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Netherton syndrome associated with idiopathic congenital hemihypertrophy.

Netherton syndrome is a rare genodermatosis comprised of anichthyosiform dermatitis, hair shaft defects, and atopic features. Other problems associated with Netherton syndrome are delayed growth and development, immune abnormalities, recurrent infections, and intermittent aminoaciduria. We describe an 18-month-old girl with Netherton syndrome who had idiopathic congenital hemihypertrophy on her right side with contralateral benign nephromegaly in addition to the characteristic clinical signs of the syndrome. To our knowledge, this is the first case of Netherton syndrome associated with idiopathic congenital hemihypertrophy to be reported.

Abnormalities, Multiple↗

Phthirus pubis infestation of the eyelashes and scalp hairs in a girl.

A 4-year-old girl was seen because of foreign bodies on the eyelashes. Parasites and their nits were seen on the patient's eyelashes and scalp. Her parents denied having Phthirus pubis infection of the axillary, pubic, or body hair, despite confirmation of the infestation in their child. The parasites were removed and the lashes with nits were cut off at the base. The parasite was identified as P. pubis. The scalp was washed with phenothrin shampoo. One month later no P. pubis infestation was found. Removal of the parasites, cutting the lashes at the base, and using phenothrin shampoo on the scalp were effective in resolving phthiriasis.

Child, Preschool↗

[Dithranol in the treatment of scalp psoriasis].

Dithranol in its usual petrolatum base cannot be effectively applied to the scalp. The washable cream base is not often employed in Germany, both because this form of application is not well-known and because the positive effects are underestimated while the adverse effects are overestimated. Therefore we have searched the literature for appropriate studies, application recommendations and reports on side effects. We list scalp preparations containing dithranol available in neighbouring European countries together with recommendations and warning notes. Since the dithranol molecule contains hydrophilic and lipophilic parts, it can be easily incorporated into soaps. The stability of such preparations is limited; their effectiveness is supported by the usage of dithranol in an emulsifying oil base in the Charité Department of Dermatology for more than twenty years. The special vehicle used, bio-wash-oil, is an oily fluid soap which was designed for cleaning the heavily soiled hands of factory workers. It can be easily applied to the scalp and washed off with water. Here we re-examine the original study on dithranol in bio-wash-oil published by Meffert et al. in 1979, summarize our subsequent experience and present a recent comparative study paying special attention to side effects, practical notes, and patient comfort and satisfaction.

Anthralin↗

An unusual case.

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Adult↗

Clinical and mycological evaluation of therapeutic effectiveness of Solanum chrysotrichum standardized extract on patients with Pityriasis capitis (dandruff). A double blind and randomized clinical trial controlled with ketoconazole.

Dandruff (also called Pityriasis capitis) is a seborrhoeic dermatitis of the scalp. It has been correlated with the pathological colonization of the scalp with yeast from the genus Malassezia; this illness has a worldwide distribution and represents 25% of all scalp dermatosis cases. It has been demonstrated that the extract obtained from leaves of the plant Solanum chrysotrichum possesses biological activity against dermatophytes and yeast. Different steroidal saponins with antimycotic activity have been isolated from the active extract. Clinical trials with standardized extracts prepared with this vegetal species report high rates of clinical and mycological effectiveness in the treatment of Tinea pedis,without producing secondary effects. The aim of this randomized, double blind and controlled clinical study, was to compare the therapeutic effectiveness and tolerability of a shampoo containing a standardized extract of S. chrysotrichum (applied every third day, for 4 weeks), against 2% ketoconazole in the topical treatment of Pityriasis capitis. From a total of 120 patients with the clinical diagnosis of Pityriasis capitis, 14 subjects were eliminated because the presence of Malassezia was not proved, an-other two patients withdrew from the study due to non-medical causes and one more withdrew because Tinea capitis was diagnosed. Therefore, the final analysis included 51 subjects in the experimental group and 52 in the control; in 45.6% of the cases M. furfur was identified as the pathogenic agent, in 44.66% M. globosa was isolated, and 9.71 % of the patients had a mixed infestation. At the end of the treatment period, the prepared phytopharmaceutical with the standardized extract from S. chrysotrichum achieved a clinical effectiveness (total absence of signs and symptoms produced by Pityriasis capitis) of 92.16%;the mycological effectiveness (absence of Malassezia spp. in the direct examination and culture) was 68.63 %; whilst the tolerability (absence of side effects that prompt subjects to abandon the treatment) was 100%. The therapeutic success (clinical and mycological effectiveness plus tolerability) was 64.71%. The comparison of these results with that obtained from the group treated with 2% ketoconazole, showed no significant differences (Z2, p >0.23). These results show the therapeutic effectiveness and tolerability of the standardized extract from S. chrysotrichum on the local treatment of Pityriasis capitis associated with the yeast of the genus Malassezia.

Adolescent↗

The shoelace method in congenital aplasia of the scalp and skull.

