Occipital Scalp Research Articles

Cirsoid aneurysm of the scalp: case report

AbstractWe report a case of a 23-year-old man presented with a painful swelling over his right occipital region. Selective right carotid angiogram demonstrated a markedly tortuous and dilated right occipital artery feeding into a circular or cirsoid aneurysm in the right occipital scalp. Percutaneous occlusion of the cirsoid aneurysm was not attempted and the patient underwent a successful resection of the fistula with good outcome after three months followed up.

Renbok phenomenon between psoriasis and alopecia areata

Conflict of interest: none declared. A 20‐year‐old man presented with recent development of alopecia areata (AA). There were no associated autoimmune diseases or family history. The patient had Down syndrome (DS) and long‐standing early‐onset chronic plaque psoriasis. On physical examination, extensive inflammatory psoriasis was seen on the scalp, sparing the areas of AA. Localized patches of nonscarring hair loss were found on the apex and occipital scalp, the largest measuring up to 20 mm. Using dermatoscopy, evidence was found of perifollicular pigmentation, early peripheral poliosis and exclamation hairs, in keeping with the diagnosis of AA. Large confluent plaques of psoriasis encroached on the areas of AA, but abruptly stopped and did not pass within these areas (Fig. 1). This was unique to the scalp, with no similar features seen at other body sites. DS is known to be a risk factor for the development of autoimmune conditions including AA. The coexistence of AA and psoriasis has been reported previously, but to our knowledge, the development of alopecia specifically spared by psoriasis has not been reported. One case of an analogous situation has been reported as a so‐called ‘Renbok phenomenon’, in which hair growth occurred only within psoriatic plaques in a patient with extensive AA.1 This is in contrast to the more common Koebner phenomenon, where there is provocation of psoriasis at sites of alopecia.2

Noncultured extracted hair follicle outer root sheath cell suspension for transplantation in vitiligo

Current noncultured cell-based transplantation therapies for vitiligo largely involve shave skin biopsy for preparation of noncultured melanocyte suspension. As the overall proportion of melanocytes is low in the epidermis, these techniques require basal cell layer enrichment, which adds additional steps. We tried follicular unit extraction (FUE) to harvest hair follicles as a source of melanocytes. To evaluate the efficacy of a novel surgical method for vitiligo: noncultured extracted hair follicular outer root sheath (ORS) cell suspension transplantation. Fourteen patients with vitiligo, stable for at least 3 months, were included in this prospective study. Fifteen to 25 hair follicles were extracted from occipital scalp using the FUE method. Hair follicles were incubated with trypsin-ethylenediamine tetraacetic acid solution at 37°C for 90 min to separate ORS cells. The cell suspension was filtered through a 70-μm cell strainer, then centrifuged for 5 min at 1000 r.p.m. to obtain a cell pellet. The pellet was resuspended and applied to the dermabraded recipient area and dressed. The mean ± SD repigmentation was 65·7 ± 36·7%. Overall, nine of 14 patients achieved > 75% repigmentation. Mean percentage repigmentation was significantly higher in patients with ≥ 1 year stability than those with < 1 year stability (P = 0·02). Extracted hair follicular ORS cell suspension can be a useful simplified transplantation method for vitiligo. The transplantation procedure should be reserved for patients with vitiligo stable for at least 1 year. A larger study is needed for further evaluation.

Brain activity elicited by positive and negative feedback in preschool-aged children.

To investigate the processing of positive vs. negative feedback in children aged 4–5 years, we devised a prize-guessing game that is analogous to gambling tasks used to measure feedback-related brain responses in adult studies. Unlike adult studies, the feedback-related negativity (FRN) elicited by positive feedback was as large as that elicited by negative feedback, suggesting that the neural system underlying the FRN may not process feedback valence in early childhood. In addition, positive feedback, compared with negative feedback, evoked a larger P1 over the occipital scalp area and a larger positive slow wave (PSW) over the right central-parietal scalp area. We believe that the PSW is related to emotional arousal and the intensive focus on positive feedback that is present in the preschool and early school years has adaptive significance for both cognitive and emotional development during this period.

