Examination Of Scalp Research Articles

Diastasis of the coronal suture with a difference

This 6-year-old boy presented with headache and vomiting 6 hours after a television tipover injury to the head. A CT scan and MR imaging with venography revealed diastatic disruption of the coronal suture extending 1.5 inches on either side of the midline with embedded skin under the fracture line (Fig. 1A). Because of the patient’s hair, this was not appreciated on initial scalp examination (Fig. 1B). There was a small epidural hematoma posterior to the embedded skin. We decided to operate as there was concern regarding skin viability and infection. An incision was made 1 cm posterior and parallel to the embedded skin edge. Using selfretaining retractors, we were able to remove the intact skin (1 × 3 inches) from underneath the fracture line (Fig. 1C). At 6-weeks’ follow-up, the skin was viable and intact (Fig. 1D). Television tipover is a significant cause of head injury in children.2 Concealed injuries, including embedding of foreign bodies in subcutaneous tissue or the skull, may be missed on initial examination of the scalp.1 In this case the television fell on the child’s head and its edge caused blunt injury leading to opening of the coronal sutures. The intact scalp was driven into the suture line and was entrapped. In closed skull fractures, galeal tissue or periosteum can be entrapped in the fracture line; but in the present case intact skin was embedded underneath the fracture line. To the best of our knowledge this has not been described before. (DOI: 10.3171/2010.8.PEDS1034)

The Role of Endoscopy in a Patient with Recurrent Gastric Trichobezoar

Purpose: Bezoars are accumulations of food and fiber in the alimentary tract. We present a case of a patient with recurrent trichobezoar in which endoscopic removal was tedious, time consuming, and ultimately unsuccessful. Methods: CASE:A 37-year-old female with medical history of hypertension and depression was admitted with nausea, vomiting and constipation for four days. It started 1 month ago with bloating, early satiety and weight loss of 40 pounds. Her medical history was significant for trichotillomania, and trichobezoar 18 months ago, which was removed successfully endoscopically over 2 days. On physical exam, she was of moderate built, malnourished, with a HR of 103 and BP of 156/91 mmHg. Scalp examination revealed sparse hair and red colored extensions that were missing in some areas. Abdominal exam was significant for mild epigastric fullness and tenderness on palpation. Labs were significant for a Hb of 10.4 g/dL. An abdominal radiograph showed a dilated loop of duodenum measuring 4.6 cm with mottled lucencies in the left upper quadrant. A CT confirmed a gastric bezoar within the stomach and small bezoars in the distal duodenum. She underwent upper endoscopy which showed a black hair bezoar. After spending 2 hours with multiple passes, less than 25% was removed and was referred for surgery. Two masses of hair 17 × 5 × 5 cm and 12 × 10 × 6 cm were removed via gastrotomy and a 6.5 × 3 × 3 cm was removed via ileal enterotomy. Results: DISSCUSSION: The term “bezoar” comes from the Arabic “badzhar” or the Persian “pahnzahr”, both meaning counterpoison or antidote. They are indigestible foreign body masses in the GI tract. They are classified into five types: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar, and foreign body bezoars. Trichobezoar is seen in females less than 30 years of age. Ingestion of hair, (trichophagia), carpet, and clothing fiber are commonly implicated. They become trapped in the gastric folds forming a mass with symptoms of early satiety, weight loss, abdominal pain, and leading to obstructive symptoms. Plain radiographs and CT may be diagnostic, but endoscopy still remains the gold standard. Many approaches have been described such as enzymatic dissolution, to endoscopic removal with advanced instrumentation. Surgical removal via gastrotomy allows it to be removed in its entirety. Conclusion: CONCLUSION: Our case suggests that although endoscopic advances have been made, and success has been accomplished by some, their superiority to conventional techniques is still lacking. Gastrotomy should be considered over the tedious and time consuming endoscopic attempts. More ever, the patient should have psychiatric follow up to prevent recurrence, which our patient did not have, after her first episode.

Acromegaly presenting as cutis verticis gyrata

A 17-year-old Saudi male patient presented with progressive asymptomatic skin changes on the scalp for 4 years. Upon examination, he was a well-built muscular male with coarse facial features with broadening of the nasal bridge and thick lips. Scalp examination revealed multiple gyriform oblong skin folds in the fronto-parietal region (Fig. 1). Extensive velvety dark brown plaques were seen on sides of the neck, axillae, and groin. Similar eruption was seen on the knuckles of both hands and around the eyes. Clinical diagnosis of cutis verticis gyrata of the scalp and acanthosis nigricans was made. Because of the extent and the rapid progression of the above changes, acromegaly was suspected. Endocrinology referral confirmed this by the findings of high random growth hormone level at the value of 37.3 mIU/L (normal 0.2-13.0). Arrangement of magnetic resonance imaging (MRI) of the brain was made, but unfortunately the patient was lost to follow-up.

