Scanning electron microscopy of panitumumab-induced eyelash and hair alterations - Pili canaliculi

Abstract Panitumumab is a monoclonal antibody against the epidermal growth factor receptor used in metastatic colorectal cancer; in addition to tumor cells, it acts on epidermal keratinocytes and on the outer root sheath and presents skin toxicity in up to 90% of cases. A scanning electron microscope was used to examine the eyelashes and hairs of a 65-year-old patient with eyelash trichomegaly, curly hair, and paronychia undergoing treatment with panitumumab. Grooving in the hair shafts were identified, which were more evident in the eyelashes. Similar to oral epidermal growth factor inhibitors (erlotinib and gefitinib), panitumumab can cause acquired pili canaliculi.

Lichen planopilaris and frontal fibrosing alopecia: review and update of diagnostic and therapeutic features

Abstract Lichen planopilaris and frontal fibrosing alopecia are primary scarring alopecias where diagnosis can be suggested by clinical and trichoscopy features, especially in the early stages, but scalp biopsy is the standard exam for definitive diagnosis. Frontal fibrosing alopecia is considered a variant of lichen planopilaris, as the histopathological findings are similar, with a perifollicular lymphohistiocytic infiltrate, sometimes with a lichenoid pattern. A thorough clinical examination, trichoscopy and photographic documentation are essential to assess the evolution and therapeutic response. To date, there are no validated treatments or guidelines for these diseases, but there are recommendations that vary with the individual characteristics of each patient. This article presents a comprehensive review of the literature, including an update on topics related to the diagnosis, follow-up, histopathological aspects and available treatments for lichen planopilaris and frontal fibrosing alopecia, highlighting their similarities, differences and peculiarities.

Abordagem dos aspectos técnicos no preparo da lâmina de tricograma com base de esmalte incolor / How to prepare a trichogram with transparent enamel base coat?

O tricograma configura-se em método semi-invasivo de fácil aplicabilidade e baixo custo, útil na avaliação dos diversos tipos de queda capilar no consultório dermatológico. Até o momento, não há padronização da técnica para coleta e realização do exame. A utilização de meios de interface entre lâmina e lamínula para a leitura do tricograma à microscopia óptica varia amplamente na literatura. Dentre as alternativas, a utilização de base de esmalte incolor configura-se em opção barata, acessível e prática, além de permitir a visualização das hastes capilares com mínima formação de artefato

The trichogram pictures an easy and semi-invasive method useful in the evaluation of different types of hair loss in daily practice. As of yet, there is no standardized methodology on how to collect and perform the exam. The use of liquid interface between blade and coverslip to read the trichogram under optical microscopy varies widely in the literature. Among the alternatives, the use of translucid fingernail polish is an inexpensive, accessible, and practical option, providing the examiner with proper visualization of the hair shafts with minimal artifact formation.

Cistos cutâneos no couro cabeludo: descrição de técnica inovadora / Cutaneous pilar cysts: description of an innovative technique

Cistos são tumores epiteliais benignos extremamente comuns. O cisto triquilemal ou pilar tem origem no istmo do pelo anágeno, representa cerca de 20% dos cistos e localiza-se mais frequentemente no couro cabeludo (90%). Vários métodos podem ser usados para a retirada dos mesmos. A escolha da técnica depende de suas características, como: tamanho, mobilidade, consistência, quiescência, inflamação e quantidade. Porém, eles podem reaparecer se houver remoção incompleta da cápsula. Os autores apresentam uma variante simples da técnica de marsupialização que permite a sua retirada total.

Cysts are benign epithelial tumors widespread. The trichilemmal cysts, originating from the anagen's isthmus, represent about 20% of the cysts and are located more frequently in the scalp (90%). Several methods can be used for the removal of the cysts. The choice of technique depends on its characteristics, such as size, mobility, consistency, quiescence, inflammation, and quantity. However, they may grow again if the capsule is incomplete removed. The authors present a simple variant of the marsupialization technique that allows its complete removal.

