Percutaneous ethanol sclerotherapy is a promising treatment for recalcitrant angiolymphoid hyperplasia with eosinophilia.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular proliferation, which manifests as characteristic red nodules and papules, mostly located on the scalp and periauricular regions. Patients seek treatment for both aesthetic and functional reasons, as lesions may ulcerate, bleed and itch. Many therapeutic approaches have been reported, with variable success, and relapse remains a troublesome issue. The aim of this study was to report our experience treating ALHE using percutaneous ethanol sclerotherapy (PES). We present a retrospective case series of three patients treated with PES (1-2 treatment sessions each). All patients had tried and failed other treatments prior to this intervention, but following PES treatment, all patients demonstrated significant improvement, which was sustained at follow-up (range 8-17 months after first treatment). Adverse effects were tolerable and transient. This case series demonstrates PES as a promising treatment for recalcitrant ALHE.

Regression of lipoedematous scalp following cryolipolysis using an icepack, with a novel dermoscopic feature of yellow background.

The novel use of cryolipolysis via icepacks, a readily available and inexpensive device, is described for lipoedematous scalp with subjective and objective relief. This is a simple solution to a troublesome, intractable condition and may readily be utilized for patient benefit. Juxtaposing pre and post clinical images.

Ectoparasites: Pediculosis and tungiasis.

Pediculosis is an infestation of lice on the body, head, or pubic region that occurs worldwide. Lice are ectoparasites of the order Phthiraptera that feed on the blood of infested hosts. Their morphotype dictates their clinical features. Body lice may transmit bacterial pathogens that cause trench fever, relapsing fever, and epidemic typhus, which are potentially life-threatening diseases that remain relevant in contemporary times. Recent data from some settings suggest that head lice may harbor pathogens. The epidemiology, clinical manifestations, and management of body, head, and pubic louse infestation are reviewed. New therapies for head lice and screening considerations for pubic lice are discussed. Tungiasis is an ectoparasitic disease caused by skin penetration by the female Tunga penetrans or, less commonly, Tunga trimamillata flea. It is endemic in Latin America, the Caribbean and sub-Saharan Africa and seen in travelers returning from these regions. Risk factors for acquiring tungiasis, associated morbidity, and potential strategies for prevention and treatment are discussed.

Evaluation of the effects of COVID-19 pandemic on hair diseases through a web-based questionnaire.

AIM: Current quarantine conditions are a difficult process for individuals and can worsen the psychological state. Increased psychosocial stress can affect the course of many common "stress-sensitive" skin conditions. This study examined the possible effects of coronavirus disease 2019 (COVID-19) on hair and scalp diseases such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD) in individuals who had to stay at home for a long time and the patients' methods of dealing with these diseases. METHODS: The study was conducted using an online questionnaire. All the individuals were asked questions about pre- and post-pandemic TE, AA, and SD. Participants with complaints were asked what they did for treatment. RESULTS: During the pandemic, TE was seen in 27.9% of the participants, AA on the scalp was seen in 2.8%, AA on the face was seen in 2.5%, and SD was seen in 19.9%. Applying to a dermatologist for complaints during the pandemic was lower than before pandemic. TE was higher in women before and during the pandemic. CONCLUSION: It was found that the rates of referring to a dermatologist for the complaints before the pandemic varied between 15% and 28% and that these rates decreased significantly during the pandemic (2.5%-12.5%).

Interventions for infantile seborrhoeic dermatitis (including cradle cap).

