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Preventing chemotherapy-induced alopecia in cancer patients: is scalp cooling worthwhile?

Alopecia (hair loss) is often singled out as the most distressing side-effect of cancer chemotherapy treatment. This paper provides a comprehensive and critical review of the research literature on scalp cooling, a procedure introduced to prevent chemotherapy-induced alopecia. In spite of a considerable amount of research (both nursing and medical) over a 15-year period, the evidence on scalp cooling is inconclusive. Although concerned with a specialist issue, this paper may interest the general reader as it illustrates the value of a literature review in raising questions about current practice and in identifying issues for future research.

Alopecia↗

Tinea versicolor of the scalp.

BACKGROUND: Tinea versicolor (TV) is commonly described on the trunk without giving attention to involvement of the scalp. We examined cases with dandruff with and without TV on the body to see how frequent Malassezia furfur (M. furfur) is present in dandruff scales. METHODS: A total of 80 patients were examined mycologically using KOH preparation for the presence of M. furfur in dandruff scales. RESULTS: M. furfur was found in dandruff scales in 7 out of 20 men with TV (35%) and 5 out of 20 women with TV (25%), whereas it was absent in another 40 cases without clinical lesions of TV on the body. CONCLUSIONS: Attention must be paid to TV of the hairy scalp. Cases of dandruff, especially those accompanied with TV of the body, must be examined for the presence of M. furfur because of its prognostic significance. Positive cases should be treated accordingly.

Adult↗

Quantification of hair follicle parameters using computer image analysis: a comparison of androgenetic alopecia with normal scalp biopsies.

Computer image analysis enables large numbers of hairs to be measured in an automated fashion. In this study, we examined horizontal scalp biopsies from 10 patients with a histological diagnosis of androgenetic alopecia and 10 normal control subjects. The density of hair follicles and the ratio of terminal to vellus hairs were determined. Hair shaft, hair canal and hair follicle diameter, inner root sheath width and outer root sheath area were measured using the Chromatic Colour Image Analysis program. This study showed a statistically significant progressive decrease in size of hair canal diameters from normal terminal hairs (85.93 +/- 10.07 microns) through to androgenetic alopecia terminal (68.83 +/- 13.60 microns) and vellus hairs (28.67 +/- 5.60 microns). This pattern is also seen with hair follicle diameters; normal terminal (268.41 +/- 24.88 microns), androgenetic alopecia terminal (236.34 +/- 17.23 microns), and vellus hairs (130.88 +/- 19.96 microns). Outer root sheath areas, hair shaft diameters and ratio of terminal to vellus hairs were significantly larger in normal (18,500 +/- 4222 microns 2; 82.71 +/- 13.79 microns; 36:1; respectively) compared with androgenetic alopecia scalp biopsies (8403 +/- 3322 microns 2; 61.11 +/- 14.42 microns; 3:1; respectively), whereas inner root sheath width and density did not vary significantly. Computer image analysis can be adapted for use in clinical trials where large numbers and objectivity are critical in determining the efficacy of hair growth promoters.

Adult↗

Acquired scalp alopecia. Part I: A review.

In this two-part series we review the acquired scalp alopecias. A broad spectrum of diseases result in alopecia. In this first part we provide a framework for the assessment and diagnosis of scalp hair loss, and begin covering the individual conditions. The non-scarring alopecias covered include effluvium, androgenetic alopecia, alopecia areata, trichotillomania, and loose anagen syndrome. The scarring alopecias cause permanent pilosebaceous follicle loss; the lymphocyte-associated scarring alopecia described encompasses lichen planopilaris, discoid lupus erythematosus, pseudopelade, and follicular mucinosis. Part II will cover the neutrophil-associated and infiltrative processes causing scarring alopecia followed by the medical management of alopecia. There is particular reference to newly described conditions and progress in the understanding of older conditions. More recently characterized conditions include the loose anagen syndrome, chronic telogen effluvium, and the frontal fibrosing variant of lichen planopilaris.

Alopecia↗

Diffuse fibromatosis on the scalp in infancy: a variant of juvenile hyaline fibromatosis.