Scalp Pathology for the Hair Transplant Surgeon: Beware of the “Imitators”

1. Bernard P. Nusbaum, MD <!-- --> 1. Miami, Florida T he primary requirement in a hair transplant consultation is to make the correct diagnosis. The scalp examination usually begins by looking for a recognizable pattern. Generally, recognizable patterns are seen in male or female pattern

Trichotillomania. Presentation, etiology, diagnosis and therapy.

Trichotillomania (TTM) is an impulse disorder, in which patients chronically pull hair from the scalp and/or other sites. Very early onset of hair pulling in children under the age of 6 may be more benign and self-limiting than the more common syndrome of late childhood onset hair pulling. While far more women and adolescent girls appear for treatment, survey studies suggest chronic hair pulling also occurs in males. Diagnosis may be complicated by patient and family denial or ignorance of the hair pulling; accurate scalp examination and biopsy can be critical. Classic scalp biopsies for TTM feature trichomalacia, pigment clumps, peribulbar hemorrhage and hair canal pigment casts, and lack lymphocytic infiltrates seen in alopecia areata. Treatment is difficult: the tricyclic antidepressant clomipramine is the most promising agent, although many patients find it difficult to tolerate at adequate dosages, and treatment response may not be maintained over the long term. More benign medications have not demonstrated efficacy in controlled studies. Augmentation with topical preparations or psychotropic medications may be helpful for patients experiencing limited efficacy or relapse. Specialized psychotherapy, known as habit reversal training, is highly recommended; however, the treatment is intensive and highly specialized. Skilled therapists are difficult to locate.

Waardenburg syndrome type II in a Taiwanese woman with a family history of pseudoxanthoma elasticum

A 37‐year‐old Taiwanese woman presented to the Dermatology Clinic for a skin exam to rule out pseudoxanthoma elasticum (PXE). The patient stated she had a known family history of PXE, with a 31 ‐year‐old brother with biopsy‐proven cutaneous lesions of the lateral neck and another brother (33 years of age) with recently documented angioid streaks on ophthalmologic examination. The patient stated that two other living brothers were without known cutaneous lesions and had refused ophthalmologic examinations. A fifth brother had died in infancy of unknown causes. There was no other known family history of PXE, and neither of the affected brothers had a known history of cardiovascular disease.The patient's past medical history was significant only for gestational diabetes during pregnancy. She had no history of hypertension, angina, myocardial infarction, cerebrovascular accident, visual difficulty, bleeding abnormality, or intermittent claudication.Physical examination was notable for multiple hypo‐ and depigmented macules and patches of the anterior trunk, face, and dorsal hands. There were no cutaneous findings of PXE. Scalp examination revealed diffuse depigmentation of the hair roots (Fig. 1), and the patient admitted to the regular use of hair dyes since experiencing premature graying at 22 years of age. Ophthalmologic exam revealed heterochromia iridis (Fig. 2). The Windex (see below) was calculated to be 1.65 (within normal limits). Fundoscopic examination was normal. There was no history of hearing impairment.An expanded family history was performed after noting the patient's clinical phenotype suggestive of Waardenburg syndrome, and revealed several relatives with early graying, leukoderma, heterochromia iridis, and congenital deafness (see pedigree. Fig. 3). All of the patient's relatives lived in Taiwan, and therefore examinations were not possible.

Tinea capitis in south-east London--a new pattern of infection with public health implications.

Recent observations on tinea capitis cases in London suggest that there has been a change in the pattern of infection with a recent and significant rise in the incidence of infections due to anthropophilic fungi. The purpose of this study was to investigate the prevalence and identity of tinea capitis in schools in south-east London and factors which might affect the spread of infection. This was achieved by carrying out a survey of all children, with parental consent for scalp examination, in 14 nursery, infant or junior schools in Lambeth. In addition, the accuracy of clinical diagnosis was compared with mycological findings. There were 1057 children from 4 to 14 years of age in the study. The infection rate in different schools ranged from 0 to 12% with a mean of 2.5%. A further 4.9% of children were scalp carriers of dermatophytes (range in classes 0-47%). A striking feature was that all infections were caused by anthropophilic fungi, mainly Trichophyton tonsurans or Microsporum rivalieri, and there was a correlation between the presence of two or more carriers within a class and the infection in the other children. There was a poor correlation between ability of trained observers to predict infection on clinical grounds and mycological results. This investigation shows variable but significant levels of scalp ringworm in schools and that the dominant organisms are anthropophilic. It provides support for the observation that there has been a shift in the pattern of tinea capitis in London and, possibly, other U.K. centres, with a trend towards more infections transmissible among children, with T, tonsurans being the commonest organism. The implications for control, which involve screening in schools, where appropriate, and guidance to general practitioners on treatment, are discussed.