BACKGROUND: Infantile seborrhoeic dermatitis (ISD) is a chronic, inflammatory, scaling skin condition, which causes redness and a greasy scaling rash in infants and young children. It can last from weeks to months, but rarely years. When it occurs on the scalp, it is referred to as 'cradle cap'. While benign and self-limiting, irrelevant of its location on the body, it can distress parents. The effectiveness of commonly promoted treatments is unclear. OBJECTIVES: To assess the effects of interventions for infantile seborrhoeic dermatitis in children from birth to 24 months of age. SEARCH METHODS: We searched the following databases up to 22 May 2018: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched trials registers and checked reference lists of included studies for further references to randomised controlled trials (RCTs). We searched for unpublished RCTs and grey literature via web search engines, and wrote to authors and pharmaceutical companies. SELECTION CRITERIA: We included RCTs of interventions for ISD in children from birth up to 24 months who were clinically diagnosed by a healthcare practitioner with ISD or cradle cap. We allowed comparison of any treatment to no treatment or placebo, and the comparison of two or more treatments or a combination of treatments. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. The primary outcome measures were 'Change in severity score from baseline to end of study' and 'Percentage of infants treated who develop adverse effects or intolerance to treatment'. The secondary outcome was 'Improvement in quality of life (QoL) as reported by parents'. MAIN RESULTS: We included six RCTs (one with a cross-over design) randomising 310 children and reporting outcomes for 297 children. Most participants were aged under seven months with only two participants aged over one year (seven and 12 years old); where specified, 60% were boys. In two studies, condition severity was mild to moderate; one study included two participants with severe ISD; the other studies did not describe baseline severity or described it as body surface area affected.The study setting was not always clear but likely a paediatric outpatient clinic in the following countries: Thailand, Israel, USA, France, and Australia.Two studies compared oral biotin (a B group vitamin) against placebo, two studies compared proprietary products against placebo cream or a control shampoo, and two studies compared topical corticosteroids against other products. The studies were generally short-term, between 10 and 42 days' duration; only one study followed the participants until resolution of the rash or eight months of age.We assessed the risk of bias as unclear for most aspects due to lack of reporting, but two of the studies were at high risk of performance and detection bias due to the appearance of the intervention, the trial design (open-label), or use of overlabelled tubes. Two trials had a high risk of attrition bias.All the results given below were based on very low-quality evidence. Treatment duration ranged from one week to three weeks.For the two trials comparing biotin versus placebo (n = 35), one did not report a measure of change in severity (only change in duration of rash) while the other did not report raw data (only 'no statistically significant difference'), measured at three weeks. Neither trial reported on adverse events.Two trials compared proprietary products against placebo (n = 160). One trial assessed change in severity via percentage success (96% of participants in non-steroidal cream Promiseb versus 92% in placebo), and reported no adverse events (both assessed at day 14). The other trial assessed change in severity via reduction in lesional score (surface area covered), finding better results for lactamide MEA gel (a moisturising agent) plus shampoo (81.4%) compared with shampoo only (70.2%; P = 0.0092). No adverse events were described, but signs of discomfort were similar in both groups (both assessed at day 21).In the comparison of topical steroids versus another product, change in severity was measured through evaluation of cure and body surface (n = 102).In one trial comparing hydrocortisone 1% lotion with licochalcone 0.025% lotion, there was no significant difference in participants cured (95.8% with hydrocortisone compared to 97.1% with licochalcone). One person in the licochalcone group developed more erythema, but there were no other adverse events (both outcomes assessed at day 14). In the trial comparing flumethasone pivalate 0.02% ointment versus eosin 2% aqueous solution, a reduction in body surface area affected was seen in both groups at day 10 (9% with corticosteroid versus 7% with aqueous solution), with all infants showing less than 10% involvement. There were no adverse events (both outcomes assessed at day 10).No studies measured QoL.We found no trials testing commonly used treatments such as mineral oils, salicylic acid, or antifungals. AUTHORS' CONCLUSIONS: Our review identified only a limited number of studies investigating the effects of interventions for ISD in infants and young children. Unlike the reviews investigating the effects of treatments in adults, our results showed that there is uncertainty regarding the effectiveness and safety of studied treatments due to the very low-certainty evidence for all comparisons and outcomes.We assessed most bias domains as at unclear risk, but there was a high risk of bias for (mainly) performance, attrition, and detection bias. Evidence was limited further by imprecision (small studies, low number of events), indirectness (mainly with the outcomes assessed), and poor trial reporting. In most studies, the prognosis for the condition was favourable regardless of intervention but interpretation is limited by the very low-certainty evidence.Further research is needed with large, well-conducted, and well-reported intervention trials, particularly of interventions commonly recommended or used, such as emollients or shampoos and brushing, antifungals, or steroids. All studies should report standardised and validated relevant outcome measures, including adverse events, severity, and QoL, and they should be conducted in primary care settings where the majority of ISD is managed. Future trials should compare against placebo, no treatment, or standard care.

