New Donor Excision Design for Better Hair Alignment in Hair Restoration Surgery.

BACKGROUND: The linear scar and misalignment of hair follicles are disadvantages of the follicular unit transplantation (FUT) or strip technique. The most common misalignment is at the end of the strip. Although most surgeons try to match hair direction to achieve optimal hair alignment, their attempts are often unsuccessful. OBJECTIVES: We aimed to assess strip designs to improve hair alignment during hair transplantation. METHODS: We conducted a retrospective study of 157 patients who underwent hair transplantation with either the commonly used elliptical incision or our novel triangular flag-shaped designed incision on the donor strip tip. Two blind evaluators assessed the outcome of hair alignment using a 5-point visual analog scale. RESULTS: In total, 303 wounds on 157 patients were assessed. Overall, our triangular flag-shaped design (TFD) achieved better hair alignment than the common elliptical design (CED) (p=0.01). Patients with hair direction straight on the upper wound edge and hair direction inward on the lower wound edge showed improved outcomes with TFD, whereas patients with hair direction inward on both upper and lower wound edges showed better outcomes with CED. CONCLUSIONS: The TFD tip of donor strips achieved proper hair alignment for most hair transplant patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

In vitro antifungal activity of luliconazole against nondermatophytic moulds.

In vitro antifungal activity of luliconazole against nondermatophytic moulds causing superficial infections was compared with that of five classes of 12 topical and systemic drugs. The minimum inhibitory concentration (MIC) of the drugs against the genera of Neoscytalidium, Fusarium, Aspergillus, Scedosporium, and Alternaria was measured via modified microdilution method. In results, the nondermatophytic moulds were found to be less susceptible to drugs to which Neoscytalidium spp. and Fusarium spp. were typically drug resistant. However, luliconazole was effective against all the genera tested, including afore-mentioned two species, and had the lowest MICs among the drugs tested.

Unilateral Linear Punctate Palmoplantar Keratoderma: A Case Report.

Punctate palmoplantar keratoderma (PPPK) is a rare entity with an estimated prevalence rate of 1.17/100,000. PPPK usually presents with bilateral asymptomatic, tiny, hyperkeratotic punctate papules and plaques on the palmoplantar surface. Among the PPPK varieties, the linear presentation is much rarer, and so far there have been only 3 case reports. Here, we report the case of a 27-year-old female Thai patient who presented to our outpatient clinic with unilateral asymptomatic linear thickening lesions on her right sole since childhood. There were no similar lesions on other parts of the body. A histopathologic examination revealed epidermal hyperplasia and hyperkeratosis without columns of parakeratosis or cornoid lamella. The other examinations were normal. The clinical and histological contexts were consistent with a diagnosis of unilateral linear PPPK. The patient was treated with topical 10% urea cream and 10% salicylic acid cream twice daily. To the best of our knowledge, this is the first reported case of unilateral linear PPPK in Thailand, and the fourth reported case worldwide.

CHROMOBLASTOMYCOSIS MASQUERADING AS DERMATOPHYTOSIS, WITH THE DESCRIPTION OF A NEW OPPORTUNISTIC SPECIES.

An unusual case of chromoblastomycosis is reported, it resembled dermatophytosis, tinea faciei due to the presence of a well-demarcated scaly ery- thematous patch on the face. The patient was a 63-year-old farmer from central Thailand, who had the skin lesion for 10 years. Mycological and histopathologi- cal investigations of scales and skin biopsy specimen revealed a granulomatous infiltrate with sclerotic bodies, the hallmark of chromoblastomycosis. The infec- tion showed only localized superficial expansion with a scaly patch suggesting a new clinical type of the disease. The causative organism was identified by DNA sequencing as Rhinocladiella phaeophora. R.phaeophora originally was a saprophytic dematiaceous fungus recovered from maize field soil from Colombia. The case was unusual in its clinical presentation and this is the first case of chromoblastomycosis reported to be caused by a new opportunistic species of the genus Rhinocladiella. The disease was not responsive to itraconazole, but was later treated successfully with terbinafine.

Epidermal permeability barrier in the treatment of keratosis pilaris.

Objectives. To evaluate and compare the efficacy, safety, hydrating properties, and tolerability of 10% lactic acid (LA) and 5% salicylic acid (SA) in the therapy of keratosis pilaris (KP). Material and Method. Patients with KP were randomized for treatment with either 10% LA or 5% SA creams being applied twice daily for 3 months. The patients were clinically assessed at baseline and after 4, 8, and 12 weeks of treatment and 4 weeks after treatment. The functional properties of the stratum corneum (SC) were determined before treatment, 12 weeks, and follow-up phase by high-frequency conductance and transepidermal water loss (TEWL). Results. At the end of the trial, the mean reduction of the lesions from baseline was statistically significant for 10% LA (66%) and 5% SA (52%). During the treatment, higher conductance values were found on both group and this improvement was maintained until the follow up period. No significant differences in transepidermal water loss were observed after treatment. The adverse effects were limited to mild irritation localized on the skin without systemic side effect. Conclusion. The study demonstrated that 10% LA and 5% SA are beneficial to treat KP with the significantly clearance and marked improvement as by instrumental evaluation.

Measuring herpes zoster, zoster-associated pain, post-herpetic neuralgia-associated loss of quality of life, and healthcare utilization and costs in Thailand.

