Aplasia cutis congenita and low molecular weight heparin.
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Indications for biopsy of scalp skin are discussed and the technique for obtaining adequate tissue for histologic examination is described.
Fourteen cases of complications from implantation of acrylic fibers into scalps for correction of male-pattern baldness were studied. The complications were severe enough in all of them to force attempts to remove the fibers, many of which from the nature of their knotted insertion could not be extracted. Thus, immediate complications were encountered and serious, delayed, bad effects are anticipated. Among the early complications already observed are marked edema of the face; hemorrhagic oozing; microbial infection; foreign-body reactions; scarring; acneform comedones and pustules; pain, pruritus, and numbness; and loss of natural hair. Complications in the furture are likely to be progressive sclerosis from irretrievable fragments and knots of the artificial materials and conceivably malignant degeneration of tissues of the scalp. For all of these known and possible bad effects, implantation of present-day synthetic fibers into the scalp must be judged to be a dangerous practice that must be stopped at once.
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Thatching (simple interrupted suture implant) can be corrected by removing the interrupted sutures. To date, no method has been devised to totally eradicate the problem of multiple suture implants; this is particularly true for knotted-fiber implants. Various corrective methods have been discussed. These techniques were performed to counteract the damage caused by implant procedures. The techniques and their ensuing complications are based on the author's experience with 127 patients. In selected cases, autograft punch and excision with rotation flaps appeared to be the most cosmetically acceptable surgical approach to the hair and fiber implant problem.
An unusual case of pyogenic granuloma is presented. Clinical and histological features of this lesion are reviewed. Differential diagnosis, common variants, and treatment modalities are also discussed.
A 63-year-old cachectic white male developed subcutaneous scalp nodules. Clinically these were felt most likely to represent metastatic tumor, although the patient was known to have rheumatoid arthritis. Aspiration cytology was interpreted as malignant due to the presence of atypical cells, but tissue biopsies demonstrated necrotizing palisading granulomas. The diagnostic hazard of cellular atypia in rheumatoid nodules is discussed.
Multiple pyogenic granuloma-like lesions occurring at punch graft sites are an unusual complication of hair transplantation heretofore unreported. While the etiology and pathogenesis of such lesions remain elusive, physicians performing hair transplantations should be aware of this potential sequela.
We describe the successful use of the carbon dioxide (CO2) laser for localized surgical therapy in a patient with perifolliculitis capitis abscedens et suffodiens that was refractory to conservative treatment.
Recipient hair transplant plugs may heal into place with palpable, and unfortunately, visible borders. This appearance, called "cobblestoning," is reminiscent of the bumps in a cobblestone street. The author presents a new, rapid method of suturing transplanted plugs that greatly reduces cobblestoning, virtually eliminates traumatic plug loss, and facilitates row-by-row hair transplantation. Additionally, postoperative bandaging is not necessary, shower cleansing may commence within hours, and postoperative activity may be unlimited.
Dissecting folliculitis of the scalp can develop into an extensive, hypertrophic scarred lesion that is unresponsive to routine treatment. In these situations, radical excision of the affected area and concurrent perioperative treatment with isotretinoin (13-cis-retinoic acid) may be effective. The authors describe a case, illustrating the successful clinical application of this technique.
BACKGROUND: The differential diagnosis of nodular scalp lesions in a child is surprisingly extensive. OBJECTIVE: To present a case of eosinophilic granuloma that was manifested by a scalp mass in a pediatric patient. METHODS: The case is presented and the relevant literature is reviewed. CONCLUSIONS: The seriousness of some of these lesions requires a thorough evaluation, including noninvasive imaging, and carefully planned surgical intervention so that effective diagnosis and treatment are ensured. Surgical exposure of unsuspected central nervous system connections may lead to infection, hemorrhage, seizures, or other significant morbidity and mortality.
BACKGROUND: Adequate preparation of the skin is necessary for a successful chemical peel. Little detailed attention has been given to the effect of degreasing on the efficacy of the peel. OBJECTIVE: To assess the influence of degreasers on the peel, compare their flammabilities, and discuss alternatives. METHODS: Six patients with androgenetic alopecia and widespread actinic keratoses of the scalp were treated with 35% trichloroacetic acid. Scalps were divided into sections and degreased with acetone, rubbing alcohol, Freon Skin Degreaser, or Hibiclens. The influence of these degreasers on trichloroacetic acid peels was assessed by clinical and histologic examination. CONCLUSION: Acetone was not found to be superior to the other agents. Furthermore, the flashpoint of acetone is markedly lower than the others, making it more flammable and hazardous in the workplace. The use of alternative degreasers may lessen or eliminate this hazard.
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