Erosive pustular dermatosis of the scalp in an adolescent with near-total hair regrowth: Case report and review of the literature.

Erosive pustular dermatosis of the scalp (EPDS) is an uncommon chronic inflammatory response to scalp trauma that usually resolves with cicatricial alopecia. It most commonly affects elderly patients with a history of actinic damage. Herein, we describe a 16-year-old girl with acrofacial dysostosis type 1 presenting after surgery with crusting purulent scalp lesions, whose clinical presentation and histopathologic findings were consistent with EPDS. A review of the literature on EPDS in children is also detailed.

Erosive pustular dermatosis of the scalp - an Australian perspective: Insights to aid clinical practice.

Erosive pustular dermatosis of the scalp has particular relevance in Australia, due to its association with actinic damage. Despite its rarity, the recalcitrant nature of erosive pustular dermatosis of the scalp dictates a protracted recovery fraught with relapse and recurrence, posing inherent challenges to successful treatment and complete recovery. In Australia, erosive pustular dermatosis of the scalp is prevalent in the elderly, who are negatively affected due to the condition. We propose a management outline to aid clinical practice, to improve the quality of life in the elderly, whilst providing insight into the current understanding and treatment of erosive pustular dermatosis of the scalp.

Resolution of folliculitis decalvans with medical honey.

Folliculitis decalvans is a rare scarring alopecia that presents with indurated, tender pustules and papules on the vertex and occipital scalp. Although systemic antibiotics with activity against Staphylococcus species provide some symptomatic improvement, folliculitis decalvans remains a significant management challenge and often exhibits a relapsing-and-remitting course. In this report, we posit the potential utility of medical grade honey as a safe and cost-effective adjuvant therapy in the treatment of folliculitis decalvans. We describe a patient with painful, boggy scalp pustules who achieved clearance of his scalp lesions with the addition of Manuka honey. To our knowledge, this report is the first to demonstrate the clinical use of honey in the management of folliculitis decalvans and may lend support to the role of Staphylococcus in the pathogenesis of this disease.

Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails.

Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.

Erosive pustular dermatosis of the scalp: reappraisal of an underrecognized entity.

Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis of unknown etiology. Herein, we present a review of the disease and report our own clinical and histopathological experience in eleven patients. EPDS tends to spontaneously affect bald areas of the scalp in elderly individuals. A history of previous surgery at the same site - as observed in four of our patients - is common. Coronary artery disease, cerebrovascular insult, arterial hypertension, diabetes mellitus, and severe cases of cancer were frequent comorbidities. Most patients show an undulating clinical course despite topical anti-inflammatory treatment; in some individuals, the lesions heal with scarring. Histopathology reveals scaly crusts or erosions and granulation tissue-like changes in the dermis, evolving into a scar in more advanced stages. Apart from actinic/local damage, impaired immunity and microcirculation may be predisposing factors of the disease. Similar to pyoderma gangrenosum, EPDS must be considered in the context of nonhealing wounds in the elderly after the differential diagnoses mimicking EPDS have been ruled out. Given that previous or concomitant adjacent basal cell or squamous cell carcinoma is a common finding and that infiltrative variants extending beyond the clinically visible tumor may occur, histological mapping of the surrounding skin may be advisable in doubtful cases.

Use of an epidermal growth factor-infused foam dressing in a complicated case of Adams-Oliver syndrome.

