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PubMed1998

Tufted folliculitis of the scalp: a distinctive clinicohistological variant of folliculitis decalvans.

Tufted folliculitis is an uncommon folliculitis of the scalp that resolves with patches of scarring alopecia within which multiple hair tufts emerge from dilated follicular orifices. The clinicohistological data from a group of 15 patients with tufted folliculitis were reviewed and compared with those of seven patients with folliculitis decalvans, five with acne keloidalis nuchae, four with dissecting cellulitis of the scalp, three with kerion celsi and 20 with follicular lichen planus. It was found that tufted folliculitis could be differentiated from folliculitis decalvans only by finding several hair tufts scattered within patches of scarring alopecia. Histologically, a single tuft consisted of peculiar clustering of adjacent follicular units opening at the bottom of an epidermal depression. Conversely, the presence of keloidal plaques in acne keloidalis nuchae, coalescing nodules discharging purulent material in dissecting cellulitis of the scalp, erythematous plaques covered by pustules replete with fungal elements in kerion celsi, and the absence of follicular pustules in follicular lichen planus distinguished these diseases from tufted folliculitis. On the basis of these findings, it is suggested that tufted folliculitis should be considered as a distinctive clinicohistological variant of folliculitis decalvans. Tufting of hair is caused by clustering of adjacent follicular units due to a fibrosing process and to retention of telogen hairs within the involved follicular units.

Acne Keloid↗

PubMed1998

Malignant blue nevus of the scalp.

A 70-year-old woman had noticed, at the age of 30, a single blue nodule of about 1 cm in size on her scalp. The lesion remained stable until 1991, when it became larger and ulcerated and, because of the sudden onset of additional macules and nodules around it, the patient presented at our Dermatological Division in August 1992. Physical examination showed a blue-black plaque, 2 x 2 cm in size, on the left parietal area of the scalp, surrounded by several blue-grey pigmented nodules and macules (Fig. 1). Chest X-ray, abdomen scan, and a total body computed tomography (CT) scan were negative for metastatic disease. A wide resection of the scalp lesion was performed. The histologic evaluation revealed a dense collection of spindled melanocytes in the dermis and in the subcutaneous fat. Nuclear and cytoplasmic pleomorphism, some mitotic figures, and necrosis foci were present (Figs 2 and 3). Pictures of cellular blue nevus were found in the surrounding lesions. Ten months later, new blue macular and papular lesions appeared in proximity to the surgical scar. The patient refused any additional surgery, and so was treated with dacarbazine (DTIC) 800 mg intravenously (every 20 days) and 2 alpha interferon (3 million units subcutaneously, three times weekly). The growth of the lesions slowed down for a few weeks, and then increased again to become a wide, blue-black vegetating mass (Fig. 4). In June 1995, a total body CT scan revealed multiple focal nodules on the lungs and two metastatic masses on the eighth segment of the liver. A palliative polychemotherapy, with vindesin 3 mg/m2 and DTIC 400 mg/m2, was started, but did not stop the progression of the disease, and the patient died in December 1996.

Aged↗

PubMed2002

Temporal arteritis presenting with scalp ulceration.

We report the case of a 75-year-old-woman who presented with bilateral scalp ulcerations and blindness, accompanied by severe headache and scalp tenderness, due to bilateral temporal arteritis without systemic involvement. A biopsy taken from the border of an ulceration showed evidence of giant cell arteritis. She was treated with oral prednisone, 60 mg per day. The ulcerations healed in a few weeks but the vision loss was irreversible. This case highlights for temporal arteritis the importance of accurate and timely diagnosis as well as the need for prompt therapy with systemic steroids in order to avoid major complications, namely loss of vision. It also demonstrates that scalp necrosis and ulcerations are skin signs associated with a poor prognosis.

Aged↗

PubMed2002

Meshed reversed dermal graft in patients with surgical defects of sole and scalp: technique and long-term results.

