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Four cases of sebopsoriasis or seborrheic dermatitis of the face and scalp successfully treated with 1a-24 (R)-dihydroxycholecalciferol (tacalcitol) cream.

A 71-year-old woman visited our clinic due to the presence of widespread scaly erythema on her face, scalp, and lower extremities. She was tentatively diagnosed as having seborrheic dermatitis but the symptoms were difficult to distinguish from psoriasis vulgaris. As a result, she was diagnosed as having sebopsoriasis. She was treated topically with an active vitamin D3 compound, 1a-24 (R)-dihydroxycholecalciferol D3 (tacalcitol) cream. She applied tacalcitol cream twice daily for 4 weeks, and her facial eruptions thus cleared up completely. No recurrence was observed for 2 months thereafter, even though the use of tacalcitol cream was stopped. To investigate whether or not tacalcitol cream is generally effective for the treatment of such seborrheic dermatitis-like eruptions, three more patients were treated with tacalcitol cream. All patients exhibited scaly erythematous macules on the face and/or scalp, and their eruptions improved rapidly with tacalcitol cream. Tacalcitol cream was thus found to be effective and useful for the treatment of both sebopsoriasis and even seborrheic dermatitis of the face and scalp.

Administration, Topical↗

[Treating cicatricial baldness with scalp expanding and hair autografting].

OBJECTIVE: To investigate the effective method to treat cicatricial baldness. METHODS: From 1993 to 1998, 21 cases with multi-region or great-dimensional cicatricial baldness were treated with scalp expanding and hair autografting. Among them, there were 17 males and 4 females, aged from 14 to 49 years old. The operation was divided into two stages, stage one meaned to embed the expander under the scalp and stage two meaned to sow the autogenous hair. RESULTS: All cases, no matter what the position and area, were repaired successfully. The biggest dimension of repaired baldness was 340 cm2, one expander exposed and one failed in expanding after operation and be corrected immediately. The normal hair direction changed in two cases. CONCLUSION: Combined use of scalp expanding and hair autografting is an effective method to treat multi-region or great dimensional cicarticial baldness.

Adolescent↗

Scalp psoriasis: topical calcipotriol 50 micrograms/g/ml solution vs. betamethasone valerate 1% lotion.

Forty-two patients aged between 6 and 61 years (mean: 33.5 years) with psoriasis of the scalp were enrolled in this study. Twenty-seven patients (69%) were males and 15 (31%) were females. The aim of our study was to evaluate the efficacy, safety and tolerability of topical calcipotriol 50 micrograms/g/ml solution vs. betamethasone valerate 1% lotion in the treatment of psoriasis of the scalp. The study was randomized with the twice-daily application of either calcipotriol solution or betamethasone valerate lotion for 6 weeks. Treatment evaluation was clinically based on signs of psoriasis (thickness, redness, scaliness) which were scored from 0 = absent to 4 = severest possible involvement and was performed at the start of treatment and at weeks 2 and 6 of treatment. The results showed a marked improvement and clearance at the end of treatment in 15 (72.8%) of the 24 patients in the calcipotriol group and in 13 of the 18 patients (72%) in the betamethasone group. The mean total sign score at baseline was 5.1 in the calcipotriol group and 5.4 in the betamethasone valerate group. At the end of treatment, this score was decreased to 2.1 and 1.49, respectively. No significant adverse effects were reported in either group except in two patients (8.3%) in the calcipotriol group who developed signs of irritation including itching and erythema. In conclusion, both drugs were effective and well tolerated in the treatment of scalp psoriasis but in some patients calcipotriol had to be given for more prolonged courses.

Administration, Topical↗

[Eosinophilic arteritis of the scalp].