Adams-Oliver syndrome is a rare disorder with varying degrees of scalp and cranial bone defects as well as limb anomalies, which can range from mild to more pronounced manifestations. In mild cases, closure of these defects can be achieved with a conservative approach. However, surgical closure is recommended in cases where the defect is extensive and includes cranial involvement. Several complicated cases of Adams-Oliver syndrome have been reported, in which flap failures were encountered and other alternatives had to be used to close critical scalp defects. Here, the case of a 4-year-old child with Adams-Oliver syndrome and a complex cranial defect with exposed titanium mesh is described. The patient was successfully treated with epidermal growth factor (EGF) infused foam dressings and subsequent split-thickness skin grafting. The EGF has been highlighted for its essential role in dermal wound repair through the stimulation of the proliferation and migration of keratinocytes, and showed accelerated wound healing when used in partial or full-thickness skin wounds.

[Tropical dermatology-relevant disorders of the scalp]. / Tropendermatologisch relevante Erkrankungen der Kopfhaut.

People whose ancestors came from tropical regions present specific structural characteristics of their skin and hair, including the scalp region. On the one hand, this is for protection against the challenges of these climatic zones; on the other hand, this may lead to an enhanced sensitivity against certain dermatological diseases, either of autoimmune, chronic inflammatory, infectious, or of mechanical origin. A collection of these are discussed in this article.

[Allergic contact dermatitis of the scalp]. / Kontaktallergien der Kopfhaut.

Contact allergy represents an important differential diagnosis to other skin diseases of the scalp. The typical efflorescences, spreading in the periphery, pruritus, and the clinical history support the differential diagnosis. Since the scalp is particularly resistant to contact dermatitis, allergens applied to this area often produce dermatitis of the eyelids, ears and neck. Nevertheless, potent allergens such as para-phenylendiamine can also cause severe reactions of the scalp. The most important allergens eliciting contact allergy of the scalp are found in bleaches and dyes, shampoos and conditioners, products for perm waves and straighteners as well as topical drugs. Besides active ingredients or drugs, vehicles and preservative agents represent additional allergens. The use of topical steroids and oral antihistamines usually results in rapid resolution of the dermatitis, systemic steroids are only necessary in severe cases. Epicutaneous patch testing on the basis of available series combined with the ingredients of the suspected elicitors confirms the diagnosis and facilitates allergen avoidance as well as the selection of alternative products.

[Psoriasis capitis and seborrhoic eczema of scalp diseases]. / Psoriasis capitis und seborrhoisches Ekzem der Kopfhaut.

The scalp may be affected by various diseases with equally varying manifestations. Erythema and scaling is often accompanied by agonizing itch. Scalp psoriasis and seborrheic eczema represent the most frequent diseases, which can be differentiated into classical cases; however, overlap and similarities are seen. Sharply demarcated erythematosquamous plaques across the natural hairline in psoriasis are opposed to blurred dark-red erythema and yellowish, greasy scales in seborrheic eczema. Whereas with the latter diffuse alopecia may frequently be found, hair loss is rarely seen in psoriasis and may also be related to therapeutic agents. Treatment is based on acuity as well as extent of disease and individual life quality aspects of the patients. It is mainly based on topical corticosteroids, combined with vitamin D derivatives in psoriasis and antimycotic agents in seborrheic eczema. In severe cases and widespread psoriatic disease, systemic treatment may be necessary, including the classic agents methotrexate, fumarates and ciclosporin as well as biologicals. Systemic treatment of seborrheic eczema is rarely necessary and resides on corticosteroids, antimycotic agents and vitamin A derivatives. In addition, intensive counseling of patients on the necessity of consequent and long-term treatment as well as use of mild skin care products is mandatory.

[Psychosomatic disorders of the scalp]. / Psychosomatik der Kopfhaut.

