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PubMed2001

Sensitivity of recordings at sphenoidal electrode site for detecting seizure onset: evidence from scalp, superficial and deep foramen ovale recordings.

OBJECTIVES: Some authors have recently stressed that the position of the tip of sphenoidal electrodes plays a crucial role in their efficacy in detecting ictal onset. An opportunity to test this hypothesis is provided by recordings from the most superficial contacts of foramen ovale (FO) electrode bundles because these contacts are located at the FO, in a position equivalent to that of optimally located sphenoidal electrodes. To simplify wording, recordings obtained by superficial FO electrodes will hereafter be called sphenoidal recordings, although they have not been obtained with standard sphenoidal electrodes. The sensitivities of simultaneous scalp and sphenoidal recordings for detecting ictal onset have been compared with each other, and with a 'gold standard' provided by simultaneous deep intracranial FO recordings from the mesial aspect of the temporal lobe. METHODS: Three hundred and fourteen seizures obtained from 110 patients under telemetric presurgical assessment for temporal lobe epilepsy have been studied. Scalp electrodes included anterior temporal placements. All scalp electrodes were considered when identifying seizure onset but the anterior temporal electrodes were most frequently involved. RESULTS: Ictal onset time at sphenoidal and scalp recordings: initial ictal changes appeared simultaneously in scalp and sphenoidal recordings in 123 seizures (39.2%). Initial changes occurred earlier in sphenoidal recordings in 63 seizures (20.1%), whereas they were seen earlier on the scalp in 76 seizures (24.2%). Artefacts prevented the comparison between sphenoidal and scalp recordings in 16 seizures (5.1%) and no ictal changes were seen on the scalp and/or sphenoidal recordings in 36 seizures (11.5%). In most of the 63 seizures where ictal changes appeared earlier in sphenoidal recordings, a delayed ipsilateral scalp onset was seen as the signal amplitude increased or scalp changes could be identified retrospectively on the scalp with an onset which appeared simultaneous and ipsilateral to the initial sphenoidal changes. Sphenoidal recordings supplied additional information when compared to scalp recordings in only 22 seizures (7%): in 5 seizures with artefacts on the scalp, in 6 seizures with no changes on the scalp and in 11 seizures with discrepant laterality at onset. Congruence in laterality with respect to deep intracraneal FO recordings: of the 61 seizures with unilateral onset on the scalp, onsets at sphenoidal recordings and deep FO electrodes were ipsilateral in most cases. In only 3 of these 61 seizures (4.9%), sphenoidal recordings lateralized ipsilateral to the deep FO electrodes in the presence of a contralateral onset on the scalp. In 14 among the 122 seizures (11.5%) with bilateral asymmetrical onset on the scalp, sphenoidal recordings lateralized seizure onset ipsilateral to the deep FO electrodes in the presence of a contralateral scalp onset. Thus, when compared with scalp EEG, sphenoidal recordings increased laterality congruence with respect to deep FO electrodes in 17 seizures (5.4%). CONCLUSIONS: Extracranial electrodes located next to the FO at the sphenoidal electrode site yield an improvement over suitable surface electrodes in the identification of ictal onset in only 5.4-7% of seizures. Such improvement derives from the fact that the low amplitude signals often seen at seizure onset may show higher amplitude on sphenoidal than on scalp recordings.

Electroencephalography↗

PubMed2002

A non-invasive tape absorption method for recovery of inflammatory mediators to differentiate normal from compromised scalp conditions.