Various types of fibromatosis have been reported in infancy and early childhood. We describe an infant with diffuse fibromatosis on the scalp. A one year and five months-old girl showed a diffuse and hard mass 3 x 5 cm in diameter and no tenderness on the scalp. Two months later, the size of the mass had increased and several other tumors appeared on the lateral head. The magnetic resonance imaging (MRI) disclosed that a large and diffuse tumor had spread from the frontal to occipital head; a 'helmet-like' configuration of the tumor was exhibited on sagittal MR images. The tumor showed high signal intensity on T2-weighted images and was enhanced with Gd-DTPA. Histological examination showed a fibroblastic proliferation with intervening thick collagen bundles. The patient was diagnosed as having diffuse fibromatosis. The tumor at the resection site immediately recurred, whereas the tumor in the frontal head showed marked regression. Three months after the resection, new tumors appeared in the occipital head. The size and number of these tumors have remained unchanged for more than 18 months. The sites and appearance of the tumors were identical to that of juvenile hyaline fibromatosis (JHF) in this patient. However, JHF usually includes fibroblasts associated with large amounts of hyalinized collagen-like material, which were not present in our patient. The different histology of JHF comparing our case and other reported cases may depend on the different phase of the disease progression at resection. Long-term observation is necessary for the appropriate diagnosis and evaluation of prognosis in this patient.

Female↗

The use of tissue expanders in scalp alopecia.

This paper examines the role of tissue expansion, to correct scalp alopecia. The technique provides a means of producing sufficient hair bearing scalp to close defects which were previously not correctable. Reference is made to several surgical techniques which were found to be useful.

Adult↗

Safety and efficacy of ciclopirox 1% shampoo for the treatment of seborrheic dermatitis of the scalp in the US population: results of a double-blind, vehicle-controlled trial.

BACKGROUND: Seborrheic dermatitis is a common inflammatory skin disorder. Yeasts of the genus Malassezia have been implicated in the etiology of seborrheic dermatitis, although this connection remains controversial. Ciclopirox is a synthetic, hydroxypyridone-derived, broad-spectrum antifungal agent with anti-inflammatory properties. METHODS: A total of 499 US patients with seborrheic dermatitis of the scalp were randomized to apply either ciclopirox shampoo 1% or vehicle twice weekly for 4 weeks. The main efficacy parameters were based on 6-point ordinal scales describing the disease's signs and symptoms (scaling, erythema and itching) and a 6-point scale providing a global evaluation of the status of seborrheic dermatitis. RESULTS: Ciclopirox was significantly better than vehicle in effectively treating seborrheic dermatitis. 'Effective treatment' (score of 0 or 1 for disease status, scaling and erythema) was achieved in 26.0% of ciclopirox-treated patients compared with 12.9% of vehicle-treated patients (P = 0.0001; OR: 2.383, 95% CI: 1.494-3.799). The majority of subjects experienced adverse events that were mild in intensity, with skin and appendage reactions the most commonly reported, at similar frequency in both groups. CONCLUSIONS: Ciclopirox shampoo 1% is effective and safe in the treatment of seborrheic dermatitis of the scalp.

Administration, Cutaneous↗

Early detection of cutaneous angiosarcoma of the face and scalp and treatment with placitaxel.

Cutaneous angiosarcoma (AS) of the face and scalp of the elderly is a rare malignant tumour with a very poor prognosis. The variable presentation and the benign appearance of the cutaneous AS may often delay the correct diagnosis. Because it is extremely aggressive, only early detection and treatment can modify the prognosis. We describe a case of an old man who was diagnosed of AS of the face and scalp 1 month after developing the cutaneous lesion. After treatment with placitaxel, the lesion completely diminished. Unfortunately, he developed pulmonary fibrosis and died 6 months after diagnosis. Predisposing factors of this entity are also discussed.

Aged↗

Subcutaneous oxygen tension in the fetal scalp during labour continuous monitoring with a needle electrode.