Aplasia cutis congenita (ACC) is an uncommon skin disorder characterised by the absence of some or all layers of the skin. It may involve any part of the body, but is most common in the scalp. Some scalp lesions are associated with a defect of the underlying skull or even dura. Small superficial lesions heal spontaneously. Options available for larger defects and those involving the skull include conservative management, skin grafts, composite grafts, local scalp or pericranial flaps, and free microvascular transplants. This case report presents a delayed primary closure of a scalp and skull defect with the shoelace method and a temporary skin graft. The method is simple, gives an excellent cosmetic result, and can be used in moderately sized defects, where a direct suture is not possible.

Diseases in Twins↗

Necrotizing fasciitis of the scalp in neonates.

Two premature infants with acute necrotizing fasciitis of the scalp are reported. In both cases the infection most likely arose from infiltrations of intravenous fluids into the subcutaneous region of the scalp. Aggressive surgical debridement, as well as antibiotic therapy, resulted in healing in both infants. A review of neonatal fasciitis is included.

Anti-Bacterial Agents↗

[Recurrent staphylodermas in marked IgE elevation: the hyper-IgE syndrome].

This is a report of a 6-year-old boy with repeated staphylococcus infections especially in the hairy region of the head. Investigating the disease an extremely elevated IgE of 10,000 KU/l was found, specific IgE in RAST only at a low level. The immunologic investigations showed a reduction of the T-suppressor-cells and an increase of IgG levels. Defects of phagocytosis or chemotaxis could not be demonstrated.

Child↗

Cranial fasciitis of childhood: a case report.

We present a case with cranial fasciitis in childhood and review the literature. A 7-year-old boy presented with hard mass on the scalp. He had sustained a bruise on the right temporal region about 2 years previously. Ultrasonic examination and CT scanning revealed the ossifying soft tissue mass in the right temporal scalp causing erosion and scalloping of the outer table of the skull. At surgery the lesion was firmly attached to the periosteum and the skull. The lesion was completely excised and the lytic bone curettaged. The tumor was composed of immature fibroblasts and diagnosed as cranial fasciitis in childhood. A brief review of the literature is included emphasizing the need to investigate further this completely benign lesion that is frequently confused with a malignant neoplasm.

Calcinosis↗

Head lice.

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Animals↗

Keratosis pilaris and hereditary koilonychia without monilethrix.

Keratosis pilaris is found commonly in isolation as well as associated with other conditions. We describe a family with keratosis pilaris and hereditary koilonychia, with an autosomal dominant pattern of inheritance. These two findings have only been previously found in the context of monilethrix. The coexistence of the two disorders suggests a close association of their genetic pathogenesis.

Adult↗

Dandruff has an altered stratum corneum ultrastructure that is improved with zinc pyrithione shampoo.

Transmission electron microscopy of scalp tape strips indicates that dandruff scalp possesses abnormal stratum corneum (SC) ultrastructure that is normalized by treatment with small-particle zinc pyrithione (ZPT). Similar abnormalities occur throughout the scalp of those with dandruff, even where no flaking is present. SC abnormalities are consistent with hyperproliferation, including parakeratosis, lipid droplets within corneocytes, few desmosomes, corneocyte membrane interdigitation, and excessive disorganized intercellular lipid. Reversal of SC abnormalities would require treatment of the cause(s) of dandruff, not merely flake removal. A protocol was developed to quantify scalp structural abnormalities by scoring cells from scalp tape strips for yeast number, amount of intercellular lipid, normal intercellular lipid structures, prevalence of intracellular lipid droplets, parakeratotic corneocytes, and corneocyte interdigitation. This protocol was used to compare dandruff and normal SC to dandruff SC treated with either commercial ZPT-containing shampoo or a placebo. Treatment with commercial ZPT shampoo significantly returned SC ultrastructure to normal, suggesting control of the cause of dandruff.

Female↗

Treatment of dandruff with 5% tea tree oil shampoo.

BACKGROUND: Dandruff appears to be related to the yeast Pityrosporum ovale. Tea tree oil has antifungal properties with activity against P ovale and may be useful in the treatment of dandruff. OBJECTIVE: We conducted a randomized, single-blind, parallel-group study to investigate the efficacy and tolerability of 5% tea tree oil and placebo in patients with mild to moderate dandruff. METHODS: One hundred twenty-six male and female patients, aged 14 years and older, were randomly assigned to receive either 5% tea tree oil shampoo or placebo, which was used daily for 4 weeks. The dandruff was scored on a quadrant-area-severity scale and by patient self-assessment scores of scaliness, itchiness, and greasiness. RESULTS: The 5% tea tree oil shampoo group showed a 41% improvement in the quadrant-area-severity score compared with 11% in the placebo group (P <.001). Statistically significant improvements were also observed in the total area of involvement score, the total severity score, and the itchiness and greasiness components of the patients' self-assessments. The scaliness component of patient self-assessment improved but was not statistically significant. There were no adverse effects. CONCLUSION: Five percent tea tree oil appears to effective and well tolerated in the treatment of dandruff.

Administration, Topical↗