The pathophysiology of infant subdural haematomas.

The widely accepted theories concerning the pathophysiology of infant subdural haematoma (SDH) were formulated in the pre-computed tomographic (CT) scan era. Violent shaking is considered to be a crucial cause of SDH in non-accidentally injured infants. This theory has been re-examined in a clinical and CT scan review, and our findings have been correlated with results of recent head injury research. A retrospective review was conducted of all head injured infants (up to 18 months old) treated at Atkinson Morley's Hospital over a recent 20-year period (n = 100). Twenty-eight infants with a SDH were identified. CT scans were reviewed and each SDH greater than 0.5 cm thick was morphometrically analysed. Seventeen infants were Caucasian, 10 were non-Caucasian and one was of mixed race. A race-dependent pattern of SDH pathophysiology was noted, with non-Caucasian infants with a head injury more likely to have a SDH than Caucasian infants (67 v 21%, p < 0.01). All had a history of, or radiographic and clinical findings most consistent with, an impact injury, and non-Caucasian infants were significantly more likely to have a normal scalp examination despite the impact injury (p < 0.05) and to have developed the SDH after a relatively trivial fall (p < 0.01). They were also more likely to have a large (> 0.5 cm thick) SDH (p < 0.05), and to suffer post-traumatic seizures (p < 0.05). Our findings do not support shaking as the only cause of infant SDH formation and also suggest that non-accidental injury is a less common cause of SDH than it is believed to be.

The use of dolls as a teaching aid for children undergoing treatment with the flashlamp-pulsed tunable dye laser

during the preceding month. A biopsy specimen disclosed a basal cell carcinoma (Fig. 1) arising in a nevus sebaceus (Fig. 2). Mohs surgery was successfully performed. Thereafter, completeexcision of the underlying nevus was accomplished. Further history uncovered two other family members with similar bald spots. Examination of the daughter's scalp showed a nevus sebaceus (Fig. 3) on the left frontal aspect of the scalp and a nevus sebaceus on the right partial aspect of the scalp of his granddaughter (Fig. 4). Neither ofthese lesions was histologically examined or excised. The cutaneous lesions in this family were not associated with neurologic abnormalities. Discussion. Familial nevus sebaceus of Jadassohn in a mother and daughter was first described by Monk and Journal of the American Academy of Dermatology

Masking of fluorescence by tetrachloroparabenzoquinone (spergon).

In the treatment of tinea capitis, or ringworm of the scalp, caused by the microspora, the criteria generally accepted for clinical cure are loss of fluorescence, absence of organisms in smears or hairs, negative culture, and disappearance of clinical or gross evidence of a lesion for a period of at least two months following the discontinuance of all treatment. The patient is usually observed at weekly or biweekly intervals. As long as fluorescence is present, there is no absolute need for either a microscopic examination or a culture. With the disappearance of fluorescence, however, smears and cultures of the lesion become imperative. Thick greases or ointments may easily mask fluorescence. In the routine examination of a patient's scalp, it should be impressed on the child's parents that the medicament must be washed out thoroughly before such an examination. Felsher,1for example, has found that 10 or 20% potassium iodide

Case of Abnormal Development of the Scalp

The accompanying illustration represents what is believed to be a hitherto undescribed abnormality of the scalp. The condition was discovered accidentally. I observed an attendant cutting a lad's hair, and remarked that he was not doing it very well, as there appeared to be numerous scissor-marks. It was explained that the marks were due to the arrangement of the hair. This led to careful examination of the whole scalp. Its condition is very well represented in the illustration. On each side there are five deep furrows, passing from behind forwards. Those nearest the middle line are straight; the others slightly curved, and they are the more curved the further they are removed from the middle line, and at the same time they diminish in length. When the hair is of ordinary length the condition of the scalp would not be suspected; it is only when the hair is very short that the furrows become evident. For the purpose of preparing the accompanying illustration the hair was cut as short as possible, but the hair growing in the furrows was necessarily left somewhat longer than elsewhere, with the result of indicating with great clearness the course and arrangement of the depressions. The furrowing of the forehead is not abnormal, but is produced by the patient whenever he is annoyed, as he was when the photograph was taken.