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BACKGROUND: Severity of Alopecia Tool (SALT) is widely used to assess the severity of alopecia areata (AA). However, physician-related subjectivity exists in SALT scoring (S1-5), especially with initial inspection in the clinical practice. This study investigated two-dimensional planimetric method to calculate actual surface area of AA, validating SALT scoring. MATERIALS AND METHODS: SALT score was measured twice in each patient based on "initial" inspection in the clinic (SALT-I) and retrospective assessment of the "photograph" (SALT-P). Planimetric surface area was calculated by Image J program. Subgroup analysis was performed depending on the agreement between SALT-I and -P; score was described in the order of SALT-I and SALT-P. RESULTS: A total of 93 subjects were enrolled. Planimetric surface area (cm2 ) of SALT-I was 2.5-74.9 (S1), 48.8-100.6 (S2), 83.6-205.4 (S3), and 282-367.9 (S4), while SALT-P was 2.5-59.2 (S1), 41.6-205.4 (S2), 48.8-183.2 (S3), and 282-367.9 (S4). In subgroup analysis, SALT-I and SALT-P agreed group showed planimetric surface area (cm2 ) as 2.5-59.2 (S1-1), 64.2-100.6 (S2-2), 168.3-183 (S3-3), and 282.6-367.9 (S4-4). Disagreed group showed the value as 54.7 (S1-2), 41.6-74.9 (S2-1), 83.6-205.4 (S2-3), and 48.8-88.6 (S3-2). CONCLUSION: SALT-P was more clearly correlated with actual surface area than SALT-I. Planimetric surface area measurement could be used as a supplementary method especially in the S1 to S3, suggesting 60 cm2 , 100 cm2 , and 200 cm2 as objective cutoff values to differentiate S1, S2, and S3.
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Excessive increase in melanin pigment in the skin can be caused by a variety of environmental factors, including UV radiation, and can result in spots, freckles, and skin cancer. Therefore, it is important to develop functional whitening cosmetic reagents that regulate melanogenesis. In this study, we investigated the effects of echinochrome A (Ech A) on melanogenesis in the B16F10 murine melanoma cell line. We triggered B16F10 cells using α-MSH under Ech A treatment to observe melanin synthesis and analyze expression changes in melanogenesis-related enzymes (tyrosinase, tyrosinase-related protein 1 (TYRP1), and tyrosinase-related protein 2 (TYRP2)) at the mRNA and protein levels. Furthermore, we measured expression changes in the microphthalmia-associated transcription factor (MITF), CREB, and pCREB proteins. Melanin synthesis in the cells stimulated by α-MSH was significantly reduced by Ech A. The expression of the tyrosinase, TYRP1, and TYRP2 mRNA and proteins was significantly decreased by Ech A, as was that of the MITF, CREB, and pCREB proteins. These results show that Ech A suppresses melanin synthesis by regulating melanogenesis-related enzymes through the CREB signaling pathway and suggest the potential of Ech A as a functional agent to prevent pigmentation and promote skin whitening.
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Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico , Melanoma Experimental , Naftoquinonas , Animais , Linhagem Celular Tumoral , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico/metabolismo , Melaninas , Camundongos , Fator de Transcrição Associado à Microftalmia/genética , Fator de Transcrição Associado à Microftalmia/metabolismo , Monofenol Mono-Oxigenase/metabolismo , Naftoquinonas/farmacologia , RNA Mensageiro , Transdução de Sinais , alfa-MSH/farmacologiaRESUMO
Post-menopausal dry mouth or xerostomia is caused by reduced salivary secretion. This study aimed to investigate the efficacy of echinochrome A (Ech A) in alleviating submandibular gland dysfunctions in ovariectomized rats that mimic menopause. Female rats that were eight-weeks-old were randomly divided into SHAM-6, -12; OVX-6, -12; and ECH-6, -12 groups (consisting of 6- and 12-weeks post-sham-operated, ovariectomized, and Ech A-treated ovariectomized rats, respectively). The ECH groups had lower body weight than OVX but similar food intake and estradiol or estrogen receptor ß expression. However, the ECH groups had lower mRNA expression of sterol-regulatory element binding protein-1c (Srebp-1c), acetyl-CoA carboxylase (Acc), fatty acid synthase (Fasn), cluster of differentiation 36 (Cd36), and lipid vacuole deposition than OVX mice. Moreover, reactive oxygen species (ROS), malondialdehyde (MDA), and iron accumulation were lower in the ECH than in the OVX groups. Fibrosis markers, transforming growth factor ß (Tgf-ßI and Tgf-ßII mRNA) increased in the OVX than SHAM groups but decreased in the ECH groups. Aquaporin (Aqp-1 and Aqp-5 mRNA) and mucin expressions were downregulated in the OVX groups but improved with Ech A. In addition, Ech A prevented post-menopausal salivary gland dysfunction by inhibiting lipogenesis and ferroptosis. These findings suggest Ech A as an effective remedy for treating menopausal dry mouth.
