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We present a case of a 75-year old woman, who developed scalp necrosis as a result of giant cell arteritis in the temporal arteries. This is a very rare, but serious complication of temporal arteritis, which implies an increased risk of visual loss and other catastrophic sequelae. Healing of the ulceration was achieved after cortico-steroid therapy supplemented with split skin transplantation.
The purpose of our work is to contribute to the definitive standardization of the phototrichogram in view of the new possibilities offered by information technology. We placed under investigation a 1 cm2 scalp area on the vertex of 28 healthy volunteers (20 women and 8 men) between the ages of 18 and 30 (average age was 23.32 +/- 3.48 years). We performed the examination using a computerised videomicroscope equipped with lenses x 20 and x 50. The results obtained can be summarized as follows: total hair density was 260 +/- 30/cm2 in men and 300 +/- 20/cm2 in women; telogen percentage was higher in men (16.5 +/- 1.5% vs 11 +/- 1% of women); thin hairs (< 0.040 mm) were 9.4 +/- 1.8% in men and 9 +/- 2% in women; growth rate was 0.35 +/- 0.03 mm/day in men and 0.38 +/- 0.03mm/day in women. Thanks to its integration with digital imaging, the phototrichogram has undoubtedly become an examination of primary importance in trichology because of its simplicity and sensitivity even if it cannot yet be considered the ideal technique to replace all the others.
Erosive pustular dermatosis of the scalp (EPDS), first described in 1979, is a rare, chronic, pustular condition with scarring alopecia, and nonspecific histological findings. While the initial responded to steroids is good, it can be treated successfully by oral administration of zinc sulphate. Local trauma has recently been suggested to play a role in the pathogenesis of EPDS. The differential diagnosis of EPDS includes folliculitis decalvans, sterile eosinophilic pustulosis Ofuji, pustular psoriasis vulgaris, trichophytosis, Perifolliculitis capitis abscedens et suffodiens, pemphigus vulgaris and cicatricial pemphigoid. We present the cases of a 74-year-old woman suffering from EPDS following herpes zoster ophthalmicus and of a 54-year-old man in whom EPDS followed a head injury.
The scalp is a unique site of the human body that may exhibit some particular physiopathological reactions. A few manifestations are paroxysmal. The main ones are the acute pruritus of pediculosis, and the pruritus at onset of dandruff or seborrhoeic dermatitis. One must add the telogen effuvium after solar exposure or during the post-partum, and the anagen dystrophic alopecia following chemotherapy. Other paroxysmal events include acute canitia and alopecia areata.
We present a case report of metastatic gastric adenocarcinoma in which the cutaneous metastases were the first sign of disease recurrence. A 73-year-old man presented with painless red plaques on his scalp and forehead. He was diagnosed with gastric carcinoma with metastases to perigastric lymph nodes 3 1/2 years earlier. Histopathology results revealed signet-ring cells consistent with gastric adenocarcinoma. The patient failed to respond to treatment with intralesional interleukin 2, previously reported to be effective, and expired 7 months later.
A 63-year-old woman with a history of exaggerated use of topical skin care products of post-traumatic scarring alopecia presented with a monstrous cutaneous horn-like pomade crust of the scalp hidden beneath a wig. The crust consisted of corneocytes and bacterial debris. Pomade crusts have not been described previously in this localization. They are usually found in the inguinal or gluteal folds of infants, and occasionally in other body regions, e.g., on the face of adults.
The reconstruction of a large scalp defect is extremely difficult on many occasions and repeated operations or a long-term hospitalization is often required. In addition, unsatisfactory results are not unusual. However, it is now possible to perform reconstruction by a one-stage operation of free tissue transplantation (free flap) using microsurgical vascular anastomosis which has rapidly developed in the past ten years. We performed reconstructions applying latissimus dorsi musculocutaneous, greater omentum, groin and scapular flaps. The advantages with the free flap are: (1) one-stage reconstruction is possible; (2) no restrictions on the postoperative position, (3) the flap, which is independent of the blood supply from the recipient, well survives on the recipient with an insufficient blood supply and (4) the damage at the donor site can be minimized. On the other hand, its disadvantages are as follows: (1) the operation requires microsurgical vascular anastomoses; and (2) recipient vessels should be normal. The above report was based on favorable results we obtained in 6 cases of reconstruction with free flap applying microvascular techniques.
