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Several thousand persons had artificial hairs of fiber implanted in their scalps 5 years ago with disastrous results. These persons may still require late repair to remove retained fiber fragments from the skin. The hair-bearing punch graft is a useful method of repair in some patients.
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BACKGROUND AND OBJECTIVES: Scalp psoriasis is a frustrating disorder whose treatments can all too often be cumbersome and ineffective. Our objective was to test a combination device involving the 308-nm excimer laser in tandem with a hair blower for treating scalp psoriasis. STUDY DESIGN/MATERIALS AND METHODS: Adult subjects with scalp psoriasis unresponsive to class I topical steroids used in conjunction with medicated shampoos were treated with 308-nm excimer laser pulses in conjunction with a hair blower that parted the obstructing hair twice a week for up to 15 weeks. Half of the scalp served as a control. Starting doses were based on standard minimal erythema dose (MED)'s with subsequent increments of up to 20%. RESULTS: Thirteen subjects completed the study without adverse events. Two were dropped due to lack of compliance. At the end of the investigation, the difference in the mean modified PASI scores between the control and treated sites was 4.0 (<0.0001). CONCLUSIONS: The air blower device in conjunction with the 308-nm excimer laser can safely and effectively treat otherwise refractory scalp psoriasis.
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During a period of 8 years 300 cases of dermatophytoses involving both hairy areas and the glabrous skin were found to be caused by M. canis. There was scalp involvement in 60%, including 8 infants and 27 adults; most of the adults presented Kerion-like lesions and presented various clinical aspects such as seborrhea capitis, folliculitis and discoid lupus erythematosus. In the 21 patients showing invasion of the beard the clinical manifestations included superficial erythemato-squamous patches with hyperemic slightly elevated margins, folliculitis or abscess-like lesions and Kerion-like lesions. Among the lesions found on the glabrous skin there were unusual aspects of tinea faciei in 19 adults, mimicking lymphocytic infiltration, granuloma faciale or discoid lupus erythematosus. Some of the cases of tinea corporis found in 70 patients also had lesions simulating various other dermatological entities, including erythema multiforme, psoriasiform eruption, pityriasis rosea and seborrheic dermatitis. The hands were invaded in 5 adults patients, with involvement of the finger nails in one. Repeated mycologic examinations were necessary to establish the true etiology in many of these cases.
A case of red grain mycetoma on the scalp is described. The disease, caused by Actinomadura pelletieri, is extremely rare in this part of the world, and from India this is perhaps the first case with scalp involvement. The lesion showed satisfactory response to partial excision followed by chemotherapy with streptomycin.
Clinical data on 1068 cases of dermatophytosis as well as mycological data on 382 of these cases seen from March 1983 to September 1984 are reported. Tinea cruris was present in 34.1%, with Trichophyton rubrum and Epidermophyton floccosum isolated from 31% and 25% respectively. Tinea corporis was found in 17.9% of all patients of dermatophytosis with T. tonsurans responsible in 30.8%. Tinea pedis and Tinea unguium were present in 7.2% and 2% respectively, T. rubrum being the main causative agent; nail involvement was present in 27.3% of these cases. Tinea capitis was observed in 38.7% of 1068 dermatophytosis cases with T. violaceum and M. canis causing 48% and 32% of all T.C. cases respectively. The dermatophytic flora of the West Bank of Jordan apparently comprises about 14 dermatophytes, T. violaceum being the predominant agent of infection (in more than 34%). Other most common agents found in this survey were M. canis, T. rubrum, E. floccosum, T. schoenleini, T. tonsurans, and T. mentagrophytes.
A 13-year old black girl presented with an unusual scalp lesion felt to be compatible with mycotic granuloma. She had undergone surgery two years earlier for removal of three similar scalp lesions. Material excised during surgical removal of the cyst-like lesion again revealed histopathology compatible with mycotic granuloma. Surgical material cultured out pure growth of a fungus identified as Microsporum canis Bodin. Subsequent histopathological study of the infected tissue resulted in a diagnosis of dermatophytic 'mycetoma'. The disease will be reviewed and discussed as regards its nomenclature, histopathology and salient clinical features.
