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PubMed2003

'Bad hair days', scalp sebum excretion and the menstrual cycle.

BACKGROUND: Many women complain that their hair is periodically unmanageable, popularly known as 'bad hair days' (BHDs). At an anecdotal level BHDs are more common around the time of menstruation and, in view of previous studies reporting menstrual variation in sebum excretion, the authors hypothesised that changes in scalp sebum levels during the menstrual cycle might contribute to perceive differences in hair quality. AIMS: To test whether there is a relationship between BHDs, the menstrual cycle and scalp sebum excretion. METHODS: Thirteen women were studied through three menstrual cycles. Sebum levels on the scalp and forehead were measured twice weekly using a Sebumeter and each subject kept a record of hair quality and hair washing practice. RESULTS: BHDs occurred throughout the menstrual cycle but were more common during menstruation. There was no discernible variation in sebum levels on the scalp or forehead during the menstrual cycle and there was no correlation between individual mean skin sebum levels and the frequency of BHDs. However, BHDs were more common in those women who washed their hair infrequently, although the association between the frequency of hair washing and BHDs just failed to reach statistical significance (p = 0.06). CONCLUSIONS: BHDs are more common during menstruation and in women who wash their hair infrequently. This may relate to a build-up of sebum on the hair but menstrual variations in the frequency of BHDs are unrelated to sebum levels.

Journal Article↗

PubMed1993

Two-stage correction of depressed glabella and nasal root scar contracture utilizing subcutaneous tissue advancement flaps and a layered soft tissue/procerus muscle transposition flap.

BACKGROUND: A postoperative nasal root and glabellar forehead deformity comprised both vertical and horizontal elements, with scar contracture and fixation across the left medial nose base, extending into the adjacent superior canthal region. METHODS: A two-stage reconstruction was performed, initially correcting the vertical centrally placed forehead depression by dual subcutaneous flaps advanced centrally and joined. The horizontal nasal root contracture was repaired at a second stage utilizing a procerus muscle transposition flap elevated on the ipsilateral deep contracture side, imbricated in serpentine fashion on itself and sutured into the depression over the scar base. RESULT: Significant improvement followed. CONCLUSION: The careful and precise placement of subcutaneous tissue and muscle can serve to assist in filling certain deep defects and in elevating scar lines.

Aged↗

PubMed1998

Collagen shrinkage (selective dermaplasty) with the high-energy pulsed carbon dioxide laser.

BACKGROUND: The high-energy pulsed carbon dioxide (CO2) laser has proven useful for skin resurfacing. The modality can be less penetrating than chemical peels and more accurate than dermabrasion. OBJECTIVE: To demonstrate the additional benefit of dermal remodeling (selective dermaplasty) of skin lesions, scars, grafts, folds, and eyelids. METHODS: The collimated and the computerized pattern generator handpieces were used with the high-energy pulsed CO2 laser at 250-350 mJ to remodel tissue. Usually three or four passes were adequate to vaporize tissue and shrink collagen. RESULTS: A rejuvenated earlobe, eyelid, or forehead was produced in a predictable fashion. The tissue irregularities of scars, dog-ears, or trap-door deformities were reduced and remodeled. CONCLUSION: Dermal remodeling (selective dermaplasty) with the high-energy pulsed CO2 laser has proved a useful tool to remodel the skin. Areas such as the earlobe, the forehead, the eyelids, or skin lesions can be vaporized to develop a more youthful appearance. We find this a useful addition to the armamentarium of the cosmetic dermatologist.

Collagen↗

PubMed2005

Staged cheek-to-nose and auricular interpolation flaps.