BACKGROUND: Defects of the sole and the scalp require a reconstruction technique that combines a high survival rate in poorly vascularized areas with maximal mechanical strain. OBJECTIVE: To describe the technique of the meshed reversed dermal graft for reconstruction and to summarize the postoperative and long-term results. METHODS: Twenty-one patients have undergone reconstruction of defects following excision of acral lentiginous melanoma of the sole or squamous cell carcinoma of the sole or scalp. One patient had undergone covering of a perforating ulcer of the foot. RESULTS: In 19 of the 21 patients the meshed reversed dermal graft survived without complications. Of the patients who had undergone successful reconstruction, 14 patients were reinterviewed: 13 reported on excellent functional and satisfying cosmetic results. CONCLUSION: The meshed reversed dermal graft is an appropriate technique for reconstruction of large defects of the sole or scalp because of its high survival rate and excellent long-term functional results.

Adult↗

PubMed2002

Cerebriform giant melanocytic nevus of the scalp: report of two cases with different surgical approaches.

Cerebriform giant melanocytic nevus of the scalp is an extremely rare malformation. Clinical appearance with maceration and fetor within the crypts and the risk of malignant transformation may require surgical therapy. We report two cases with different methods of surgical management. A 27-year-old woman noticed a swelling of the parietal scalp that developed over a period of 4 years into a gyrus-like tumor measuring 12 cm x 18 cm. The crypts between the gyri could not be inspected. Serial excisions under subcutaneous infusion anesthesia were performed to reduce the size of the nevus and to flatten the surface of the scalp. The second patient, a 26-year-old man, demonstrated a giant 10 cm x 10 cm cerebriform nevus on the occiput. The nevus also contained areas of fetid maceration. After implanting a tissue expander under general anesthesia the nevus was excised. The defect was closed using a rotation flap.

Adult↗

PubMed2002

Microcystic adnexal carcinoma (MAC) of the scalp with extensive pilar differentiation.

BACKGROUND: Microcystic adnexal carcinoma (MAC), or sclerosing sweat duct tumor, is an uncommon, locally aggressive tumor. It typically involves the upper lip or face of middle-aged adults and rarely involves the scalp. It is characterized histologically by both pilar and eccrine differentiation and is associated with frequent perineural invasion. MAC is frequently misdiagnosed because of its bland and asymptomatic clinical presentation. In addition, its defining histologic features may be missed with a superficial biopsy. OBJECTIVE: To describe a case of MAC in the scalp treated with Mohs surgery. We describe a case with extensive pilar differentiation and clear cell changes. In addition, the clinical and histologic characteristics of this rare neoplasm are reviewed. METHODS: Mohs micrographic surgery (MMS) was performed on this neoplasm. RESULTS: The tumor was successfully excised in one surgery (five stages) and is without evidence of recurrence at 18 months. CONCLUSION: We present a case of MAC of the scalp in a 64-year-old white man treated successfully with MMS.

Carcinoma, Skin Appendage↗

PubMed2002

The arrector pili muscle and the follicular unit of the scalp: a microscopic anatomy study.

BACKGROUND: The arrector pili muscle is a smooth muscle bundle that attaches to the bulge region of the follicle and extends to its superior attachment in the upper dermis. Hair follicles in the scalp are grouped, forming well-defined anatomic structures known as follicular units, which are composed of terminal and vellus hairs, the associated sebaceous glands, and the arrector pili muscles. OBJECTIVE: To describe the microscopic anatomy of the arrector pili muscles in relation to the follicular units, using horizontal sections of scalp skin. METHODS: Normal scalp skin was obtained from 20 adult cadavers. Tissue specimens were horizontally sectioned at all levels of depth, including the infundibulum, isthmus, and inferior segment. Sections were stained with hematoxylin and eosin, and Masson's trichrome. RESULTS: The distribution of hair follicles in follicular units was only present above the insertions of the arrector pili muscles, at the infundibulum and isthmus. Masson's trichrome proved to be a very useful stain to delineate the follicular units. At the isthmus level, bulky cords of arrector pili muscle were located specifically at one pole of the follicular unit. These bulky cords appeared to be located at the same pole in different follicular units. CONCLUSION: At the isthmus level, above their follicular attachments, the arrector pili muscles that originate from their respective follicles join together, forming a single muscular structure that extends upward to its superior attachment zone. An anatomic model is proposed in which a single arrector pili muscular structure is shared by all the follicles contained within the follicular unit.