The pathomorphological and pathophysiological reactions of the spontaneous and artificially induced skincycle in psoriasis capitis-lesions were clinically and histologically investigated. 1. After the epilation in the psoriasis capitis-lesion a healing of the psoriatic efflorescence was observed. 2. Histologically a close correlation between the induced anagen and the regression of the psoriasis existed: As a cause of this phenomenon an interaction between the dermis, the follicular proliferation and the epidermal proliferation of psoriasis is assumed.
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In contrast to scales collected from the scalps of nine healthy individuals where a few parakeratotic cells are observable, a large number of parakeratotic cells associated with some infiltrated polymorphonuclear leukocytes (PMNLs) were found in the scales obtained from 11 individuals complaining of dandruff. Therefore, we determined the neutrophil chemotactic properties of the water-soluble extracts of dandruff scales and normal control scalp scales. Aqeous extracts fractionated by Sephadex G-75 showed a potent chemotactic activity only in the fractions of the dandruff patients that eluted with cytochrome C marker (cyt C; molecular weight, 12 kDa). It was comparatively stable to heat but was greatly inhibited by the addition of anti-C5 antiserum. Radioimmunoassay demonstrated that, although small amounts of C5a and C4a anaphylatoxins were demonstratable even in the extracts of normal scalp, they were found in significantly increased amounts in the extracts of dandruff. Moreover, there was a significantly positive correlation between C5a and C4a concentrations in these extracts. These results suggest that classical complement pathway activation with resultant production of C5a anaphylatoxin is involved in the migration of PMNLs into the lesional skin of dandruff.
Free cholesterol in lipids from the scalp and hair is predominantly a constituent of epidermal lipids. Therefore, a reduction in cholesterol content induced by a drug indicates a reduction in cell turnover in the epidermis. As, according to the literature, increased cell turnover in the epidermis results in formation of dandruff, a reduction in the proportion of cholesterol should indicate inhibition of the formation of dandruff. Conversely, an increase in free cholesterol should generally indicate a "keratolytic" effect. So unequivocal an interpretation has not so far been possible in persons with dandruff, as it was not known whether free cholesterol was increased or decreased. In addition, this interpretation was not possible after use of antimicrobial substances, as in vitro investigations had failed to exclude microbial esterification of cholesterol on the scalp. The present investigation has shown that correlation of free cholesterol level with cell turnover is permissible in patients with dandruff, even if antimicrobial drugs are being tested.
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Radiation-induced meningiomas have a characteristic biological behaviour, so that their recognition is important as regards follow-up. We stress the importance of a scalp lesion over the meningioma on magnetic resonance imaging as a sign of previous radiotherapy.
A study of Tinea capitis in Outpatient Clinic, Skin Department, Government General Hospital, Madras during a three year period from November, 1973 to October, 1976, has shown a gradual increase in incidence of 3.56%, 5.09% and 6.25% respectively. Findings suggest that Tinea capitis is endemic in South India. Male children were more commonly affected than female children and the age groups chiefly affected were between 5 and 10 years. A considerably number of adults were also affected. The disease showed no correlation to environmental temperature, humidity and rainfall but was correlated to all types of mycoses and total incidence of mycoses. Among 357 isolates, Trichophyton violaceum was the commonest in 264 (73.94%) and T. tonsurans was the next common in 47 (13.16%). The other agents were T. rubrum in 30 (8.4%), T. mentagrophytes in 11 (3.08%) and T. simii in 5 (1.4%). Noninflammatory lesions were more common than inflammatory lesions and both were produced by T. violaceum and T. tonsurans, suggesting strain differences in pathogenesis. Treatment with oral griseofulvin was satisfactory in all but had to be discontinued in 4 patients due to side effects.
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