OBJECTIVES: This study aimed to measure the herpes zoster-associated burden of illness, healthcare utilization, and costs among Thai patients. METHODS: This prospective cohort study of 180 patients aged ≥ 50 years and healthy, or ≥ 20 years and immunosuppressed, with zoster rash, was conducted in Bangkok and its environs, Thailand, during 2007-2008. Each patient was followed for six months for zoster-associated rash, pain, quality of life (QoL), and healthcare utilization and costs. RESULTS: A total of 180 subjects were enrolled in the study. Their mean ± standard deviation (SD) age was 58.9 ± 13.8 years. Of the 180 patients enrolled, 138 (76.7%), 34 (18.9%) and eight (4.4%) patients were elderly, HIV-infected, and receiving immunosuppressive agents, respectively; 35 (19.4%) had post-herpetic neuralgia (PHN), and 13 (7.2%) had zoster ophthalmicus. The severity of zoster pain was moderately highly correlated with activities of daily living (ADL), at 0.68 ≤ ρ ≤ 0.76. Most patients required only one or two outpatient visits. The mean ± SD total of direct healthcare costs was 3083.4 ± 5047.0 Thai baht or ∼ 1.1% of annual income per capita. CONCLUSIONS: Herpes zoster contributes a significant burden of illness to both patients and the wider community.

Phimosis and scrotal lesions in leprosy: two case reports.

We report two cases of borderline leprosy patients, one with scrotal lesions, the other presenting with leprosy on the prepuce with phimosis.

Assessment of subclinical leprosy infection through the measurement of PGL-1 antibody levels in residents of a former leprosy colony in Thailand.

OBJECTIVES: To investigate the hypothesis that there is continuing subclinical M. leprae infection, contributing to ongoing transmission of leprosy in Phra-Pradaeng Colony. DESIGN: A sero-epidemiological survey was carried out in Phra-Pradaeng Colony, Thailand between May and August 2005. The clinical and serological examinations were conducted in 398 people, aged 3-84 years (average 50 years), comprising 196 males and 202 females. RESULTS: Measurement of serum anti PGL-I antibodies in eligible contacts and ex-patients showed that 18 people (4.5%) were seropositive, six people (1.5%) were strongly positive and 374 people (94.0%) were seronegative. All six people who were strongly seropositive were ex-patients; five of them had no evidence of active leprosy but the sixth person had relapsed BL leprosy with a reversal reaction. CONCLUSIONS: This study failed to confirm the hypothesis that there was ongoing subclinical M. leprae infection. More appropriate diagnostic methods and a total survey of the colony should be considered to further clarify this problem.

Squamous cell carcinoma arising in chronic ulcers in leprosy.

Squamous cell carcinoma (SCC) arising in chronic ulcers of leprosy patients is uncommon. A retrospective analytical study of 416 biopsy specimens of chronic ulcers during 1976 - 2000 occuring on the extremity of leprosy patients was performed. Pathologic examination showed that 217 specimens (52.2%) were reported as pseudoepitheliomatous hyperplasia (PH). A total of 102 (24.5%) specimens reported as SCC, involving 100 individual patients (69 males, 31 females). SCC was localized on the lower extremity in 87 specimens (85.3%). No significant difference was observed between left and right foot using Chi-square test. The sole was the commonest site of involvement, and then the heel. SCC on the upper extremity which was much less common, presented in 15 specimens (14.7%). The tumor was localized on the palm in 10 specimens (right: 9, left: 1). SCC in chronic ulcers of leprosy patients were much more common on the lower extremity than on the upper extremity. Most of the tumors on the upper extremity were localized on the right palm. This emphasizes the need for an active policy of prevention of disability in leprosy control programs.

Assessment of the quality of leprosy services from the clients' perspective in Thailand.

To assess the quality of the leprosy service in health facilities from the clients' perspective, qualitative data collection methods, i.e. semi-structured interviews, focus group discussions (FGDs) and priority cards, were conducted in six health facilities located in all regions of Thailand. A total of 29 patients were interviewed and three focus group discussions involving 20 patients were carried out. In addition, six health staff and six community members were interviewed. The results show that patients delayed months to years before they went to a public health facility. This is due to the poor knowledge about leprosy. Most of the interviewed patients tried to get rid of the skin symptoms at home, using topical medicated cream or herbs. Distance was not regarded as a problem, because most patients go to nearby district hospitals. In district hospitals misdiagnosis is still common. More than half of leprosy patients said they did not receive any information about leprosy before they were diagnosed. Travel costs seem to cause problems for a few poor and aged patients who needed someone to accompany them. Patients at district and provincial hospitals complained that the waiting times to consult staff were too long. In most health facilities, privacy during examinations was not adequate. Patients placed a priority on health staff being friendly and respectful to them. When patients were asked to list their priorities of the quality of services, they considered the attitude of health staff, low costs to go to the leprosy services, adequate attention to POD and adequate information to leprosy patients on their disease, as their top four items. Important recommendations resulting from the study were: (1) health education to the public has to be strengthened; (2) training of health staff to minimize doctors' delay; (3) good attitude of health staff towards leprosy patients should be sustained; and (4) leprosy services in district and provincial hospitals should be improved as a one-stop service for leprosy patients.