Hair Follicle↗

PubMed2003

Superficial malignant schwannoma of the scalp.

BACKGROUND: Malignant schwannoma is a rare sarcoma that is located mostly on trunk and extremities; the head and neck are unusual sites for its development. Almost half of these tumors arise from neurofibromas with or without von Recklinghousen's disease, and most of the remainder develop de novo from peripheral nerve trunks. Development in the superficial soft tissues is extremely rare. OBJECTIVE: To present a case of superficial malignant schwannoma of the scalp, which is an uncommon presentation. METHODS: An 80-year-old male patient presented with a painless ulceration on his scalp. The clinical and radiologic properties of the tumor were consistent with a skin tumor. RESULTS: The lesion was excised, and reconstruction was achieved by transposition scalp flap. Malignant schwannoma was given as diagnosis by histopathologic examination with immunohistochemistry. CONCLUSION: Malignant schwannomas may also occur in the skin. Clinically, these superficial forms closely resemble skin tumors, especially malignant melanoma. The treatment of choice in these tumors is wide resection combined with radiotherapy.

Aged↗

PubMedDate not supplied

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↗

PubMed2003

[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↗

PubMed2000

Large scalp and skull defect in aplasia cutis congenita.

Aplasia cutis congenita (ACC) is a rare disease, which may involve any site on the body but usually the vertex with scalp and even skull involvement. Superficial lesions may heal spontaneously and seldom result in morbidity or mortality. However, in patients with large scalp and skull defects, there are risks of infection and bleeding. Both surgical and conservative treatment have been proposed. We report a case of successful treatment of ACC by early debridement and wound closure with split-thickness skin graft (STSG) in the neonatal stage followed by replacement of the STSG with a hairy scalp flap by means of tissue expansion at the age of 3 years. The original skull defect, 7 x 10 cm in size, decreased to 1.2 x 1.2 cm after a 4.5-year follow-up. No complications, such as haemorrhage or meningitis, were encountered. The final result was satisfactory.

Ectodermal Dysplasia↗

PubMed2004

Congenital lipoblastoma of the scalp.

Lipoblastoma is a unique tumor of infancy and early childhood that can occur congenitally. It commonly occurs in trunk and extremities, but also rarely in head and neck. We have not encountered any report of congenital lipoblastoma of scalp in published literature. Here we describe the case of an infant who presented with a rapidly growing large scalp mass that measured 15 x 15 x 10 cm. At birth, the mass was located on the bregma but progressed to extend into the left upper eyelid and eyebrow. The mass was resected in two stages: the first stage consisted of resecting the scalp mass and the second stage consisted of excising the eyelid extension of the lesion. The histology of both resection specimens was similar and showed lobular adipose tissue separated by fibrous septae, which was consistent with a lipoblastoma. The child is free of recurrence at follow-up 3 years after the resection.

Biopsy, Fine-Needle↗

PubMed2005

Rationale for reconstruction of large scalp defects using the anterolateral thigh flap: structural and aesthetic outcomes.