BACKGROUND/AIMS: A simple non-invasive tape (Sebutape) adsorption method was used to recover inflammatory proteins from normal and compromised human scalp (i.e. dandruff and seborrheic dermatitis) in order to assess the inflammatory and immunologic changes relevant to these clinical conditions. METHODS: The scalps of subjects identified by a dermatologist as having either dandruff (n = 18), seborrheic dermatitis (n = 19) or normal scalp (n = 16) were visually graded to obtain total adherent scalp flaking scores (TASFS). Sebutape samples were then collected from both the high and low TASFS scalp sites using a one-minute tape application. To recover inflammatory molecules, tapes were extracted in buffered saline with sonication and the tape extracts analysed using commercial immunoassay methods for pro-inflammatory cytokines [i.e. interleukin-1alpha (IL-1alpha), IL-1beta, IL-1 receptor antagonist (IL-1ra), IL-8 and tumor necrosis factor-alpha (TNF-alpha)] and the immunologic cytokines [i.e. IL-2, IL-4, IL-10, IL-12, IL-15 and interferon gamma (IFN-gamma)]. Nitric oxide (NO) was also assayed on tape extracts using the Greiss reaction. To account for differences in protein loading on the tapes all cytokine and NO results were normalized using the total protein (TP) amounts recovered in tape extracts. RESULTS: The IL-1alpha/TP levels recovered from dandruff and seborrheic scalps were significantly decreased (P = 0.03) compared to normal appearing scalp levels. The scalp levels of IL-1ra/TP and the ratio of IL-ra to IL-1alpha were significantly (P = 0.002) or directionally (P = 0.07) higher in seborrheic dermatitis scalps and dandruff scalps, respectively, compared to normal scalps. The IL-1ra and the IL-1ra/IL-1alpha ratio values correlated well with the TASFS. The TNF-alpha/TP levels recovered from dandruff scalps were significantly higher (P = 0.02) than levels recovered from seborrheic dermatitis and normal scalp subjects. IL-2/TP was significantly increased (P = 0.01) and IFN-gamma and NO significantly decreased (P = 0.05) in the seborrheic dermatitis scalp samples compared to normal controls. CONCLUSION: The Sebutape method has proven useful for distinguishing normal from diseased scalp conditions. The cytokines recovered from the scalp tape samples showed distinct patterns that differentiated dandruff, seborrheic dermatitis and normal scalp populations. These methods may also prove useful for monitoring the clinical efficacy of therapeutic actives for treating dandruff and seborrhea.

Absorption↗

PubMed1996

Transcutaneous PO2 of the scalp in male pattern baldness: a new piece to the puzzle.

Our study was designed to measure the transcutaneous PO2 of the scalp to determine if there was a relative microvascular insufficiency and associated tissue hypoxia in areas of hair loss in male pattern baldness. A controlled prospective study was performed at Butterworth Hospital, Grand Rapids, Michigan. Eighteen nonsmoking male volunteers aged 18 years and older were studied. Nine men had male pattern baldness (Juri degree II or III), and nine were controls (no male pattern baldness). Scalp temperature and transcutaneous PO2 were obtained at frontal and temporal sites in each subject. Peripheral circulation was assessed from postocclusive transcutaneous PO2 recovery time by means of maximum initial slope measurements. Statistical significance was assessed at p < 0.05. There was no significant difference in scalp temperature between male pattern baldness subjects and controls. Temporal scalp blood flow was significantly higher than frontal scalp blood flow in male pattern baldness subjects; however, there was no significant difference in controls. Transcutaneous PO2 was significantly lower in bald frontal scalp (32.2 +/- 2.0 mmHg) than in hair-bearing temporal scalp (51.8 +/- 4.4 mmHg) in men with male pattern baldness. In controls, there was no significant difference in transcutaneous PO2 of frontal scalp (53.9 +/- 3.5 mmHg) and temporal scalp (61.4 +/- 2.7 mmHg). Transcutaneous PO2 also was significantly lower in the frontal scalp of male pattern baldness subjects (32.2 +/- 2.0 mmHg) than in either frontal or temporal scalp of controls (53.9 +/- 3.5 mmHg and 61.4 +/- 2.7 mmHg, respectively). There is a relative microvascular insufficiency to regions of the scalp that lose hair in male pattern baldness. We have identified a previously unreported tissue hypoxia in bald scalp compared with hair-bearing scalp.

Adolescent↗

PubMed1993

Scalp extension.

BACKGROUND: Surgery to correct extensive alopecia requires increasing the surface of hair-bearing scalp and removing bald scalp. Two commonly used methods, scalp expansion and scalp reduction, have disadvantages. OBJECTIVE: To describe a new method, scalp extension, that employs a thin sheet of bioplastic (an extender) stretched and attached with hooks to the galea after scalp reduction. METHODS: The surgical technique is described and the results compared with those of patients who have undergone scalp reduction and scalp expansion. A study of the first fifteen cases treated is presented. RESULTS: During the few weeks that the extender is implanted, the constant tension it exerts on the galea causes a progressive stretching of the scalp. Data from the first fifteen cases treated reveal eradication of more extensive bald areas than with scalp reduction, making it possible to cut the number of operations necessary in half while considerably shortening total treatment time. The absence of major side effects, along with the absence of any deformation of the scalp (unlike scalp expansion), explains the excellent acceptability of the instrument by patients. CONCLUSION: Scalp extension appears to be a useful adjunctive technique in hair replacement and reconstructive surgery, and has distinct advantages over standard scalp reduction and tissue expansion techniques.

