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Aplasia cutis congenita of the scalp in an infant exposed to valproic acid in utero.

We report a newborn with isolated aplasia cutis congenita of the scalp whose mother was treated with valproic acid during pregnancy. Aplasia cutis congenita has been described in infants exposed in utero to antithyroid drugs, but has not been related to other tetratogenic agents. Fetal exposure to valproic acid is known to increase the risks of spina bifida and other midline defects. Interestingly, aplasia cutis congenita of the scalp is regarded as a cutaneous marker for neural dysraphism. However, this defect of the scalp and valproic acid intake during pregnancy may be a random association and similar observations are needed to suggest causality.

Abnormalities, Drug-Induced↗

Familial cirsoid aneurysm of the scalp.

One brother and one sister, of seven siblings, had cirsoid aneurysms of the occipital scalp with underlying skull defects and possible intracranial communication. Another sister had no gross scalp abnormality but radiographs of the skull revealed a small occipital bony defect. This is thought to be the first reported example of familial cirsoid aneurysm of the scalp.

Adolescent↗

Myogenic and scalp signals evoked by midinspiratory airway occlusion.

A somatosensory potential that is evoked by transient added inspiratory load has previously been described (Davenport PW, Friedman WA, Thompson FJ, and Franzen O. J Appl Physiol 60: 1843-1848, 1986). This evoked potential is novel because it arises in response to a stimulus that also evokes a muscle response, and so this potential could contain myogenic components. The present study was undertaken to define the relationship between the scalp response and other physiological responses that are evoked by airway occlusion. Evoked signals were recorded from the scalp, scalenus anterior, masseter, and electrooculogram. Responses to a 200-ms midinspiratory occlusion were recorded in 12 healthy volunteers. Evoked responses were reliably recorded at C(3)-C(Z) and C(4)-C(Z) and from the skin overlying the scalenus anterior in 11 of these subjects. The onset latencies were 15.7 +/- 3.1 at C(3)-C(Z), 15.9 +/- 2.1 at C(4)-C(Z), and 17.6 +/- 5.5 ms at scalenus anterior. In nine subjects, the masseter response appeared to coincide with the mouth pressure trace, and this was interpreted as movement artifact. No consistent electrooculogram or frontal electroencephalogram response was recorded. Because of the similarity in onset latency at C(3)-C(Z), C(4)-C(Z), and scalenus anterior, it was concluded that the myogenic signal may contribute to the scalp response and should be viewed as a potential source of artifact in experiments of this nature.

Adult↗

Millivolt-scale DC shifts in the human scalp EEG: evidence for a nonneuronal generator.

Slow shifts in the human scalp-recorded EEG, including those related to changes in brain CO(2) levels, have been generally assumed to result from changes in the level of tonic excitation of apical dendrites of cortical pyramidal neurons. We readdressed this issue using DC-EEG shifts elicited in healthy adult subjects by hypo- or hypercapnia. A 3-min period of hyperventilation resulted in a prompt negative shift with a rate of up to 10 microV/s at the vertex (Cz) and an extremely steep dependence (up to 100 microV/mmHg) on the end-tidal Pco(2). This shift had a maximum of up to -2 mV at Cz versus the temporal derivations (T3/T4). Hyperventilation-like breathing of 5% CO(2)-95% O(2), which does not lead to a significant hypocapnia, resulted in a near-complete block of the negative DC shift at Cz. Hypoventilation, or breathing 5% CO(2) in air at normal respiratory rate, induced a positive shift. The high amplitude of the voltage gradients on the scalp induced by hyperventilation is not consistent with a neuronal origin. Instead, the present data suggest that they are generated by extracortical volume currents driven by a Pco(2)-dependent potential difference across epithelia separating the cerebrospinal fluid and blood. Since changes in respiratory patterns and, hence, in the level of brain Pco(2), are likely to occur under a number of experimental conditions in which slow EEG responses have been reported (e.g., attention shifts, preparatory states, epileptic seizures, and hypoxic episodes), the present results call for a thorough reexamination of the mechanisms underlying scalp-recorded DC-EEG responses.

Adult↗

Maternal lung adenocarcinoma metastatic to the scalp of a fetus. Case report.

