Ultrasound Pattern of Cutis Verticis Gyrata.

Cutis verticis gyrata (CVG) is a cutaneous benign condition that usually presents symmetric or asymmetric convoluted folds and deep furrows in the scalp, which mimic the disposition of the cerebral sulci and gyri. This scalp deformation may be a worrying situation for the patients and their families. Clinically, its diagnosis may be challenging because it can mimic other cutaneous conditions. So far, the ultrasonographic pattern of CVG has not been reported. Thus, we aim to review the ultrasound findings of this entity. All patients (n = 14) presented zones with dermal and hypodermal thickening that corresponded with the elevated clinical zones, followed by folds with normal cutaneous thicknesses. There was undulation of the cutaneous layers in all cases. The scalp areas involved the frontal, parietal, and occipital regions bilaterally. The mean maximum dermal and hypodermal thicknesses and echogenicities and the color Doppler characteristics are provided. No significant dilation of the hair follicles was detected. In conclusion, CVG presents an ultrasonographic pattern that can support its diagnosis and follow-up. This can help its differential diagnosis with other scalp dermatologic conditions.

Diagnostic Accuracy of Trichoscopy in Inflammatory Scalp Diseases: A Systematic Review.

BACKGROUND: The common inflammatory scalp diseases, such as psoriasis, seborrheic dermatitis, lichen planopilaris, discoid lupus erythematosus, contact dermatitis, or pemphigus may share similar clinical features. OBJECTIVE: To identify and systematically review the available evidence on the accuracy of trichoscopy in inflammatory scalp disorders. METHODS: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 58 articles were included in the analysis. RESULTS: The following trichoscopy features were found to show the highest specificity for the respective diseases: in psoriasis: diffuse scaling, simple and twisted red loops, red dots and globules, and glomerular vessels; in seborrheic dermatitis: atypical vessels, thin arborizing vessels, and structureless red areas; in discoid lupus erythematosus: follicular plugs and erythema encircling follicles; in lichen planopilaris: milky red areas or fibrotic patches; in contact dermatitis: twisted red loops; in pemphigus foliaceus: white polygonal structures and serpentine vessels; in pemphigus vulgaris: red dots with whitish halo and lace-like vessels; and in dermatomyositis: lake-like vascular structures. LIMITATIONS: Different nomenclature and variability in parameters, which were analyzed in different studies. CONCLUSION: This systemic analysis indicates that trichoscopy may be used with high accuracy in the differential diagnosis of inflammatory scalp diseases.

Long-Term Utility of Follicular Unit Excision in Lichen Planopilaris-Correlation of Graft Survival With Histopathological and Ultrasound Biomicroscopic Parameters.

BACKGROUND: Hair transplantation in scarring alopecia is challenging and transplant surgeons are hesitant due to fear of poor graft survival apart from the risk of reactivating the disease. OBJECTIVE: Survival rate of hair follicles transplanted in cases of lichen planopilaris (LPP). To correlate histopathological and ultrasonography findings and their impact on graft survival. METHODS: In 32 patients of inactive LPP included, a 5-cm2 recipient area was tattooed. The follicular unit density of the transplanted area was 20 to 25 FU/cm2. Postoperative follow-up was conducted at 6, 12, and 24 months. The recipient area density and ultrasound biomicroscopic parameters were assessed at each follow-up visit. RESULTS: The survival of grafts was 78.62% at 12 months, and 79.96% at 24 months. Histopathology variables studied at the time of transplantation such as epidermal atrophy, fibrosis, and inflammatory infiltrate were not found to have any effect on the graft survival. Ultrasonography parameters of the involved scalp skin were found to be markedly improved on follow-up. This suggests that the overall health of the scalp improved after hair transplantation. CONCLUSION: Follicular unit excision is a ray of hope for cases of primary cicatricial alopecia such as LPP because the result is satisfying to both the patient as well as the doctor.

Pemphigus scalp lesions: is trichoscopy helpful in clinical diagnosis?