The advent of free tissue transfer has provided multiple options that allow preservation and maintain both the structural and aesthetic status of the scalp. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. Eleven free anterolateral thigh flaps were used to reconstruct soft-tissue defects of different regions of the scalp. Two of these flaps were used for the occipital region, six for temporal regions, two for the frontoparietal midline region, and the remaining flap for a defect of the forehead. The study consisted of 10 males and one female whose ages ranged from 18 to 82 years (mean age: 52.5 years). Six patients had primary or recurrent cancer, four had acute or subacute wounds resulting from trauma or craniotomy, and one had high-tension electrical burn injury. The size of the flaps ranged from 14 to 27 cm in length and from 6 to 18 cm in width. The overall flap success rate was 100%. In two cases, primary thinning of the flap was performed to reconstruct a tissue defect of the temporal region in one patient and a forehead defect in the other. In two patients, the fascial layer of the flap was used as a source for a vascularized fascial flap to cover defects of the dura mater. No secondary corrections, including debulking procedures or scar revision, were necessary. No infections or hematomas were observed. Six cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed directly. No donor-site morbidity was observed. The authors conclude that with its evident structural and cosmetic advantages, the anterolateral thigh flap can be considered an excellent flap option for most scalp defects.

Adolescent↗

PubMed2006

Using the magnetic resonance three-dimensional volume rendering for tissues technique in the planning of craniotomy flaps with linear scalp incision.

Preoperative three-dimensional images with surface venous anatomy may be used in the planning of a linear scalp incision and the opening site of the dura mater for protection of surface veins during surgical dissection, and to find the splitting site of the brain according to the lesion. In 45 patients who had a brain tumor, linear scalp incision planning was done by regarding the three-dimensional images derived from post-contrast time-of-flight (TOF) sequence raw data. The findings of correspondence and the quality of routine contrast-enhanced magnetic resonance imaging (MRI) and three-dimensional volume rendering for tissues (VRT) images were analyzed separately with the surgical findings according to a visual grading system. Our experience revealed that the surgical findings correlated well with the three-dimensional VRT images. According to a visual surgical grading system, a grade III correlation was found in 20 (45%), grade II in 15 (33%), grade I in 7 (15%), and grade 0 in 3 (7%) patients in our study population. At the end of our research we conclude that this method is useful in terms of the preoperative determination of brain surface anatomy and may be used in the determination of the site of a linear scalp incision according to the localization of an intracranial lesion.

Adult↗

PubMed1999

Free adipofascial flap for scalp reconstruction: case report.

The authors describe a case in which a large defect of the scalp was present after tumor excision. It was covered with a free adipofascial flap and a split-thickness skin graft, with satisfactory results. Numerous similar cases of scalp defects reconstructed with other free flaps have been described. But since donor-site morbidity is minimized with free adipofascial flaps, they should be used more often for reconstruction of scalp defects.

Adipose Tissue↗

PubMed1993

Microsurgical replantation of the avulsed scalp: report of six cases.

This article reports the successful microsurgical replantation of six scalps avulsed for over 3 to 11 hr, after trauma and before repair, including five total and one partial avulsion. The authors believe that one key to successful replantation is effective vessel anastomoses. In the reported series, three scalps were reconstructed with two superficial temporal vessels and in five cases, with a 1:1 ratio between arteries and veins. The partially avulsed scalp was replanted successfully with only one artery and one vein. The management of postoperative complications is discussed.

Accidents, Occupational↗

PubMed1986

Successful replantation of a totally avulsed scalp.

A case of successful replantation of a totally avulsed scalp in a 19-year-old woman is presented. Although severely traumatized, about 90 percent of the surface of the replanted scalp survived. Only one artery (left superficial temporal) and four veins were anastomosed, sufficient enough to revascularize the entire scalp.

Adult↗

PubMed1987

[Temporal arteritis with hypotension syndrome and necrosis of the scalp].

An 80-year-old male patient with histologically confirmed temporal arteritis presented with two very rare complications: ocular hypotony and bilateral scalp necrosis. The intraocular pressure gradually normalized on high-dose cortisone therapy. Scalp necrosis was surgically removed and covered with a split-skin graft with good incorporation of the transplant. Scalp necrosis as well as ocular hypotony are serious complications of temporal arteritis, indicating a poor prognosis. To date three similar cases have been reported in the literature.

Aged↗