Maternal malignancy metastatic to the fetus is a rare event, with most neoplasms being either melanocytic or hematopoietic in origin. This report is the first known case of a maternal lung adenocarcinoma metastatic to a fetus. At 2 months of age, this male infant developed multiple scalp masses that were locally resected but rapidly recurred. The histology of the scalp lesions and that of a biopsy of the mother's tumor were both adenocarcinoma and were remarkably similar in appearance. In situ hybridization of tumor cells from this male infant found many large nuclei with XX signals indicating that the tumor was of maternal origin. This patient is alive, well and free of malignancy 5 years after a wide local resection of the scalp and skin grafting.

Adenocarcinoma↗

Acute diffuse and total alopecia of the female scalp. A new subtype of diffuse alopecia areata that has a favorable prognosis.

BACKGROUND: Although alopecia areata (AA) usually starts with focal lesions of hair loss and then presents several different clinical forms, AA may begin as diffuse hair loss. We examined 9 female patients who presented with acute, diffuse and total hair loss of the scalp and took a similar clinical course with a favorable prognosis. OBJECTIVE: To categorize such cases as a new subgroup of diffuse alopecia. METHODS: We studied 9 patients who showed acute, diffuse and total hair loss of the scalp within 1 month after their first visit to our hospital by comparing their clinical course, laboratory tests and histopathological findings with those of common, patchy AA, alopecia totalis or alopecia universalis. RESULTS: None of the patients had a background of systemic diseases or telogen effluvium. All the patients were female, and 8 of the 9 cases recovered cosmetically acceptable hair growth within 6 months regardless of steroid administration. The histology of he lesions was indistinguishable from that of AA except for a remarkable eosinophilic infiltrate. CONCLUSIONS: These cases can be categorized as a new subtype of inflammatory noncicatricial alopecia that is characterized by a marked female predominance, tissue eosinophilia and uniquely short clinical course. We suggest to name it 'acute diffuse and total alopecia of the female scalp (ADTAFS)'.

Acute Disease↗

Dithranol in an emulsifying oil base (bio-wash-oil) for the treatment of psoriasis of the scalp.

On the scalp, dithranol has been studied in only a few trials. The dithranol molecule that contains both hydrophilic and lipophilic centers can be incorporated into detergents and allows easy removal from hair. This property has led to the incorporation of dithranol in an emulsifying oil base (bio-wash-oil). The formulation has been used routinely for more than two decades in East Germany. We reexamined the efficacy and safety of dithranol in bio-wash-oil and compared it to dithranol embedded in crystalline monoglycerides (Micanol) in patients with psoriasis of the scalp. In a prospective, parallel group study, 64 patients attending a day-care clinic were randomly allocated to 3 treatment groups: (1) dithranol in bio-wash-oil; (2) Micanol cream, and (3) Micanol cream in bio-wash-oil. Treatment was carried out for 3 weeks and results assessed using a modified Psoriasis Area and Severity Index score. Dithranol in bio-wash-oil resulted in a reduction in the score of 34% on day 7 and 57% on day 14. This was significantly better than in groups 2 and 3, as were the overall response and patients' assessment at the end of treatment (p < 0.05). Dithranol in a bio-wash-oil is an effective, well-tolerated and low-priced treatment in psoriasis of the scalp.

Administration, Topical↗

Pseudocyst of the scalp.

We describe 4 cases of pseudocyst of the scalp, which still is only being described in the Japanese literature. The tumor is characterized as follows: localized between the top and the forehead area of the scalp, it first appears as a solitary reddish, painful small nodule or papule; it then gradually increases in size, protruding into a dome-shaped mass, and becomes associated with alopecia limited to the lesion area. This report describes typical cases of pseudocyst of the scalp, reviews the reported Japanese cases and introduces this tumor to western dermatology.

Adult↗

Congenital scalp defects: Adams-Oliver syndrome. A case report and review of the literature.

Localized agenesis of the scalp is a well-recognized phenomenon, with over 300 cases reported in the literature. These defects have previously been called congenital ulcer of the newborn, Streeters spots or aplasia cutis congenita (ACC). First described 160 years ago, ACC is recognized as a heterogenous group of disorders all having focal absence of scalp. Type III ACC, Adams-Oliver syndrome, consists of a scalp defect associated with a distal limb anomaly. Typically, the lesions appear as small ulcerations which may heal spontaneously. Larger lesions associated with underlying bony defects occur, and may cause death secondary to infection or hemorrhage from the sagittal sinus. We report a case of Adams-Oliver syndrome that required surgical excision and closure because of involvement of the sagittal sinus documented by multiple imaging modalities.

