[Incidence of scalp problems among soldiers in Sessvollmoen].
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Subcutaneous granuloma annulare (SGA) is a benign inflammatory disorder that may be alarming in its presentation because of its rapid growth and extensive differential diagnosis. The purpose of our study was to improve the appropriate evaluation and management of pediatric patients with subcutaneous scalp nodules. This article presents the clinical presentation, histopathologic data, evaluation, and management of a patient with subcutaneous scalp nodules diagnosed as SGA. Additionally, the clinical data of all other cases of SGA diagnosed at our institution over a 9-year period were reviewed. The majority (72%) of SGA patients encountered at our facility were children. Most of the SGA lesions were located on the extremities; however, all of the lesions located on the scalp were in children. This article reviews the differential diagnosis and workup of scalp nodules. In evaluating the patient with subcutaneous scalp nodules, we conclude that SGA should be added to the differential diagnosis.
Psoriasis is characterized by three main pathogenic features: abnormal differentiation, keratinocyte hyperproliferation and inflammation. The lesions may disappear spontaneously or as a result of therapy, but recurrences are almost certain. Twenty-seven patients with scalp psoriasis were treated with calcipotriol solution 50 g/ml as twice-daily application for 8 weeks. The assessment was based on the mean sign scores (erythema, thickness and scaliness) at 0, 2, 4, 6 and 8 weeks. The results indicated that five patients were excluded from the study (four because of irregularity and one because of irritation), and 22 patients had completed the treatment course. There was a marked reduction in the total mean scores of erythema, thickness and scaling from 2.8, 2.7 and 2.7 to 0.3, 0.34 and 0.4, respectively. Fifteen patients (68.2%) showed complete clearance of their psoriasis, and most of the lesions cleared by week 6 of treatment. Two patients (9.1%) had marked improvement and four (18.2%) patients showed moderate improvement. No response to calcipotriol solution was seen in only one patient. No adverse effects occurred except severe irritation in one patient, who was excluded from this study. In conclusion, calcipotriol could be a valid choice for the treatment of scalp psoriasis.
Acquired ichthyosis is a rare dermatosis associated with a number of malignancies. Side effects seen on the skin secondary to megavoltage radiotherapy are uncommon but may include fine dry desquamation and tanning. We present a case of ichthyosiform scaling limited to the radiation fields in a patient treated for brain metastases of a primary small cell lung carcinoma. The reader is reminded that side effects of megavoltage treatment do occur on the skin. A brief review of these effects is included.
Pediculosis capitis (head lice) is an infestation that affects many children. Although, there are a number of different treatment modalities, at the present study, we investigated the efficacy of permethrin in the treatment of pediculosis capitis in children. This study was carried out in 3 village primary schools in the Kayseri region involving 185 of 712 school children infested with Pediculus humanus capitis during a survey conducted in March 2001. It was found that 173 (97.29%) of the 178 students who applied the prescribed medications were cured, indicating that interestingly 1% permethrin shampoo (Kwellada) is an effective and safe treatment choice for pediculosis capitis.
The authors describe a case of progressive facial hemiatrophy in a woman aged 26 years, coming from the Isfarin region of Tadzhikistan. The patient views herself as being ill for 14 years, since the moment of an epileptic attack with tonic and clonic convulsions. Approximately at the same time she noted a small dry ulcer on the left on the vertex. The ulcer slowly increased, followed by skin atrophy. The disease progressed for 4 to 5 years. At present to the left there are folds in the form of scars on the face. The skin is thinned, united with the bones in the frontal and parietal areas, the subcutaneous fat is atrophic. The lips and nose at the left are subatrophic. Negligible enophthalmos, hemiatrophy of the tongue at the left. Alopecia. A certain deterioration of memory and reduction of the critical attitude are recorded. The patient is in a state of euphoria. Left-sided anosmia. The left auricular floor is subatrophic, hearing is almost lacking. Diffuse elevation of the tendinous reflexes of the limbs on the left side. X-ray signs of osteoporosis of the bones of the cranial vault on the left.
Proliferating trichilemmal cysts, also known as pilar tumors, are slow-growing lobulated masses most commonly found on the scalp of elderly women. We present the case of a 69-year-old woman with a 25-year history of multiple enlarging scalp masses. The patient was evaluated for surgical consultation after the dominant mass presented with malignant degeneration. A CT of the head revealed multiple large, subcutaneous, cystic masses with calcifications.
