Abstract Background In 2007, Lee et al . introduced a basic and specific (BASP) classification for pattern hair loss that was comprehensive and applicable regardless of race or gender. However, this BASP classification has several limitations. Frontal type hair loss classification is relatively crude, and a specific hair loss pattern cannot be ascertained when hair loss is associated with the temporal and occipital areas. Methods In our modified BASP classification, frontal type classification was subdivided into five instead of three grades. Basic type classification remained the same as in the previous method. In addition, information regarding the involvement of the temporal or occipital scalp was recorded. Accuracy and ease of use were evaluated and compared with the existing BASP classification in 138 patients with pattern hair loss. Results Temporal or occipital involvement was observed in 14 patients, accounting for 11.1% of subjects. Final type accuracy was 82.5% in the existing BASP classification and 71.4% in the modified classification. Ease of use for two practitioners was 70.2 and 72.1% for the existing BASP classification, and 48.9 and 52.2% for the modified method. Conclusion We expect that the modified BASP classification will overcome the limitations of the existing BASP classification. We believe this modified classification will be a valuable tool for pattern hair loss classification because of its classification of previously unclassified types.
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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. (C) Wavy hair follicles with perifollicular infiltration of the inflammatory cells (H&E, ×40).
Fig. 2
Mean hair diameters were measured by phototrichogram. (A) Normal hairs on the vertex (0.086 mm). (B) Abnormal hairs on the occipital scalp (0.041 mm).
Woolly hair is characterized by curly and fine hair. It is presented at birth and is usually the most severe during childhood. The growth rate is usually normal, but the hair may not grow longer than a few centimeters, and it may be caused by a shortened growth cycle1. Hutchinson et al.2 classified three groups of woolly hair: autosomal dominant hereditary woolly hair, autosomal recessive familial woolly hair, and woolly hair nevus. Woolly hair nevus is a rare condition associated with unruly, curly hair. These hairs tend to be lighter in color, smaller in diameter than the surrounding normal hair without an increase in fragility, and appears to be sparse1,3. It has been commonly reported that the affected hair is smaller in diameter than normal hair and the area of involved scalp has been described as being several centimeters and round in shape1,3,4. Our patient displayed woolly hair nevus on her entire occipital and lower temporal area. The involvement area is much larger than that of other cases in previous reports. To the best of our knowledge, this type of widespread woolly hair nevus has never been reported in the literature.
About 50% of woolly hair nevi are associated with an ipsilateral pigmented or epidermal nevus4. Our patient showed no other abnormalities except pectus excavatum, but it is uncertain whether the pectus excavatum is associated with the woolly hair nevus or not.
Alopecia areata (AA) is a common dermatologic condition with a broad spectrum of clinical features and age of onset, classically characterized by nonscarring patches of hair loss. In the past, early-onset (before adolescence) AA has been associated with various autoimmune diseases, especially atopic diseases and lupus erythematosus and demonstrates a worse prognosis compared with late onset AA.To evaluate the differences in the comorbidity profile of AA with regard to age at onset.We completed a retrospective study of 871 Korean AA patients seen at our department within the last 10 years. After these patients were subdivided according to onset before or after age 13 years, the two groups were compared on the basis of their comorbid disorders, family history of AA, and hematologic test results.Our results demonstrate that significantly more patients in the early-onset group had a personal history of atopic dermatitis or family history of AA. These findings are consistent with previous reports associating early-onset AA with autoimmune diseases and a family history of AA in different ethnic populations. Most of the serologic test values showed no significant differences between the groups and the results were considerably affected by age.This study is significant because it is a large group study in Korean AA patients, and Korean AA patients with an onset age before adolescence show similar clinical manifestations to other ethnic populations.
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