[The Prevalence and Management of Pediculosis Capitis in Turkey: A Systematic Review]. / Türkiye'de Pedikulozis Kapitis Prevalansi ve Yönetimi: Sistematik Derleme.

This study aimed to examine scientific articles performed in Turkey on the prevalence and management of PK (diagnosis, contagion, prevention, treatment) from a critical perspective. The population of the systematic review consisted of total 63 published and unpublished theses or dissertations and peer-reviewed articles published in Turkish or English in national or foreign scientific journals from studies performed in Turkey between 1982 and 2012 years. It reached 578,938 people in 63 studies. Seventy-eight percent of the studies were related to the prevalence of PK and/or associated factors. The number of the studies was limited regarding diagnosis, prevention, contagion, treatment compliance, difficulties and causes of failure. Of the studies, 90.5% had been performed in public schools, almost exclusively elementary schools. The prevalence of PK was 0.3-34.1%, 0-35.4%, and it was 0.3-34.1% in elementary school children. It increased with years of education. It was double that of the boys in the girls (p<0.05). The prevalence among the subjects with low economic status were 1.9-42.3%, and it increased with worsening economic status (p<0.05). The prevalence reached up to 44.1% among children with illiterate mother. Basic recommendations include increasing the number of studies on the diagnosis, prevention, contagion, treatment compliance and efficacy, treatment failures and difficulties; public health workers also should prioritize investigation of head lice infestation.

Recommendations for a patient-centered approach to the assessment and treatment of scalp psoriasis: a consensus statement from the Asia Scalp Psoriasis Study Group.

BACKGROUND: International consensus statements on the management of scalp psoriasis are available, but no such recommendations exist for Asia. METHODS: The Asia Scalp Psoriasis Study Group (ASPSG) met in May 2011 to review the epidemiologic pattern of scalp psoriasis in Southeast Asia and to develop Asia-specific recommendations for its management. RESULTS: The overall prevalence of psoriasis in Asia is <0.3%, but 75-90% have scalp involvement, whether isolated or with lesions elsewhere, which can negatively impact quality of life (QoL). Treatment decisions should be based primarily on objective disease severity, but should also take account of patient QoL. Psychosocial support and more aggressive treatment should be offered to all patients with moderate to severe QoL impairment. Topical therapy is indicated first-line in all patients, with combination therapy (corticosteroid + calcipotriol), more occlusive formulations, keratolytics, and very potent corticosteroids for patients needing greater or faster efficacy. Systemic therapies, light or laser treatments should be reserved for patients with severe and recalcitrant disease. CONCLUSIONS: The ASPSG recommends a patient-centered approach to scalp psoriasis management, consistent with the international consensus statements. Asian physicians should also consider patient QoL, prior treatment response, formulation preferences, likely adherence, cost, time available for self-management, and potential adverse events.

Heterogeneity in the treatment of moderately severe scalp psoriasis in Scotland - results of a survey of Scottish health professionals.

BACKGROUND: Scalp psoriasis is a chronic recalcitrant condition. An aging literature for topical treatments used in clinical practice and no treatment guidelines means there is no current gold standard for its management in Scotland. There are no Scottish data on the resources and costs of treatment of the scalp psoriasis patient. OBJECTIVE: Conduct a survey of Scottish healthcare professionals to understand how patients are typically managed to support the development of a model estimating the cost-effectiveness of a new treatment for moderately severe scalp psoriasis in Scotland. RESEARCH DESIGN AND METHODS: Experts from primary and secondary care were invited to participate in an interview programme to collect information on the management of scalp psoriasis in Scotland. This was further informed by Scottish prescribing statistics. Simple descriptive statistics were performed. RESULTS: Forty-three healthcare professionals (33 from primary care and ten in secondary care) completed the survey which illuminated national prescribing statistics. While an overall 72% response rate was achieved, representation from five of 14 Health Boards was not available. There was significant variation in stated patient pathways but some common themes. Most patients were treated initially with coal tar preparations and shampoos, then often progressing to topical potent corticosteroids. There was no consensus on the order patients might receive topicals thereafter although if referred for specialist review they would typically have been treated with three topicals in primary care first. Treatment in secondary care comprised application of topicals available in primary care or alternative preparations with nurse assistance to improve compliance. Phototherapy and systemic agents were not given to patients with scalp psoriasis alone. Study limitations are not considered to impact on the study observations. CONCLUSIONS: There was a large variety in first-, second- and third-line agents in primary care in scalp psoriasis although our interview programme and prescribing data confirmed which treatments were most frequently prescribed. Treatment heterogeneity reflects the limitations in current therapies, paucity of evidence-based effectiveness data and lack of clinical guidelines. Experts agreed 'current standard practice' in Scotland was best described as an average across five plausible treatment pathways.

Survey assessment of parental perceptions regarding head lice.

