Relative effectiveness of different classes of fungicides against Pityrosporum ovale.
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Four patients are described in whom rosacea occurred on the face, and on the scalp in patches of baldness. Histopathological examination of the specimens taken from the scalp showed changes of rosacea and basophilic degeneration of collagen. In two patients direct immunofluorescence studies were performed; in one of these the presence of IgG deposits at the dermo-epidermal junction was demonstrated. These observations confirm the influence of external factors in the pathogenesis of rosacea.
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The literature on hair casts suggests they are rare even though Kligman intimated in 1957 that in some scalp diseases they might well be common. In this study, casts have been looked for in a group of orthokeratotic and parakeratotic scalp conditions. Hair casts are indeed common in psoriasis, pityriasis amiantacea, pityriasis capitis and seborrhoeic dermatitis. No casts were seen in women with traction hair styles or in those regularly using hair sprays.
We report six patients with a previously undescribed but characteristic pustular dermatosis confined to the scalp. All the patients were elderly women who developed chronic, extensive, pustular, crusted and occasionally eroded lesions of the scalp which produced scarring alopecia. Investigations were essentially negative and skin biopsies showed only non-specific changes of atrophy and chronic inflammation, sometimes with increased plasma cells in the infiltrate. The condition did not respond to antibiotics, but was suppressed by potent topical steroids.
A patient is described who developed pruritic lesions of the scalp with increasing hair loss and plaque formation over a period of 15 years, in association with patches of white atrophic skin on her trunk and vulva in the last 5 years. Biopsies of the scalp and trunk lesions both showed lichen sclerosus et atrophicus. This would appear to be the first recorded case of lichen sclerosus et atrophicus of the scalp in the English literature.
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A randomized double-blind placebo-controlled cross-over study was made of ketoconazole 200 mg daily in nineteen patients with seborrhoeic dermatitis. All had scalp lesions and sixteen had seborrhoeic dermatitis at other sites. Responses were measured by clinician and patients independently, using a linear analogue scale. Body and scalp lesions and itch regressed considerably and significantly with ketoconazole in all but five patients, three of whom subsequently responded to a higher dose. The patients studied with seborrhoeic dermatitis had been sent by their family doctors in answer to a request for patients with dandruff, and the clinical difference between the two was found to be only of degree. Three patients with dandruff without erythema were studied separately using the same study design: all three responded similarly to those with seborrhoeic eczema. It is concluded that Pityrosporum yeast infection is the immediate cause of seborrhoeic dermatitis and that dandruff is its mildest manifestation.
Thirty-two subjects who suffered from dandruff participated in a study in which one-half of the head was washed with a shampoo containing 1% zinc pyrithione (ZPT) and the other half was washed with the same shampoo without ZPT. Four groups, eight subjects per group, were shampooed one, three, six or nine times (shampoo frequency twice per week). Clinical dandruff gradings of each half of the head were made 4 days after the last shampoo in each group, when scalp biopsy samples were also taken from each half of the head. Measurements of labelling index (LI), mean epidermal thickness (MET), and assessment of the numbers of PAS- and Gram-positive micro-organisms were made on the biopsy samples. There was a progressive reduction in dandruff on the sides of the head treated with the ZPT shampoo, the differences relative to the placebo-treated areas being statistically significant after three, six and nine washes. There were no significant differences in LI between treatment groups and the MET was shown to vary according to the treatment and the number of washes. There was a significant reduction in the number of PAS-positive micro-organisms (but not Gram-positive micro-organisms) on the ZPT-treated areas.