BACKGROUND: Staged interpolation flaps are priceless options in skin cancer reconstruction. Their value lies in their flexibility, reach, reliability, and ability to repair distant, complex facial defects. Familiar interpolation flaps to dermatologic surgeons include the paramedian forehead flap, cheek-to-nose interpolation flaps, and auricular staged flaps. OBJECTIVE: In this special reconstructive issue, the paramedian forehead flap is discussed separately. This article highlights the cheek-to-nose and auricular interpolation flaps as applied to skin cancer defects. Design considerations, anatomic basis, execution, and the distinctions of each repair are presented. MATERIALS AND METHODS: Patients with facial defects from Mohs micrographic surgery serve to illustrate the surgical techniques of each repair. RESULTS: With meticulous planning and thoughtful execution, cheek-to-nose and auricular staged flaps are capable of restoring both function and cosmesis. Several surgical stages are necessary, and an adequate supporting infrastructure is essential for an optimal outcome. CONCLUSION: Skin cancer patients with complex facial wounds from Mohs micrographic surgery may be assured of the highest possible cure rate. Further, their esthetic and functional reconstructive goals may be achieved with staged flaps for the nose and ear.

Cheek↗

PubMed1993

Neonatal lupus erythematosus and maternal lupus erythematosus mimicking HELLP syndrome.

A 4-month-old boy had a faint, confluent, macular erythema involving the forehead, nose, and philtrum, and matlike telangiectases over the forehead and eyelids. The clinical features, course, and laboratory studies were characteristic of neonatal lupus erythematosus. He was otherwise healthy and the product of a preterm twin pregnancy complicated by the development of maternal HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. The patient had elevated Ro(SSA) and La(SSB) antibody titers, and studies performed on maternal blood disclosed positive antinuclear antibodies and elevated Ro and La antibody titers.

Adult↗

PubMedDate not supplied

Unilateral refractory (erosive) conjunctivitis: a peculiar manifestation of pemphigus vulgaris.

A woman aged 57 years had conjunctivitis of the right eye since February 2003. It had started with a pinhead-sized blister at the margin of the upper eyelid and was progressive in nature. Intense redness of the right eye, lacrimation, and severe pain confined to the right forehead were the major complaints. She had been under medical care ever since, without any tangible outcome. Its refractory nature impelled the ophthalmologist to seek dermatologic consultation, for apparently the diagnosis seemed to have eluded the consultant. Accordingly, she reported on March 2, 2004 for the opinion of severe incessant itching, profuse lacrimation, and pain that was confined only to the right eye and forehead. The very fact that she had reported with continuous rubbing of the right eye re-enforced the suspicion of the episode being an exclusive expression of pemphigus vulgaris of the eye that probably was the reason for ineffectiveness of the drugs given thus far to her. Examination of the right eye was marked by intense inflammation of the palpebral and bulbar conjunctiva, apparent in the form of severe redness (Figure 1). The conjunctiva was studded with several scattered minute erosions. Corneal opacity and cataract were its accompaniment, whereas the left eye was normal. Mucous membrane of the oral cavity was thoroughly scanned for blister and/or erosions but was normal. The rest of the skin surface was also unaffected. Nikolsky's sign was elicited by asking the patient to rub the eye. In fact, this was responsible for periodic recurrence of the episode. Tzanck test was performed by preparing, fixing, and Giemsa staining the smear from one of the erosions over the conjunctiva. The stained slides were examined under oil-immersion, which revealed plentiful acantholytic cells characterized by large nucleus containing nucleoli and occupying almost the entire eosinophilic cytoplasm and basophilic cell wall. The two biopsies from the conjunctiva were also taken with the help of a 3-mm punch. One of the biopsies was subjected to serial sections. The sections were stained with hematoxylin and eosin stain and examined by light microscopy. The presence of split/cleavage in the epidermis (intraepidermal) above the basal (suprabasal) was cardinal. The cleavage was filled with acantholytic cells of characteristic morphology (vide supra) (Figure 2). The other biopsy was subjected to direct immunofluorescence and was found complementary to the preceding microscopic pathology. Routine investigations comprising total and differential leukocyte count, liver and kidney function tests, chest skiagram, and electrocardiogram were normal. The preceding findings were fairly conducive to form the diagnosis of erosive conjunctivitis emanating from pemphigus vulgaris. Accordingly, pulse therapy (intermittent high-dose) containing 100 mg dexamethasone in 5% glucose daily by slow IV infusion on 3 consecutive days, along with 500 mg of cyclophosphamide on Day 1 only followed by continuous low-dose 50 mg cyclophosphamide, was administered. The patient has since recovered completely and is now under surveillance.