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Estrogênios , Xerostomia , Animais , Feminino , Camundongos , Ratos , Estradiol , Estrogênios/farmacologia , Ovariectomia , Ratos Sprague-Dawley , RNA Mensageiro , Glândula SubmandibularRESUMO
Cereblon (CRBN) is a substrate recognition protein in the E3-ligase ubiquitin complex. The binding target of CRBN varies according to tissues and cells, and the protein regulates various biological functions by regulating tissue-specific targets. As new endogenous targets of CRBN have been identified over the past decade, the physiological and pathological functions of CRBN and its potential as a therapeutic target in various diseases have greatly expanded. For this purpose, in this review article, we introduce the basic principle of the ubiquitin-proteasome system, the regulation of physiological/pathological functions related to the endogenous substrate of CRBN, and the discovery of immunomodulatory imide drug-mediated neo-substrates of CRBN. In addition, the development of CRBN-based proteolysis-targeting chimeras, which has been actively researched recently, and strategies for developing therapeutic agents using them are introduced. These recent updates on CRBN will be useful in the establishment of strategies for disease treatment and utilization of CRBNs in biomedical engineering and clinical medicine.
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Ubiquitina-Proteína Ligases/metabolismo , Animais , Humanos , Complexo de Endopeptidases do Proteassoma/metabolismo , ProteóliseRESUMO
Echinochrome A (Ech A, 7-ethyl-2,3,5,6,8-pentahydroxy-1,4-naphthoquinone) has been known to exhibit anti-oxidative and anti-inflammatory effects. However, no study has been carried out on the efficacy of Ech A against skin photoaging; this process is largely mediated by oxidative stress. Six-week-old male SKH-1 hairless mice (n = 36) were divided into five groups. Except for a group that were not treated (n = 4), all mice underwent ultraviolet-B (UVB) exposure for 8 weeks while applying phosphate-buffered saline or Ech A through intraperitoneal injection. UVB impaired skin barrier function, showing increased transepidermal water loss and decreased stratum corneum hydration. UVB induced dermal collagen degeneration and mast cell infiltration. Ech A injection was found to significantly lower transepidermal water loss while attenuating tissue inflammatory changes and collagen degeneration compared to the control. Furthermore, Ech A was found to decrease the relative expression of matrix metalloproteinase, tryptase, and chymase. Taken together, these results suggest that Ech A protects against UVB-induced photoaging in both functional and histologic aspects, causing a lowering of collagen degradation and inflammatory cell infiltration.