Continuous intrapartum PO2 recordings were made in 25 fetuses, using a needle electrode that measures PO2 in the subcutaneous (sc) tissue of the scalp or the breech. This small electrode is combined with a spiral ECG electrode and can be easily applied in early labour. One hour after application of the electrode in the early first stage, a mean fetal scPO2 of 29.4 +/- 7.5 mm Hg was found. In the course of labour, scPO2 gradually fell to a mean value of 22.2 +/- 5.6 mm Hg, recorded just before the onset of bearing down contractions, and stabilised in the second stage of labour. ScPO2 values of less than 20 mm Hg were not recorded for a longer period except in one case of severe fetal distress. The relation between scPO2 just before delivery and cord arterial PO2 revealed a coefficient of correlation of 0.85. In general, scPO2 appeared higher than tcPO2 as described in the literature. This is ascribed to the different technique of measurement: the needle electrode measures in the deeper layers of the scalp, whereas the tc electrode is supplied with oxygen form the more superficial capillaries, where blood flow is more liable to be affected by mechanical factors.

Electrodes↗

Scalp reduction for alopecia.

A 17-year-old boy had a large, scarred area of alopecia from a thermal burn. Forty square centimeters of scarred scalp skin were excised in six sessions. The cosmetic result was excellent. Neither hypertrophic nor keloidal scarring supervened. The technique of scalp reduction and its procedure as an adjunct to hair transplantation is discussed.

Adolescent↗

Transplantation of single hairs from the scalp as eyelashes. Review of the literature and a case report.

Japanese dermatologists have successfully used single-hair grafts and grafts of two and three hairs for the reconstruction of eyebrows, eyelashes, pubic hair, and alopecic scars in scalps. A brief review of the Japanese literature and surgical technique is given followed by a case report of transplantation of hairs from the scalp as lashes by the author's modification of the Japanese technique.

Adult↗

Scalp reduction as an adjunct to hair transplantation. Review of relevant literature and presentation of an improved technique.

The literature on scalp reduction is reviewed and an improved technique of scalp reduction is presented. The amount of bald skin that can be excised by the author's technique exceeds that previously reported by two to three times. The technique rests on tried principles of wide undermining in the galeal-periosteal plane, use of serial relaxing incisions in the galea, closure of specifically designed flap edges under increased tension, and the administration of adrenocorticosteroids postoperatively.

Alopecia↗

Basal-cell carcinomas on the scalp of a black patient many years after epilation by x rays.

The development of skin cancers in areas treated with X rays for benign dermatoses has not been common. Moreover, basal-cell carcinomas in blacks are exceedingly rare. We report successive development of two basal-cell carcinomas in the hair-covered scalp of a black man three decades after he had undergone epilation of the scalp by X rays of tinea capitis while a youth.

Black People↗

Scalp reduction surgery with the carbon dioxide laser.

When used in the focused cutting mode, the carbon dioxide (CO2) laser can permit virtually bloodless scalp reduction surgery as a function of its remarkable hemostatic properties. This instrument speeds the operating time and allows the surgeon to close the wound with confidence that postoperative bleeding is unlikely to compromise the results. The additional potential benefits of decreased swelling and pain due to sealing of lymphatics and nerve endings are more difficult to quantify. It appears that the CO2 laser offers many benefits in scalp reduction surgery and is a useful modification of the standard technique.

Carbon Dioxide↗

Nonsurgical management of an electrical burn of the scalp.

The remarkable regenerative capability of the scalp reduces the need for skin grafting in electrical burns of this area. We report on a deep 7.5 cm electrical burn of the scalp which healed completely under conservative management with 20% urea compresses, benzoyl peroxide gel, and systemic erythromycin.

Accidents, Occupational↗

New instrumentation for scalp reduction.

We have reviewed modifications in scalp reduction instrumentation that have enabled the physicians of the group to substantially reduce patient discomfort and operative time. Simultaneously, we are assured that the risk of errors relative to the optimal size of the excisions, correct plane of undermining, and the possibility of excessive blood loss are minimized. The incorporation of this instrumentation has reduced the average scalp reduction procedure time, in our hands, from 70 to 35 minutes without increasing the complication rate.

Hair↗