Alopecia↗

PubMed2005

Prevalence of scalp scaling in prepubertal children.

OBJECTIVE: To determine the prevalence and most common etiologies of scalp scaling in infants and prepubertal children and the specificity of head and neck lymphadenopathy for the diagnosis of tinea capitis associated with scalp scaling. DESIGN/METHODS: A cross-sectional study of 300 children, 200 from an urban general pediatric practice and 100 from 2 urban pediatric dermatology practices, was conducted. Half of the subjects were <2 years old, and half were 2 to 10 years old. Demographic data, medical history, and clinical data noting the presence of scalp scaling and other scalp signs and symptoms, as well as adenopathy of the head and neck, were collected. RESULTS: Scalp scaling was seen in 66 (22%) children. There was an insignificantly higher prevalence of scalp scaling in those <2 years old compared with the 2- to 10-year-old group. In those <2 years old with scalp scaling, the most common diagnoses were seborrheic dermatitis (thick, adherent, greasy scale predominantly in the frontal and/or vertex areas of the scalp) and atopic dermatitis/eczema. Among those 2 to 10 years old with scalp scaling, the most common diagnoses were nonspecific (fine, white) scaling, seborrheic dermatitis, and atopic dermatitis/eczema. Nine (3%) patients were culture-positive for a dermatophyte, all of whom were black, and grew Trichophyton tonsurans. More than half (52.7%) of all patients had head and neck adenopathy. The presence of posterior nodes was significantly associated with atopic dermatitis/eczema and marginally associated with a positive dermatophyte culture. The presence of scalp scaling plus posterior adenopathy was significantly associated with seborrheic dermatitis and a positive dermatophyte culture in the entire study population and with atopic dermatitis in the pediatric dermatology clinics. CONCLUSIONS: Scalp scaling was common in children 0 to 10 years old. Infantile-type seborrheic dermatitis was noted in both age groups: it was 3 times as likely in children <2 years old (18%) than in those 2 to 10 years old (6%). Contrary to traditional teaching, seborrheic dermatitis can be found in preadolescent children. Atopic dermatitis/eczema was associated with scalp scaling in both age groups. Head and neck adenopathy was very common and nonspecific for any 1 diagnosis. Posterior adenopathy with concurrent scalp scaling was significantly associated with seborrheic dermatitis, a positive dermatophyte culture, and atopic dermatitis. In this nonselected pediatric population, scalp scaling with adenopathy was not associated exclusively with tinea capitis.

Age Distribution↗

PubMed2004

Characteristics of scalp electrical fields associated with deep medial temporal epileptiform discharges.

OBJECTIVE: To determine scalp characteristics of epileptiform discharges arising from medial temporal structures (MT). METHODS: Signal-to-noise ratio was increased by averaging simultaneous recordings from intracranial and scalp electrodes synchronised on discharges recorded by foramen ovale (FO) electrodes. The topography, amplitude and distribution of averaged scalp signals were analysed. RESULTS: Four thousand three hundred and twenty-seven discharges from 20 patients were averaged into 77 patterns. Before averaging, only 9% of discharges were detectable on the scalp without the need of simultaneous FO recordings (SED). A further 72.3% of discharges fell into averaged patterns that could be detected on the scalp as small transients before or after averaging (STBA or STAA). In 18.7% of discharges, no scalp signal was seen after averaging. Whereas most SED patterns had largest amplitude on the scalp at anterior temporal electrodes, STBA and STAA patterns showed greater variability and more widespread scalp fields, suggesting a deeper source. Dipole source localisation modelled the majority of SED patterns as radial dipoles located just behind the eye. In contrast, dipoles corresponding to STBA or STAA patterns showed greater variability in location and orientation and tended to be located at MT. CONCLUSIONS: SED patterns seem to arise from widespread subtemporal and/or superficial neocortical activation, generating EEG fields that are distorted by the high electrical conductivity of anterior cranial foramina. In contrast, STBA and STAA patterns represent electrical fields from neuronal activity more restricted to MT, that reach the scalp highly attenuated by volume-conduction and less distorted by cranial foramina. SIGNIFICANCE: Low amplitude scalp signals can be related to MT activity and must be taken into consideration for the diagnosis of temporal lobe epilepsy, pre-surgical assessment and for valid modelling of deep sources from the scalp EEG and magnetoencephalogram.

