Clinical and Experimental Dermatology 1992; 17: 382-383.
Correspondence Semicircular lipoatrophy SIR, A 56-year-old woman was referred to us with an 8-month history of asymptomatic symmetric depressions ofthe antero-lateral aspects of the right thigh (Fig. 1). The lesion was 2 cm wide and 0-5-1 cm deep. The overlying skin was normal. The lesion had not been preceded by tenderne,ss, swelling or other inflammatory signs. Moreover, there was no history of trauma, the family history was negative and the patient was in good health. Laboratory studies showed no particular abnormalities. Histopathology revealed only a partial loss of suhcutaneous fat, partially replaced by collagen fibres. The epidermis was normal. There was a mild dermal perivascular lymphocyte infiltration. The lesion spontaneously resolved 4 months after presentation. Cutaneous echoscans showed a reduction in depth ofthe subcutaneous tissue. Semicircular lipoatrophy is a clinical form rarely described and recognized. To our knowledge only 44 cases have been reported. There is some confusion in clinical findings compared to those of other forms of localized lipoatrophy or lipodystrophy. The literature differentiates semicircular lipoatrophy from annular lipoatrophy and annular atrophy of the ankles.' In semicircular lipoatrophy, most ofthe cases reported are young women; the lesions are symmetrically distributed over both thighs, but one case with a
unilateral location, like ours, has been rported.^ The lesions are asymptomatic, with clinically normal overlying skin and no associated features, such as rheumatic pain or myopathy and resolution is spontaneous. Repeated local mechanical trauma' or impaired circulation in the afffected region have both been suggested in explanation of the constant and specific localization of the lesions. Many reports support the mechanical explanation, for example, the patient reported by Hodak et at..,^'* but in too many cases there is no overt trauma. Moreover, spontaneous resolution has been recorded after total or partial suppression of trauma, or without any particular intervention, Clinica Dermatologiea Ospedale San Paolo
R.BETTI CE.URBANI
Via A. di Rudini, 8
E.INSELVINI
20142 Milano Italy
C.CROSTI
References
1. Rongioletti F, Rebora A. Annular and semicircular lipoatrophies, Journa/o/' American Academy of Dermatotogy 1989; 20: 433-436. 2. Mallett RB, Champion RI I, Lipoatrophia semicircularis, British Journal of Dermalotogy 1989; 121 (Suppl 34): 94-94, 3. Mascaro JM, Ferrando J. I.ipoatrophia semicircularis: the perils of wearing feansr Intemationat Journat of Oermatotogy 1983; 21: 138-139. 4. Hodak E, David M, Sandbank M. Semicircular lipoatrophy—a pressureinduced lipoatrophy? Clinical and Experimental Dermatology 1990; IS: 464465,
Induction of dysplastic-dystrophic anagen-hair-root condition SIR, Although the nosological interpretation ofthe so-called dysplastic hairs in trichograms is no more controversial—they are ranged among normal anagen roots—the mechanism of their origin is obviously still disputed. Dr Chapman concludes in his recent study ofthe experimental induction ofthe dysplastic-dystrophic anagen-hair-root condition through micromanipulations of epilated 'typical' ensheathed anagen hair' that this condition may also result in a trichogram shown similar alterations to extracted 'typical' hairs during their subsequent passage through the hair canal. However, we have previously described, in a srudy of histoiogical alterations of anagen hair bulbs in specimens biopsed immediately after epilation,^ that in addition to bulb remnants of epilated ensbeathed anagen hairs there are also some bulb remnants which correspond to epilated unsheathed, 'dysplastic' anagen hairs. This finding indicates that at least some ofthe observed 'dysplastic' anagen hairs result from an alternative break pattern at the level ofthe hair bulb. As the exact position ofthe anagen bulb break during epilation seems to correspond fairly well to the site of the highest mitotic rate within the bulb, it seems reasonable to speculate that in addition to the velocity ofthe epilation, some variation in the proliferative activity ofthe anagen hair during distinct subpha.ses of the anagen hair stage^ may partly account for differences in the hair break pattern during epilation.