Conjunctivitis↗

PubMed1989

Immediate contact reactions to benzoic acid and the sodium salt of pyrrolidone carboxylic acid. Comparison of various skin sites.

Benzoic acid (BA) and the sodium salt of pyrrolidone carboxylic acid (NaPCA) were tested in 13 healthy persons to obtain information about, firstly, the irritant properties of NaPCA and, secondly, the reactivity of various skin sites. BA at 16, 8, and 4 mM pet., and NaPCA at 50, 25, 12.5, and 6.25% in water, were applied to the forehead, cheek, neck and upper back. Erythema reactions were observed visually, and the changes in the skin blood flow were monitored using a laser-Doppler flowmeter. BA at 16 mM increased blood flow on the cheek of 12 test subjects, and on the neck, forehead and upper back of 6 subjects, but 8 and 4 mM BA elicited reactions only on the cheek. NaPCA caused reactions on the upper back of 3 test subjects only, but not on other test sites.

Adult↗

PubMed2006

Functional map and age-related differences in the human face: nonimmunologic contact urticaria induced by hexyl nicotinate.

Variation in human skin reactivity to various irritants in association with age and body region has been reported. Hexyl nicotinate (HN), a lipophilic nicotinate ester, was used to induce nonimmunologic contact urticaria in human volunteers of 2 age groups: 10 young subjects [24-34 years, mean +/- standard deviation (SD) 29.8 +/- 3.9 years] and 10 older volunteers (66-83 years, mean +/- SD 73.6 +/- 17.4 years); and to define skin function and potential age-related differences in various facial areas. About 5 mM of HN in ethanol was applied to 8 locations on the face, neck, and volar forearm. A laser Doppler flowmeter was used to determine baseline blood flow and to monitor the skin blood flow changes after HN application. In the contralateral areas, stratum corneum turnover was determined using 5% dansyl chloride in petrolatum. In the young group, the perioral area exhibited the strongest reaction to HN. In the older group, the chin was the most sensitive site. In both the groups, the forearm was the least responsive. The older group demonstrated a stronger reaction than the younger group in 3 sites (forehead, cheek, and nasolabial area). Stratum corneum turnover was slower in the nasolabial area and in the forearm in both age groups, whereas the fastest was in the perioral area and the chin in the younger group and in the chin and the forehead in the older group. Compared to the older group, the younger group showed a slower stratum corneum turnover in the nose and the neck. This study demonstrates the regional and the age-related variability of the stratum corneum turnover and the skin reactions to HN. These observations may help explain some aspects of the cutaneous intolerance in skin care of the face.

Adult↗

PubMed1996

Annual reduction of solar UV exposure to the facial area of outdoor workers in Southeast Queensland by wearing a hat.

The total annual exposure to erythemally effective UVR was estimated for average work situations in a high exposure environment, viz, farm workers in Southeast Queensland (27.5 degrees S), and the effect of hat usage was examined. If no sun protection is used, the annual erythema exposures for this group of workers at three facial sites forehead, nose and cheek are 40, 57 and 34 J.cm-2 respectively. If a hat is worn throughout the year, the exposures are reduced to 6, 19 and 20 J.cm-2, respectively. The mean ratio of exposure without the hat to that with the hat (mean protection factor, MPF) was found to be 6 for the forehead, 3 for the nose and 2 for the cheek. The risk of non-melanoma skin cancers without the protection of the hat is estimated to increase by up to 100 times for basal cell carcinomas and 13 times for squamous cell carcinomas for a whole year of exposure.

