Standardizing the 60-second hair count.

OBJECTIVE: To define the range of normal for a standardized 60-second hair count in men without alopecia. DESIGN: Convenience sample. SETTING: Hospital-based practice. PARTICIPANTS: The study included 60 healthy men (age range, 20-60 years) without evidence of alopecia. MAIN OUTCOME MEASURE: Range of normal for a standardized 60-second hair count. RESULTS: Among the 20- through 40-year-old men, the shedding range was 0 to 78 hairs, with a mean of 10.2 hairs. Among the 41- through 60-year-old men, the range was 0-43 hairs, with a mean of 10.3 hairs. Low intrapatient variability for hair counts was found in both age groups, indicating consistent results on consecutive days for all participants. When repeated 6 months later in both age groups, the hair counts did not change much. The hair counts were repeated and verified by a trained investigator, with results similar to those of subject hair counts. CONCLUSION: A properly performed 60-second hair count is a simple, practical, and reliable tool for the assessment of hair shedding.

Soft tissue augmentation: a review.

The continuing quest for the ideal dermal filler has led to an abundance of injectable agents. The ideal filler should be easy to manufacture, store, and administer. It should also be inexpensive, nontoxic, nonallergenic, natural appearing, and long lasting. There is not yet a filler that fulfills all of these criteria; each product has its own advantages and disadvantages. This review will examine the diverse array of fillers to date.

Successful treatment of delusions of parasitosis with olanzapine.

BACKGROUND: Delusional parasitosis is a rare disorder in which patients have a fixed, false belief of being infested with parasites. It is often accompanied by a refusal to seek psychiatric care. Delusions of parasitosis is classically treated with typical antipsychotic agents, the traditional dermatologic choice being pimozide. However, pimozide's adverse effect profile and the need for frequent electrocardiographic monitoring make such treatment less practical. OBSERVATION: We describe 3 patients who were diagnosed as having delusional parasitosis that was successfully treated with a recently Food and Drug Administration-approved atypical antipsychotic agent, olanzapine (5 mg/d). Olanzapine has a more benign adverse effect profile than typical antipsychotic agents and eliminates the need for electrocardiographic monitoring. Olanzapine therapy has been associated with such adverse effects as sedation, hyperlipidemia, weight gain, and insulin resistance, all of which were infrequent in our patients. CONCLUSION: Olanzapine is an atypical antipsychotic agent that can be used as a first-line agent in delusional parasitosis as a safer therapeutic option without a specialized monitoring regimen.

Body dysmorphic disorder.

BACKGROUND: Body dysmorphic disorder (BDD) is a syndrome characterized by distress secondary to imagined or minor defects in one's appearance. Although it is a psychiatric disorder, most affected patients present to the dermatologist or plastic surgeon to improve their perceived defect. OBJECTIVE: The objective was to review the literature on BDD, examining the epidemiology, etiology, clinical features, diagnostic criteria, and treatment of the disorder. METHODS: Three representative cases of BDD are presented; in addition, a search of MEDLINE was completed and a review of all published data on BDD was performed. RESULTS: BDD has an estimated prevalence of 1 to 2% in the general population; this prevalence is increased in patient populations. There is significant comorbidity associated with BDD. CONCLUSIONS: BDD is a relatively common psychiatric disorder in which patients typically present to cosmetic surgeons for treatment of their perceived or imagined defect. Surgical treatments usually prove unsatisfactory to the patient and to the practitioner. Psychiatric treatment is extremely challenging.

Diagnosing and managing the patient with rosacea.

Rosacea is a common, chronic facial dermatosis that may present in varying manners. Subtypes of rosacea include erythematotelangiectatic, papulopustular, phymatous, and ocular. In this article, we discuss the diagnosis of these rosacea subtypes and focus on the therapeutics specific to each. Treatments include topical agents, oral antibiotics, laser therapies, surgical treatments, and the role of cosmetics and skin care.

Accelerated cutaneous nodulosis during infliximab therapy in a patient with rheumatoid arthritis.

Up to one fourth of patients with rheumatoid arthritis (RA) may have extraarticular findings such as subcutaneous nodules. These are discrete subcutaneous granulomatous nodules located on extensor surfaces, especially of the elbows. Over the past 10 to 15 years, there have been reports of accelerated cutaneous nodulosis in patients receiving methotrexate therapy. Recently, antitumor necrosis factor alpha (anti-TNFalpha) biologic therapy has become commonplace in the management of RA, especially in methotrexate-resistant or toxic patients. There have been recent reports of accelerated nodulosis in patients with RA on etanercept. We describe what we believe is the first case of accelerated cutaneous nodulosis resulting from infliximab anti-TNFalpha therapy in a patient with RA. One year after the initiation of infliximab, with RA in remission, our patient noted the rapid development of rheumatoid nodules of both hands. A biopsy was characteristic of a rheumatoid nodule, revealing palisading granulomas and fibrinoid necrosis.

Delayed-type hypersensitivity to lidocaine.

BACKGROUND: Lidocaine hydrochloride is the preferred anesthetic agent used in outpatient surgical procedures. While type I hypersensitivity reactions to lidocaine are uncommon, type IV hypersensitivity is reported even less frequently. OBSERVATIONS: Between January 1, 2001, and December 31, 2001, 183 patients were patch tested at the Penn State Milton S. Hershey Medical Center (Hershey, Pa) to the North American Contact Dermatitis Group tray. All patients who had a positive patch test reaction to lidocaine were challenged with 0.1 mL of preservative-free 1% lidocaine intradermally. Of the 183 patients patch tested, 4 had positive reactions to lidocaine, 2 of whom had histories of sensitivity to local injections of lidocaine manifested by dermatitis. CONCLUSIONS: Delayed-type hypersensitivity to lidocaine may occur more frequently than previously thought. In cases of suspected lidocaine contact type IV sensitivity, patients should be patch tested to lidocaine. Positive patch test reactions should be confirmed by intradermal challenge with lidocaine. To provide the patient with alternative local anesthetics, patch testing should be performed with other injectable anesthetics. If positive patch test results occur, intradermal testing should follow.

Alopecia mucinosa: report of a case and review.

BACKGROUND: Alopecia mucinosa has been shown to be associated with many benign and malignant conditions. It can be seen in childhood but is seen more commonly in adulthood. Alopecia mucinosa is generally felt to occur in three settings: a primary idiopathic form, a form associated with malignancy, and a form secondary to inflammatory conditions. The histologic hallmark is the accumulation of mucin in the follicular epithelium, called follicular mucinosis. Therapy for alopecia mucinosa remains problematic. OBJECTIVE: We present a representative case of alopecia mucinosa and discuss the etiology, histology, epidemiology, treatment, and prognosis. CONCLUSION: We report a case of idiopathic alopecia mucinosa that responded to minocycline with a complete remission and we review the literature on alopecia mucinosa.

Eczema herpeticum: a dermatologic emergency.

Eczema herpeticum is a potentially life-threatening herpetic superinfection of a pre-existing skin disease. Despite the availability of antiviral therapies, eczema herpeticum remains a dermatologic emergency today. Two representative cases of eczema herpeticum along with discussion of the etiology, means of diagnosis, treatments, and complications of eczema herpeticum are presented.