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Colágeno/metabolismo , Naftoquinonas/farmacologia , Substâncias Protetoras/farmacologia , Envelhecimento da Pele/efeitos dos fármacos , Animais , Organismos Aquáticos , Modelos Animais de Doenças , Masculino , Mastócitos/efeitos dos fármacos , Camundongos , Camundongos Pelados , Naftoquinonas/administração & dosagem , Substâncias Protetoras/administração & dosagem , Raios Ultravioleta , Perda Insensível de Água/efeitos dos fármacosRESUMO
Atopic dermatitis (AD) is a chronic inflammatory skin disease in which skin barrier dysfunction leads to dryness, pruritus, and erythematous lesions. AD is triggered by immune imbalance and oxidative stress. Echinochrome A (Ech A), a natural pigment isolated from sea urchins, exerts antioxidant and beneficial effects in various inflammatory disease models. In the present study, we tested whether Ech A treatment alleviated AD-like skin lesions. We examined the anti-inflammatory effect of Ech A on 2,4-dinitrochlorobenzene (DNCB)-induced AD-like lesions in an NC/Nga mouse model. AD-like skin symptoms were induced by treatment with 1% DNCB for 1 week and 0.4% DNCB for 5 weeks in NC/Nga mice. The results showed that Ech A alleviated AD clinical symptoms, such as edema, erythema, and dryness. Treatment with Ech A induced the recovery of epidermis skin lesions as observed histologically. Tewameter® and Corneometer® measurements indicated that Ech A treatment reduced transepidermal water loss and improved stratum corneum hydration, respectively. Ech A treatment also inhibited inflammatory-response-induced mast cell infiltration in AD-like skin lesions and suppressed the expression of proinflammatory cytokines, such as interferon-γ, interleukin-4, and interleukin-13. Collectively, these results suggest that Ech A may be beneficial for treating AD owing to its anti-inflammatory effects.
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Anti-Inflamatórios/farmacologia , Naftoquinonas/farmacologia , Ouriços-do-Mar , Animais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/química , Organismos Aquáticos , Dermatite Atópica/tratamento farmacológico , Modelos Animais de Doenças , Interleucina-3/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos , Naftoquinonas/administração & dosagem , Naftoquinonas/química , Pele/efeitos dos fármacos , Perda Insensível de Água/efeitos dos fármacosRESUMO
Foreign body granuloma is a potential adverse effect of acupuncture and usually occurs as an inflammatory reaction to foreign bodies that are accidentally or intentionally injected. This case presents a foreign body granuloma caused by honeybee acupuncture at the site of postherpetic neuralgia and highlights the need for caution and awareness of the side effects of acupuncture-related procedures.
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Terapia por Acupuntura/efeitos adversos , Venenos de Abelha/efeitos adversos , Corpos Estranhos/complicações , Granuloma de Corpo Estranho/diagnóstico , Granuloma de Corpo Estranho/etiologia , Terapia por Acupuntura/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/terapiaRESUMO
BACKGROUND/OBJECTIVES: The need for dermatology consultations for neonatal intensive care unit (NICU) patients is increasing, but no study has systemically examined the skin diseases of patients in NICUs. The aim of this study was to analyze dermatology consultations in the NICU of a tertiary medical center in Korea and determine the effect of the dermatology consultation on the clinical course and management of the patients after the consultation. METHODS: The medical records of patients undergoing dermatologic consultation during their stay in a NICU between March 2009 and February 2016 were reviewed retrospectively. RESULTS: Sixty patients were enrolled in this study; the male-to-female ratio was 1:1.1, and mean age at the time of consultation was 3.7 weeks. Mean gestational age was 33.7 weeks, and 35 of the subjects (58.3%) were preterm neonates. Mean birth weight was 2.14 kg (range 550-4,200 g). The most-common disease category was birthmarks and neoplasms (20.0%), followed by eczematous dermatoses (18.3%), skin appendageal disease (16.7%), and infectious disease (13.3%). CONCLUSION: This study identified the dermatologic problems of neonates in a NICU and can raise dermatologists' awareness of the types of patients they may encounter in a NICU.
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Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/epidemiologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Masculino , República da Coreia , Estudos RetrospectivosRESUMO
BACKGROUND: Alopecic and aseptic nodule of the scalp (AANS) is a rare disease entity first reported in 1992 as pseudocyst of the scalp (PCS). Controversy exists regarding the histopathology and etiology of reported cases. OBJECTIVE: We performed this study to analyze the clinical and histopathologic features of AANS/PCS in Korean patients. METHODS: A retrospective review of medical records from 2008 to 2013 at Inje University Busan Paik Hospital was performed. RESULTS: Eleven patients were enrolled. All patients were male, and their mean age was 21.6 years. Most patients had a solitary nodule (10/11) located predominantly on the vertex. The mean nodule size was 20 mm. Inflammatory cell infiltration in the deep dermis was a histologic feature of AANS/PCS. Eight patients showed granulomatous infiltration. All patients were treated with short-term antibiotics and intralesional steroid injection. CONCLUSION: Our results suggest that dermatologists should consider AANS when diagnosing an alopecic nodule on the scalp.