Face↗

PubMed2005

Comparative evaporimetry in man.

BACKGROUND/AIMS: Transepidermal water loss (TEWL) measurements are frequently used; the most widely utilized instrument has been the open chamber device. Traditional open-chamber systems for measuring TEWL have limitations related to ambient and body-induced airflows near the probe, probe size, measurement site and angles. Recent technology provides a portable and battery-operated closed chamber Evaporimeter. It is presumably less affected by external factors such as room- or body-induced airflows, breathing or heating of the probe by the operators' hand. This study compares this commercial instrument, a closed chamber device, with a traditional open-chamber device. METHODS: Two open chamber devices and one closed chamber device were used in such a way that each instrument could simultaneously measure TEWL in an identical experimental environment with known relative humidity and temperature values. TEWL values of seven locations on healthy volunteers were measured simultaneously with each instrument in the same room according to the guidelines of the standardization group of the European society of contact dermatitis. RESULTS: For TEWL values of all forearm locations, there was no statistically significant difference between the mean values measured by all three instruments. For TEWL values of forehead locations, there was a significant difference between the mean values of open chamber device and closed chamber device. For the forehead, values from closed chamber device were higher than the open one. CONCLUSION: The TEWL values measured by all instruments were constant with small standard deviations. These instruments appear sufficiently robust that a standardization group could document similarities and differences with in vitro models. We suspect that both techniques will continue to be used and that the closed method will find increasing use because of its ease of use.

Adult↗

PubMed1989

Difference in TcB readings between full term newborn infants born vaginally and by cesarean section.

We studied the influence of method of delivery on TcB readings at the forehead and sternum in full term neonates in the first week of life. Our present study demonstrated that TcB readings at the forehead and sternum of the infants delivered by cesarean section were significantly lower than readings from infants delivered vaginally without complications, from day 1 to day 7 of life (p less than 0.05). This is probably due to the decreased placental transfusion at cesarean section. The present study suggests that the degree of placental transfusion or time of cord clamping may be more influential than meconium passage or weight loss on serum bilirubin levels in the first week of life.

Bilirubin↗

PubMed1994

Intrafascicular recordings of afferent multi-unit activity from the human supraorbital nerve.

Intrafascicular recordings of afferent multi-unit activity were obtained from the supraorbital nerve in 40 healthy human volunteers, using tungsten micro-electrodes inserted percutaneously at the eyebrow. Seventy-seven fascicular receptive fields were mapped; their area ranged from 2 to 76 cm2, with a median of 19 cm2. The smallest fields were found in the eyebrow region, and the largest on the scalp. In response to non-painful electrical intradermal stimulation, the conduction velocity of the fastest nerve fibres was calculated to be 40 +/- 2 m s-1 (mean +/- SEM), and the later part of the afferent volley corresponded to a velocity of 20 +/- 1 m s-1. The responses to skin indentation indicated that the density of mechanoreceptive innervation was higher in the lower part of the forehead than in the upper/posterior part of the innervation territory of the nerve. A rapid mechanical tap on the forehead and scalp evoked two major afferent volleys corresponding to the on- and off-phase of the stimulus. Manipulation of hairs resulted not only in dynamic responses to hair movement, but also in a static discharge during sustained hair displacement. When a fascicular field included the eyebrow region, skin stretching during blinking movements evoked distinct afferent activity. Following mechanical and electrical stimuli there were no signs of 'trigeminal antidromic potentials' of the type described in the cat and monkey.

Adult↗

PubMed1997

Seasonal variation in urocanic acid isomers in human skin.

