ABSTRACT
BACKGROUND: Pressure alopecia is the loss of hair following a prolonged immobilization, probably due to pressure-induced local ischemia. It is most commonly observed after surgical procedures under general anesthesia. Most of the studies or reports of pressure alopecia deal with postoperative cases. OBJECTIVE: This study was undertaken to investigate and understand the clinical manifestations, course and histopathological characteristics of pressure alopecia in various circumstances. METHOD: 27 patients with pressure alopecia, who had visited the Department of Dermatology at Busan Paik Hospital between 1998 and 2004, were examined clinically and histopathologically. RESULTS: The ratio of males to females was 4: 5, and the mean age of patients was 36+/-22 years. The cause of pressure alopecia were classified into 5 groups: open heart surgery, craniectomy, other surgeries, long-term bed rest, and the miscellaneous causes including wearing of hair prosthesis and group punishment. The most commonly involved site was the occipito-parietal area. Histopathological examination showed upper dermal edema and fibrosis, follicular fibrosis, melanin pigments, hair follicles in telogen and catagen stages, perifollicular lymphocytic infiltration and vascular change. The mean operation time was 8.1+/-7.2 hours in the patients with temporary alopecia and 17.8+/-7.6 hours in those with permanent alopecia. The mean operation time of the patients with temporary alopecia was shorter than those with permanent alopecia (p<0.05). CONCLUSION: This study revealed several causative factors of pressure alopecia including surgery, long-term bed rest, and miscellaneous causes. Therefore, close observation of the pressure site and changing the position of the patient's head at regular intervals are essential during the various surgical and nonsurgical treatments to prevent pressure alopecia.
Subject(s)
Female , Humans , Male , Alopecia , Anesthesia, General , Bed Rest , Dermatology , Edema , Fibrosis , Hair , Hair Follicle , Head , Immobilization , Ischemia , Melanins , Prostheses and Implants , Punishment , Thoracic SurgeryABSTRACT
BACKGROUND: Drug rash with eosinophilia and systemic symptoms (DRESS), previously named drug `hypersensitivity syndrome', is a subset of severe drug eruption with quite distinct clinical presentations. Perhaps because of its relatively late onset and variable presentations, the diagnosis of DRESS may be delayed. OBJECTIVE: This study was designed to determine the incidence and investigate the causative drugs and clinical characteristics of DRESS. METHOD: We retrospectively reviewed the clinical features and laboratory findings of DRESS in 795 drug eruption patients who had visited Pusan National University Hospital over the last 10 years (1995-2004). RESULTS: 1. Of 795 drug eruption patients, 14 (1.76%) received a diagnosis of DRESS. 2. The average age of onset was 44.5 years and there was no significant difference according to sex. 3. The most common causative agent of DRESS was carbamazepine (50%), followed by allopurinol, captopril, phenytoin and antituberculous medications. 4. DRESS developed 2-10 weeks after administration of the causative agent, and the average latent period was 4.6 weeks.
Subject(s)
Humans , Age of Onset , Allopurinol , Captopril , Carbamazepine , Diagnosis , Drug Eruptions , Eosinophilia , Exanthema , Incidence , Phenytoin , Retrospective StudiesABSTRACT
BACKGROUND: Pressure alopecia(PA), also referred to as postoperative pressure-induced alopecia, is seen most often after prolonged pressure on the scalp during general anesthesia, with the head fixed in one position. It may also occur in chronically ill persons after prolonged bed rest in one position, which causes persistent pressure on one part of the scalp. It probably arises due to pressure-induced ischemia. Although a few clinical studies of PA have been reported, extensive histopathological study of transverse section has not been performed. OBJECTIVE: The purpose of this study was to investigate the clinical features and histopathological characteristics of transverse section in PA in order to find differential points from other alopecic diseases. METHODS: Enrolled in this study was a total of 12 patients confirmed as PA at the Chungbuk National University Hospital from 1991 to 2001. The hospital charts and transverse sections of histopathological slides were reviewed. RESULTS: 1. The male and female ratio was 3:1. The mean age of the patients was 37.7 years. The mean ages of male and female patients were 34.7 and 46.7 years, respectively. 2. Most commonly involved sites were the parietooccipital area(8 cases). Temporoparietal area(4 cases) was followed. Signs and symptoms including pain, tenderness, erythema, swelling or numbness were present in seven cases. Five cases presented no signs or symptoms. The clinical appearance of alopecic patches varied mimicking alopecia areata or trichotillomania very closely. The mean operation time was 6.8 hours(from 2 to 11) and the mean postoperation onset time was 14.7 days(from 9 to 25). The hair regrowth was apparent 14.3 weeks in average(from 10 to 24) after operation. All cases were recovered within 6 months without any treatment. 3. Histopathological examination showed nearly all catagen stage of hair follicles, incontinent melanin pigment(12 cases), a perifollicular inflammatory infiltrate(3 cases including follicular infundibulum level in 2 cases and inferior segment level in 1 case), fat necrosis and a foamy macrophage infiltrate(5 cases), and vascular thrombosis(2 cases). CONCLUSION: The clinical appearance of PA varied mimicking alopecia areata or trichotillomania very closely. Histopathological findings could be similar to those of alopecia areata, but PA could be differentiated from alopecia areata by nearly all hair follicles in catagen stages, fat necrosis and a foamy macrophage infiltrate, vascular thrombosis, and the absence of a peribulbar lymphocytic infiltrate. The dermatologist should be aware of these characteristic findings of PA to avoid misdiagnosis and unnecessary additional treatments.
Subject(s)
Female , Humans , Male , Alopecia Areata , Alopecia , Anesthesia, General , Bed Rest , Chronic Disease , Diagnostic Errors , Erythema , Fat Necrosis , Hair , Hair Follicle , Head , Hypesthesia , Ischemia , Macrophages , Melanins , Scalp , Thrombosis , TrichotillomaniaABSTRACT
Postoperative (pressure) alopecia is the temporary or permanent loss of hair that occurs following a prolonged immobilization during and/or after general anesthesia and intubation. The cause is considered to be pressure-induced ischemia. Although not an uncommon condition, it is frequently overlooked as a minor complication relative to a causative surgical procedure. We report a 22-year-old woman who was presented with focal hair loss of two weeks' duration after a 9-hour operation for a left brachial plexus injury. Histopathologic examination showed that nearly all terminal follicles were in catagen phase with marked atrophic change of subcutaneous fat.
Subject(s)
Female , Humans , Young Adult , Alopecia , Anesthesia, General , Brachial Plexus , Hair , Immobilization , Intubation , Ischemia , Subcutaneous FatABSTRACT
Pressure alopecia can occur after prolonged pressure on the scalp with the head fixed in one position. We have repor ted 5 cases of pressure alopecia, occurring over the contralateral temporoparietal 1 area after tympanomastoidectomy due to chronic ot.itis media. Total times of operations were from 4 hours to 7 hours. Four of the 5 patients experienced scalp pain during the early postoperative period and one of them showed large bulla formation. Loss of hairs followed between the 14th and 36th postoperative day, and new hairs began to grow 2 or 3 months after the operation.