Carcinoma basocelular gigante em couro cabeludo: relato de reconstrução tardia / Giant basal cell carcinoma of the scalp: report of late reconstruction

O carcinoma basocelular (CBC) gigante é uma variante rara, sendo o reparo de grandes defeitos no couro cabeludo, gerados após ressecção oncológica, um desafio cirúrgico. Relata-se o caso de um paciente submetido à reconstrução tardia do couro cabeludo após ressecção oncológica de CBC gigante no couro cabeludo, com associação de técnicas. A reconstrução das lesões do couro cabeludo depende de uma compreensão abrangente da anatomia desse local, um conhecimento do arsenal de técnicas cirúrgicas e uma avaliação detalhada dos fatores e expectativas do paciente, tendo em vista o impacto na qualidade de vida e a morbidade relacionada a cada opção terapêutica

The giant BCC is a rare variant, and the repair of large defects in the scalp, generated after oncologic resection, is a surgical challenge. We report the case of a patient submitted to late scalp reconstruction after oncologic resection of giant BCC in the scalp with the association of techniques. Reconstruction of scalp lesions depends on a comprehensive understanding of the anatomy of this site, knowledge of the arsenal of surgical techniques, and a detailed assessment of patient factors and expectations, given the impact on the quality of life and morbidity related to each therapeutic option

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.

Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings

Abstract: Lichen simplex chronicus is a skin disease that mostly affects female patients, with a peak incidence between ages 35 and 50 years. On the scalp, it appears as a single or multiple oval lesions, showing scaling and hair shaft loss or breakage. An important dermoscopic feature of the disease are the "broom fibers." Histopathology reveals the "hamburger" and the "gear wheel" signs. The aim of this report is to demonstrate a case of lichen simplex chronicus on the scalp with typical and exuberant clinical, dermoscopic, and histopathological findings.

A Case of Scalp Metastasis from Breast Cancer without Other Distant Metastases

Cutaneous metastases of malignant tumors are relatively rare, and breast cancer is the most common malignancy in women with cutaneous metastases. Since newly developed cutaneous lesions can be the first signs of metastases in breast cancer patients, it is crucial to rule out the possibility of malignancy. Although only a few cases have been reported, breast cancer contributes to a large portion of scalp metastases. This case report demonstrates a rare case of breast cancer metastasis only confined to the scalp. The patient was a 55-year-old woman who was diagnosed with scalp metastasis from breast cancer 10 years after the first curative surgery. The scalp lesion was palpable for 4 years and showed a sudden increase in size over a few months. The patient underwent wide excision with flap coverage. After surgery the patient received radiotherapy, but she has refused additional hormonal therapy. To date, there is no evidence of disease recurrence.

Cilindros capilares: relato de caso e revisão de literatura / Hair rollers: case report and literature review

Introdução: Os cilindros capilares (CC) caracterizam-se por concreções cilíndricas branco-amareladas que envolvem a haste capilar, sem, porém, a ela aderir. Relato de caso: Paciente sexo feminino, 20 anos, fototipo III. Vem a consulta dermatológica devido a queda de cabelos de início há 3 meses. No início do quadro começou a observar nódulações esbranquiçadas aderidas às hastes dos fios, na porção proximal dos mesmos, assintomáticos. Exame micológico direto e cultura negativos. Levantada então a hipótese clínica de eflúvio telógeno e cilindros capilares. Foi então prescrito solução capilar de ácido retinóico 0,05% diariamente e orientada a não amarrar os fios. A paciente retornou ao consultório 4 semanas após, com diminuição das concreções esbranquiçadas. Discussão: Embora os CC sejam uma condição benigna e de baixa morbidade, é difícil o diagnóstico nas primeiras consultas, o que gera custos desnecessários com tratamentos inadequados.

Introduction: The capillary cylinders characterize for white-yellow cylindrical concretions that involve the hair shaft, without, however, adhering to it. They were described for the first time in 1957 for Kligman, and even though they are not uncommon, its bibliographic references are somehow rare, mostly in books. Case report: Female patient, 20 years old, photype III. The patient comes to the dermatologist complaining of losing hair for the last three months after applying a "brush progressive" which contained formaldehyde, without information of its concentration in the product. In the beginning the patient has also noticed some white little balls attached to the hair shafts in the proximal portion of it, whit no symptoms. She still reports having the habit to tie her hair strongly. To the dermatological examination, there have been noticed homogeneous thickness hair, positive to the traction (falling 6 hairs to traction in the right temporal region) and a discreet bitemporal rarefaction. The patient presented white concretions mostly in the front-temporal regions, which easily release to manipulation. Direct mycological examination and culture were negatives. There have been brought up two clinical hypothesis: telogen effluvium and capillary cylinders. It has been prescribed capillary solution of retinoic acid 0,05% daily and oriented to not tie her hair. The patient came back 4 weeks later, with decreasing of white concretions. Discussion: Even though the capillary cylinders are benign conditions and have low morbidity, and the fact of not being well known, frequently, there is confusion in its diagnosis, which can generate unnecessary costs and inadequate treatment.