Lipedematous scalp is a rare disorder, mainly described in adult African-American females. We report 2 adult caucasian males with lipedematous scalp associated with androgenetic alopecia. Patients were studied by dermoscopy and histopathology; they were treated with finasteride 1 mg. In our patients, lipedematous scalp affected the occipital and the vertex areas and pathologically exhibited mild edema and thickening of the adipose subcutaneous layer. At videodermoscopy, lipedematous scalp areas showed linear areas of teleangiectasia within the scalp creases, possibly caused by compression of the superficial blood capillaries by the increased volume of the subcutaneous fat layer within the thickened scalp. Finasteride at a dose of 1 mg per day for 1 year induced mild improvement of androgenetic alopecia in one patient and stabilization of the disease in the other. The lipedematous scalps remain unchanged. Lipedematous scalp is apparently a rare disease even though the condition is probably underdiagnosed. As a matter of fact, we diagnosed lipedematous scalp in our patients during a clinical examination for androgenetic alopecia, which was the patients' complaint. The association of lipedematous scalp and androgenetic alopecia in our two patients appears to be coincidental.
Clobetasol propionate is known to be a very effective treatment for psoriasis; however, its use is limited by potent corticosteroid class related side effects such as hypothalamic-pituitary-adrenal (HPA) axis suppression and atrophogenicity. The aim of this single-center, parallel group, randomized study was to assess the HPA axis suppression potential, atrophogenicity, and ocular tolerability of clobetasol propionate shampoo in 26 patients with scalp psoriasis. Suitable subjects were treated once daily for 4 weeks with clobetasol propionate shampoo, to be rinsed off after 15 minutes or with a leave-on clobetasol propionate gel. The study demonstrated that clobetasol propionate shampoo did not lead to HPA axis suppression or to skin atrophy. Conversely, the gel led to HPA axis suppression and a decrease in skin thickness. Neither formulation had an impact on ocular safety. Despite the short contact application time, the clobetasol propionate shampoo provides similar efficacy results to the gel.
Photodynamic therapy (PDT) with topical application of either aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) is increasingly used for the treatment of actinic keratoses (AKs). Although PDT is a well-tolerated treatment, pain is the most severe side effect. Sixty-nine patients (mean age 69 years, 61 male, 8 female) suffering from multiple AKs on the scalp (field cancerization) were included in the study. PDT treatment was performed, using red light (Waldmann PDT 1200) with a light dose of 100 J/cm2 delivered at a dose rate of 160 mW/cm2. Either ALA or MAL were used as photosensitizer. Patients were asked to rate their pain on a scale from 0 to 10 (0 = no pain, 10 = unbearable pain). Upon reaching a score of 10 treatment was discontinued. Comparison of ALA and MAL in patients with AK revealed that MAL induced less pain than ALA. While 14% of the patients treated with MAL discontinued treatment before reaching the required light dose of 100 J/cm2, the number of patients treated with ALA who discontinued treatment reached 54%. PDT using MAL appears to be a better tolerated treatment for multiple AKs on the scalp compared to ALA-PDT. Differences in selectivity for tumor cells and transport of ALA in peripheral neurons may play a role.
Of the pediculicides on the market, most are not 100% ovicidal and don't have a residual activity of more than 2 days. Therefore, at least 2 treatments are necessary to control the entire louse population. In order for a pediculicide to be effective it should kill all active stages of the louse after a single treatment. Otherwise remaining lice will continue laying eggs and the following treatments will not be fully effective, at least against the eggs. However, there is no general consensus as to when the second treatment should be conducted. Taking into consideration that head louse eggs hatch between 5 to 11 days, it is suggested that a second treatment should be administered 10 days after the beginning of the treatment. This might also explain why most of the clinical trials that were conducted by treating the patients twice with an interval of 6, 7, or 8 days showed a poor efficacy, and clinical trials where the pediculicide was applied with an interval of 10 days showed an efficacy level of more than 90%.
This descriptive, analytical study was carried out in 2003 to determine the prevalence of pediculosis capitis and some risk factors among primary-school pupils in Kerman. We selected 1200 pupils (53% girls) from 50 primary schools by multistage, systematic random sampling. Their hair was examined for head louse infestation: 45 (3.8%) were infected with lice, 43 (95.5%) girls and 2 (4.5%) boys. The highest rate of infestation was in 9-year-olds. There was a significant relationship between head louse infestation and sex (P < 0.0001), age (P < 0.05), parents' education (P < 0.0001), father's job (P < 0.01), family size (P < 0.01), length of hair (P < 0.0001) and having separate bathing facilities in the house (P < 0.0001).
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