Adolescent↗

PubMed2002

Temporo-spatial correlations between scalp and centromedian thalamic EEG activities of stage II slow wave sleep in patients with generalized seizures of the cryptogenic Lennox-Gastaut syndrome.

OBJECTIVES: Temporo-spatial correlations between scalp and centromedian thalamic (CM) normal and abnormal electroencephalographic (EEG) activities of stage II slow wave sleep (SWS II) were investigated in 5 patients with cryptogenic Lennox-Gastaut syndrome (CLGS). METHODS: In each patient, 8h/all-night sleep studies were performed with routine methods; and a total of 1233 normal and 206 abnormal individual activities, spontaneously occurring during 200 epochs of early and late SWS II, were analyzed. Normal activities included scalp-CM K-complexes (KC-CMKC), vertex waves (VW-CMVW), and sleep spindles (SS-CMSS). Abnormal activities included: thalamo-cortical spikes (TCS-CMTCS), and epileptic (EPKC-CMEPKC) and W K-complexes (WKC-CMWKC). RESULTS: (1) All abnormal and normal spontaneous SWS II activities occurred associated in scalp and CM regions except the SS. Associated spindles were significantly larger (P<0.01) than dissociated ones, this occurring during both early and late SWS II. (2) The peak of VW significantly anticipated (P<0.02) that of its CM counterpart (CM-VW), while the peak of CMTCS anticipated that of its scalp counterpart. The onset of CMSS significantly anticipated (P=0.02) that of its scalp counterpart (SS). The behavior of VW-CMVW and TCS-CMTCS of the abnormal KC was similar to those of the normal complexes, while the onset of abnormal spindles was simultaneous in scalp and CM regions. Scalp VW, CTS, and SS attained maximal amplitude at the parietal region bilaterally with decreasing amplitude gradients to other scalp regions, while CMVW, CMTCS, and CMSS attained maximal amplitude in all thalamo-mesencephalic regions of CM. (3) Normal spindles significantly reduced (P<0.02) the amplitude of the positive CM, CMVW, and scalp TCS counterparts of the negative scalp VW and CM (CMTCS), respectively, while abnormal spindles reduced the amplitudes (P<0.01) of both negative VW and CMTCS and positive counterparts. CONCLUSION: These data suggest the following: (1) that all SWS II activities, including SS, are mediated by common thalamo-cortical systems; (2) that VW originate from the parietal scalp and normal spindles and TCS from the CM regions bilaterally while abnormal spindles originate either from widespread cortical and CM regions or from a site outside the thalamo-cortical systems, and (3) that the functional role of SS is to inhibit non-specific thalamo-cortical systems for sleep preservation.

Adolescent↗

PubMed1999

Serial scalp reductions: a biomechanical approach.

BACKGROUND: Several technical aspects of scalp-reduction procedures still need to be clearly elucidated: in particular, (a) the quantitative effects provided by different amounts of subgaleal undermining, (b) the immediate gains provided by increasing amount of tension when advancing a scalp flap, and (c) the eventual benefits provided by galeotomies. OBJECTIVE: The aim of the present paper is to report on some biomechanical properties of scalp flaps as related to serial scalp reduction procedures for correction of male pattern baldness. METHODS: Data were collected by stepwise loading of 20 scalp flaps, obtained by a reversed-Y scalp incision, after increasing amounts of undermining, as well as after performing three galeotomies. RESULTS: Increasing amounts of tension (while advancing a scalp flap) affect the compliance of a scalp flap in a non-linear fashion; increasing amounts of undermining permit obtaining significant, but not proportional, gains; performing galeotomies is a useful adjunct to decrease the amount of closing tension when performing scalp-reduction procedures. CONCLUSION: When performing serial scalp reductions, to take into account the biomechanics of scalp flaps may be of some utility in obtaining an optimal result.

Adult↗

PubMed2002

Nucleated red blood cells in human fetal scalp capillary blood samples: a feasibility study.