Figure 1. Atrophic area on right thigh.
382
Department of Dermatology University Erlangen-NUmberg Hartmannstr. 14 D-W-8520 Erkngen Germany
I.D.BASSUKAS O.P.HORNSTEIN
CORRESPONDENCE
383
References
2. Bassukas ID, Hornstein OP. Effects of plucking on the anatomy of the anagen hair bulb. A light microscopic study. Archives of Dermatologicat 1, Chapman DM. An experimental induction of the dysplastic-dystrophic Research 1989; 281: 188-192. anagen-hair-root condition Ctinuat and Experimentat Dermatotogy 1991; 16: ?•. Moretti G. Das Haar. In: Stuttgen G, ed. Die normate und pathiitogi.uhe 273-276. Physiotogie der Haul. Stuttgart; Fischer, 1965: 506-55.1.
News and Notices 17th Annual Plawaii Dermatology Seminars Pre-Seminar (financial and business matters) 16-19 February 1993, Mancle Bay Hotel/The Lodge at Koele, Lanai, Hawaii. Hawaii Dermatology Seminar 19-24 February 1993, Hyatt Regency Waikoloa, Big Island, Hawaii. Post-Seminar Meeting 19-24 February 1993, Westin Surf Resort, Kauai, Hawaii. For information and registration contact: Dr Henry Roenigk Jr, Department of Dermatology, Northwestern University, 303 E. Chicago Avenue, Chicago, II 60611, USA. Tel: 312-908-8173 (Judy), Fax: 312-908-0664.
3rd Self Assessment Workshop in Dermatopathology, 17-19 September 1992, Catholic University, Rome Guest speakers A.B.Ackerman, New York University, USA; E.Wilson-Jones, London University and R.Cerio, Royal Eondon Hospital. Tel: (06) 33051; Fax: 3051343.
Correspondence Semicircular lipoatrophy SIR, A 56-year-old woman was referred to us with an 8-month history of asymptomatic symmetric depressions ofthe antero-lateral aspects of the right thigh (Fig. 1). The lesion was 2 cm wide and 0-5-1 cm deep. The overlying skin was normal. The lesion had not been preceded by tenderne,ss, swelling or other inflammatory signs. Moreover, there was no history of trauma, the family history was negative and the patient was in good health. Laboratory studies showed no particular abnormalities. Histopathology revealed only a partial loss of suhcutaneous fat, partially replaced by collagen fibres. The epidermis was normal. There was a mild dermal perivascular lymphocyte infiltration. The lesion spontaneously resolved 4 months after presentation. Cutaneous echoscans showed a reduction in depth ofthe subcutaneous tissue. Semicircular lipoatrophy is a clinical form rarely described and recognized. To our knowledge only 44 cases have been reported. There is some confusion in clinical findings compared to those of other forms of localized lipoatrophy or lipodystrophy. The literature differentiates semicircular lipoatrophy from annular lipoatrophy and annular atrophy of the ankles.' In semicircular lipoatrophy, most ofthe cases reported are young women; the lesions are symmetrically distributed over both thighs, but one case with a
unilateral location, like ours, has been rported.^ The lesions are asymptomatic, with clinically normal overlying skin and no associated features, such as rheumatic pain or myopathy and resolution is spontaneous. Repeated local mechanical trauma' or impaired circulation in the afffected region have both been suggested in explanation of the constant and specific localization of the lesions. Many reports support the mechanical explanation, for example, the patient reported by Hodak et at..,^'* but in too many cases there is no overt trauma. Moreover, spontaneous resolution has been recorded after total or partial suppression of trauma, or without any particular intervention, Clinica Dermatologiea Ospedale San Paolo
R.BETTI CE.URBANI
Via A. di Rudini, 8
