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PubMed2005

Clinical diagnosis of common scalp disorders.

Scalp skin is unique on the body due to the density of hair follicles and high rate of sebum production. These features make it susceptible to superficial mycotic conditions (dandruff, seborrheic dermatitis, and tinea capitis), parasitic infestation (pediculosis capitis), and inflammatory conditions (psoriasis). Because these scalp conditions share similar clinical manifestations of scaling, inflammation, hair loss, and pruritus, differential diagnosis is critically important. Diagnostic techniques and effective treatment strategies for each of the above conditions will be discussed.

Adult↗
PubMed1988

Pustular ulcerative dermatosis of the scalp.

Six young African patients are described with erosive pustular scalp lesions leading to extensive ulceration. No bacterial or fungal cause was found. Biopsies showed non-specific changes of atrophy with subacute or chronic inflammation. Four patients were malnourished and anaemic and three were infested with hookworm. The condition did not respond to antibiotics. Healing was obtained in one patient with systemic steroids. The relationship of this disorder to erosive pustular dermatosis of the scalp and to pyoderma gangrenosum of atypical distribution is discussed.

Adolescent↗
PubMed1992

Seborrhoeic dermatitis of the scalp--a manifestation of Hailey-Hailey disease in a predisposed individual?

A 59-year-old man was found to have typical Hailey-Hailey disease of the back, neck and axillae. In addition, he had fine white scaling in the scalp and postauricular areas. Despite the clinical appearance of seborrhoeic dermatitis, a biopsy of his scalp showed prominent suprabasal epidermal separation with acantholysis. We propose that in a genetically predisposed individual, Hailey-Hailey disease can assume atypical and non-specific appearances.

Acantholysis↗
PubMed1993

Severe skin erosions and scalp infections in AEC syndrome.

Hay-Wells syndrome is an autosomal dominant condition characterized by ankyloblepharon filiforme adnatum, ectodermal dysplasia, and cleft palate with or without associated cleft lip (AEC syndrome). Although several reported patients had eroded skin at birth and recurrent scalp infections, these are not generally regarded as major features of the disorder. In our experience, denuded skin at birth and chronic scalp erosions complicated by infection are common features of this syndrome. Aggressive wound care in conjunction with early administration of topical or systemic antibiotics is suggested.

Abnormalities, Multiple↗
PubMed1997

Erosive pustular dermatosis of the scalp in skin grafts: report of three cases.

Three patients developed erosive pustular dermatosis of the scalp (EPDS). Two of them, both males, had previously undergone surgical excision for squamous cell carcinoma and basal cell carcinoma, and a female experienced avulsive trauma of the scalp. The erosive lesions and crusts were located at the site of a skin graft; microbiological cultures were negative for bacterial and fungal growth. Histological examination ruled out pustular bullous disorders. Topical therapy with corticosteroids and antibiotics resulted in clinical remission in only 2 cases. The third case showed a tendency to recur despite numerous therapeutic attempts with oral dapsone and isotretinoin. We conclude that surgical trauma is a possible cause of EPDS. Our patients seem to be the first reported cases of EPDS in skin grafts following plastic surgical procedures.

Administration, Cutaneous↗
PubMed1995

Angiosarcoma of the scalp. A case with a particularly aggressive evolution.

A 80-year-old woman presented with a spontaneously bleeding wound on her scalp. The diagnosis of angiosarcoma was made based on histopathological examination of the second biopsy 1 month later. At that time, a large hematoma was present on the scalp and forehead with two bleeding erosions and numerous small blue-black nodules as well as a right cervical lymphadenopathy. The patient was treated by wide-field electron-beam radiotherapy, which showed no effect. The particularly aggressive evolution of this angiosarcoma led to death within less than 2 months.

Aged↗
PubMed2001

[Persistent scalp infestation by Dermanyssus gallinae in an Emilian country-woman].