BACKGROUND: The occurrence of recurrent peripheral arterial thromboses together with a blood eosinophilia generally suggests an occlusive vascular disease or a systemic vasculitis. CASE REPORT: In a 31-year-old woman with a 15-year history of severe smoking and a blood eosinophilia from 1,200 to 2,500/mm(3), we observed recurrent attacks of pruritus and urticaria and recurrent lesions of eosinophilic thromboangiitis of hypodermal medium-sized elastic arteries of the scalp. In spite of the persistent eosinophilia, the evolution was spontaneously regressive and no other clinical or biological sign occurred within a follow-up time of 3 years. DISCUSSION: In Buerger's disease (thromboangiitis obliterans) and in most systemic vasculitis, especially in Churg-Strauss syndrome, the first lesions may be inflammatory thromboses of the extra-cranial scalp arteries. The diagnosis of an eosinophilic arteritis of the scalp may only be considered if the examination of the other peripheral vessels is normal and if the course of the disease is benign, without any treatment, in spite of a persistent blood eosinophilia. This clinico-pathological presentation should be considered as a distinct entity.

Adult↗

The effects of cosmic particle radiation on pocket mice aboard Apollo XVIII: VII: results of scalp examination.

The scalps of the four pocket mice that were recovered alive from the Apollo XVII flight contained acute focal lesions in the epidermis and an inflammatory reaction in the subjacent dermis and subcutaneous tissue. Hair follicles were focally damaged in three of the four mice. There were 13 scalp lesions singled out in the four flight mice because of histological features that distinguished them from changes observed in the scalps of the control mice. There was only one possible coincidence between a lesion and the trajectory of a cosmic ray particle registered in a subscalp dosimeter. There is, however, a possibility that at least some lesions were produced by unregistered particles.

Animals↗

[Clinical study on effect of scalp-acupuncture in treating acute cerebral hemorrhage].

OBJECTIVE: To study the therapeutic effect of scalp-acupuncture in treating acute cerebral hemorrhage and its mechanism. METHODS: Sixty-four patients were divided into two groups, the acupuncture group and the control group. All were treated with mannitol and furosemide to reduce intracranial pressure, p-aminomethyl benzoic acid for hemostasis. The acupuncture group received scalp-acupuncture additionally. Neurofunction deficit scoring (NDS), hemorheology, thromboxane, prostacyclin, endothelin and transcranial Doppler (TCD) ultrasonic examination were taken before and after treatment. RESULTS: NDS of the acupuncture group was markedly better than that of the control group, especially in function recovering of limbs and speech. Blood viscosity, thromboxane and endothelin level of the acupuncture group lowered obviously, as compared with the control group, the difference was significant, P < 0.05. TCD showed that the cerebral blood flow was markedly improved in the acupuncture group. CONCLUSION: Scalp-acupuncture is safe and effective in treating acute cerebral hemorrhage, it is particularly effective in recovering limb paralysis and speech disturbance caused by cerebral hemorrhage.

Acupuncture Therapy↗

[Reconstruction of both eyebrows with scalp flaps with the anastomotic branch in occipital region of superficial temporal artery as the pedicle].

OBJECTIVE: To explore the effects of the reconstruction of both eyebrows with scalp flaps with pedicles supplied by superficial temporal arteries. METHODS: The parietal branch of the superficial temporal and its anastomotic branch of occipital artery at temporoparietal region on the same side were designed as the pedicles, with which two scalp flaps on temporoparietal and temporo-occipital regions with reverse directions were employed to restore the eyebrows on both sides. RESULTS: Four patients were treated with this method with satisfactory appearance and survival rate (100%). The reconstructed eyebrows appeared symmetrical and heavy. CONCLUSION: Scalp flaps with the anastomotic branch at occipital region of superficial temporal artery as the pedicle might be a good choice for the reconstruction of lost eyebrows.

Adolescent↗

Melanoma of the scalp: an underdiagnosed malignancy?

We report a case of scalp melanoma that was found incidentally after the patient complained of pruritic lesions on his scalp. The melanoma was 13 mm in diameter and had a Breslow thickness of 0.25 mm. The incidence of melanoma has been on the rise, with a high incidence occurring in men on the head, neck, and trunk. This case stresses the need to thoroughly examine the entire scalp when performing total body screening examinations for skin cancer.

Aged↗

[The clinical application of scalp expansion in the repair of cicatricial baldness in children].