Trichilemmal Cyst Nevus of the Scalp

We report the observation of a 24-year-old woman presenting a plaque-like lesion of the occipital scalp with hair rarefaction. This lesion was congenital and consisted of numerous, agminated, very small, trichilemmal cysts. It remained stable since birth, slowly growing in proportion with the patient during childhood. We discuss the nosological status of this intriguing lesion and its relationship with the recently described trichilemmal cyst nevus.

A Comparison of Levels of Select Minerals in Scalp Hair Samples with Estimated Dietary Intakes of These Minerals in Women of Reproductive Age

The objective of this study was to evaluate daily intake of minerals and concentrations of minerals in hair in women of reproductive age. The study included 77 menstruating women, aged 35.9 ± 9.7 years. Subjects were divided into three groups according to age. All women were healthy. Hair samples were taken from several points of the occipital scalp. The content of minerals in hair samples was determined by flame atomic absorption spectrometry. Dietary intake of the analysed minerals was assayed on the basis of dietary intake interviews from three preceding days and evaluated using the dietetic computer programme. It was shown that calcium and iron daily intake by the women was below the recommended value. Only few women had low concentrations (below reference values) of magnesium, copper and zinc in hair. Statistically significant differences were shown between age groups. Generally, the concentrations of minerals in hair in the younger (19–30 years) and the older women (41–50 years) were higher than in hair of middle-aged women (31–40 years). The content of calcium, magnesium, iron and zinc in daily diets of women correlated inversely with copper level in their hair. Food products with good bioavailability of iron and calcium should be recommended for women of childbearing age in all age groups.

Folliculitis et perifolliculitis capitis abscedens et suffodiens controlled with a combination therapy: Systemic antibiosis (Metronidazole Plus Clindamycin), dermatosurgical approach, and high-dose isotretinoin

Folliculitis et perifolliculitis capitis abscedens et suffodiens is a rare disease of unknown etiology. It is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. The condition is also known as ‘acne necrotica miliaris’ or ‘Proprionibacterium’ folliculitis. Most often the disease affects men of African-American or African-Caribbean descent between 20 and 40 years of age. The clinical picture is determined by fluctuating painful fistule-forming conglomerates of abscesses in the region of the occipital scalp. The cause of scalp folliculitis is not well understood. It is generally considered to be an inflammatory reaction to components of the hair follicle, particularly the micro-organisms. These include: bacteria (especially Propionibacterium acnes, but in severe cases, also Staphylococcus aureus), Yeasts (Malassezia species) and mites (Demodex folliculorum). The initial histopathologic finding is an exclusively neutrophilic infiltration followed by a granulomatous infiltrate. The treatment of the disease is usually difficult and often disappointing. Successful treatment with isotretinoin 1 mg/kg body mass could be achieved only after regular systematic administration in the course of 3–4 months. Here we describe a patient with eruptive purulent form of the disease, which has been controlled with combination therapy: systemic antibiosis with metronidazole and clindamycin, dermatosurgical removal of single nodular formations, and isotretinoin 1 mg/kg body mass for 3–5 months.

Morphometric Analysis of the Human Scalp Hair Follicle: Practical Implications for the Hair Transplant Surgeon and Hair Regeneration Studies

The bulge stem cell region is a structure important for the regeneration of the pilosebaceous unit. Measurements of the different compartments of a hair follicle may have implications in hair transplantation and hair regeneration studies. To measure the length of the different portions of the occipital scalp hair and to estimate at what depth they are located. Hair follicles from the occipital scalp were obtained from 29 individuals. Measurements were performed on digital pictures using a software imaging system. Antibody anticytokeratin (CK), 15 was used as a bulge stem cell marker. The mean length of a scalp hair follicle is 4.16 mm. The infundibulum measures 0.76 mm, the isthmus 0.89 mm, and the inferior portion 2.5 mm. The insertion of the arrector pili muscle is located 1.65 mm deep. CK15 immunoreactivity starts at a depth of 1 mm and extends down to 1.8 mm. The ideal depth for the trichophytic procedure is to cut the wound edge at a depth of less than 1 mm to avoid the bulge zone. The data provided can serve as an objective anatomical reference in hair regeneration studies using horizontally transected follicles.