E.INSELVINI
20142 Milano Italy
C.CROSTI
References
1. Rongioletti F, Rebora A. Annular and semicircular lipoatrophies, Journa/o/' American Academy of Dermatotogy 1989; 20: 433-436. 2. Mallett RB, Champion RI I, Lipoatrophia semicircularis, British Journal of Dermalotogy 1989; 121 (Suppl 34): 94-94, 3. Mascaro JM, Ferrando J. I.ipoatrophia semicircularis: the perils of wearing feansr Intemationat Journat of Oermatotogy 1983; 21: 138-139. 4. Hodak E, David M, Sandbank M. Semicircular lipoatrophy—a pressureinduced lipoatrophy? Clinical and Experimental Dermatology 1990; IS: 464465,
Induction of dysplastic-dystrophic anagen-hair-root condition SIR, Although the nosological interpretation ofthe so-called dysplastic hairs in trichograms is no more controversial—they are ranged among normal anagen roots—the mechanism of their origin is obviously still disputed. Dr Chapman concludes in his recent study ofthe experimental induction ofthe dysplastic-dystrophic anagen-hair-root condition through micromanipulations of epilated 'typical' ensheathed anagen hair' that this condition may also result in a trichogram shown similar alterations to extracted 'typical' hairs during their subsequent passage through the hair canal. However, we have previously described, in a srudy of histoiogical alterations of anagen hair bulbs in specimens biopsed immediately after epilation,^ that in addition to bulb remnants of epilated ensbeathed anagen hairs there are also some bulb remnants which correspond to epilated unsheathed, 'dysplastic' anagen hairs. This finding indicates that at least some ofthe observed 'dysplastic' anagen hairs result from an alternative break pattern at the level ofthe hair bulb. As the exact position ofthe anagen bulb break during epilation seems to correspond fairly well to the site of the highest mitotic rate within the bulb, it seems reasonable to speculate that in addition to the velocity ofthe epilation, some variation in the proliferative activity ofthe anagen hair during distinct subpha.ses of the anagen hair stage^ may partly account for differences in the hair break pattern during epilation.
Figure 1. Atrophic area on right thigh.
382
Department of Dermatology University Erlangen-NUmberg Hartmannstr. 14 D-W-8520 Erkngen Germany
I.D.BASSUKAS O.P.HORNSTEIN
CORRESPONDENCE
383
References
2. Bassukas ID, Hornstein OP. Effects of plucking on the anatomy of the anagen hair bulb. A light microscopic study. Archives of Dermatologicat 1, Chapman DM. An experimental induction of the dysplastic-dystrophic Research 1989; 281: 188-192. anagen-hair-root condition Ctinuat and Experimentat Dermatotogy 1991; 16: ?•. Moretti G. Das Haar. In: Stuttgen G, ed. Die normate und pathiitogi.uhe 273-276. Physiotogie der Haul. Stuttgart; Fischer, 1965: 506-55.1.
News and Notices 17th Annual Plawaii Dermatology Seminars Pre-Seminar (financial and business matters) 16-19 February 1993, Mancle Bay Hotel/The Lodge at Koele, Lanai, Hawaii. Hawaii Dermatology Seminar 19-24 February 1993, Hyatt Regency Waikoloa, Big Island, Hawaii. Post-Seminar Meeting 19-24 February 1993, Westin Surf Resort, Kauai, Hawaii. For information and registration contact: Dr Henry Roenigk Jr, Department of Dermatology, Northwestern University, 303 E. Chicago Avenue, Chicago, II 60611, USA. Tel: 312-908-8173 (Judy), Fax: 312-908-0664.
3rd Self Assessment Workshop in Dermatopathology, 17-19 September 1992, Catholic University, Rome Guest speakers A.B.Ackerman, New York University, USA; E.Wilson-Jones, London University and R.Cerio, Royal Eondon Hospital. Tel: (06) 33051; Fax: 3051343.