OBJECTIVE: Elevated umbilical cord nucleated red blood cell (NRBC) counts have been suggested as a predictor of adverse perinatal outcome. We sought to evaluate the feasibility of obtaining fetal scalp capillary blood NRBC counts during labor and to assess their correlation with umbilical cord NRBC counts. METHODS: Fetal scalp capillary blood specimens were prospectively collected in laboring patients who underwent scalp sampling because of the presence of an abnormal fetal heart rate pattern. Matched umbilical cord blood samples were collected immediately after birth. Outcome measures were the feasibility of obtaining fetal scalp NRBC counts and their correlation with umbilical cord NRBC counts. RESULTS: Thirteen term singleton pregnancies formed the study population. In four patients, fetal scalp capillary blood sampling was performed twice. Of the attempts to evaluate fetal scalp capillary samples for NRBC counts, 16 out of 17 (94.1%) were successful. The mean fetal scalp capillary blood NRBC count per 100 white blood cells was 12.6 +/- 7.6 (+/- SD). Umbilical cord mixed, venous and arterial NRBC counts were 15.5 +/- 8.8, 13.4 +/- 10.7 and 12.6 +/- 10.7, with p = 0.09, p = 0.59 and p = 0.68, respectively, when compared to the corresponding scalp sample. The Spearman rank correlation between fetal scalp capillary samples and umbilical cord mixed, venous and arterial NRBC counts were r = 0.86, r = 0.92 and r = 0.95, respectively, with all p values < 0.001. CONCLUSION: Previous studies have established the clinical utility of umbilical cord NRBC counts. Our study demonstrated that it was possible to obtain NRBC counts from a fetal scalp capillary sample and that these counts correlated highly with umbilical cord NRBC counts. Future studies are needed to evaluate fetal scalp NRBC counts as a predictor of perinatal outcome.

Blood Specimen Collection↗

PubMed2003

Hyperplasia of the subcutaneous adipose tissue is the primary histopathologic abnormality in lipedematous scalp.

A 51-year-old white woman presented with thickening of the scalp located at the vertex and left lateral occiput without hair abnormalities or alopecia. Skin biopsies of the thickened scalp showed thickening of the subcutaneous tissue with proliferation of mature subcutaneous fat cells but no signs of inflammation or hair abnormalities. During 2.5 years of follow-up, scalp thickening progressed over the entire hair-bearing scalp and persisted without signs of further progression at 3.5 year follow-up. Lipedematous scalp is an extremely rare diagnosis. It is defined by a thickening of the subcutaneous layer of the scalp and can be distinguished from lipedematous alopecia, in which subcutaneous thickening is associated with diffuse alopecia and shortening of scalp hairs. A total of seven cases of lipedematous alopecia and two cases of lipedematous scalp have been reported. We report the third case of lipedematous scalp in a 51-year-old white woman associated with early symptoms of meningitis. Additional features described in the literature include pruritus, pain, and paresthesia of the scalp as well as associated medical problems such as hyperelasticity of skin and laxity of joints, renal failure, and diabetes mellitus. This sporadic disorder is predominantly located at the vertex and occiput. The etiology and pathogenesis of lipedematous scalp and alopecia remain unclear. The treatment is symptomatic.

Adipose Tissue↗

PubMed1996

Spine and scalp recordings as a function of intensity. A model for changes during spinal cord monitoring.

STUDY DESIGN: Spinal cord monitoring has used both spine and scalp recordings as indicators of spinal cord integrity. The relative merits of spine or scalp recordings to predict the quality of the afferent volley in the somatosensory pathway were addressed in this study by using various stimulus intensities as a way to model alterations of the size of the afferent volley. OBJECTIVES: The results were analyzed to determine the correlation of central recordings taken at the spine or scalp with peripheral recordings. SUMMARY OF BACKGROUND DATA: Spinal cord monitoring with somatosensory evoked potentials has been achieved with recordings of signals generated by either the spinal cord or the somatosensory cortex. Spine recordings are thought to be more stable, yet little evidence exists to document this statement. METHODS: Seven patients were studied in the course of standard intraoperative spinal cord monitoring. Responses were recorded at the popliteal fossa, thoracic epidural, cervical spine, and scalp to tibial nerve stimulation at intensities varying from 0.5 to 2.0 times muscle twitch threshold. RESULTS: Normalized amplitudes of the response at the popliteal fossa were used to reflect the magnitude of the afferent volley. The amplitudes of the popliteal fossa response showed a high correlation (r = 0.90) with normalized amplitudes of epidural and cervical spine responses and moderate correlation (r = 0.49) with normalized amplitudes of scalp responses. The width of the 95% confidence limits for the inverse prediction of the afferent volley from epidural and cervical responses was nearly a third narrower than that from scalp responses. At low stimulus intensities, scalp responses were consistently observed when spine responses were absent, and scalp responses had lower response thresholds than did spine responses. The latencies of the popliteal fossa responses were not well correlated with latencies of either the epidural or cervical responses. CONCLUSIONS: These correlation and inverse prediction data suggest that the size of an afferent volley may be predicted more accurately by spine responses than by scalp responses. The presence of scalp responses at intensities too low to elicit detectable spinal-level responses suggests that scalp responses may be considered a sensitive indicator of a minimal afferent volley.