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Alopecia/complicações , Alopecia/patologia , Cisto Epidérmico/complicações , Cisto Epidérmico/patologia , Dermatoses do Couro Cabeludo/etiologia , Dermatoses do Couro Cabeludo/patologia , Adolescente , Adulto , Alopecia/tratamento farmacológico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Cefalosporinas/uso terapêutico , Criança , Quimioterapia Combinada , Cisto Epidérmico/tratamento farmacológico , Humanos , Injeções Intralesionais , Masculino , República da Coreia , Estudos Retrospectivos , Dermatoses do Couro Cabeludo/tratamento farmacológico , Triancinolona/administração & dosagem , Adulto JovemRESUMO
BACKGROUND: It is well known that adequate water intake and moisturizer application improves skin barrier function. OBJECTIVE: This study was conducted to analyze the effects of daily water intake and moisturizer application on skin barrier function and the degree of response to barrier recovery. METHODS: Participants with daily water intake more than 1 L were classified as high daily water intake group (H) and those with less than 1 L as low daily water intake group (L). Each group was subcategorized into four groups according to intervention method: additional water intake (H1, L1), moisturizer (H2, L2), both (H3, L3), and control (H4, L4). Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) were measured at baseline during the 2nd and 4th week. RESULTS: A total of 43 participants completed the study (H: 22, L: 21). At baseline, there was no significant difference in SCH and TEWL in any on the anatomical sites between the high daily water intake and low daily water intake groups. However, SCHs of left forearm (group H2, p=0.004; group H3, p=0.004), left hand dorsum (group H2, p=0.010; group H3, p=0.026), and left shin (group H2, p=0.016; group H3, p=0.001) in group H2 and H3 were significantly increased in the 4th week as compared to the baseline values. CONCLUSION: The results suggest that the degree of water intake may be related to improved skin barrier function. However, application of additional moisturizers had more favorable impact on skin hydration as compared to additional water intake.
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After anaplastic large-cell lymphoma (ALCL) was first described by Stain in 1985, there have been several histological variants of ALCL reported. There are classified histological subtypes of ALCL, such as lymphohistiocytic, small cell, Hodgkin-like, composite pattern, and other less common variants including neutrophil-rich ALCL. A 63-year-old male patient presented with erythematous exophytic mass on the left lower leg. In the past, his condition had been diagnosed as abdominal primary cutaneous ALCL (pcALCL), which recurred as systemic ALCL (sALCL) in the left bronchus. After treatment, he achieved complete remission. Histopathologic examination showed large-sized pleomorphic, anaplastic mitotic tumor cells, several neutrophils, and a few lymphocytes. Neutrophil-rich ALCL is a rare histological variant of ALCL. It is characterized by the presence of CD30-positive anaplastic tumor cells with numerous neutrophil infiltrations. Neutrophil-rich ALCL responds well to treatment but tends to recur. There were four cases reported to have recurrent neutrophil-rich ALCL. All cases were diagnosed with neutrophil-rich pcALCL prior to recurrence. Three cases had local recurrence, and only one case relapsed as sALCL. Herein, we present the first case of neutrophil-rich ALCL recurring as sALCL twice.
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By utilizing a multimodal nonlinear optical system that combines coherent anti-Stokes Raman scattering and second harmonic generation to investigate biological characteristics of dermal tissues ex vivo, we demonstrate the potential feasibility of using this optical approach as a powerful new investigative tool for future biomedical research. For this study, our optical system was utilized for the first time to analyze lipid and collagen profiles in cereblon knockout (KO) mouse skin, and we were able to discover significant alterations in the number of carbon-carbon double bonds (wild-type vs. cereblon KO; NCC : 0.75 vs. 0.85) of skin fatty acids in triacylglycerides as well as changes in dermal collagen fibers (25% reduction in cereblon KO). By adopting our optical system to biological studies, we provide researchers with another diagnostic approach to validate their experimental results, which will significantly advance the state of biomedical research.
