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[Erosive pustular dermatosis of the scalp. A new entity or a variant of pyoderma vegetans].

We report on a 69-year-old woman suffering from an erosive pustular and crusted lesion of the scalp having persisted over years. There could not be found any external cause, and a large number of different physical and medicamental therapies failed. Prompt healing was achieved, however, after a low serum zinc level was corrected by a zinc preparation administered orally.-The dermatosis described closely resembles the so-called "erosive pustular dermatosis of the scalp". A search of the earlier dermatological literature supported our view that this is not a new disease, but rather a variant of pyoderma vegetans, a disease showing extremely variable clinical and histopathological features.

Aged↗

New multipronged fetal scalp electrode: a preliminary report.

Presented is a preliminary report of the use of a new type of scalp electrode (patent pending), which, because of its design, may have the advantage of improved safety. It was used on 40 patients in labor. To confirm the quality of the recording, in all cases, a fetal electrocardiogram was also obtained. Application was achieved on the first attempt in 37 cases in two additional cases on the second attempt. There were no reported cases of the electrode being dislodged during labor. The quality of the recording was reported to be good. There were no reported cases of trauma to the fetal scalp nor were there any cases of infection noted.

Electrodes↗

Fetal scalp electrode complications: cerebrospinal fluid leak.

A newborn with cerebrospinal fluid leakage secondary to a fetal scalp electrode is presented. Although infrequent complications from fetal scalp electrode monitoring may be significant. Personnel using these monitoring devices should be alert to possible complications.

Cerebrospinal Fluid↗

[Mucinous adenocarcinomas of the scalp. Anatomo-clinical, histochemical and ultrastructural study of a case and a review of the literature].

The third recurrence of a primary mucinous adenocarcinoma of the right parietal scalp was studied by histochemistry and electron microscopy. Histochemically the mucin produced by this neoplasm was of the sialomucine type. Electron microscopy revealed a high differentiated tumour whose cells looked like eccrine mucinous ones. The natural history of this carcinoma is similar to that of 33 ones already published. The tumours, round and elevated, grow in 75 p. 100 of the cases in patients over 50 years of age. They are located on the face or the scalp and more rarely on the trunk. Such tumours are frequently misdiagnosed as carcinomas. But the knowledge of thier morphological and histochemical features should lead to the right diagnosis all the more since the various biological and radiological investigations do not discover other primary neoplasm. Besides if these neoplasms are not metastases they are quite different from the other sweat gland carcinomas. They have a better prognosis than these tumours. However they give local recurrences, lymph node or subcutaneous metastases and a fatal issue in 6 p. 100 of the cases.

Adenocarcinoma↗

Study of some minerals in scalp hair and blood sera of psoriatics.

Scalp hair and blood sera of two groups of psoriatic individuals were examined regarding some of their mineral contents by flame photometric and colorimetric procedures, and the findings compared with a normal control group. The result obtained revealed changes in the mineral content of scalp hair of psoriatics. A possible relationship may exist between hair and serum minerals.

Adolescent↗

Calcification of superficial scalp veins secondary to intravenous infusion of sodium bicarbonate and calcium chloride.

Soft tissue calcification has been reported following the intramuscular injection of calcium salts and the intravenous administration of calcium gluconate. The present case report describes a neonate in whom calcification of the superficial scalp veins developed following administration of calcium chloride and sodium bicarbonate through a scalp vein needle.

Bicarbonates↗

[Association of a melanoma and a spinocellular epithelioma on a burn scar of the scalp].

A thirty-nine-year-old caucasian man presented with an ulceration of the scalp, developing on an alopecia. The scalp indeed had been burnt by boiling water when the boy was two. During childhood and youth microtraumatisms induced superficial wounds which always healed easily. Nine months ago, a new ulceration followed a new trauma; the wound did not heal, and lay on a dark brown area. A biopsy diagnosed a malignant melanoma. The whole alopecic area was resected, under the ulceration and the pigmented area, as well as the external surface and the diploe. The defect was covered with a free transplant of omentum, revascularized by microsurgical anastomoses to the external carotid artery and the external jugular vein in the parotid bed. The omentum was immediately covered with split-thickness skin grafts. Histologic investigations demonstrated the association of a melanoma developing on a Hutchinson melanotic freckle and a squamous cell carcinoma.