OBJECTIVE: To introduce the clinical application of the expanded graft from scalp in the repair of cicatricial baldness in children. METHODS: 45 cases with baldness following burn from 1988 to 1998 were reported. All of these patients (age ranged from 5-11 years) were treated by soft tissue expander. RESULTS: 5 cases were followed up for 1-2 years, the clinical results showed that the result from the graft of scalp expansion was satisfactory, and the long-term follow-up revealed that the hair in expended area and that in normal area was almost the same except the orientation of hair distribution had some difference. CONCLUSION: The head scalp expansion might be the first choice in the repair of cicatricial baldness following burn.

Adolescent↗

Infected cephalohematoma associated with sepsis and scalp cellulitis: a case report.

Infected cephalohematoma is rarely complicated by sepsis. We report a case of an infected cephalohematoma caused by Escherichia coli sepsis in an otherwise healthy neonate. Skull X-ray revealed soft tissue swelling over parieto-temporal region but no osteolytic lesion. 99mTc bone scan showed scalp cellulitis. Blood culture and scalp wound culture identified E. coli. Treatment with surgical incision and drainage and administration of antibiotics resulted in prompt improvement. The relationship of scalp cellulitis, infected cephalohematoma, and sepsis are discussed.

Cellulitis↗

Meningothelial hamartoma of the scalp. A case report with immunohistochemical studies.

An unusual and, apparently, hitherto undescribed congenital lesion of the scalp which proved to be heterotopic meningothelial tissue is reported, and its clinical, morphological, and theoretical implications are reviewed. A 14-month-old male infant exhibited a soft tissue lesion on the midline of the parietal scalp since birth. The lesion had grown in size since birth. Histological examination showed an admixture of mature adipose tissue, bands consisting of bundles and small nodules of dense collagen, both enclosed and bordered by rests and strands of meningothelial cells. A network of vessel-like channels lined by plump hyperchromatic cells with spindle-shaped nuclei and occasionally multinucleated giant cells was one of the prominent features. Immunohistochemically, these cells were positive for vimentin, but staining was negative for EMA and all other antibodies tested. A fibrocollagenous stalk via bony defect showed no arachnoid cell rests. The authors believe that the herein described lesion and the hamartoma of the scalp described by Suster and Rosai (1990) may represent varying morphological expressions of a pathogenetically related process. Precautions appropriate to the possibility of intracranial extension must be taken at the time of surgery.

Antigens, Neoplasm↗

[Microvascular anastomosis in replantation of 6 avulsed scalps].

From 1990 to 1991, 6 avulsed scalps (total avulsing in 5, partial avulsing in 1) were replanted successfully. Follow-up for over 6 months showed that the hair of the replanted scalps grew normally in all the 6 patients. We think that the key to successful replantation is to anastomose the vessels effectively. The scalp can survive just with its superficial temporal vessels on both sides and with an artery-vein ratio of 1:1. The management of postoperative complications is discussed.

Adult↗

Reconstruction of avulsed scalp after go-cart injury.

Scalp avulsion is a rare injury that has significant physical and psychological consequences. It may require emergency replantation or late, challenging surgical reconstruction, or both. The authors describe two patients who had scalp avulsion. Each patient got long hair entangled in the uncovered engine of a go-cart. One underwent unsuccessful replantation without vascular repair; the other had a large segment of scalp successfully replanted with microvascular repair. Both patients required late reconstruction with tissue expansion. The final results were good. When feasible, microvascular replantation is the treatment of choice. If replantation is not possible, temporary cover by skin grafts followed by later reconstruction with tissue expansion can be effective.

Child↗

Renal cell carcinoma presenting as a scalp swelling.

BACKGROUND: Renal cell carcinoma occasionally presents in an unusual manner. AIM: To report the rare presentation of renal cell carcinoma as a scalp swelling. METHOD: The case record of a patient with renal cell carcinoma and the literature on the disease were reviewed. RESULT: A 42-year old woman presented with a scalp swelling. Haematuria was missed at the first visit until she volunteered it on a subsequent visit. Investigations suggested renal cell carcinoma. This was confirmed following a right nephrectomy. The scalp lesion was a metastasis extending through the skull into the intracranial compartment. She was not given any systemic drugs because none was available. She survived until she was lost to follow up. CONCLUSION: Haematuria remains an important symptom of renal cell cancer and should be elicited during systemic enquiry.