Female↗

Metabolism of 5 alpha-androstane-3 beta,17 beta-diol in bald and hairy areas of the scalp.

In androgen target tissues, testosterone undergoes extensive biotransformation to 5 alpha-dihydrotestosterone which in turn is metabolized into 5 alpha-androstane-3 alpha,17 beta-diol and 5 alpha-androstane-3 beta,17 beta-diol. From studies mainly in the prostate, it has been shown that 5 alpha-androstane-3 beta, 17 beta-diol can be further converted to 5 alpha-androstane-3 beta,6 alpha(beta)/7 alpha(beta),17 beta-triols. The present studies show that among the metabolites of 5 alpha-androstane-3 beta,17 beta-diol in scalp homogenates, three were isolated by thin-layer chromatography and identified against standard steroids: 5 alpha-dihydrotestosterone, epiandrosterone, and 5 alpha-androstanedione. Another peak was observed near the origin with a greater polarity than 5 alpha-androstane-3 beta,17 beta-diol. The chromatograms obtained by incubating 5 alpha-androstane-3 beta,17 beta-diol with scalp and prostate homogenates are similar, and it is known that the polar metabolites in the prostate are 5 alpha-androstane-3 beta,6 alpha(beta)/7 alpha(beta),17 beta-triols, suggesting that these steroids are formed in both tissues. In addition, the similarity of chromatograms and mass spectra, obtained when 3 beta-diol polar metabolite(s) and authentic 5 alpha-androstane-3 beta,7 beta,17 beta-triol were subjected to GC/MS, confirms this hypothesis. The dependence of the formation of polar metabolites on the substrate (5 alpha-androstane-3 beta, 17 beta-diol) concentration (50 nM-1.3 microM) was studied and resulted in saturation and linear Lineweaver plots from both bald and hairy areas of the scalp.(ABSTRACT TRUNCATED AT 250 WORDS)

Alopecia↗

The penetration enhancer SEPA augments stimulation of scalp hair growth by topical minoxidil in the balding stumptail macaque.

The purpose of this study was to determine if the penetration enhancer SEPA (2-n-nonyl-1,3-dioxolane) would augment the scalp hair growth effects of topical minoxidil in the balding stumptail macaque. A 1-in2 area on the balding scalp of 40 adult female monkeys (four drug-treated and four vehicle-treated groups of 5 monkeys each) was topically treated 5 days/week, q.d. or b.i.d., with approximately 250 microliters of minoxidil-SEPA (2.5% minoxidil, weight/volume in 10% SEPA, 25% propylene glycol and 65% isopropyl alcohol), Rogaine topical solution (TS, 2% minoxidil, weight/volume in 20% propylene glycol, 60% ethanol and 20% water) or respective vehicles (without drug) for 16 weeks via paintbrush application. Scalp hair was collected by shaving and vacuuming the dosed area at baseline and at 4-week intervals. The shaved hair was filtered, weighed and recorded as the change from baseline. The q.d. and b.i.d. minoxidil-SEPA groups displayed a significant increase in hair weight compared to their respective vehicles at week 4 whereas q.d. and b.i.d. Rogaine TS groups were not active until week 8 and 12, respectively. Both minoxidil-SEPA treatments produced significantly greater cumulative hair weight over the entire 16-week study compared to either of the Rogaine TS treatments. Comparable increases in cumulative hair weight were evident between q.d. and b.i.d. minoxidil-SEPA groups and between q.d. and b.i.d. Rogaine TS groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗

Autoimmune hair loss (alopecia areata) transferred by T lymphocytes to human scalp explants on SCID mice.