Adult↗

Scalping: the savage and the surgeon.

The treatment of the scalped patient has challenged and fascinated the surgeon for over two millennia. It is an esthetically disastrous mutilation, and the resultant soft tissue defect is a form of trauma calling for the surgeon's most creative efforts. The story of scalping is the story of innovative surgeons, both renowned and obscure, which parallels the development of plastic surgery.

Adult↗

Aggressive basal cell carcinoma of the scalp.

Three examples of an unusually aggressive form of basal cell carcinoma in the skin of the scalp were treated surgically. The extent of each tumor was verified with gross and microscopic examination. The tumors invaded fat, muscle, fascia, and bone. Dural involvement was seen in one case. Light microscopy showed a marked variation in growth patterns and cytologic types from one portion of the tumor to another. Characteristics included a diffusely infiltrating pattern with a fibrotic stromal response, rare intraepidermal tumor nests, formation of occasional duct-like structures, poor cellular cohesion with single-life invasion through dermal collagen, perineural invasion, and pleomorphism with varying nuclear cytoplasmic ratios. Basaloid populations with peripheral palisading were seen in each tumor. These malignancies may be representative of an unusual basal cell carcinoma variant unique to the scalp.

Adult↗

[How are the Blaschko lines arranged on the scalp?].

Linear inherited or nevoid skin lesions mostly follow a characteristic pattern which was delineated by Blaschko in 1901. The system of lines published by this author covered the entire human body, with the exception of the scalp because of lack of pertinent case reports regarding this area. We here report an observation which enables us to fill the blank area in the atlas of the lines of Blaschko. On the scalp of a girl affected with the oral-facial-digital syndrome, we observed an alopecia distributed in several spiral streaks. The pattern resembled that of the normal vertex, but the direction of the hairless streaks did not correspond completely to the direction of hair growth. As the oral-facial-digital syndrome is inherited as an X-linked dominant trait, the linear alopecia probably reflects functional X-chromosome mosaicism. Arguments are presented in favor of the assumption that the hairless streaks of this child follow the lines of Blaschko.

Abnormalities, Multiple↗

Treatment of psoriasis of the scalp with coal tar gel and shampoo preparations.

Psoriatic lesions on the scalp are cosmetically troublesome and present problems for therapy, particularly over a long-term period. A gel containing refined coal tar in solution (psoriGel) was effective in clearing or markedly improving psoriasis of the scalp in 83 percent of 112 patients. The study population included thirty-five patients who were unresponsive to other therapies. The treatment regimen described here used tar gel for five days, vegetable oil soaking for the sixth day, and no treatment on the seventh day. This procedure reduced considerably the tendency of tar gel to cause drying of the skin. Fifty percent of the patients remained in remission for about three months using a nontar shampoo. However, using a tar shampoo (Ionil T), the median remission time was extended to over eight months with 30 percent of the patients still in remission thirteen months later. No adverse reactions were reported.

Adolescent↗

Surgical treatment of the totally avulsed scalp.

Scalp avulsion is associated with significant physical and psychological morbidity. In the past, extended hospitalizations and multiple procedures to achieve coverage were the rule and the chronic morbidity of partial thickness coverage was high. Microvascular surgery now allows an initial chance for successful replantation or a subsequent one-stage reconstruction with well-vascularized tissue with a 90 per cent chance of success. The use of the free latissimus dorsi muscle has been a significant advance in this regard. When progress in immunologic research allows allotransplantation with little morbidity, scalp transplantation may become a useful reconstructive tool.