Perceptual load modifies processing of unattended stimuli both in the presence and absence of attended stimuli

This study explored effects of perceptual load on stimulus processing in the presence and absence of an attended stimulus. Participants were presented with a bilateral or unilateral display and asked to perform a discrimination task at either low or high perceptual load. Electrophysiological responses to stimuli were then compared at the P100 and N100. As in previous studies, perceptual load modified processing of attended and unattended stimuli seen at occipital scalp sites. Moreover, perceptual load modulated attention effects when the attended stimulus was presented at high perceptual load for unilateral displays. However, this was not true when the attended and unattended stimulus appeared simultaneously in bilateral displays. Instead, only a main effect of perceptual load was found. Reductions in processing contralateral to the unattended stimulus at the N100 provide support for Lavie's (1995) theory of selective attention.

Arterial vascularization of occipital scalp: mapping of vascular cutaneous territories and surgical applications

Although the vascular supply of the occipital region of the scalp is usually considered as depending on the occipital arteries, in our clinical experience the importance of the posterior auricular arteries seems to have been underestimated. Most of the authors consider that the occipital artery is the main artery to the vascular supply of this region. The role of the posterior auricular artery has not been clearly investigated. In order to describe the cutaneous territories of these two arteries, 20 occipital areas have been dissected after bilateral injection of coloured latex (40 occipital and 40 posterior auricular arteries studied), and 4 occipital areas have been dissected after selective injection of china ink in the occipital and posterior auricular arteries (4 occipital and 4 posterior auricular arteries injected). The occipital artery was deep from its origin to the arch constituted by the insertions of the trapezius and sternocleidomastoid muscles. Then the occipital artery was becoming superficial while ascending to the vertex. The cutaneous territory of the occipital arteries was paramedian and median (38% of the occipital area). The posterior auricular artery was superficial in the auriculomastoid sulcus and divided into three branches: auricular and mastoid as usually described and also a third terminal branch that we called "transverse nuchal artery". The posterior auricular arteries supplied the major part of the occipital area of the scalp (62%).

Inflammatory Tinea Capitis: Non-healing Plaque on the Occiput of a 4-year-old Child

Inflammatory tinea capitis is an uncommon condition in Singapore. In this case report we present a patient whom we managed for this condition. A 4-year-old girl presented to us with multiple pustules over the occipital scalp for 6 weeks, associated with painful cervical lymphadenopathy. Her condition did not respond to topical and oral antibiotics. The patient was diagnosed with kerion (inflammatory tinea capitis) and fungal culture of plucked hairs from the kerion grew Microsporum species of dermatophyte. She was treated with a course of oral griseofulvin and topical selenium sulfide shampoo. She was advised to bring her pet cats to the veterinarian for screening, as well as not to share combs with her other siblings. Her condition improved with the antifungal therapy, and there was no residual alopecia. Physicians should consider tinea capitis when they encounter a patient with scalp folliculitis or scarring alopecia in the appropriate clinical context.

An ulcerated tumor in an infant

Cutaneous leiomyoma is a benign dermal tumor of smooth muscle. Leiomyoma can occur at any age but typically develops during adolescence or early adult life. Congenital leiomyoma is an extremely rare reported variant. A five-month-old boy presented to our clinic with a progressively enlarging mass on his occipital scalp. Microscopic examination of the solitary ulcerated nodule showed a non-encapsulated mass in the dermis composed of spindle-shaped cells. The diagnosis was confirmed by immunohistochemical studies, which were compatible with leiomyoma. Therefore, clinical suspicion of leiomyoma should be considered in the case of a solitary ulcerated nodule in an infant.