Adolescent↗

PubMed2005

Reconstruction of acquired scalp defects: an algorithmic approach.

LEARNING OBJECTIVES: After studying this article, the participant should: 1. Understand scalp anatomy, hair physiology, and skin viscoelastic properties as they relate to scalp reconstruction. 2. Understand the principles that allow for aesthetic reconstruction of scalp defects. 3. Understand the use of local tissue rearrangement for reconstruction of specific areas of the scalp. 4. Understand the use of tissue expansion and free tissue transfer for scalp reconstruction. BACKGROUND: Reconstruction of scalp defects is required for acute trauma, tumor extirpation, radiation necrosis, and the repair of traumatic alopecia or cosmetically displeasing scars. METHODS: The proper choice of a reconstructive technique is affected by several factors-the size and location of the defect, the presence or absence of periosteum, the quality of surrounding scalp tissue, the presence or absence of hair, location of the hairline, and patient comorbidities. Successful reconstruction of these defects requires a detailed knowledge of scalp anatomy, hair physiology, skin biomechanics, and the variety of possible local tissue rearrangements. In nearly total defects, local tissues may be inadequate and tissue expansion or free tissue transfer may be the only alternatives. RESULTS: Plastic surgeons are now able to obtain coverage over the calvaria after the most devastating of defects; however, the challenge to the reconstructive surgeon today is to do so with excellent cosmetic results. Cosmetic scalp reconstruction requires restoration and preservation of normal hair patterns and hair lines. CONCLUSIONS: Successful reconstruction of the scalp requires careful preoperative planning and precise intraoperative execution. Detailed knowledge of scalp anatomy, skin biomechanics, hair physiology, and the variety of available local tissue rearrangements allows for excellent aesthetic reconstruction.

Algorithms↗

PubMed2000

A pilot study to assess the feasibility of prior scalp cooling with palliative whole brain radiotherapy.

The objective of this work was to perform a feasibility study on the use of scalp cooling during palliative whole brain radiotherapy. Seven patients (1 male, 6 female) with good performance status underwent scalp cooling prior to and during radiotherapy for cerebral metastases. Five patients were prescribed 12 Gy in two fractions and two patients were prescribed 20 Gy in five fractions. Phantom thermoluminescent dosemeter (TLD) studies to assess the build-up effect from the scalp cap were performed. Seven out of eight patients that were offered scalp cooling completed treatment uneventfully. One patient reported discomfort on application of the scalp cap and continued treatment without scalp cooling. No patients reported other adverse effects from use of the cap during treatment or at follow-up. TLD studies demonstrated a 55-80% increase in dose to the scalp after application of the scalp cap. All patients experienced hair loss. Scalp cooling caps are well tolerated through a course of palliative whole brain radiotherapy. The scalp dose is significantly increased owing to a bolus effect from the scalp cap.

Adult↗

PubMed2001

Psoriasis of the scalp. Diagnosis and management.

