Dissecting folliculitis (dissecting cellulitis) of the scalp: a 66-patient case series and proposal of classification.

BACKGROUND AND OBJECTIVES: Dissecting folliculitis (DF) or dissecting cellulitis of the scalp is regarded as a rare disease with disfiguring scarring alopecia. This study aimed to analyze the features of DF and to propose a classification to define its severity. PATIENTS AND METHODS: A hospital-based retrospective study was conducted. Patients with a histopathological diagnosis or clinical features leading to diagnosis of DF were included and classified into three stages. RESULTS: Among the 66 patients recruited (63 men / 3 women, mean age 24.9 years), multiple interconnected alopecic nodules involving the vertex scalp were the main feature. Histopathology showed an extensive inflamed granulation abscess forming a dissection plane in the lower dermis/subcutis in the acute stage. Lymphocytic infiltration was predominant in seven of 21 histology specimens. Overweight and obesity were noted in 29 of 45 patients examined. No association with smoking was found. There was comorbidity with acne conglobata in 15 of 66 patients, two of whom had acne inversa. Longer disease duration and greater number of nodules were associated with higher severity of DF (p < 0.05). A complete remission rate of 25 % was achieved by any treatment, and a rate of 37.5 % was achieved with oral isotretinoin alone. CONCLUSIONS: DF is not uncommon in Taiwan. An association with obesity needs to be clarified.

[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.

Lichen planopilaris: Epidemiology and prevalence of subtypes - a retrospective analysis in 104 patients.

BACKGROUND: Management of patients with lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) is rendered difficult as robust epidemiologic data, insights on pathogenesis, associated diseases, possible relevance of concomitant medications or environmental factors are lacking. PATIENTS AND METHODS: Retrospective analysis of demography, skin status, concomitant medication and diagnostic procedures were performed on 104 medical records (71 classic LPP, 32 FFA, and one Graham-Little-Piccardi-Lassueur syndrome). RESULTS: Women were more often affected (distribution F: M classic LPP 4.9: 1; FFA: 31: 1). Compared to LPP patients, patients with FFA were significantly older (p < 0.001), more often postmenopausal, and more frequently on hormone replacement therapy. No other specific associations were identified. An association with lichen planus, other autoimmune diseases, or hepatitis virus infection was found only in individual patients. Clinically, FFA patients were significantly more often reported to have reduced eyebrows (p < 0.005), axillary, and/or pubic hair (p = 0.050). CONCLUSIONS: The findings obtained from this study, with currently largest LPP/FFA patient cohort in Germany, encouraged us to set up a national FFA patient registry. Prospective data collected from larger numbers of patients with standardized questionnaires will help to assess assumed associations and influencing factors and to develop, in the long-term, recommendations for diagnosis and treatment.

Lipedematous diseases of the scalp are not separate entities but part of a spectrum of lipomatous lesions.

BACKGROUND: Lipedematous lesions of the scalp share a wide range of morphologic criteria with classical lipomatosis. In the past decade, lipedematous scalp and lipedematous alopecia have been described as pathomorphologically related diseases of the scalp, but many clinicians and dermatopathologists disagree with this assessment. Morphologic and pathogenetic concepts remain unclear and raise the concern that a plethora of terms are being used to describe and distinguish phenotypical variations of an identical theme. PATIENT AND METHODS: Here, we report a 15-year-old male Turkish child with what we could consider, according to the currently accepted classifications, lipedematous scalp without associated alopecia. RESULTS: The principal aim of this manuscript is to critically reappraise the current literature on lipomatous lesions and focus on morphologic features in order to reestablish five crucial diagnostic criteria. CONCLUSIONS: Due to the possibility of excluding therapeutic elements by separating the lipomatous lesions into various entities, we propose using the term "localized lipomatosis of the scalp with or without associated alopecia" in order to arrive at a straightforward diagnosis, thereby avoiding numerous partially synonymous terms; moreover, we do not intend to expand the spectrum of distinct lipomatous entities, but propose classification of these diseases within the group of conventional lipomatosis.

Classification of segmental vitiligo on the face: clues for prognosis.

BACKGROUND: The origin of the distribution of segmental vitiligo (SV) has not yet been clearly elucidated. Segmental configurations of cutaneous disorders have been explained using two main interpretations, i.e. following either dermatomal or blaschkolinear distributions. However, facial SV does not always correspond to either of these distributions. OBJECTIVES: We classified facial SV into several distinctive subtypes according to specific distributions based on long-term observations. METHODS: In total, 257 patients with facial SV were included, all of whom were closely observed for more than 1 year. The distribution patterns of facial SV were classified according to morphological similarities based on clinical observations. RESULTS: The lesions of facial SV were categorized into six subtypes: types I-a and I-b, and types II-V. Type I-a and type IV broadly involved the mid-level face from the forehead to the lower cheek, but type IV lesions selectively appeared on the right side of the face and did not cross the midline. Type I-b lesions chiefly involved the forehead and scalp hair. Types II and III involved the lower face and, frequently, the neck area, and type V lesions were distributed mostly around the right orbital area. The most frequent type of lesion in this study was type I-a (28·8%), followed by types II (16·0%), III (14·4%), IV (10·9%), I-b (10·5%) and V (8·6%). CONCLUSIONS: Newly established patterns of facial SV may be valuable for certain aspects of prognosis, such as the likely degree and path of lesion spreading.

Steroid-responsive facial eruption with cornoid lamellae--a possible new entity.