Psychosomatic disorders of the scalp have some special characteristics due to the visibility, possible stigmatization, and amount/patterns of hair. Of practical relevance is trichotillomania, which is now classified as an obsessive-compulsive disorder (OCD). Patients who are obsessed with normal physiological hair loss represent a further psychodermatological challenge. Psychosomatic therapy includes basic psychosomatic care, behavior therapy, or treatment with psychopharmaceuticals.

Resolution of psoriasis after tonsillectomy.

A 19-year-old woman experienced recalcitrantpsoriasis after streptococcal pharyngitis. Multipletreatment regimens were employed, but results werepoor until after the patient underwent tonsillectomy.

[Diseases affecting the scalp]. / Choroby postihující kuzi kstice.

The skin of the scalp differs from the skin on the other areas of the body because of a higher density of hair follicles and higher sebum production. These, together with the presence of hair, provide a suitable environment for superficial infections, infestations and inflammatory diseases. The good condition of the scalp has a significant impact on the patient's mental well-being and social interaction. The visibility of this part of the skin and the presence of hair itself restrict the range of possible therapeutic agents that can be used due to the complicated application and poor cosmetic outcome. That is the reason why different galenic forms are usually chosen for the scalp compared to the other sites of the skin. The article provides an overview of the most common scalp disorders, the diagnostic approach and recommendations for the treatment.

Primary cicatricial alopecia: Other lymphocytic primary cicatricial alopecias and neutrophilic and mixed primary cicatricial alopecias.

Primary cicatricial alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary cicatricial alopecias, which include pseudopelade of Brocq, central centrifugal cicatricial alopecia, alopecia mucinosa, and keratosis follicularis spinulosa decalvans. It will also discuss the neutrophilic and mixed primary cicatricial alopecias, namely folliculitis decalvans, dissecting cellulitis, folliculitis keloidalis, folliculitis (acne) necrotica, and erosive pustular dermatosis.

A Novel Nit Comb Concept Using Ultrasound Actuation: Preclinical Evaluation.

Nit combing and removal of head louse, Pediculus humanus capitis De Geer (Anoplura: Pediculidae), eggs is a task made more difficult because "nit combs" vary in efficiency. There is currently no evidence that the binding of the eggshell to the hair can be loosened chemically and few hair treatments improve the slip of the louse eggs along the hair. Ultrasound, applied through the teeth of a nit comb, may facilitate the flow of fluids into the gap between the hair shaft and the tube of fixative holding louse eggs in place to improve lubrication. Ultrasound alone had little effect to initiate sliding, requiring a force of 121.5 ± 23.8 millinewtons (mN) compared with 125.8 ± 18.0 mN without ultrasound, but once the egg started to move it made the process easier. In the presence of a conditioner-like creamy lotion, ultrasound reduced the Peak force required to start movement to 24.3 ± 8.8 mN from 50.4 ± 13.0 mN without ultrasound. In contrast, some head louse treatments made removal of eggs more difficult, requiring approximately twice the Peak force to initiate movement compared with dry hair in the absence of ultrasound. However, following application of ultrasound, the forces required to initiate movement increased for an essential oil product, remained the same for isopropyl myristate and cyclomethicone, and halved for 4% dimeticone lotion. Fixing the nit comb at an estimated angle of 16.5° to the direction of pull gave an optimum effect to improve the removal process when a suitable lubricant was used.

Cutaneous Mycobacterium abscessus infection following hair transplant.

A 28-year-old man presented with a 10-day history of scalp nodules. He had undergone hair transplantation 2 months previously. Incision and drainage of one of the nodules yielded gelatinous material, which was sent for microscopy and culture, including low-temperature culture. After 2 weeks of incubation, culture of the nodule yielded acid- and alcohol-fast bacilli, which were identified as Mycobacterium abscessus, a rapidly growing, nontuberculous mycobacterium, which has been reported to cause cutaneous, soft tissue and respiratory infections following trauma, surgery or injection with nonsterile needles. A high index of suspicion is therefore needed in patients who present with cutaneous infections after cosmetic dermatological procedures, including hair transplantation.