Psoriasis of the scalp is a frequently occurring condition affecting approximately 2% of the Western population. The sharply demarcated erythematosquamous lesions with silver-white scaling characterize scalp psoriasis. Quality of life can be seriously reduced by this condition and therefore long term treatment is needed in most patients. Coal tar shampoos, containing 2 to 10% coal tar solution, are effective in scalp psoriasis. However, no double-blind studies are available to support such an assumption. Salicylic acid 5 to 10% has a pronounced keratolytic effect. Salicylic acid should be formulated in an ointment, which can be washed off easily. Crude coal tar is the most effective tar available for the treatment of psoriasis. An important feature of coal tar is its potent efficacy against pruritus. At the scalp, the application of crude coal tar is difficult. Therefore coal tar solution is the most frequently applied tar preparation in scalp psoriasis. Dithranol 0.1 to 3% is manufactured in various formulations. Treatment is initiated at a low concentration and the concentration is increased stepwise until a slight irritation, the feeling of warmth, is reached. In the treatment of scalp psoriasis, cream formulations are used. Imidazole antifungals have been used with success in scalp psoriasis. Overgrowth of the scalp with pityrosporon is a well-known feature of scalp psoriasis and seborrheic dermatitis. In case of resistance to other topical treatments use of a topical or systemic imidazole derivative might be helpful. So far, topical corticosteroids are the most frequently used treatments for psoriasis of the scalp. Corticosteroids inhibit epidermal proliferation, inhibit inflammation and modulate immune functions. Topical corticosteroids are fast acting: within 3 to 4 weeks maximal efficacy is reached. No data are available to support the efficacy and safety of topical corticosteroids during long term use. However, from epidemiologic surveys we know that these treatments are used by the majority of patients for more than 8 weeks. Since 1992 vitamin D3 formulations have been developed for the treatment of psoriasis. Calcipotriol is available in most countries. Tacalcitol is available in Japan and several other countries. Vitamin D3 analogues inhibit epidermal proliferation, enhance cornification and inhibit inflammation. Therefore, vitamin D3 analogues have a substantial antipsoriatic effect. Systemic treatments such as methotrexate, cyclosporine and acitretin are indicated in patients with recalcitrant disease. Management of scalp psoriasis requires long term strategies in order to reach an optimal improvement of the condition, while avoiding the adverse effects associated with the long term use of treatments.

Administration, Cutaneous↗

PubMed2005

An evaluation of topical 3% salicylic acid and 1% hydrocortisone in the maintenance of scalp pruritus.

BACKGROUND: Scalp pruritus is a common condition causing dermatologic distress. The presence of skin scale on clothing is cosmetically undesirable and scalp scratching in public is socially embarrassing. Scratching can also result in removal of the cuticle and premature hair shaft fracture. OBJECTIVE: To demonstrate the efficacy of 3% salicylic acid in combination with 1% hydrocortisone in the treatment of scalp pruritus. METHODS: Sixty subjects with moderate scalp scaling and scalp pruritus were enrolled in a three-arm double blind 2-week study. The 20 subjects in arm 1 applied a topical 1% hydrocortisone product twice daily. The 20 subjects in arm 2 applied a topical 3% salicylic acid product twice daily. Lastly, the 20 subjects in arm 3 applied a topical 3% salicylic acid product in the morning and a topical 1% hydrocortisone product in the evening. Evaluations were performed at baseline, after 1 week of treatment, and after 2 weeks of treatment. The study investigator evaluated the subjects for scalp scale, erythema, excoriation, and overall assessment. In addition, scalp scale scrapings were collected and analyzed to gain further insight into scalp scale morphology. Subject assessments and scalp photography was also performed. RESULTS: The investigator assessments revealed less excoriation in the hydrocortisone twice daily arm over the salicylic acid twice daily arm (P = 0.03), which might be expected because of its anti-inflammatory effect. The morning salicylic acid application and evening hydrocortisone application arm performed better than the salicylic acid twice daily group at week 2 in terms of erythema (P = 0.02), excoriation (P = 0.03), and overall assessment (P = 0.01). Scalp scale scrapings revealed the least amount of retained skin scale in the combination salicylic acid/hydrocortisone group. CONCLUSION: The combination of a 3% salicylic acid keratolytic combined with a 1% hydrocortisone anti-inflammatory provides the best relief of scalp pruritus.

Journal Article↗

PubMed2000

Functional analysis of the stratum corneum of scalp skin: studies in patients with alopecia areata and androgenetic alopecia.