A GENOME-WIDE LINKAGE SCAN OF THETA BAND ACTIVITY AS AN ENDOPHENOTYPE FOR SCHIZOPHRENIA

Background: Deviant brain oscillations are candidate endophenotypes for schizophrenia. Our aim was to find new quantitative trait loci for brain oscillations and putatively schizophrenia. Methods: We systematically investigated the genetic characteristics of theta, alpha, and beta oscillations at frontal, central, and occipital scalp locations in 25 extended multiplex families affected with schizophrenia using familial correlations, heritability estimates, and segregation analysis. Subsequently, in a genome-wide linkage scan we genotyped seven pedigrees (n=118, including 649 relative pairs) for 6,090 single nucleotide polymorphic markers. Two-point and multipoint variance-component based linkage analyses were performed using MERLIN. Results: Theta activity at occipital sites constituted the most heritable phenotype (h2 of up to 0.55), fitting Mendelian transmission models and was included in a genome-wide scan. Suggestive two-point peaks (empirical p

Occipital involvement in female pattern hair loss: histopathological evidences

Female pattern hair loss (FPHL) is characterized by diffuse thinning of hair in the frontal and parietal areas of the scalp, and preservation of the frontal hairline is the norm. Hair on the occipital scalp is thought to be preserved. To investigate whether the occipital area is involved in FPHL or whether there is a diffuse type of FPHL. Forty female patients who had complained about hair loss for more than a year and were diagnosed with FPHL according to the Ludwig classification were included. Two punch biopsies from both the midscalp and the occiput were taken. Histological sections were prepared horizontally and stained with haematoxylin and eosin. Terminal follicles, vellus like follicles, anagen, telogen, catagen follicles, hair bulbs and telogen germinal units were counted in two sections of the upper dermis and the dermal-subcutaneous junction. If the terminal/vellus ratio was lower than 4:1, the diagnosis of androgenetic alopecia (AGA) was made. When the ratio was between four and seven to one, AGA was suspected. While 29 of 40 patients (72.5%) had findings consistent with AGA on the midscalp, 11 of 40 (27.5%) displayed signs of suspected AGA. Ten of 40 patients (25%) had AGA involving the occiput. The involvement of the occipital scalp is significant in FPHL. In some patients, this situation may be so apparent that clinically visible alopecia is seen. However, in other patients, it may also present only as thinning.

Solitary plaque on the scalp as a primary manifestation of Hodgkin lymphoma: a case report and review of the literature

Cutaneous Hodgkin lymphoma is infrequent and typically occurs after extensive involvement of the lymph nodes. The condition decreased significantly in incidence in the past two decades, likely owing to the new treatment protocols composed of chemotherapy, radiotherapy and stem cell transplantation. Nevertheless, recognition of this uncommon but significant disease manifestation is important from a prognostic and therapeutic perspective. We are sharing a recent case of Hodgkin lymphoma where the primary presentation appeared as a solitary plaque on the left side of the occipital scalp, clinically suspected to represent a ruptured follicular cyst. The patient underwent excisional biopsy. Histological assessment revealed Hodgkin lymphoma affecting the skin. Radiological studies showed no regional lymphadenopathy. However, two enlarged lymph nodes were identified in the mediastinum and were positron emission tomography avid. The patient underwent systemic treatment without further histopathological examination of these two lymph nodes. Not being clear if these enlarged two lymph nodes were related to his cutaneous disease or not, we cannot be sure if the patient was afflicted either by primary cutaneous Hodgkin lymphoma or by secondary cutaneous involvement because of hematogenous spread. In either case, primary or secondary cutaneous Hodgkin disease is an extreme rarity. The literature is critically reviewed.