BACKGROUND: Pemphigus is an autoimmune intraepidermal bullous disease which can affect skin and∕or mucous membranes. Trichoscopy is a non-invasive tool that can help in the clinical diagnosis especially if the patient is presented with only scalp lesions. We conducted this study to investigate the trichoscopic features of pemphigus scalp lesions. METHODS: A total of 100 patients with confirmed diagnosis of pemphigus entered the study; Seventy-nine patients were diagnosed as pemphigus vulgaris (PV) and 21 as pemphigus foliaceus (PF). Trichoscopy of the scalp lesions was performed, and three dermatologists examined separately the trichoscopic images of each patient. The results were re-checked simultaneously by the examiners. Association between variables was analyzed by using different tests including: chi-square test or Fischer's exact test, independent T-Test or Mann-Whitney nonparametric test and logistic regression model when applicable. RESULTS: Mean age of the patients was 45.41 ± 11.13 years, and 58% of cases were male. The most common trichoscopic features observed among all cases were diffuse scaling (71/100), presence of any types of vessels (67/100), and extravasation (63/100). Positive anagen pull test, extravasation, yellow hemorrhagic crust, and polymorphic vessels were more commonly seen in PV than PF cases (P value < 0.05), and by having data of these variables, we can differentiate between PV and PF scalp lesions with 74% sensitivity and 91% specificity. CONCLUSION: Trichoscopy can help in clinical diagnosis of pemphigus scalp lesions but should be followed by other modalities such as biopsy and direct immunofluorescence for definite diagnosis.

Dermoscopy of plaque psoriasis differs with plaque location, its duration, and patient's sex.

INTRODUCTION: Literature data on dermoscopic features of psoriasis vulgaris are inconsistent. The aim of the study was to evaluate whether dermoscopic features of psoriatic plaques differ with anatomic location or any clinical characteristics. MATERIALS AND METHODS: Clinical evaluation and videodermoscopy of psoriatic plaques located on the face, chest, abdomen, forearms, lower legs, back, and scalp were performed in 50 patients with psoriasis vulgaris. RESULTS: A total of 306 plaques were evaluated. Videodermoscopy with a 20-fold magnification revealed red dots and globules in 306/306 (100%) plaques, arranged in diffuse (170/306, 56%), patchy (117/306, 38%), or polygonal (19/306, 6%) pattern. A 70 fold magnification of these vessels revealed the presence of bushy vessels (213/306, 70%) and twisted loops (107/306, 35%), with the latter occurring more commonly on the scalp and face (P < .001). In lesions lasting less or equal 5 weeks on forearms and scalp, patchy distribution of the scale predominated, whereas in older lesions-diffuse type (forearm P = .005, scalp P = .017). Diffuse distribution of the scale in lesions located on the face was more common in women, than men (P = .003). CONCLUSIONS: Videodermoscopic picture of psoriatic plaques may differ with the anatomic location and duration of the psoriatic plaque and with patient's sex.

Lipedematous scalp. A rare entity in the pediatric ageLipedema de cuero cabelludo: una entidad infrecuente en pediatría.

Lipedematous scalp is an uncommon entity of unknown etiology, rarely described in the pediatric age. It is characterized by boggy thickening of the scalp predominantly located at the vertex and occiput, which acquires a cotton-like consistency. This condition is palpable rather than visible. It is a casual finding because it is usually asymptomatic, although it may involve alopecia, pruritus, or dysesthesia. We report a 10-year-old girl with lipedematous scalp without alopecia. Sonographic and MRI findings confirmed the diagnosis of lipidematous scalp.  El lipedema de cuero cabelludo o cuero cabelludo lipedematoso es una entidad infrecuente y de etiología desconocida, rara vez descrita en la edad pediátrica. Se caracteriza por un engrosamiento difuso y de tacto esponjoso del tejido celular subcutáneo localizado principalmente en vértex y occipucio. Suele ser un hallazgo casual dado que habitualmente cursa de forma asintomática, aunque puede asociar alopecia, prurito o disestesias. Presentamos el caso de una niña de 10 años de edad con lipedema de cuero cabelludo sin alopecia asociada. Los hallazgos ecográficos y de resonancia magnética confirmaron el diagnóstico de lipedema de cuero cabelludo.

Trichoscopy findings in dissecting cellulitis.

Dissecting cellulitis is an inflammatory, chronic, and recurrent disease of the hair follicles that mainly affects young Afro-descendent men. Trichoscopy is a method of great diagnostic value for disorders of the scalp. Clinical and trichoscopic findings of dissecting cellulitis are heterogeneous and may present features common to non-cicatricial and scarring alopecia. This article presents the trichoscopic findings of dissecting cellulitis that help in the diagnosis and consequent institution of the appropriate therapy and better prognosis of the disease.