Urocanic acid (UCA) is a major chromophore for UV in the skin and has been suggested to act as an initiator of UV-induced immunosuppression. It converts from the naturally occurring trans-isomer to the cis-isomer on UV exposure. Isomerization is dose dependent until the photostationary state is reached, and the seasonal variation in irradiance from the sun may lead to changes in the percentage of UCA present as cis-UCA throughout the year. Thirty young healthy subjects, skin types I-IV, were followed from early summer till spring. At each of six visits (June, July, August, October, December, March), pigmentation and the concentration of UCA isomers were measured at six body sites: forehead, upper chest, upper back, outer upper arm, inner upper arm and buttock. In exposed as well as unexposed regions a variation in pigmentation was found, peak values being recorded in August. Total UCA concentration was lower in July and August than in the rest of the year, irrespective of body site. In July, the percentage of cis-UCA was close to the maximal obtainable (50-60%) at all sites except the buttock. In the three winter months the percentage of cis-UCA was below 7% in all regions except for the forehead, where the mean cis-UCA was 18% in October and March. No consistent relationship was found between UCA isomers and pigmentation or skin type.

Adolescent↗

PubMed1992

A new hereditary syndrome with a bleeding tendency, extreme miosis, spasms, dyslexia, thrombocytopathia etc. Pupillometric, evaporimetric, and ophthalmological observations.

A recently described familiar syndrome consists of the following components: A bleeding tendency with thrombocytopathia, miosis, muscular weakness and spasms, ichthyosis, asplenia, dyslexia, and headache. Four definite and 2 probable patients have been identified in 4 generations. In the present study, the pupillary behaviour was scrutinized in two 'definite' cases with the infrared, binocular pupillometer. The forehead sweating pattern was also investigated with an Evaporimeter. The basal pupillary widths were: 1.25-1.75 mm. Only minor responses were noted upon topical stimulation with an indirectly acting pupillodilating agent (OH-amphetamine). A directly acting sympathicomimetic drug (phenylephrine) exerted a more marked influence on the pupil, indicating a relative supersensitivity. The evaporimetric pattern in the forehead seemed to be within reference limits, at variance with what is the case in Horner's syndrome. Further findings were: the orbit seemed to be smaller than normal; a bilateral VI. cranial nerve palsy was identified, and a marked upward gaze palsy coexisted with pupils with Argyll Robertson's traits. There is no readily acceptable explanation for the ocular abnormalities. The disorder underlying the pupillary abnormality may possibly be located in the upper mesencephalon.

Adult↗

PubMed1979

Natural selective cooling of the human brain: evidence of its occurrence and magnitude.

1. The technique of perceptual rating of thermal stimuli was used, in eight human subjects immersed in warm water, in order to appreciate whether they were hypo-, normo- or hyperthermic. Oesophageal, tympanic and forehead skin temperatures were recorded, as also was the temperature of the skin above the angularis oculi vein. Once the subjects gave clearly hyperthermic ratings, one arm was exposed to a 6 m/s wind. After 5--10 min the arm was re-immersed and the face was fanned. 2. Fanning of the arm resulted in lowering of body core temperature. However ratings of thermal stimuli remained hyperthermic. 3. Face fanning decreased forehead skin, angularis oculi vein and tympanic temperatures. Hyperthermic ratings were replaced by normothermic ratings, although oesophageal temperature continued to rise. 4. The upper limit of oesophageal temperature for normothermic ratings was 37.o6 +/- 0.09 degrees C during the control period without fanning. This temperature rose to 37.91 +/- 0.09 degrees C during facial ventilation. 5. These results suggest a selective cerebral cooling due to venous blood returning from facial skin via the ophthalmic vein to the cavernous sinus, where a cooling of arterial blood ascending to the brain can take place.

Body Temperature Regulation↗

PubMedDate not supplied

Noninvasive determination of the optical properties of adult brain: near-infrared spectroscopy approach.