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Colágeno , Dispositivos Ópticos , Camundongos , Animais , Pele , Ácidos Graxos , Análise Espectral RamanRESUMO
BACKGROUND: Alopecia areata (AA) is common non-scarring hair loss disease. Sleep distrubance has been regarded as a triggering or aggravating factor for AA. However, objective evaluation of sleep disturbance and its clinical effect on AA has not been clearly demonstrated. OBJECTIVE: This study investigated objective sleep evaluation tool for AA patients and their clinical correlation. METHODS: Patients presenting with new-onset AA or recurrences of pre-existing AA were included, and those who reported sleep disturbance in the preliminary survey were designated as the sleep disturbance group (SD group). Sleep quality was investigated for them using three self-administered questionnaires: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleep Scale (ESS). Demographic information and clinical features of AA were analyzed according to sleep quality. RESULTS: A total of 400 participants were enrolled, and 53 were categorized into the SD group. The incidence of stressful events was significantly higher in the SD group (54.7%) than in the non-SD group (25.1%) (p<0.001). Based on the PSQI, 77.3% of participants were objective poor sleepers (score of 5 or more), and they showed a significantly higher incidence of stressful events compared to good sleepers (p=0.019). The proportion of poor sleepers was significantly lower in patients with mild AA (S1) than in those with moderate to severe AA (S2~S5) (p=0.045). CONCLUSION: This study demonstrated a positive correlation among stress, SD, and AA. The degree of SD was objectively represented by the PSQI score, showing different scores according to AA severity.
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Palisading encapsulated neuroma is a rare, benign, cutaneous nerve sheath tumor. It usually occurs as an asymptomatic solitary skin-colored papule and commonly affects the nose and cheeks. Sometimes, it involves other sites, including the shoulder, upper arm, and trunk, but rarely involves the oral mucosa, including that of the lip. In our case, a 63-year-old female patient complained of a pinkish rubbery nodule on her lower lip. Histopathologic examination demonstrated a well-circumscribed nodule encapsulated by connective tissue stroma in the dermis. The nodule consisted of palisading spindle-shaped tumor cells with wavy and basophilic nuclei. The cells were arranged in streaming fascicles with multiple clefts and were strongly positive for S-100 proteins. To our knowledge, only three cases of palisading encapsulated neuroma on the lower lip have been reported in the Korean literature. Herein, we report a rare case of an oral palisaded encapsulated neuroma.
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Cereblon (CRBN) is a substrate receptor of the cullin-RING E3 ubiquitin ligase (CRL) complex that mediates the ubiquitination of several substrates. In this study, CRBN knockout (KO) mice exhibited decreased levels of stratum corneum hydration (SCH) and collagen I expression with an elevated protein level of matrix metalloprotease 1 (MMP1). The absence of cereblon in the skin of CRBN KO mice mimics the damage caused by narrowband ultraviolet B (NB-UVB). The primary CRBN deficient mouse embryonic fibroblasts (MEFs) undergo G2/M-arrested premature senescence via protein signaling of p38 MAPK and its dependent p53/p21pathway. The absence of CRBN induced the markers of cellular senescence, such as the senescence-associated heterochromatin foci (SAHF), SA-ß-Gal staining, and p21 upregulation while the ectopic expression of CRBN reversed the phenotypes of SA-ß-Gal staining and p21 upregulation. Reversion of the decreased protein level of collagen I was demonstrated after the reintroduction of the CRBN gene back into CRBN KO MEFs, validating the promising role of CRBN as a potential regulator for the function of the skin barrier and its cellular homeostasis.
