Rejuvenation of the male scalp using 1,927 nm non-ablative fractional thulium fiber laser.

OBJECTIVE: The male scalp undergoes extensive photodamage due to a high prevalence of androgenic alopecia and exposure to ultraviolet radiation. This photodamage presents as solar lentigines, fine rhytides, and keratosis, and can prematurely age a patient. In this study, we demonstrate the safety and efficacy of the fractionated 1,927 nm thulium fiber laser using high density and high energy settings to achieve rejuvenation of the male scalp after a single treatment session. METHODS: Four male patients with Fitzpatrick skin types II-III and extensive photodamage on the scalp underwent one treatment with the fractional non-ablative 1,927 nm thulium fiber laser. RESULTS: The patients had a 60-90% improvement in dyspigmentation, lentigines, and keratosis. No adverse events were observed and the patients tolerated the procedure well. CONCLUSION: This case series is the first report in the literature demonstrating the successful rejuvenation of the scalp using the 1,927 nm thulium fiber laser. Lasers Surg. Med. 49:475-479, 2017. © 2017 Wiley Periodicals, Inc.

Treatment of folliculitis decalvans using intensity-modulated radiation via tomotherapy.

BACKGROUND: Folliculitis decalvans (FD) is a form of primary neutrophilic scarring alopecia that is characterized clinically by chronic suppurative folliculitis and often associated with pruritus or even pain. Treatment of FD is often difficult. Herein, we report a case of recalcitrant and painful folliculitis decalvans refractory to antibiotic and anti-inflammatory therapies, which was successfully treated by intensity-modulated radiotherapy (IMRT) in order to irreversibly eliminate hair follicles that prove to be one etiological trigger. CASE PRESENTATION: A 45-year-old male patient with a refractory FD presented with a crusting suppurative folliculitis and atrophic scarring patches on the scalp associated with pain and pruritus. We attempted relief of symptoms by reducing scalp inflammation and eliminating hair follicles through radiation. We delivered 11.0 Gy in two radiation series using tomotherapy, 5.0 Gy in 5 equivalent fractions as a first radiation course. The symptoms markedly decreased but did not totally disappear. Therefore, we delivered a second radiation series 4 months later with an additional 6 Gy. This led to almost complete epilation on the scalp and abolished pain and pruritus on the capillitium. The patient was regularly followed up until 26 months after radiotherapy. Draining lesions or exudation did not recur. He only experienced discrete hair regrowth in the occipital region with folliculitis 12 months after radiotherapy. These residual lesions are currently treated with laser epilation therapy. CONCLUSION: A radical approach to eliminating hair follicles by repeated radiation therapy may induce lasting relief of symptoms in chronic suppurative FD associated with persistent trichodynia.

Improving acne keloidalis nuchae with targeted ultraviolet B treatment: a prospective, randomized, split-scalp comparison study.

BACKGROUND: Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis with fibrotic papules on the occipital scalp. Its treatment is limited and unsatisfactory. OBJECTIVES: To determine whether targeted ultraviolet B (tUVB) phototherapy will (i) improve the clinical appearance of AKN and (ii) induce extracellular matrix remodelling in affected lesions. METHODS: Eleven patients with AKN were enrolled in a prospective, randomized, split-scalp comparison study. One randomly selected side of the scalp was treated with tUVB up to three times weekly for 8 weeks. After week 8, both sides were treated for eight additional weeks. Assessment included lesion counts in two 3 × 3-cm regions of interest (ROIs), one on each side of the scalp (ROI-1: tUVB weeks 0-16, ROI-2: tUVB weeks 9-16), patient self-assessment and analysis of MMP1, MMP9, TGFB1 and COL1A1 mRNA expression by quantitative reverse-transcription polymerase chain reaction. RESULTS: Before treatment, the mean lesion count was similar between tUVB-treated and untreated sides (14·8 vs. 15·0). After 8 weeks of tUVB, the mean lesion count decreased significantly to 9·4 ± 1·2 (P =  0·03), with no change on the untreated side. With continued treatment, the mean lesion count in ROI-1 decreased further to 7 ± 1·5 (P = 0·04) after 16 weeks of tUVB. CONCLUSIONS: tUVB significantly improved the clinical appearance of AKN, led to patient satisfaction and was well tolerated.

Erosive pustular dermatosis of the scalp. A chronic recalcitrant dermatosis developed upon CO2 laser treatment.