Because of the presence of thick long hairs on the scalp, little information is available concerning the functional characteristics of the stratum corneum (SC) of scalp skin. We therefore conducted a functional study of the SC of lesional scalp skin of patients with alopecia areata and of patients with androgenetic alopecia. We compared the scalp with the cheek and the flexor surface of the forearm (volar forearm). The water barrier function of the scalp SC of both patient groups, in terms of transepidermal water loss (TEWL), was almost comparable to that of the volar forearm, and was far better than that of facial skin. However, hydration of the scalp skin surface, as evaluated by measurement of high-frequency conductance, was markedly higher than that of facial skin, and showed significantly higher values than the volar forearm. These characteristics seem to be dependent, at least to some extent, on the amount of sebum-derived skin surface lipids because these were abundant on the scalp skin. Moreover, removal of skin surface lipids led to a significant decrease in skin surface hydration. The superficial corneocytes, the size of which reflects the proliferative activity of the epidermis, were substantially smaller on the scalp than on the volar forearm but significantly larger than on the cheek. These findings suggest that the rate of turnover of the scalp epidermis is intermediate between that of the facial and volar forearm epidermis. We conclude that the SC of the scalp skin in humans is functionally distinct from that of the face and extremities.

Adolescent↗

PubMed1999

Predictive value of fetal scalp blood lactate concentration and pH as markers of neurologic disability.

OBJECTIVES: We aimed to analyze the predictive value of the fetal scalp blood lactate concentration and pH, especially in regard to outcome variables that are strong predictors of impaired long-term outcome. An additional aim was to establish cutoff lactate levels in fetal scalp blood. STUDY DESIGN: We conducted a retrospective study of all patients who had fetal scalp blood sampling performed because of an ominous fetal heart rate pattern at Huddinge University Hospital from October 1993 to October 1998. Fetal scalp blood sampling was performed in 1709 patients. The pH and the lactate concentration were determined in fetal scalp blood of 1221 and 814 of these patients, respectively. Outcome variables included pH <7.0 in umbilical artery blood; base deficit >16.0 mmol/L in umbilical artery blood; Apgar scores <7 at 1 minute, <7 at 5 minutes, and <4 at 5 minutes; and hypoxic-ischemic encephalopathy. RESULTS: Sensitivity and specificity were generally higher in the lactate group than in the pH group, particularly in relation to an Apgar score <4 at 5 minutes and moderate to severe hypoxic-ischemic encephalopathy. In 326 patients the scalp blood lactate concentration and pH value had been obtained at the same time, thus allowing a comparison between these methods. The areas under the receiver operating characteristic curves were significantly higher for the lactate concentration than for the pH value with 2 outcome variables: Apgar score <4 at 5 minutes (P =.033) and moderate to severe hypoxic-ischemic encephalopathy (P =.015). CONCLUSIONS: Our findings suggest that determination of the lactate concentration in fetal scalp blood is a more sensitive diagnostic tool than is determination of the pH value for predicting either an Apgar score <4 at 5 minutes or moderate to severe hypoxic-ischemic encephalopathy. In previous studies we also showed lactate measurements to be more often successful than pH analysis. Therefore we consider the measurement of lactate in fetal scalp blood to be an attractive alternative to pH analysis, and determination of the lactate concentration in fetal scalp blood seems to be a useful tool for monitoring the condition of the fetus. A suitable cutoff limit for fetal scalp blood lactate concentration as an indicator of fetal asphyxia could be 4.8 mmol/L.

Apgar Score↗

PubMed2002

Correlation between fetal scalp blood samples and intravascular blood pH, pO2 and oxygen saturation measurements.

OBJECTIVE: This study was designed to compare the values of blood gases in local scalp blood, obtained by scalp blood sampling, with direct measurements of fetal preductal arterial blood in fetal sheep. METHODS: Six fetal lambs were catheterized in the brachial artery and vein. Maternal oxygenation was reduced in steps from a fractional inspired oxygen concentration (FiO2) of 20 to 5% by addition of nitrogen to the inhaled gas mixture. Fetal scalp and arterial blood were sampled simultaneously at maternal FiO2 step intervals after maternal FiO2 and oxygen were stable for > 5 min. Blood pH, pO2 and oxygen saturation were measured and linear regression was performed to determine the correlation between these values. RESULTS: Scalp pH correlated well with arterial pH, whereas scalp pO2, pCO2 and oxygen saturation did not. However, when a secondary analysis was performed taking into account the effects of aerobic contamination, scalp pCO2, pO2 and oxygen saturation became highly correlated with arterial values. CONCLUSIONS: Local scalp blood oxygen saturation correlates highly with fetal preductal arterial values, when physiological artifacts are eliminated. The technique of scalp blood sampling introduces error into oxygenation saturation measurements, owing to difficulties in anaerobic sample collection. These results suggest that continuous measurement of fetal scalp oxygenation by noninvasive oximetry may be superior to direct sampling of scalp blood.

Animals↗