BACKGROUND: Head lice constitute a problem in children. Each year, numerous cases of pediculosis occur worldwide. Little work has been performed to evaluate the understanding, opinions, and actions of populations regarding head lice. These areas are important as they enable clinicians and educators to alert parents on how to avoid treatments that are innocuous or of high risk to patients. METHODS: A cross-sectional study was performed by interviewing the heads of households of 100 randomly chosen residences within the study area. RESULTS: The results obtained showed that 13% were infested during the first week of the survey, and 86% in the 24 weeks prior to the study. The number of positive cases increased with increasing resident number, and decreased in families with parents with a higher educational level. Itching was the principal clinical manifestation and caused sleep compromise in 65% of respondents. Innocuous and unhealthy practices to combat infestation, such as the use of inflammables and home insecticides, were common. CONCLUSION: The results showed that certain beliefs generated worry and confusion in parents, who blamed head lice as the cause of various health problems which were not due to this insect.

The importance of socio-economic status and individual characteristics on the prevalence of head lice in schoolchildren.

Pediculosis is a common infestation in schoolchildren but little is known about the factors influencing its prevalence. The aim of this study was to determine the prevalence of head lice in schoolchildren in Ghent and to investigate the independent association between individual characteristics of the child, socio-economic status (SES) of the family and head lice. The prevalence of head lice at baseline and 14 days after treatment advice was determined by the wet combing method in a total of 6,169 schoolchildren age 2.5 to 12 years from Ghent (Belgium). Age, sex, educational level and hair characteristics of the child, SES of the family, and number of children in the family was collected by the school health department. The prevalence of head lice was 8.9%. The only statistically significant factors at the child level are SES, the number of children in the family, hair length and hair colour. Treatment failure was recorded in 41% of the children positive at baseline screening and was significantly related to hair colour and SES. This study demonstrated that the prevalence of head lice is determined by clustering of children rather than by characteristics of the child. The management of head lice should take a community-based approach equally involving families, schools, health care professionals and the government.

Experience in treating recalcitrant scalp psoriasis with automated shampooing and debridement.

We report the cumulative clinical experience and financial implications of treating severe scalp psoriasis in an outpatient phototherapy center by means of an automated scalp debridement unit. Benefits of this approach included increased patient and staff satisfaction, enhanced response of recalcitrant scalp psoriasis, and detection of scalp dermatoses mimicking psoriasis.

Incidence of the concrete scalp deformity associated with deep scalp donor sites and management with the Unna cap.

The scalp has become a popular donor site for split-thickness skin grafts. This donor site does, however, have complications, including the concrete scalp deformity, which consists of hairs embedded in a thick, desiccated, exudative crust. This article presents our burn unit's experience with this complication. Fifty-six patients underwent scalp skin graft harvesting between 1984 and 1996. All grafts were quite thick and were used for resurfacing facial burns. Thirty-eight donor sites were treated with medicated gauze, and 18 were treated with the Unna cap, which is an Unna dressing applied over Aquaphor gauze (Beiersdorf, Norwalk, Conn). Eighteen of the 38 patients (32%) treated with medicated gauze developed the concrete scalp deformity. None of the patients treated with the Unna cap developed the deformity. Although useful, the deep scalp donor site has complications, including the concrete scalp deformity. However, with use of the Unna cap dressing, we have had no occurrences of this problem.

Scalp psoriasis, clinical presentations and therapeutic management.

BACKGROUND: The scalp is a well-known predilection site for psoriasis. Many patients indicate that scalp psoriasis is both psychologically and socially distressing. OBJECTIVE: The aim of the present investigation is to provide epidemiological data on the various manifestations of scalp psoriasis, as well as on its therapeutic management. METHODS: A questionnaire, targeted on scalp psoriasis, was mailed to patient subscribers of a Dutch journal on psoriasis. In total 1,023 forms were returned and evaluated. RESULTS: Remarkably, a relatively high occurrence of facial psoriasis (25%) and nail psoriasis (40%) was recorded. The dynamics of scalp psoriasis were rather similar to psoriasis at other sites with respect to the total duration of the disease and exacerbations/remissions. In 57% of the patients, psoriasis was psychologically and socially distressing, at least occasionally. Itch and scaling proved to be the leading symptoms, in terms of frequency of occurrence as well as in terms of distress. Therefore, these parameters should be regarded as primary efficacy criteria in the treatment of scalp psoriasis. On average, most patients were seen by the dermatologist 5 times a year. The majority of prescriptions (76%) was given by the dermatologist. The application of topical corticosteroids was by far the most frequent treatment modality. To our surprise, calcipotriol was used by 28% of patients. At the time of investigation calcipotriol was only available as ointment. Tar shampoos were used by 51% of the patients, although the clinical efficacy of such a shampoo has never been demonstrated in a controlled study. A remarkable observation was the lack of instruction on the duration of treatment and the frequency of applications. In fact, 72% of the patients used topical treatments, including topical corticosteroids, for more than 8 weeks, and 42% of the patients used an intermittent schedule of a few applications per week. CONCLUSIONS: Based on the present survey, the following profile for an optimal treatment of scalp psoriasis can be constructed: (1) effective applications a few times per week; (2) either a lotion or an emulsion, and (3) safety for long-term use.

[Wigs as medical aids. Selection, care and cost regulation]. / Perücken als medizinisches Hilfsmittel. Auswahl, Pflege, Kostenregelung.

In a discreet way, wigs not only cover up a disfiguring loss of hair but also chronic and suppurative diseases of the scalp. We especially deal with the problems regarding the choice of such wigs, how they are--if necessary--disinfected, cleaned, and tended, and how the expenses may be settled.