Split-Skin Grafting from the Scalp

Split-skin grafting is a routine reconstructive technique associated with large variation in practice. Grafts from the thigh, buttock, or abdomen take a long time to heal and may leave unpleasant, hypopigmented scars. Retrospective reports favor the scalp as a donor site in burn patients. Evaluation of duration of healing, cosmetic outcome, and safety of split-skin grafting from the scalp in patients receiving dermatologic surgery. One hundred sixty-six consecutive patients (85 men, 81 women) were treated for coverage of chronic leg ulcers or other large skin defects with a split-skin graft taken from the posterior scalp. Area and thickness of the graft, healing time, and adverse events were documented. Mean healing time until complete reepithelization was 5.4+/-1.0 days for a single harvest (median 5 days). No major complications occurred. Spotted alopecia was a rare event. Almost all (96.5%) of the patients would undergo split-skin harvesting from the occipital scalp again if needed. Advantages of the scalp as a donor site include rapidity of wound healing, low risk of complications, and excellent cosmetic results. The large number of hair follicles containing the epidermal stem cell pool can explain these advantages.

Tinea capitis mimicking tufted hair folliculitis

We report a case of tinea capitis mimicking tufted hair folliculitis in a 56-year-old European man, who presented with a 4-year history of pain and erythema in an area of scarring alopecia of the occipital scalp, with scales and tufts of hair emerging from individual follicles. Histological examination showed hair plugging, and a dense perifollicular infiltrate of plasma cells, lymphocytes, and neutrophils. There was widespread scarring and fibrosis. Bacterial cultures were negative for Staphylococcus aureus, but fungal cultures and periodic-acid-Schiff stain were positive for Trichophyton tonsurans. Videodermatoscopy of the lesion showed a pattern consistent with folliculitis decalvans. Diagnosis was made on the basis of the clinical, histological, microbiological and videodermatoscopy data. After 30 days of systemic antifungal treatment, there were a substantial clinical improvement and disappearance of pain. After 5 months, a residual cicatricial area was seen with some hair tufts emerging from a single orifice.

The relation between race-related implicit associations and scalp-recorded neural activity evoked by faces from different races

The neural correlates of the perception of faces from different races were investigated. White participants performed a gender identification task in which Asian, Black, and White faces were presented while event-related potentials (ERPs) were recorded. Participants also completed an implicit association task for Black (IAT-Black) and Asian (IAT-Asian) faces. ERPs evoked by Black and White faces differed, with Black faces evoking a larger positive ERP that peaked at 168 ms over the frontal scalp, and White faces evoking a larger negative ERP that peaked at 244 ms. These Black/White ERP differences significantly correlated with participants’ scores on the IAT-Black. ERPs also differentiated White from Asian faces and a significant correlation was obtained between the White-Asian ERP difference waves at ~500 ms and the IAT-Asian. A positive ERP at 116 ms over occipital scalp differentiated all three races, but was not correlated with either IAT. In addition, a late positive component (around 592 ms) was greater for the same race compared to either other race faces, suggesting potentially more extended or deeper processing of the same race faces. Taken together, the ERP/IAT correlations observed for both other races indicate the influence of a race-sensitive evaluative process that may include early more automatic and/or implicit processes and relatively later more controlled processes.

Lichen planus

Lichen planus

Images in trauma: An unusual cause of airway obstruction

1. Unusual cause of upper airway obstruction1.1. PresentationA 55-year-old male with a history of alcoholism presented tothe trauma bay after being found unconscious. On arrival, he washaemodynamically stable with an oxygen saturation of 100%. Hewas able to phonate, and had clear breath sounds bilaterally. Hisexam was also notable for an occipital scalp haematoma andbilateral periorbital swelling. Rapid sequence intubation wasinitiated secondary to agitation and inability to cooperate withfurther assessment. After administration of a paralytic agent, thepatient quickly desaturated. The patient could not be intubatedsecondary to an object visibly obstructing the posterior pharynx.Bag-valve mask ventilation was also unsuccessful, thereforeemergent cricothyrotomy was performed at the bedside. Thepatient was then taken to radiology for computed tomography torule out traumatic injury.1.2. DiagnosisCoronal reconstructions of the cervical spine revealed a foreignbody in the posterior pharynx (Fig. 1). The cricothyroidotomy wasrevised to a tracheostomy in the operating room, at which time a12 cm pine cone was removed from the patient’s upper airway(Fig. 2). Creation of an emergent surgical airway is indicated in thepatient who cannot be intubated or oxygenated.