Erosive pustular dermatosis of the scalp (EPDS) is a rare, chronic inflammatory dermatosis that mostly affects elderly patients, who develop erosions, pustulation, crusting and scarring on the scalp. Its aetiology remains elusive, although the role of local trauma is being emphasized. Treatment is difficult, with several topical and systemic agents being reported to induce improvement. A 63-year-old Caucasian male had been suffering from persistent painful pustules, erosions and crusts on his scalp for 2 years. The onset of the lesions followed a CO2 laser vaporization procedure to treat multiple actinic keratoses. Different topical and systemic treatments had unsuccessfully been tried. A 4-month course of bid 0.1% tacrolimus ointment, along with strict external photoprotection, resulted in dramatic improvement, sustained after careful tapering of tacrolimus. This case is interesting in that the scalp eruption followed CO2 laser treatment. Other cases have been associated with cryosurgery, radiotherapy, surgery, and 5-FU. In fact, to our knowledge, ours is the fourth reported case of EPDS following CO2 laser treatment. Our case also strengthens previous observations as to the efficacy and safety of topical calcineurin inhibitors in this dermatosis. This is noteworthy bearing in mind the atrophic character of the skin in EPDS, which limits the usefulness of chronically administered topical steroids.

Folliculitis decalvans treated with radiation therapy.

A 33-year-old black man presented with folliculitis decalvans resistant to multiple oral and topical therapies. The patient ultimately responded to radiation therapy.

Effective treatment of scalp psoriasis using the excimer (308 nm) laser.

BACKGROUND: Psoriasis of the scalp can be a major therapeutic challenge as response to topical medication is often inadequate. The excimer laser has potential for providing local phototherapy as its high irradiance makes treatment at this site a practical option. OBJECTIVES: To analyze retrospectively results of treating scalp psoriasis with the excimer (308 nm) laser. METHODS: Thirty-five patients were treated and all had failed intensive topical therapy. Manual separation of hair was used to provide access to the treatment site. Starting doses ranged from 300 mJ/cm(2) (type I) to 1000 mJ/cm(2) (type IV) with treatment twice weekly. RESULTS: All patients improved. Seventeen/35 (49%) of patients cleared>95% (mean: 21 treatments; range: 6-52) and 16/35 (45%) cleared 50-95%. Phototoxicity in the form of erythema and blistering occurred in all patients, particularly around the ears and nape of neck. CONCLUSION: The excimer laser is a successful approach to treatment of psoriasis of the scalp being a simple treatment that can be performed in a short period of time and which has a high rate of effectiveness.

Modern external beam radiation therapy for refractory dissecting cellulitis of the scalp.

BACKGROUND: Dissecting cellulitis of the scalp can be an extremely painful and disfiguring dermatological condition. The associated pain can be severe enough in some cases to require opioid analgesics, and this pain in conjunction with the disfigurement can induce significant emotional distress. Conservative treatments often fail to provide relief. Radiation therapy has been successfully used in the past but with outdated equipment and techniques. OBJECTIVES: To evaluate the efficacy and toxicity of modern external beam radiation therapy techniques for the treatment of dissecting cellulitis of the scalp. METHODS: Four patients with intractable dissecting cellulitis of the scalp were treated with electrons or a combination of electrons and photons to the entire scalp. Daily fraction sizes were 2.5 or 3 Gy and initially prescribed to 15-21 Gy. Patients were re-evaluated 3-4 weeks after completion of therapy. Any residual hair growth was treated with additional radiation treatments to ensure full epilation, up to a maximum dose of 35 Gy. RESULTS: Rapid resolution of pain was seen in all patients with pain. Regression of nodules and decreased discharge was seen in all patients following treatment and cosmesis was subjectively improved. No long-term toxicity has been observed. CONCLUSIONS: Using modern techniques and equipment, radiation therapy appears to be a reasonable option for patients with severe/refractory dissecting cellulitis of the scalp. Acute effects are mild and well tolerated. Aside from alopecia, which was present to some extent in all patients before treatment, no long-term complications have been observed.

Broad-band UVB fiber-optic comb for the treatment of scalp psoriasis: a pilot study.

Abstract Background Scalp psoriasis is a frustrating condition with limited treatment options. Our objective was to test a new fiber-optic broad-band UVB comb device for the treatment of this condition. Methods Scalp psoriasis on adult subjects was treated three times a week for up to 12 weeks with a fiber-optic UVB comb. A minimum 50-cm(2) scalp area served as the control. Starting doses were based on the standard minimal erythema dose (MED) with increments up to 20% for subsequent treatments. Results Fourteen subjects completed the study without sunburn reactions or blisters. Treated sites showed a mean improvement in the modified PASI score of 3.6. The difference in the mean modified PASI scores between the control and treated sites was 3.9 (< 0.0001). Conclusions This fiber-optic broad-band UVB comb can safely and effectively treat scalp psoriasis.

A 308-nm excimer laser for the treatment of scalp psoriasis.

BACKGROUND AND OBJECTIVES: Scalp psoriasis is a frustrating disorder whose treatments can all too often be cumbersome and ineffective. Our objective was to test a combination device involving the 308-nm excimer laser in tandem with a hair blower for treating scalp psoriasis. STUDY DESIGN/MATERIALS AND METHODS: Adult subjects with scalp psoriasis unresponsive to class I topical steroids used in conjunction with medicated shampoos were treated with 308-nm excimer laser pulses in conjunction with a hair blower that parted the obstructing hair twice a week for up to 15 weeks. Half of the scalp served as a control. Starting doses were based on standard minimal erythema dose (MED)'s with subsequent increments of up to 20%. RESULTS: Thirteen subjects completed the study without adverse events. Two were dropped due to lack of compliance. At the end of the investigation, the difference in the mean modified PASI scores between the control and treated sites was 4.0 (<0.0001). CONCLUSIONS: The air blower device in conjunction with the 308-nm excimer laser can safely and effectively treat otherwise refractory scalp psoriasis.

