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Current Drug Targets 2024Scalp psoriasis is a common manifestation of psoriasis that significantly impacts a patient's quality of life. About 80% of cases of psoriasis involve the scalp, making... (Review)
Review
Scalp psoriasis is a common manifestation of psoriasis that significantly impacts a patient's quality of life. About 80% of cases of psoriasis involve the scalp, making it the most frequently affected area of the body. The treatment of scalp psoriasis is particularly crucial because of its hard-to-treat nature and substantial adverse impacts on overall well-being. Along with the physical symptoms of discomfort and itching, psoriasis, especially when it affects the scalp, can cause severe psychological damage. Treating scalp psoriasis can be challenging due to its location and associated symptoms, such as scaling and pruritus, which is why various drugs have become widely used for refractory cases. Topical treatments like corticosteroids and vitamin D analogs manage scalp psoriasis by reducing inflammation and regulating skin cell growth. Tar-based shampoos, salicylic acid solutions, and moisturizers control scaling. Phototherapy with UVB light reduces inflammation. Severe cases may require systemic medications such as oral retinoids and immunosuppressants. While various therapies are accessible for scalp psoriasis, concerns arise due to their limited advantages and the absence of controlled studies assessing their effectiveness. Considering these challenges, there is a clear demand for innovative approaches to address this condition effectively. Recent advancements in topical therapies, phototherapy, systemic agents, and complementary therapies have shown promising results in managing scalp psoriasis. Also, the advent of biologics, specifically anti-IL-17 and anti-IL-23 drugs for scalp psoriasis, has seen significant improvements. The review highlights the lack of well-tolerated and effective treatments for scalp psoriasis and underscores the importance of further research in this area. The objective of this review is to clarify the different treatment options currently available or being investigated in clinical trials for managing scalp psoriasis.
Topics: Humans; Psoriasis; Dermatologic Agents; Quality of Life; Phototherapy; Scalp; Scalp Dermatoses
PubMed: 38500274
DOI: 10.2174/0113894501292755240304063020 -
Medicine Jul 2023Trichilemmal cyst (TC), also known as trichodermal cyst, trichodermal isthmus-degenerative cyst. It is a benign skin lesion originating from the outer hair root sheath,...
RATIONALE
Trichilemmal cyst (TC), also known as trichodermal cyst, trichodermal isthmus-degenerative cyst. It is a benign skin lesion originating from the outer hair root sheath, with low incidence and few reports.
PATIENT CONCERNS
A 41-year-old patient had found a scalp lump for more than 10 years. A 2.0 cm × 1.0 cm × 1.0 cm lump on the right occipital region was touched more than 10 years ago without special treatment. In the past 2 years, the lump has gradually increased. Physical examination: 4 protruding lumps can be reached in the scalp. One lump in the right occipital region is about 3.0 cm × 2.0 cm × 2.0 cm, with 1 lump immediately below and 2 lumps in the left temporal region. All lumps can be pushed.
DIAGNOSES
The lesion is located in dermis, The lesion is solid, and the contents of the cyst were cheese-like white material, and the inner and outer walls of the cyst were smooth and shiny. Pathological results showed that the lesion was TC. The cyst wall is epidermal tissue, the spinous layer and basal layer are intact, there is no granular layer, and the protein in the cyst is dense.
INTERVENTIONS
All lumps were completely surgically removed.
OUTCOMES
The wound healed well after TC resection. There was no recurrence of TC after 1 year follow-up.
LESSONS
The clinical manifestations of scalp TC are not specific, and the diagnosis needs pathological examination, and the prognosis of total excision is good.
Topics: Humans; Adult; Scalp; Skin Neoplasms; Epidermal Cyst; Prognosis; Epidermis
PubMed: 37443491
DOI: 10.1097/MD.0000000000034213 -
Pediatric Clinics of North America Aug 2021There are a wide variety of scalp and skull lesions that can affect the pediatric population, many of which are first encountered by primary care physicians. The... (Review)
Review
There are a wide variety of scalp and skull lesions that can affect the pediatric population, many of which are first encountered by primary care physicians. The differential consists of a broad range of more common congenital lesions, sequelae of trauma, and vascular anomalies, to very rare neoplastic processes. It is important to understand signs and symptoms that may indicate whether a lesion may be benign versus life threatening, what imaging studies are appropriate and how to interpret them, and when to seek referrals to specialists.