A case of persistent infestation of the scalp due to Dermanyssus gallinae.--Infestation due to Dermanyssus gallinae, the common red mite of poultry, in a country-woman aged 69 years from Crevalcore (Emilia-Romagna region, Northern Italy), is described. The case was unusual either for its location, the scalp, and for its persistence, 9 months. Specimens of the mite were also found in the henhouse adjacent to the patient's house. Apparently the woman recovered by means of daily washing of camomile tea.

Acetic Acid↗
PubMed1979

[Histological differential diagnosis of psoriasis vulgaris and seborrheic eczema of the scalp].

The clinical differential diagnosis between seborrheic dermatitis and psoriasis vulgaris of the scalp can be difficult. We, therefore, tried to elaborate histopathological criteria for a differentiation of the two dermatoses. Forty excisional biopsies were analysed without knowing the clinical diagnosis. The histopathological substrate within the epidermis is characterized in psoriasis by dermatitis-like and in seborrheic dermatitis by psoriasis-like alterations. Therefore, in some cases a definite histopathological diagnosis could not be made. Strong criteria favouring psoriasis are: moderate condensed hyperkeratosis with alternating parakeratosis, PAS-reactive serum inclusions and Munro abscesses within the horny layer, spongiform pustles and neutrophilic leukocytes within the epidermis. Strong criteria for seborrheic dermatitis are: irregular acanthosis with relatively thin condensed orthoor parakeratotic horny layer, spongiosis and spongiotic vesicles, exocytosis of lymphocytes and the lack of any hard criterias for psoriasis. The results may suggest that seborrheic dermatitis of the scalp may transform into psoriasis in patients with a genetical disposition ("psoriatic diathesis", "latent psoriasis") via a Köbner reaction. The existence of the seborrheic dermatitis (Morbus Unna) is not doubted by these investigations.

Biopsy↗
PubMed1987

[Erosive pustulous dermatitis of the scalp].

We present a 46-year-old female patient suffering from progressive, pustular and erosive lesions of the scalp. The nosology and the differential diagnosis of this disease entity, called erosive pustular dermatosis of the scalp, are discussed.

Alopecia↗
PubMed2004

Photodynamic therapy with aminolevulinic acid topical solution and visible blue light in the treatment of multiple actinic keratoses of the face and scalp: investigator-blinded, phase 3, multicenter trials.

OBJECTIVE: To determine the safety and efficacy of photodynamic therapy (PDT) using 20% wt/vol aminolevulinic acid hydrochloride (hereinafter "ALA") and visible blue light for the treatment of multiple actinic keratoses of the face and scalp. DESIGN: Randomized, placebo-controlled, uneven parallel-group study. INTERVENTIONS: Patients (N = 243) were randomized to receive vehicle or ALA followed within 14 to 18 hours by PDT. Follow-up visits occurred 24 hours and 1, 4, 8, and 12 weeks following PDT. Target lesions remaining at week 8 were re-treated. MAIN OUTCOME MEASURE: Clinical response based on lesion clearing by week 8. RESULTS: Most patients in both groups had 4 to 7 lesions. Complete response rates for patients with 75% or more of the treated lesions clearing at weeks 8 and 12 were 77% (128/166) and 89% (133/149), respectively, for the drug group and 18% (10/55) and 13% (7/52), respectively, for the vehicle group (P<.001, Cochran-Mantel-Haenszel general association test). The 95% confidence interval for the difference in response rates at week 8 was 46.9% to 71.0% and at week 12, 65.3% to 86.3%. The week 12 response rate includes 30% of patients who received a second treatment. Most patients experienced erythema and edema at the treated sites, which resolved or improved within 1 to 4 weeks after therapy, and stinging or burning during light treatment, which decreased or resolved by 24 hours after light treatment. CONCLUSION: Findings indicate that topical ALA PDT is an effective and safe treatment for multiple actinic keratoses of the face and scalp.

Administration, Topical↗
PubMed2006

Special concern about squamous cell carcinoma of the scalp in organ transplant recipients.