Female↗

Surgical management of the burned scalp.

Alopecia from scalp burns can present psychological problems. Reconstructive surgery with rotating hair-bearing skin flaps has been useful in the rehabilitation of these patients. In many patients, one flap shift can establish an acceptable hair line. In extensive cases, multiple operations are necessary, including fractional excision of small burns that have been skin-grafted or fractional excision of the donor site when large hair flaps were rotated. It is remarkable how the occipital flap can reach the forehead by a series of transfers without delay, using a rotation of 90 to 180 degrees. Worthen presented an interesting case of revascularization of the skull in a victim of an electrical burn. In conclusion, scalding hot liquids accidentally spilled on the young child's scalp will produce a deep burn with loss of hair. Small areas of alopecia that are skin-grafted can be handled by staged fractional excision. The hair line can be reestablished in larger areas of alopecia by a series of operative procedures that require years to accomplish. When the periosteum of the skull is affected, resection of the outer table of bone and skin grafting will expedite wound healing.

Alopecia↗

Retroperitoneal liposarcoma metastatic to scalp.

Metastasis of liposarcoma to the scalp occurred in a 50-year-old-man. Review of the literature disclosed no documented reports. Although cutaneous metastases from internal malignancies are of relative infrequent occurrence, such metastases may be limited to the scalp and a diagnosis can be established by a biopsy.

Humans↗

[Surgical treatment of basal-cell epitheliomas of the scalp and ear (author's transl)].

Basal-cell epitheliomas of the scalp are frequently observed on pre-existing chronic lesions: radiodermatitis or Jadassohn's sebaceous naevus. In cases where no irradiation has been given, basal-cell epitheliomas of the scalp should be treated by simple surgical excision. When irradiation has been applied, deep invasion must be recognized as an insufficient excision can often be fatal.

Basal Cell Carcinoma↗

The strip scalp graft.

Hair transplantation for male pattern baldness has been done on many patients by dermatologists and plastic surgeons during the past 20 years. In selected cases, hair transplantation has been successful for adequate replacement of hair in bald areas of the scalp. In most cases, the punch graft technique alone is used. However, in selected cases, especially in younger individuals desiring a dense growth in the frontal area, the strip graft in conjunction with punch grafts can be used. When the strip graft operation is properly executed, the results are very gratifying. My most impressive results have been with those who have had the strip graft operation combined with the punch graft method (Figs. 13 and 14). The strip graft, like the punch graft, has proved to be extremely versatile. It can be transplanted in any conceivable direction and in any area of the scalp. It may be twisted into any desired shape so as to conform to any recipient site. It can also be made short or long and may be cut into smaller strips or even into small square grafts. If careful attention is paid to the simple steps of the operation discussed in this article, a surgeon will usually be rewarded with a good take of the strip graft.

Adult↗

Angiosarcoma (angioendothelioma) of the scalp. An unusual case of scarring alopecia.

Angiosarcoma with initial involvement of the scalp is a rare, malignant neoplasm. We present the case of a 77-year-old woman in whom extensive scarring alopecia developed that was proved histologically to be due to angiosarcoma. She had a good initial response to treatment with electron-beam therapy, but after seven months, extensive nodules and indurated areas on the face beyond the borders of the radiation field developed. Subsequently, massive cervical adenopathy and metastases to the lungs, liver, and spleen developed. Angiosarcoma must be differentiated from other malignant blood vessel tumors and should be considered in the differential diagnosis of scarring alopecia of the scalp in elderly patients.

Aged↗

A case of angiosarcoma of the scalp.

This is a report of a second case of angiosarcoma of the scalp occurring in an Oriental. In spite of surgical excision, radiotherapy and chemotherapy the tumour not only recurred but new lesions appeared. She developed liver metastases and died from chest complications 4 1/2 years after the initial presentation of the tumour. The clinical features, histology and treatment of angiosarcomas of the scalp are briefly discussed.

Aged↗