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Proteínas Adaptadoras de Transdução de Sinal/fisiologia , Colágeno Tipo I/metabolismo , Sistema de Sinalização das MAP Quinases , Pele/metabolismo , Envelhecimento/metabolismo , Animais , Pontos de Checagem do Ciclo Celular , Feminino , Fibroblastos/metabolismo , Fibroblastos/patologia , Fibroblastos/fisiologia , Imunofluorescência , Hylobatidae , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Reação em Cadeia da Polimerase em Tempo Real , Pele/patologia , Fenômenos Fisiológicos da PeleRESUMO
BACKGROUND: Oral alitretinoin is effective in the treatment of chronic hand eczema (CHE), and ≥12 weeks of alitretinoin treatment has been shown to be effective in Korean patients. However, in the real world, a considerable number of patients discontinue alitretinoin, which leads to treatment failure. OBJECTIVE: To evaluate the compliance rate of alitretinoin treatment and explore common reasons for poor compliance in patients with CHE in the real world. METHODS: We retrospectively reviewed the electronic medical records of CHE patients treated with alitretinoin. We defined 'poor-compliance' as subjects who were treated with alitretinoin for <12 weeks and 'good-compliance' as subjects who were treated with alitretinoin for ≥12 weeks. We reviewed the demographics, dose, and duration of alitretinoin usage, efficacy, and reasons for poor compliance. RESULTS: A total of 137 subjects were enrolled, and 77 (56.2%) did not complete the 12-week treatment with alitretinoin. Among them, the non-improvement rate was significantly higher in the poor-compliance group than in the good-compliance group (p<0.01). The main reasons for the alitretinoin cessation in the poor-compliance group were insufficient response (40.8%), followed by high cost (34.7%), and adverse events (24.5%). CONCLUSION: Alitretinoin appears the preferred long-term treatment option for CHE. Although there are complaints about late efficacy, cost, and side effects, following proper explanation, these should not justify discontinuation. Physicians need to recognize the reasons for poor compliance with alitretinoin for each patient and suggest continuing alitretinoin for the successful treatment of CHE.
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A common cause of drug hypersensitivity reactions is iodinated contrast media (ICM). ICM-induced hypersensitivity had been considered to be a non-immunological reaction, but evidence for an immunological mechanism has increased recently. Thus, we evaluated whether HLA-A, -B, and -C alleles were associated with ICM-induced hypersensitivity. In total, 126 patients who underwent contrast-enhanced computed tomography studies through outpatient clinics at a tertiary referral hospital between 2008 and 2012 were assessed. Sixty-one patients experienced ICM-induced hypersensitivity and the remainder, 65, were ICM-tolerant patients (control). ICM-induced hypersensitivity patients showed 51 with immediate, 7 with non-immediate, 3 with both or mixed type. HLA-A, -B, and -C genotyping was performed using a PCR sequence-based typing method. Four kinds of ICM were used: iopromide, iohexol, iobitridol, and iodixanol. The most used ICM among the hypersensitivity patients was iopromide. Significant difference in the frequency of HLA-B*58:01 (odds ratios [OR], 3.90; p = 0.0200, 95% confidence interval [CI], 1.16-13.07) was observed between ICM-induced immediate hypersensitivity and control. There were statistically significant differences in the frequencies of the HLA-B*38:02 (OR, 10.24; p = 0.0145; 95% CI, 1.09-96.14) and HLA-B*58:01 (OR, 3.98; p = 0.0348; 95% CI, 1.03-15.39) between iopromide-induced immediate hypersensitivity and control. The mechanism of ICM-induced hypersensitivity remains unknown, but this study showed associations, although weak, with HLA-B*58:01 alleles for ICM-induced immediate hypersensitivity and HLA-B*38:02 and HLA-B*58:01 for iopromide-induced immediate hypersensitivity as risk predictors. Further studies are needed to validate the associations in larger samples and to identify the functional mechanism behind these results.
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Background: Telogen effluvium (TE) is characterized by massive hair shedding and results from an abrupt conversion of anagen to telogen. Differentiation of TE with other hair disorders showing massive hair shedding is difficult. Objective: To evaluate the morphologic characteristics of pulled out hair of TE. Methods: We analyzed microscopic examination of pulled out hairs by hair pull test in TE patients, and compared these hairs with pulled out hairs in diffuse alopecia areata (AA) patients and healthy volunteers. Results: Hair microscopic examination in 44 TE patients (370 hairs) and 30 healthy volunteers (295 hairs) were as follows: typical club hair, 32.7%, 62.7%; club hair with tail, 23.5%, 23.7%; club hair with remnant sheath, 23.0%, 6.8%; club hair with both tail and remnant sheath, 18.9%, 5.4%; and unclassified hair, 1.9%, 1.4%. The examination in 7 diffuse AA patients (63 hairs) was as follows: typical club hair, 23.9%; atypical club hair, 47.7%; and distinctive AA hair, 28.4%. There was statistical difference between TE patients and healthy volunteers group (p=0.000). Conclusion: Increased atypical club hair in microscopic hair examination might be characteristics of TE.