Topics: Child; Craniocerebral Trauma; Head and Neck Neoplasms; Humans; Neurosurgery; Neurosurgical Procedures; Primary Health Care; Scalp; Skull Base Neoplasms
PubMed: 34247706
DOI: 10.1016/j.pcl.2021.04.003 -
NeuroImage Dec 2020To what extent electrocorticography (ECoG) and electroencephalography (scalp EEG) differ in their capability to locate sources of deep brain activity is far from...
To what extent electrocorticography (ECoG) and electroencephalography (scalp EEG) differ in their capability to locate sources of deep brain activity is far from evident. Compared to EEG, the spatial resolution and signal-to-noise ratio of ECoG is superior but its spatial coverage is more restricted, as is arguably the volume of tissue activity effectively measured from. Moreover, scalp EEG studies are providing evidence of locating activity from deep sources such as the hippocampus using high-density setups during quiet wakefulness. To address this question, we recorded a multimodal dataset from 4 patients with refractory epilepsy during quiet wakefulness. This data comprises simultaneous scalp, subdural and depth EEG electrode recordings. The latter was located in the hippocampus or insula and provided us with our "ground truth" for source localization of deep activity. We applied independent component analysis (ICA) for the purpose of separating the independent sources in theta, alpha and beta frequency band activity. In all patients subdural- and scalp EEG components were observed which had a significant zero-lag correlation with one or more contacts of the depth electrodes. Subsequent dipole modeling of the correlating components revealed dipole locations that were significantly closer to the depth electrodes compared to the dipole location of non-correlating components. These findings support the idea that components found in both recording modalities originate from neural activity in close proximity to the depth electrodes. Sources localized with subdural electrodes were ~70% closer to the depth electrode than sources localized with EEG with an absolute improvement of around ~2cm. In our opinion, this is not a considerable improvement in source localization accuracy given that, for clinical purposes, ECoG electrodes were implanted in close proximity to the depth electrodes. Furthermore, the ECoG grid attenuates the scalp EEG, due to the electrically isolating silastic sheets in which the ECoG electrodes are embedded. Our results on dipole modeling show that the deep source localization accuracy of scalp EEG is comparable to that of ECoG. SIGNIFICANCE STATEMENT: Deep and subcortical regions play an important role in brain function. However, as joint recordings at multiple spatial scales to study brain function in humans are still scarce, it is still unresolved to what extent ECoG and EEG differ in their capability to locate sources of deep brain activity. To the best of our knowledge, this is the first study presenting a dataset of simultaneously recorded EEG, ECoG and depth electrodes in the hippocampus or insula, with a focus on non-epileptiform activity (quiet wakefulness). Furthermore, we are the first study to provide experimental findings on the comparison of source localization of deep cortical structures between invasive and non-invasive brain activity measured from the cortical surface.
Topics: Adult; Brain; Electrocorticography; Electroencephalography; Female; Humans; Male; Middle Aged; Scalp; Signal Processing, Computer-Assisted
PubMed: 32898677
DOI: 10.1016/j.neuroimage.2020.117344 -
World Neurosurgery Aug 2019Scalp metastases from anaplastic oligodendroglioma (AO) are extremely rare and mostly involve intracranial recurrence or widely metastatic disease. Here we describe an...
BACKGROUND
Scalp metastases from anaplastic oligodendroglioma (AO) are extremely rare and mostly involve intracranial recurrence or widely metastatic disease. Here we describe an exceptional case of histopathologically proven scalp metastasis of AO 6 years after surgical resection and postoperative adjuvant radiation.