The histopathologic presence of a cornoid lamella is often associated with a diagnosis of porokeratosis. However, this feature is not pathognomonic for porokeratosis and can be found in a number of other dermatologic conditions, which include seborrheic keratosis, verruca vulgaris, actinic keratosis, squamous-cell carcinoma in situ, basal-cell carcinoma, milia, and scar. Notably, the etiology of none of these entities is inflammatory. Wade and Ackerman consider cornoid lamellation to be a distinctive histopathologic reaction pattern that reflects the disordered progression of epidermal cells during cornification. As such, this pattern is not specific for any given disease process. We report a case in which the lesions appeared inflammatory clinically as well as histopathologically, did not resemble porokeratosis despite the presence of cornoid lamellae, and responded to topical glucocorticoids.

The relationship between quality of life and the severity of psoriasis in Turkey.

BACKGROUND: Patients with psoriasis experience a low quality of life and high treatment burden: OBJECTIVES: To assess psoriatic patient quality of life using the Dermatology Life Quality Index (DLQI) in the Northeastern Anatolia region of Turkey. Additionally, we evaluated the correlation between the DLQI and the clinical severity of psoriasis and examined demographic data and their relationship with the DLQI and psoriasis severity: MATERIALS AND METHODS: This study was a single-center, prospective, cross-sectional study at the University of Kafkas, Kars, Turkey. 127 adult patients were included in the study. The Turkish version of the DLQI was used. To measure psoriasis severity, the Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) were simultaneously evaluated. The patient demographics were compared with quality of life and the severity of psoriasis: RESULTS: DLQI scores ranged from "very large" to "extremely large" in 61% of the patients. The psoriasis severity (BSA and PASI) was "mild" in 63% of patients. The quality of life was significantly affected in cigarette smokers and in patients whose disease included nail involvement. The PASI and BSA scores of patients with scalp and nail involvement were significantly higher. A significant, positive correlation was found between disease duration and the severity of psoriasis. BSA correlated with PASI: CONCLUSION: The quality of life of psoriasis patients is strongly reduced. A significant relationship was found for DLQI with nail psoriasis and smoking. A linear, positive correlation was detected between the DLQI and BSA but not between the DLQI and PASI.

Hair casts. Review and suggestion regarding nomenclature.

There are two types of hair cast. The common type is found frequently in association with parakeratotic scalp disorders. They have features allowing specific identification. They occur in children and adults of either sex. It is suggested they be called parakeratotic hair casts, as this name reflects the cause and composition of the casts. The uncommon type has specific features that are different from the common type. They are not usually associated with diseases of the scalp and have only been reported in female subjects. It is suggested they be called peripilar keratin casts, as this is the name frequently used for them. The proposed nomenclature should avoid confusion between two distinct types of hair casts that have often inappropriately been regarded as the same disorder, and which have not been previously differentiated by specific names.

Cutis verticis gyrata (case reports of rare causes).

Two cases of cutis verticis gyrata (CVG) one in association with a saccular aneurysm of the internal carotid artery and another with intraventricular ependymoma are reported. Not only is CVG rare, its association with intracranial aneurysms has not been reported in the literature. This paper documents those rare associations and gives a short review of CVG.

Cutis verticis gyrata: three cases with different aetiologies that demonstrate the classification system.

Cutis verticis gyrata describes a scalp condition where there are convoluted folds and deep furrows that resemble the surface of the cerebral cortex. We report three cases of cutis verticis gyrata that demonstrate the current classification structure. The first case is the most commonly described primary non-essential acquired form, appearing in the scalp of an 11-year-old girl with mental retardation. The second case is the primary non-essential congenital form, presenting at birth in a baby with Noonan's syndrome. An association between cutis verticis gyrata and Noonan's syndrome has been rarely described. The third case illustrates secondary cutis verticis gyrata, occurring in a 27-year-old man with discoid eczema.

Cutis verticis gyrata.

When the scalp exhibits folds and furrows resembling gyri, it is termed cutis verticis gyrata. The possible etiologies may be categorized as primary essential, primary nonessential, and secondary cutis verticis gyrata. This is based on history, physical examination, and histologic criteria with or without laboratory examinations.

Nevus psiloliparus: a distinct fatty tissue nevus.

BACKGROUND: Encephalocraniocutaneous lipomatosis is usually associated with a peculiar type of fatty tissue nevus which represents a smoothly surfaced and hairless lesion involving the scalp. This disorder has so far not been recognized as a cutaneous entity. OBJECTIVE: The purpose of this article is to describe the characteristic features of this nevus and to give it a name. METHOD: From the study of two cases and from a review of the literature we delineate the clinical and histopathological criteria of this disorder for which we propose the term 'nevus psiloliparus'. This name is derived from the Greek words psilós = hairless and liparós = fatty, and describes the two most characteristic features of the disorder. RESULTS: A comprehensive comparison shows that nevus psiloliparus can be distinguished from other types of fatty tissue nevi by clinical criteria such as localization on the scalp, a flat smooth surface and absence of hair follicles, by the histopathological feature of isolated arrector pili muscles and by the presence of associated extracutaneous features in the form of encephalocraniocutaneous lipomatosis. In particular, nevus psiloliparus can be separated from the Hoffmann-Zurhelle nevus that has so far never been observed in cases of encephalocraniocutaneous lipomatosis. CONCLUSION: The presently available data suggest that nevus psiloliparus represents a distinct cutaneous entity. Future clinical and genetic research should show whether this concept holds true.