BACKGROUND: Several risk factors are generally accepted to portend more aggressive behavior of cutaneous squamous cell carcinoma. These include tumor size, tumor depth, histologic subtype, location on the lip or ear, tumor arising in scar, recurrent tumor, and tumor demonstrating perineural invasion. Organ transplant recipients can have significant morbidity and mortality from squamous cell carcinoma. OBSERVATIONS: Four organ transplant recipients developed metastatic disease from squamous cell carcinoma of the scalp. CONCLUSIONS: Squamous cell carcinoma of the scalp in organ transplant recipients should be considered a high-risk tumor because of its anatomic location. Margin-controlled tumor extirpation, sentinel lymph node biopsy, and adjuvant radiation therapy should all be considered in the organ transplant recipient population.

Adult↗
PubMed1999

Fetal scalp cysts--dilemmas in diagnosis.

Detection of fetal scalp cysts may pose diagnostic challenges in terms of differentiating between structures whose origin is ectodermal, so presumed benign, and neuroectodermal, potentially having neurological significance. We describe the first case of a fetal scalp dermoid cyst to be detected antenatally and discuss the concept of sequested meningoceles which may not have neurological consequence but can be associated with other structural abnormalities.

Adult↗
PubMed2001

On the utility of fine-needle aspiration in the diagnosis of primary scalp lesions.

A study of the clinico-cytologic findings of 62 primary palpable lesions located in the scalp is reported. Trichilemmal cyst (16 cases) followed by lipoma (8 cases) and benign melanocytic proliferation (4 cases) were the most frequent benign conditions (n = 45); basal-cell carcinoma (6 cases) and squamous-cell carcinoma (5 cases) were the most frequently aspirated malignant tumors (n = 17). In the cytologic category of benign lesions (n = 45), cytohistologic correlation was carried out in 19 cases and the cytohistologic agreement was 100%, except for the three actinic keratosis cases that were diagnosed as atypical epidermal lesions. Cytohistologic agreement was 100% in the 16 malignant lesions in which excisional biopsy was performed. Based on the findings reported here, fine-needle aspiration is indicated as the first-choice technique for the clinical evaluation of primary scalp lesions. Experience with cutaneous cytopathology is essential in order to be able to carry out this task.

Adolescent↗
PubMed1988

Congenital scalp skull defects with distal limb anomalies (Adams-Oliver syndrome--McKusick 10030): further suggestion of autosomal recessive inheritance.

We describe a man with manifestations of the Adams-Oliver syndrome: congenital scalp defect with hypoplastic fingers and toes. The patient has normal first-cousin parents: among seven sibs, three sisters and two brothers are normal; two brothers born with the same scalp lesion died as a consequence of bleeding from this abnormal area. There is no evidence of other affected relatives. The family of our patient is suggestive of autosomal recessive inheritance of this disorder with phenotypic manifestations identical to those present in the autosomal dominant form. Dermatoglyphic findings are discussed.

Abnormalities, Multiple↗
PubMed1994

Scalp-ear-nipple syndrome: additional manifestations.

Scalp-ear-nipple (SEN) syndrome is a rare, autosomal dominant condition that causes aplasia cutis congenita of the scalp, alteration of the shape of the external ear, and hypoplasia of the nipple. Women in a new family, the fifth to be described, had virtually complete aplasia of the breast and a small skin dimple without any pigmentation instead of a normal nipple, although other affected women had normal breast and nipple development. Dental changes included widely spaced or missing secondary teeth; the ears were cupped or folded and stood out from the head, axillary apocrine secretion and axillary hair growth were reduced; and finger nails were brittle. There was no generalized abnormality of sweating. Some patients had partial syndactyly of the 3rd and 4th fingers, and complete cutaneous syndactyly of the 2nd and 3rd toes. and 3rd toes.

Abnormalities, Multiple↗
PubMed2003

Cutaneous angiosarcoma of the scalp: a multidisciplinary approach.