CASE DESCRIPTION
A 42-year-old woman presented with several months of progressive headache and dizziness. Preoperative magnetic resonance imaging (MRI) showed an irregular enhancing lesion in the left frontal lobe extending to the ependymal surface. Left frontal craniotomy was performed through a coronal approach, and gross total resection was achieved. Pathologic examination confirmed a World Health Organization grade III AO. The patient subsequently received 60 Gy of external beam radiotherapy in 30 fractions over 6 weeks. During 8 years of follow-up, the patient remained symptom free, and no evidence of intracranial recurrence was found. However, 6 years after intracranial tumor resection, the patient noticed a subcutaneous mass in her right frontal scalp, which was the site contralateral to her craniotomy. MRI revealed a homogeneously marked enhancing nodular lesion in the subcutaneous tissue of the right frontal scalp without intracranial recurrence. Gross total resection was performed, and the pathologic findings, which identified the mass as an AO, were consistent with those of the primary left frontal tumor.
CONCLUSIONS
This study presents a rare case of long-term AO scalp metastasis without intracranial recurrence. Intraoperative seeding and longer survival for oligodendroglial tumors may cause this rare entity. Optimal surgical strategies and standard operative procedures can promote the prevention of iatrogenic seeding.
Topics: Adult; Brain Neoplasms; Female; Head and Neck Neoplasms; Humans; Oligodendroglioma; Radiotherapy, Adjuvant; Scalp; Skin Neoplasms
PubMed: 31125773
DOI: 10.1016/j.wneu.2019.05.109 -
Skin Research and Technology : Official... Jul 2023No previous study investigated the anatomical changes of the scalp and hair follicles between tertiary androgenetic alopecia and severe alopecia areata using...
BACKGROUND AND AIM
No previous study investigated the anatomical changes of the scalp and hair follicles between tertiary androgenetic alopecia and severe alopecia areata using high-resolution magnetic resonance imaging (HR-MRI). This study aimed to explore the value of HR-MRI in assessing alopecia.
MATERIALS AND METHODS
Forty-eight people were included in this study. The imaging indicators of the vertex and occipital scalp were recorded and compared. The logistic regression model was developed for the indicators that differed between tertiary androgenetic alopecia and severe alopecia areata. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic efficacy of the model for tertiary androgenetic alopecia and severe alopecia areata.
RESULTS
At the vertex, the thickness of the subcutaneous tissue layer, follicle depth, relative follicle depth, total number of follicles within a 2-cm distance, and number of strands reaching the middle and upper third of the subcutaneous fat layer within a 2-cm distance were statistically different between patients with tertiary androgenetic alopecia, those with severe alopecia areata, and healthy volunteers (p < 0.05). The logistic regression model suggested that the subcutaneous tissue layer thickness was important in discriminating tertiary androgenetic alopecia from severe alopecia areata. The ROC curve showed that the area under the curve, sensitivity, specificity, and best cutoff values of the subcutaneous tissue layer were 0.886, 94.4%, 70%, and 4.31 mm, respectively.
CONCLUSIONS
HR-MRI can observe the changes in anatomical structures of the scalp and hair follicles in patients with alopecia. HR-MRI can be applied to the differential diagnosis of tertiary androgenetic alopecia and severe alopecia areata.
Topics: Humans; Alopecia Areata; Diagnosis, Differential; Alopecia; Hair Follicle; Scalp; Magnetic Resonance Imaging
PubMed: 37522498
DOI: 10.1111/srt.13393 -
Journal of Ultrasound in Medicine :... Feb 2024Cutis 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...
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.
Topics: Humans; Scalp Dermatoses; Scalp; Diagnosis, Differential; Ultrasonography
PubMed: 37950595
DOI: 10.1002/jum.16373 -
The Journal of Craniofacial Surgery Jun 2022Scalp expansion ensures that tissue similar in color, texture, thickness, and most importantly, hairbearing quality, is available to resurface the scalp. It is a...
BACKGROUND AND IMPORTANCE
Scalp expansion ensures that tissue similar in color, texture, thickness, and most importantly, hairbearing quality, is available to resurface the scalp. It is a critical option for reconstruction of large calvarial defects.