[UV-B comb versus betamethasone solution in scalp psoriasis]. / UV-B-kam versus betametasonoppløsning ved hodebunnspsoriasis.

BACKGROUND: The aim of the study was to assess the effectiveness of a UV-B-comb on scalp psoriasis versus betamethasone valerate solution. MATERIAL AND METHODS: Of 44 adult patients with scalp psoriasis, 22 were treated with a dermalight 80 psoracomb and 22 with betamethasone valerate solution, five times a week for three weeks. RESULTS: No difference in effect was found at the end of treatment. Two weeks after end of treatment a higher proportion of patients treated with UV-B-comb (7/22) had remained in remission than those treated with betamethasone valerate solution (3/22; p < 0.05). INTERPRETATION: Treatment with a UV-B-comb offers a good alternative to topical corticosteroids for patients with scalp psoriasis.

Total scalp treatment of mycosis fungoides: the 4 x 4 technique.

PURPOSE: A technique for treating mycosis fungoides confined to the scalp using a method known as the 4 x 4 technique is presented. METHODS AND MATERIALS: Uniform dose distribution on the scalp and acceptable "hot spots" along five match lines is accomplished by using four sets of four fields (i.e., 4 x 4) on the patient. Precise and reproducible patient and field alignment was accomplished with a solid thermoplastic mask, which is the surface on which match lines are drawn. In-vivo dosimetry (thermoluminescent dosimeters and film) are easily attached to the mask which also provides a portion of the 7 mm bolus used to shift the characteristic 6 MeV electron depth dose toward the skin surface. RESULTS: In-vivo dosimetry demonstrated that single fraction match line doses are within 25% to 30% of central axis dose. Shifting these match lines to four locations reduces these "hot spots" to satisfactory levels (less than 120%). Three patients have been treated with this technique and each patient continues to have a complete clinical response at 14 to 21 months post treatment. In addition, each patient has excellent cosmetic results with no evidence of acute or chronic side effects at the match lines. CONCLUSION: The 4 x 4 technique has proven to be useful in the treatment of mycosis fungoides confined to the scalp.

Childhood intracranial meningiomas after high-dose irradiation.

BACKGROUND: Irradiation, either alone or in association with other factors, is thought to play a role in the causation of intracranial meningioma. METHODS: The authors report two 15-year-old patients with convexity meningiomas as a result of high-dose irradiation received at a young age and review the English language literature reports of 13 pediatric patients with meningiomas after high-dose irradiation. The clinical characteristics of the 15 patients are presented. RESULTS: There were nine girls and six boys. The mean age at the time of irradiation was 2.5 years (2 months-9 years), and the mean age at diagnosis of meningioma was 13 years (5-15.5 years). The mean radiation dose was 4154 cGy (1500-8000 cGy). In 11 of the 15 patients, the meningioma was located in the calvarial area. Only 1 of 15 had multiple tumors, and only two of the tumors were clearly malignant at diagnosis. In ten patients, gross total resection was recorded, and two patients underwent subtotal resection. Three died of recurrent/disseminated meningiomas. CONCLUSIONS: This study suggests that meningiomas after high-dose radiation in children are mostly calvarial in location, rarely multiple, mostly benign in histologic type, and that complete removal is possible in most patients. The age at the time of radiation is young (mean age, 2.5 years) and the latent period is short (mean, 10.8 years). Although the clinical course of radiation-induced meningiomas in childhood generally is benign, high doses of radiation at a young age are to be avoided, and other means of therapy should be used if possible.

Evaluation of a total scalp electron irradiation technique.

A dosimetric evaluation of a total scalp electron-beam irradiation technique that uses six stationary fields was performed. The initial treatment plan specified a) that there be a 3-mm gap between abutted fields and b) that the field junctions be shifted 1 cm after 50% of the prescribed dose had been delivered. Dosimetric measurements were made at the scalp surface, scalp-skull interface, and the skull-brain interface in an anthropomorphic head phantom using both film and thermoluminescent dosimeters (TLD-100). The measurements showed that the initial technique yields areas of increased and decreased dose ranging from -50% to +70% in the region of the field junctions. To reduce regions of nonuniform dose, the treatment protocol was changed by eliminating the gap between the coronal borders of abutted fields and by increasing the field shift from 1 cm to 2 cm for all borders. Subsequent measurements showed that these changes in treatment protocol resulted in a significantly more uniform dose to the scalp and decreased variation of doses near field junctions (-10% to +50%).