,1,4 long-pulsed alexandrite laser2 and diode laser3 treatment, the present report is the first description of terminal hair growth following Q-switched alexandrite laser treatment. As mentioned above, it has been proposed that hypertrichosis develops due to local inflammation and the synchronization of hair cycling. Additionally, Bouzari and Firooz5 hypothesized that hypertrichosis is associated with heat shock proteins (HSP), such as HSP27. However, the actual mechanism of
(a)
(b)
Figure 1. (a) Vitiliginous lesion with a few white, hard and thick hairs on the cheek. (b) Hair shaft is stuck in the middle of adipose tissue (hematoxylin–eosin, original magnification 920). hypertrichosis development following IPLS or any other laser treatment remains unknown. Although we could not obtain histopathological evidence of the transformation of vellus hair to terminal hair by laser therapy, the existence of terminal hair at the treated site was confirmed in our case. Skin type IV was reported for the previously described patients who developed terminal hair growth after IPLS treatment,1 and after long-pulsed alexandrite laser.2 Alajlan et al.2 mentioned a trend of this adverse effect occurring in individuals with darker skin types and with black hair. We conclude that the possibility of such an adverse reaction following IPLS or laser therapy should be noted, especially in skin type III–IV, which is common among Japanese people.
CONFLICT OF INTEREST:
The authors have no conflict of
interest to declare.
Koichi NAKAGAWA,1 Tomoko OSHIMO,1 Aya OKABAYASHI,1 Rie KINOSHITA,1 Megumi TATEBAYASHI,2 Akira KAWADA,2 Hisayoshi IMANISHI,3 Toshiyuki OZAWA,3 Daisuke TSURUTA3 1
Department of Dermatology, Saiseikai Tondabayashi Hospital, 2Department of Dermatology, Kinki University Faculty of Medicine, and 3Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan doi: 10.1111/1346-8138.12706
Correspondence: Koichi Nakagawa, M.D., Department of Dermatology, Saiseikai Tondabayashi Hospital, 1-3-36 Koyodai, Tondabayashi City, Osaka 584-0082, Japan. Email: [email protected]
© 2014 Japanese Dermatological Association
1115
Letters to the Editor
REFERENCES 1 Vlachos SP, Kontoes PP. Development of terminal hair following skin lesion treatments with an intense pulsed light source. Aesthetic Plast Surg 2002; 26: 303–307. 2 Alajlan A, Shapiro J, Rivers JK, MacDonald N, Wiggin J, Lui H. Paradoxical hypertrichosis after laser epilation. J Am Acad Dermatol 2005; 53: 85–88.
3 Bernstein EF. Hair growth induced by diode laser treatment. Dermatol Surg 2005; 31: 584–586. 4 Radmanesh M. Paradoxical hypertrichosis and terminal hair change after intense pulsed light hair removal therapy. J Dermatolog Treat 2009; 20: 52–54. 5 Bouzari N, Firooz AR. Lasers may induce terminal hair growth. Dermatol Surg 2006; 32: 460.
Bilateral linear nevus sebaceous: An unusual case Dear Editor, Nevus sebaceous (NS) is a well-known congenital epidermal hamartoma of the skin. The condition is most commonly found on the head and face.1 NS consists of a circumscribed, slightly raised plaque, and usually appears unilaterally. Linearly arranged NS is often accompanied by other systemic abnormalities. Herein, we report a case of bilateral and linear NS on the neck in a young, healthy man. A 19-year-old man presented with multiple asymptomatic skin lesions on the right side of his neck that had been present since birth. Over time, these lesions increased in number and became more prominent and pigmented. During puberty, similar cutaneous lesions appeared on the left side of his neck. He had no previous relevant medical history, including local trauma or surgery. Upon examination, multiple, symmetrical, linearly distributed, flesh-colored and/or brownish small verrucous papules 2–4 mm in diameter were found on both lateral sides of his neck. Crusty areas and erythema as a result of unconscious scratching were present (Fig. 1a,b). Because the lesions had characteristic distribution and verrucous features, it was initially thought that the patient had inflammatory, linear, verrucous, epidermal nevus or verruca vulgaris. The most discrete papules were completely excised to obtain a diagnosis. Each specimen had the same histopathological findings, including hyperkeratosis, acanthosis, prominent papillomatosis in the epidermis and the sebaceous glands, and hyperplasia of the apocrine glands in the dermis (Fig. 1c,d). Finally, the diagnosis of bilateral linear NS was made. We recommended total excision of the remaining lesions, but the patient refused and wanted careful observation of the lesions. The published work review concluded that NS commonly occurs in a single location, rarely on multiple locations.2 One author stated that cases of multiple NS never cross the midline.3 A case of multiple NS located on both sides of the body, although extremely rare, has been reported in the English-language published work. Chi et al.4 described a case of multiple NS occurring on the scalp and the contralateral side of the face. However, interestingly, the NS lesions in our patient occurred symmetrically on both lateral sides of the neck. NS is not usually accompanied by any other abnormalities. When linearly arranged NS is accompanied by other systemic abnormalities, it is called linear NS syndrome. NS syndrome encompasses a
(a)
(b)
(c)
(d)
Figure 1. (a,b) Bilateral, linear, discrete papules on both lateral aspects of the neck. Close-up view shows flesh-colored to brown, verrucous papules. Some papules have crusts and surrounding erythema (insets). (c,d) Acanthosis, hyperkeratosis with marked papillomatosis in the epidermis and sebaceous glands hyperplasia in the dermis. Hyperplastic ectopic apocrine glands in the lower dermis (hematoxylin–eosin, original magnification 940).
broad spectrum of abnormalities that may affect every organ system, including the central nervous system, cardiovascular, skeletal, ophthalmologic and urogenital systems.5
Correspondence: Joong Sun Lee, M.D., Ph.D., Department of Dermatology, Eulji University School of Medicine, Eulji University Hospital, 95 Dunsanseo-ro, Seo-gu, Daejeon 302-799, Korea. Email: [email protected]
1116
© 2014 Japanese Dermatological Association