A case of cutis verticis gyrata (CVG) occurred in a patient with no known associated disorders. Under the present classification system, patients with primary CVG are all grouped together. We propose subclassifying patients with primary CVG into two groups: those with associated neurologic and ophthalmologic diseases and those without. Our patient was treated with a scalp reduction procedure.
Transverse sections of cylindrical scalp biopsy specimens can provide excellent samples for histologic, quantitative morphometric analyses of the follicles and hair. This study describes and illustrates the morphologic details of the normal transverse anatomy of follicular structures, including the various phases of the normal hair cycle.
Extensive resections of tumors of the scalp penetrating into the bone and the brain often require the use of free flaps for coverage as the only possibility. Four cases are reported and the specific problems of these microsurgical operations in this region are discussed.
Infection of the scalp in an elderly woman due to Microsporum canis (zoophilic, long-lived fungus) after repeated direct contact with infected cats. We think that the infection could occur because of an age-induced decrease in some of the organic functions which govern the healing process of microsporous infections during puberty.
A case of a patient with headache, visual deficiency in his left eye quickly worsening up to blindness and ischemic necrosis in the scalp regions supplied by the superficial temporal arteries, is reported. This acute gangrene began as a bandlike ischemic lesion in the temporo-parietal regions of both sides, rapidly enlarged, and acquired bizarre irregular outlines. Laboratory investigations and particularly superficial temporal artery biopsy confirmed the diagnosis of Horton's temporal arteritis, in accordance with the anamnestic and clinical data assessed at admission.
Seven infant patients with anterior fontanelle scalp cysts who were managed at the Paediatric Surgical Department of Muhimbili Medical Centre, Dar-es-Salaam between January 1986 and December, 1992 were studied. They were all Africans. There were 2 boys and 5 girls. Their ages ranged from 4 months to 24 months. The onset was at birth in 6 infants while in one case it was at 3 months of age. Their mental as well as motor development was normal. They were all easily and completely excised and in none was there intracranial communication. The histology was that of dermoid cyst in 6 patients and sebaceous cyst in one. There were no preoperative or postoperative complications noted.
Full-thickness defects of the forehead and scalp after excision of extensive skin carcinomas are a reconstructive challenge. With loss of periosteum, bone can be covered by skin grafts after altering the outer table of the skull or by flaps. Axial subcutaneous fascial flaps and crane tissue methods are alternative techniques; clinical experience has elucidated their indications, benefits, and limitations.
Hair transplantation has been used to restore the bald pate for 25 years. The dissatisfaction of some physicians and patients with the difficulty in obtaining natural density and the length of time necessary to achieve cosmetically acceptable coverage has been a stimulus to the development of scalp flap surgery. The flaps have the advantage of transferring large amounts of hair that give immediate and continuous coverage, normal density, and an improved hairline. Surgeons have applied this technique to areas affected by disease and trauma, as well as male pattern baldness. There are differences between the short temporoparietal flaps and the larger Juri flaps with regard to patient selection, planning, design, technique, complications, and most importantly, results.
Tissue expansion offers the reconstructive surgeon a better option than the conventional methods of skin grafts or the transfer for non-hair-bearing, regional or microsurgical flaps for reconstructing large defects that cannot be repaired with adjacent hair-bearing flaps. Aspects of preoperative planning and technical factors of scalp expansion are presented to assist the clinician in managing these difficult reconstructive challenges.
We describe two infants in whom extensive necrosis developed secondary to anaerobic infection at the site of scalp electrode placement. One infant required skin grafting. Pus from abscesses at the site of electrode placement should be cultured for anaerobic as well as aerobic bacteria.
Three children had pustular patches develop over the occipital areas of the scalp. Colonies of Trichophyton mentagrophytes grew on cultures with Sabouraud's dextrose agar with antibiotics. After a week of topical treatment with 1:10,000 potassium permanganate solution and oral treatment with griseofulvin, typical nodules of erythema nodosum appeared over the shins, ranging in diameter from 1 to 4 cm. Nodules on the legs resolved spontaneously within 12 days in the three children. Erythema nodosum occurring in patients with kerion may be interpreted as individual allergic hypersensitivity reactions as a result of the immune host response to allergenic products from the primary site of infection. This possibly may cause immune complexes that precipitate erythema nodosum.