The basic parameters for physiological measurements provided by near-infrared spectroscopy are the local absorption and scattering coefficients. For the adult human head, they have been difficult to measure noninvasively because of the layered structure of the head. The results of measurements of absorption and reduced scattering coefficients through the forehead on 30 adult volunteers using a multidistance frequency domain method are reported. The optode separation distance ranged from 10 to 80 mm and measurements were recorded at 758 and 830 nm. The measured absorption and reduced scattering coefficients of the forehead were used to evaluate the hemoglobin content in the scalp and brain as well as cerebral oxygen saturation. We found that cerebral oxygenation was relatively narrowly distributed within the subject group (the standard deviation was about 3% for scalp and 6% for brain, respectively), whereas hemoglobin concentrations had a relatively broader distribution. We found that as the optode distance increased, the absorption coefficients increased and the scattering coefficients decreased, retrieving the optical values of scalp and brain for shorter and longer optode distances, respectively. We present the transition curves of the absorption and reduced scattering coefficients as functions of the optode distance. In order to verify the values for each layer, a comparison between the experimental data and a prediction based on the two-layer model of the adult head was carried out. The thicknesses of scalp and skull for the two-layer model were obtained by magnetic resonance imaging of a subject's head. The optical parameters obtained from the two-layer model agreed very well with those measured by the multidistance method.

Adult↗

PubMed2004

Potential third-party radiation exposure from outpatients treated with 131I for hyperthyroidism.

Thirty-three hyperthyroid patients treated with radioiodine (mean administered activity 414 MBq, range 163-555) were studied to determine if pretreatment dosimetry could be used to give radiation protection advice that could assure compliance with the effective dose constraints suggested by the European Commission. Effective doses to travelers, co-workers, and sleeping partners were estimated by integrating the effective dose rate-versus-time curve obtained by fitting the dose rates measured several times after radioiodine administration to a biexponential function. The mean estimated effective doses to travelers, co-workers, and sleeping partners were 0.11 mSv (0.05-0.24), 0.24 mSv (0.07-0.52), and 1.8 mSv (0.6-4.1), respectively. The best correlation was found between effective dose (D) in mSv and maximum activity (AUmax) in MBq taken up in the thyroid: Dtraveler=0.0005 * (AUmax) +0.04 (r=0.88,p< 0.01); Dco-worker=0.0013 * (A Umax) +0.03 (r=0.89,p < 0.01); Dsleeping partners=0.0105 * (AUmax)+0.16 (r=0.93,p < 0.01). Private/public transports are always allowed. For the co-workers the effective dose constraint of 0.3 mSv is met without restrictions and with 3 days off work if AUmax is lower or higher than 185 MBq, respectively. For the sleeping partners the effective dose constraint of 3 mSv is met without restriction and with 4 nights separate sleeping arrangements if AUmax is lower or higher than 185 MBq, respectively. The potential for contamination by the patients was determined from perspiration samples taken from the patient's hands, forehead, and neck and in saliva at 4, 24, and 48 h after radioiodine treatment. The mean highest 131I activity levels for hands, forehead, neck, and saliva were 4.1 Bq/cm2, 1.9 Bq/cm2, 0.9 Bq/cm2, and 796 kBq/g, respectively. The results indicate that there is minimal risk of contamination from these patients.

Aged↗

PubMed1969

Effects of systemic demethylchlortetracycline on human cutaneous microflora.

The aerobic flora of the axilla and forehead of 20 normal human subjects was studied through a 3-week course of 600 mg of demethylchlortetracycline daily and a 3-week follow-up. In general in the axilla, an initial fall in bacterial density was followed by recovery in numbers due to the proliferation of resistant coagulase-negative cocci and diminution of the lipophilic diphtheroid group of bacteria within 1 week of treatment. During the remainder of the treatment period, the flora was essentially stable in both density and composition. In the follow-up phase, the initial flora was slowly re-established but resistant cocci persisted for more than 3 weeks. On the forehead the fall in density was slower and recovery during treatment was incomplete. Resistant coagulase-negative cocci became dominant and persisted through the follow-up phase. In two individuals, temporary colonization of the axilla by Staphylococcus aureus was seen.

Axilla↗