Cutis verticis gyrata primario no esencial pruriginoso / Pruritic Primary Nonessential Cutis Verticis Gyrata

No disponible

Trichoscopy findings in dissecting cellulitis

Abstract Dissecting cellulitis is an inflammatory, chronic, and recurrent disease of the hair follicles that mainly affects young Afro-descendent men. Trichoscopy is a method of great diagnostic value for disorders of the scalp. Clinical and trichoscopic findings of dissecting cellulitis are heterogeneous and may present features common to non-cicatricial and scarring alopecia. This article presents the trichoscopic findings of dissecting cellulitis that help in the diagnosis and consequent institution of the appropriate therapy and better prognosis of the disease.

Dermoscopic features of lichen planopilaris in Northern Iran: a prospective observational study.

BACKGROUND: Dermoscopy can be helpful in assessing nonpigmented lesions and inflammatory processes like lichen planopilaris (LPP). MATERIAL & METHODS: In this observational prospective study, 81 patients with a cicatricial alopecic patch on their scalp were included and underwent dermatologic examination. A biopsy was taken from the active part of the lesion based on dermoscopy evaluation. RESULTS: Analysis of 44 patients with definite diagnosis of LPP revealed that the mean age at the time of presentation was 44.05 ± 12.62 years. More than 77% of patients had at least one form of the follicular opening disorder. About 75% of patients had shaft disorders. The most common pattern of pigmentation was milky-red (97.73%). The irregular and ectatic vascular network were seen in 59.09% of patients. Patients with coiled and twisted hairs, small yellow dots, large yellow dots, and peripilar sign were more likely to have shorter disease duration (P < 0.05). Those with overall shaft disorders were younger (P = 0.02). Small yellow dots (P = 0.025) and peripilar sign (P = 0.039) were more common in female patients. CONCLUSION: Dermoscopy can be a helpful diagnostic tool in differentiating LPP among patients with primary cicatricial alopecia (PCA). Larger cohort studies are recommended to find the role of demographic factors in predicting the dermoscopic patterns among LPP patients.

Dermoscopic features of psoriasis of the skin, scalp and nails - a systematic review.

Dermoscopy is a non-invasive in-office method, which enables the diagnosis of many dermatoses and reduces the need for performing biopsies. To date, no systematic review about the diagnostic usability of dermoscopy in psoriasis has been available. The objective of this article was to summarize and critically analyse literature data on the dermoscopy of skin, scalp and nail changes in psoriasis. A systematic search of three medical databases was performed. A total of 45 articles were included into the analysis. Cutaneous psoriatic lesions assessed in all studies at a low magnification showed regularly distributed red dots. At a 50-fold or higher magnification capillary bushes (glomerular vessels) with a diameter range of 50-146 µm were observed. The background colour was described as reddish or pinkish with white or yellowish scales. The most frequent dermoscopic (trichoscopic) feature of scalp psoriasis was the presence of red dots/globules and twisted red loops. Typical dermoscopic (onychoscopic) signs of nail psoriasis were onycholysis, salmon patches and splinter haemorrhages. There is an accumulating body of evidence that dermoscopy (both handheld and videodermoscopy) is a useful tool in differential diagnosis in doubtful cases of psoriasis of the skin, scalp, nails, palms, soles and genital regions.

Posterior Distraction First or Fronto-Orbital Advancement First for Severe Syndromic Craniosynostosis.

PURPOSE: Posterior calvarial vault expansion using distraction osteogenesis is performed for syndromic craniosynostosis as the first choice. This procedure allows far greater intracranial volume than fronto-orbital advancement (FOA). This study aimed to determine the most suitable timing of posterior distraction or FOA to sufficiently increase the intracranial volume and remodel the skull shape. PATIENTS AND METHODS: From 2014 to 2017, the authors performed posterior distraction in 13 patients with syndromic craniosynostosis. Data on premature suture fusion, age at first visit, age at surgery, skull thickness, and complications were collected. RESULTS: Five patients underwent posterior distraction at approximately 12 months of age and had no complications, including cerebrospinal fluid leakage or gull wing deformity. However, during the waiting period for the operation, the skull deformity continues to extend upward (turribrachycephaly). To prevent progress of the skull deformity, the authors performed the operation at approximately 6 months of age in 7 patients. However, in 3 of 7 patients whose lambdoid sutures were opening, gull wing deformity occurred. From these results, in a patient with severe Beare-Stevenson syndrome, the authors performed FOA first at 5 months of age, followed by posterior distraction at 12 months of age, and achieved favorable results. CONCLUSIONS: Treatment patterns are patient specific and should be tailored to premature suture fusion, specific skull deformity, and required intracranial volume of each patient.