BACKGROUND: Angiosarcoma is a malignant tumor of vascular endothelial cells that arises in the head and neck. It is a rare, difficult to treat, and lethal tumor. METHODS: Clinical data from patients who were diagnosed with angiosarcoma of the scalp between 1975 and 2002 at the University of Michigan were reviewed. Analysis was performed to assess for factors impacting time to recurrence and survival. RESULTS: The study was comprised of 29 patients with a median age of 71.0 years. Most patients presented after a delay in diagnosis with either a bruise-like macule (48.3%) or a nonbruise-like nodule (51.7%). Seventy-five percent of patients had pathologic Stage T2 disease, and 76% of patients had high-grade tumors. Virtually all patients underwent surgical excision (96.6%); however, negative surgical margins were achieved in only 21.4% of patients. Multiple lesions on presentation were associated with a shorter time to recurrence (P = 0.02). The median actuarial survival was 28.4 months. Younger patients and patients with Stage T1 disease had improved survival (P = 0.024 and P = 0.013, respectively). Radiation therapy was associated significantly with a decreased chance of death (hazard ratio, 0.16; P = 0.006). CONCLUSIONS: Although surgery remains the first option for the treatment of patients with angiosarcoma of the scalp, achieving negative margins often is impossible. Patients who are younger and who have less extensive disease fare better. Postoperative radiation therapy should be employed routinely, as it may lead to improved survival.

Adult↗
PubMed2003

Aperiodic phase re-setting in scalp EEG of beta-gamma oscillations by state transitions at alpha-theta rates.

We evaluated the rapid changes in regional scalp EEG synchronization in normal subjects with spatial and temporal resolution exceeding prior art 10-fold with a high spatial density array and the Hilbert transform. A curvilinear array of 64 electrodes 3 mm apart extending 18.9 cm across the scalp was used to record EEG at 200/sec. Analytic amplitude (AA) and phase (AP) were calculated at each time step for the 64 traces in the analog pass band of 0.5-120 Hz. AP differences approximated the AP derivative (instantaneous frequency). The AP from unfiltered EEG revealed no reproducible patterns. Filtering was necessary in the beta and gamma ranges according to a technique that optimized the correlation of the AP differences with the activity band pass filtered in the alpha range. The sizes of temporal AP differences were usually within +/-0.5 radian from the average step corresponding to the center frequency of the pass band. Large AP differences were often synchronized over distances of 6 to 19 cm. An optimal pass band to detect and measure these recurring jumps in AP in the beta and gamma ranges was found by maximizing the alpha peak in the cospectrum of the correlation between unfiltered EEG and the band pass AP differences. Synchronized AP jumps recurred in clusters (CAP) at alpha and theta rates in resting subjects and with EMG. Cortex functions by serial changes in state. The Hilbert transform of EEG from high-density arrays can visualize these state transitions with high temporal and spatial resolution and should be useful in relating EEG to cognition.

Alpha Rhythm↗
PubMed1994

Measurement of temafloxacin in human scalp hair as an index of drug exposure.

Scalp hair samples were obtained at 1-month intervals up to 3 months from healthy male volunteers participating in a phase I study of a new antimicrobial quinolone, temafloxacin. Hair was sectioned into 1-cm lengths from the scalp end. After corresponding portions from 10 pieces of hair were dissolved in 1 N NaOH, temafloxacin was extracted by chloroform and measured by HPLC equipped with fluorescence detection (excitation and detection wavelengths, 280 and 460 nm, respectively). In all subjects taking a single oral dose (600 mg; n = 6) or repeated oral doses (900 mg/day, b.i.d., for 6.5 days; total, 5850 mg; n = 6), the drug was detected in hair. The 1-cm length of hair, in which temafloxacin was peaked, was shown to move at the rate of 1 to 1.3 cm/month when the hair of growing stage was analyzed. The largest sum of the concentrations of temafloxacin found in any set of measurements in hair in each subject was 31.7 +/- 15.0 (mean +/- SD, n = 6) and 226.3 +/- 99.4 ng/mg hair (n = 6) for the single and repeated doses, respectively. The drug concentration in hair increased by a factor of 7.1, whereas the ratios between the single and repeated doses were 9.8, 1.3, and 10.7 for the total given dose, observed maximal plasma concentration (Cmax), and area under the plasma concentration curve, respectively. It was obvious that the Cmax was the least likely factor determining temafloxacin concentration in hair.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