Adult↗

The pathology of extracranial scalp and skull masses in young children.

OBJECTIVE: Extracranial subcutaneous masses involving the scalp and/or skull in young children are uncommon lesions that get excised by the neurosurgeon. Although the most common reported lesion is the dermoid cyst, our experience suggests that the spectrum of pathology in these lesions can present diagnostic challenges to the pathologist. MATERIAL: We reviewed 30 consecutive extracranial masses from 29 patients between July 1998 and June 2003. METHOD: Hematoxylin and eosin-stained sections were reviewed in all cases, and immunohistochemistry was performed in select cases. RESULTS: Twenty-three were within the scalp, 5 involved the scalp and skull and 2 were within the limits of the inner and outer tables of the skull. There were 8 dermoid cysts, 2 epidermoid cysts, 6 post-traumatic lesions including 3 calcified cephalhematomas and 3 pseudocysts, 5 vascular lesions including 3 capillary hemangiomas, 1 venous angioma and 1 lymphangioma, 2 cases of cranial fasciitis and 1 case each of benign teratoma, deep granuloma annulare, benign fibrous histiocytoma, congenital melanocytic nevus, hamartoma with ectopic meningothelial elements, cutaneous hyalinised ectopic meningioma and a meningocele with a fibrohistiocytic reaction. No lesions have recurred or exhibited malignant features. CONCLUSIONS: Surgical pathologists and neuropathologists should be aware that the differential diagnosis of "lumps and bumps on babie's heads" is quite varied and can be histologically challenging.

Child, Preschool↗

Circumscribed scalp hair loss following multiple hair-cutter ant invasion.

A 32-year-old woman presented with an abrupt, localized loss of scalp hair that occurred on the previous day. Her nails, skin, and mucosae were normal. On the vertex of the scalp, there was a circular patch of alopecia; the hairs were broken at approximately equal lengths above the skin surface. Several erythematous macules were seen in the affected area, but scale, twisted hair, and exclamation-mark hairs were not present. Further examination revealed the presence of ants on the scalp. This patient is one of several referred to our department presenting with hair loss associated with hair-cutter ant invasion.

Adult↗

Angiosarcoma of the of scalp with calvarium involvement in a 50-year-old African-American man.

BACKGROUND: Angiosarcoma of the scalp is a rare, aggressive, and deadly cancer that affects mainly elderly Caucasian men. OBJECTIVES: The insidious and masquerading presentation of angiosarcoma poses enormous diagnostic challenges for primary care providers. PATIENTS/METHODS: We present a case of a 50-year-old black man referred for evaluation of a 3.7-cm-x-5.4-cm ulcerated, fluctuant scalp lesion that had failed to respond to different antibiotics and proper wound care. RESULTS: Surgical excision and subsequent histopathology revealed angiosarcoma. CONCLUSIONS: This case report highlights the importance of high index of suspicion for early diagnosis of cancerous lesions in wounds and stresses the need to include angiosarcoma in the differential diagnosis for all face and scalp lesions, as early detection may save lives. A comprehensive literature review is also presented.

Adult↗

Recalcitrant scalp folliculitis: a possible role of herpes simplex virus type 2.

We report the case of a 70-year-old man with a 1 year history of relapsing folliculitis of the scalp. Bacteriological, mycological and the Tzanck tests from the lesions were negative. Histopathological study showed suppurative perifollicular flogosis. Virological cultures were negative, while HSV nested polymerase chain reaction (nPCR) assays made on swabs and histological sections from the scalp lesions demonstrated the presence of herpes simplex virus type-2 (HSV-2) in all samples. Skin swabs of healthy areas yielded negative results for HSV-2 infection. The folliculitis showed a marked and quick improvement after therapy with famciclovir suggesting a possible etiologic role of HSV-2 in the scalp folliculitis.

Aged↗