Alopecia areata is a tissue-restricted autoimmune disease of the hair follicle, which results in hair loss and baldness. It is often psychologically devastating. The role of T lymphocytes in this disorder was investigated with cell transfer experiments. Scalp explants from patients were transplanted to severe combined immunodeficiency (SCID) mice and injected with autologous T lymphocytes isolated from involved scalp. T lymphocytes which had been cultured with hair follicle homogenate along with antigen-presenting cells were capable of inducing the changes of alopecia areata, including hair loss and perifollicular infiltrates of T cells, along with HLA-DR and ICAM-1 expression of the follicular epithelium. Similar changes were not noted in grafts injected with scalp-derived T cells that had not been cultured with follicular homogenate. These data indicate that alopecia areata is mediated by T cells which recognize a follicular autoantigen.

Adult↗

Pilar tumor of the scalp.

An elderly woman presented with a large, fungating mass over the occipital portion of the scalp. Biopsy revealed this to be a pilar tumor of the scalp. The tumor was excised with a margin of normal tissue and the defect was closed with advancement of scalp and neck skin. Follow-up at 6 months revealed no recurrence of the lesion.

Aged↗

Differential effects of isoflurane on SEP recorded over parietal and frontal scalp.

We evaluated the effects of different concentrations of isoflurane on short-latency somatosensory evoked potentials recorded over the parietal and frontal scalp in 14 patients during general anesthesia at stable end-tidal concentrations between 0% and 2.5%. At concentrations between 0% and 1%, there was a marked discrepancy between the amplitude of the parietal N20, which remained stable, and the striking increase of the frontal P22. At concentrations above 1.5%, the parietal N20 disappeared in 6 patients whereas the P22 was clearly identified in 12. The central conduction time increased significantly whereas the spinal conduction was not delayed by increasing levels of isoflurane. These results show that isoflurane anesthesia is a useful pharmacologic model to demonstrate the independence of the N20 recorded over the parietal scalp and the P22 recorded over the frontal scalp.

Adult↗

Topography of scalp potentials preceding self-initiated saccades.

We studied 3 scalp potentials recorded prior to saccades in relation to visual targets (the presaccadic negativity [PSN], presaccadic positivity [PSP], and spike potential [SP]) in normal subjects performing self-initiated saccades in darkness. There was a prominent PSN beginning at -800 msec, maximal at the vertex. This finding is consistent with activation of the supplementary eye field in the anterior mesial frontal cortex, a concept which correlates with cortical neuron recordings in monkeys and cerebral blood flow studies in humans. A widespread PSP, with greatest amplitude over the posterior scalp, suggests parieto-occipital participation even in the absence of visual targets. The sharp character of SP with focal lateralized frontal negativity, its "mirror image" scalp distribution when comparing leftward to rightward saccades, and its timing near the onset of saccades support an origin near the orbit, in either ocular motor nerves or muscles.

Adult↗

Revascularization of the scalp by microsurgical techniques after complete avulsion.

A total scalp replantation was performed after a complete traumatic avulsion of the scalp with skull fracture. Multiple arterial and venous anastomoses were required. Satisfactory healing occurred, and the patient has had a subsequent uneventful cranioplasty to fill a bony defect, with normal scalp healing.

Accidents, Occupational↗

Multiple arteriovenous malformations located in the cerebellum, posterior fossa, spinal cord, dura, and scalp with associated port-wine stain and supratentorial venous anomaly.

Multiple arteriovenous malformations involving the left cerebellum and extra-axial posterior fossa with associated calcified cyst, spinal cord, dura, and scalp were present in a 7-year-old girl, who became symptomatic after a cerebellar hemorrhage. A large port-wine stain was noted on the right temporoparietal scalp, consistent with the scalp arteriovenous malformation area, as demonstrated by angiogram. In addition to the multiple arteriovenous malformations, nonfilling of the superior sagittal sinus and tortuous, irregular cortical veins were recognized.

Carotid Artery, Internal↗

Arteriovenous malformations of the scalp.

We report twenty-four patients with cirsoid aneurysms of the scalp. For nine patients (38%), the lesions were related to trauma. Each of the patients presented with a pulsatile scalp swelling with a bruit. No focal neurological deficits were noted in any of the patients. Scalp malformations in all patients were confirmed by selective internal and external carotid angiography, with no intracerebral component revealed in any of the patients. Twenty-one patients had the lesions surgically excised, with good results. The remaining three refused surgical intervention. Meticulous surgical technique, which includes removal of the pericranial component of the malformation, was paramount.

Adolescent↗