Dissecting cellulitis (Perifolliculitis Capitis Abscedens et Suffodiens): a comprehensive review focusing on new treatments and findings of the last decade with commentary comparing the therapies and causes of dissecting cellulitis to hidradenitis suppurativa.

Dissecting cellulitis (DC) also referred to as to as perifolliculitis capitis abscedens et suffodiens (Hoffman) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. In the U.S., it predominantly occurs in African American men between 20-40 years of age. DC also occurs in other races and women more rarely. DC has been reported worldwide. Older therapies reported effective include: low dose oral zinc, isotretinoin, minocycline, sulfa drugs, tetracycline, prednisone, intralesional triamcinolone, incision and drainage, dapsone, antiandrogens (in women), topical clindamycin, topical isotretinoin, X-ray epilation and ablation, ablative C02 lasers, hair removal lasers (800nm and 694nm), and surgical excision. Newer treatments reported include tumor necrosis factor blockers (TNFB), quinolones, macrolide antibiotics, rifampin, alitretinoin, metronidazole, and high dose zinc sulphate (135-220 mg TID). Isotretinoin seems to provide the best chance at remission, but the number of reports is small, dosing schedules variable, and the long term follow up beyond a year is negligible; treatment failures have been reported. TNFB can succeed when isotretinoin fails, either as monotherapy, or as a bridge to aggressive surgical treatment, but long term data is lacking. Non-medical therapies noted in the last decade include: the 1064 nm laser, ALA-PDT, and modern external beam radiation therapy. Studies that span more than 1 year are lacking. Newer pathologic hair findings include: pigmented casts, black dots, and "3D" yellow dots. Newer associations include: keratitis-ichthyosis-deafness syndrome, Crohn disease and pyoderma gangrenosum. Older associations include arthritis and keratitis. DC is likely a reaction pattern, as is shown by its varied therapeutic successes and failures. The etiology of DC remains enigmatic and DC is distinct from hidradenitis suppurativa, which is shown by their varied responses to therapies and their histologic differences. Like HS, DC likely involves both follicular dysfunction and an aberrant cutaneous immune response to commensal bacteria, such as coagulase negative staphylococci. The incidence of DC is likely under-reported. The literature suggests that now most cases of DC can be treated effectively. However, the lack of clinical studies regarding DC prevents full understanding of the disease and limits the ability to define a consensus treatment algorithm.

Occipital lesions: a possible cost of cradleboards.

This examination of a Mimbres-Mogollon pueblo skeletal sample reveals a surprising percentage of individuals with occipital lesions. Each lesion is located in the approximate center of the squama immediately superior to the external occipital protuberance. Notably, no child over the age of 1 year exhibits a lesion that would have been active at the time of death, but a number of older children and adults exhibit evidence of healed lesions in this same area on the occipital. The restricted nature of these lesions, in terms of both their locations and ages of those actively affected, suggests that the use of cradleboards may have been at least a contributing, if not initiatory, factor in their creation. Specifically, this study suggests that the pressure and friction of an infant's head against a cradleboard may have 1) produced ischemic ulcers, 2) produced the conditions favorable for bacterial infections such as impetigo or carbuncles, or 3) complicated the treatment of other infections appearing on the back of the scalp.

[The history of dandruff and dandruff in history. A homage to Raymond Sabouraud]. / Histoire des pellicules et pellicules de l'histoire. Un hommage à Raymond Sabouraud.

In one of his books, written at the beginning of this century, Raymond Sabouraud devotes some 280 pages to the history of dandruff. Their reading illustrates how, from the Greeks to Sabouraud's era, this desquamative disease has been subjected to endless doctrinal and scientific conflicts, long before the so-called "present" controversies. One of the early conflicts, between Celsus and Galen, lies in the nature of the squames, i. e. dry or exudating, leading to the inclusion (or non inclusion) or pityriasis in the group of desquamative diseases, such as psoriasis or ichytosis. Translated into Latin (furfur, porrigo) and into Arabic, the word pityriasis was replaced in the Middle Age by tinea which then referred to any disease of the human scalp. With Plenk, Lorry, Willan and others, the 18th century brought a new attitude of mind where observation took precedence over doctrine, but owing to the lack of experimental approach there was no adequate description of the squames and their anatomical origin. This was the case with Hebra who, in the 19th century, claimed that dandruff was nothing but a sebaceous disease. This major turn resulted for decades in a confusion between dandruff and seborrhoea. In the late 19th century, bacteriological studies were decisive steps taken by Rivolta, Malassez and Sabouraud. The presence on scalps affected with dandruff of a bottle-shaped "fungus" (Pityrosporum ovale was initially not regarded as a yeast) was taken as being the definite cause of the disease. The Sabouraud dogma was born, but as early as 1877 it was denied by Vidal who observed these "spores" on healthy scalps.(ABSTRACT TRUNCATED AT 250 WORDS)