CLINICAL PRESENTATION
Over 6months, a 55-year-old male patient excoriated his scalp into a full-thickness scalp and calvarial wound resulting in dural violation and meningitis. The patient presented with altered mental status and methicillin-susceptible staphylococcus aureus (MSSA) bacteremia, cranial osteomyelitis, and an intracranial abscess secondary to the large scalp defect. The patient underwent immediate debridement and dural coverage with a scalp rotational flap. Several months later he began delayed stepwise cranioplasty with multiple scalp tissue expanders given the deficiency of soft tissue.
CONCLUSIONS
This case is presented to highlight the unusual mechanism of injury and the complex reconstructive approach in surgical management.
Topics: Humans; Male; Middle Aged; Plastic Surgery Procedures; Scalp; Self-Injurious Behavior; Surgical Flaps; Tissue Expansion Devices
PubMed: 34560747
DOI: 10.1097/SCS.0000000000008192 -
Journal of the European Academy of... Sep 2020The common inflammatory scalp disorders share similar clinical manifestations, and patient work up require invasive, undesirable diagnostic procedures like biopsy to...
BACKGROUND
The common inflammatory scalp disorders share similar clinical manifestations, and patient work up require invasive, undesirable diagnostic procedures like biopsy to ensure correct diagnosis. Optical coherence tomography (OCT) is a non-invasive high-resolution imaging modality that has found a valuable tool to assist in the diagnose and evaluation of different skin diseases.
OBJECTIVES
To describe the structural and vascular dynamic OCT (D-OCT) findings of inflammatory scalp disorders including scalp psoriasis, seborrhoeic dermatitis and contact dermatitis and to compare trichoscopy and OCT features.
METHODS
Subjects with diagnosis of seborrhoeic dermatitis, psoriasis or contact dermatitis were enrolled in this study. OCT scans were taken on involved scalp, and the same scalp regions were evaluated by trichoscopy and compared with healthy scalp.
RESULTS
A total of fourteen subjects (two healthy controls, four seborrhoeic dermatitis, five psoriasis and three contact dermatitis) participated. D-OCT imaging of vascular pattern in healthy scalp and the inflammatory scalp disorders were described. D-OCT images could enhance the clinician's ability to distinguish psoriasis from seborrhoeic dermatitis by objectively detect and assess red loop density. In scalp contact dermatitis, the vessels of the deep plexus were more dilated and fewer in number than those found in seborrhoeic dermatitis.
CONCLUSION
Dynamic OCT provides information that more clearly elucidates changes at the level of the superficial and deep plexuses without invasively interfering with superficial structures. In the context of inflammatory scalp disorders, this is useful to discern disorders with overlapping symptoms and minimize the use of invasive biopsies to diagnose.
Topics: Dermatitis, Contact; Dermatitis, Seborrheic; Humans; Psoriasis; Scalp; Tomography, Optical Coherence
PubMed: 32078188
DOI: 10.1111/jdv.16304 -
Skin Research and Technology : Official... Sep 2021The sonographic characteristics of frontal fibrosing alopecia have been scarcely studied. The aim of this study was to perform a colour Doppler ultrasound evaluation in...
BACKGROUND
The sonographic characteristics of frontal fibrosing alopecia have been scarcely studied. The aim of this study was to perform a colour Doppler ultrasound evaluation in frontal fibrosing alopecia.
MATERIALS AND METHODS
A cross-sectional study including 99 women with frontal fibrosing alopecia and 40 control subjects was performed using ultrasound equipment with a lineal 18 MHz probe. Three areas were evaluated per patient: the alopecic area (a), the hairline implantation area (b) and healthy scalp (c). The diameter (cm) and flow (m/s) of the two most significant vessels were recorded.
RESULTS
With regard to the hairline implantation area, patients presented higher vessel diameter (0.127 cm vs 0.103 cm, P = .03) and vessel flow (8.183 m/s vs 7.670 m/s, P = .05) than the control group. Vessel diameter was higher in the healthy scalp area in patients than in the control group (0.088 cm vs 0.078 cm, P = .03).
CONCLUSION
Patients presented higher vessel diameter and flow in the hairline implantation area compared to the control group.
Topics: Alopecia; Cross-Sectional Studies; Female; Fibrosis; Humans; Lichen Planus; Scalp; Ultrasonography, Doppler, Color
PubMed: 33455050
DOI: 10.1111/srt.13004