Case for diagnosis. A bluish nodule on the scalp

Abstract: Acrospiroma, also known as hidradenoma, is a rare cutaneous tumor that has several histological characteristics. As a consequence, a high index of suspicion is necessary for its diagnosis. Here we report a case that illustrates the importance of a good clinical-pathologic correlation in order to recognize this disease.

Miasis cutánea por Cochliomyia hominivorax asociada a dermatitis seborreica: case report / Cutaneous myiasis due to Cochliomyia hominivorax associated with seborrheic dermatitis

Myiasis is an infestation of tissues and organs of humans and animals by Diptera larvae (flies, horseflies, mosquitoes). They are located at different body sites, and classified clinically as cutaneous, visceral and cavitary. We report a 26-year-old woman with a history of seborrheic dermatitis and recent trip to Brazil. She presented with a seven days history of suppurating wounds in the parieto-occipital area of the scalp. At physical examination we found three ulcers of approximately 1.5 cm each, with multiple mobile larvae inside. The obtained larvae were analyzed, identifying Cochliomyia hominivorax larvae at L2 and L3 stages. The patient was managed successfully with oral antimicrobials and local cleansing. The screwworm Cochliomyia hominivorax in our country is rare. Known risk factors are wounds, poor personal hygiene, extreme ages, psychiatric disorders, presence of specific dermatosis such as psoriasis and seborrheic dermatitis, among others.

Cutis verticis gyrata secundária à paquidermoperiostose. Relato de caso / Cutis verticis gyrata secondary to pachydermoperiostosis - case report

A cutis verticis gyrata é uma condição do couro cabeludo caracterizada por sulcos e dobras profundas, causando o espessamento da pele que lhe dá uma aparência semelhante aos giros do córtex cerebral. Pode ser congênita ou adquirida, e predomina no sexo masculino. É classificada de acordo com sua etiologia primária (essencial e não essencial) e secundária. Descrevemos aqui um caso de cutis verticis gyrata secundária à paquidermoperiostose em paciente do sexo masculino jovem, apresentando suas manifestações clínicas, laboratoriais e radiológicas. Estudo descritivo constando de relato de caso e revisão de literatura nas bases de dados da Biblioteca Virtual de Saúde. Foram obtidos artigos originais científicos nas bases LILACS, SciELO, Scopus e PubMed, buscando-se pelos descritores: "couro cabeludo", "doenças da pele e do tecido conjuntivo", "anormalidades da pele" e "dermatopatias". O limite temporal foi 2010 e as línguas escolhidas foram português, inglês, italiano, espanhol e francês. Paciente do sexo masculino, 25 anos, apresentando hipertrofias lineares em couro cabeludo, acompanhado de dor nas mãos, tornozelos e articulação coxofemoral. Presença de baqueteamento digital e hiperidrose palmoplantar. Trata-se de uma doença rara e progressiva, cuja avaliação clínica é essencial para definir a forma da cutis verticis gyrata e excluir outras síndromes associadas.

Cutis verticis gyrata (CVG) is a scalp condition characterized ridges and deep folds causing thickening of the skin, giving an appearance similar to the cerebral cortex gyri. It can be congenital or acquired, and predominates in males. It is classified according to its primary and secondary etiology (essential and non-essential). A case of Cutis verticis gyrata secondary to pachydermoperiostosis (PQP) is described in a young male patient, with its clinical, laboratory and radiological findings. This is a descriptive study consisting of a case report and review of literature on the Virtual Health Library databases (BVS). Scientific original articles were obtained in LILAC, SciELO, Scopus and PubMed databases, searching the keywords: "scalp", "skin and connective tissue diseases", "skin abnormalities" and "skin diseases" .The time limit was year 2010, and the languages chosen were Portuguese, English, Italian, Spanish and French. Male patient, 25 years old, with linear hypertrophy on the scalp, accompanied by pain in the hands, ankles and hip joint. Presence of digital clubbing, and palmoplantar hyperhidrosis. It is a rare, progressive disease whose clinical assessment is essential to define the type of cutis verticis gyrata, and to rule out other associated syndromes.

Leprosy on the scalp

Abstract Leprosy is a chronic infectious disease caused by Mycobacterium leprae. This bacillus has a high predilection for skin and peripheral nerves. The scalp’s anatomical properties do not favor the development of such mycobacterium. We report a case of leprosy with scalp involvement, a rare occurrence in our literature.

Clinicopathological features, treatment and prognosis of scalp angiosarcoma：16 case reports / 中华皮肤科杂志

Objective To investigate clinicopathological features of scalp angiosarcoma, and to analyze the relationship of tumor stage and treatment with prognosis. Methods Clinical and follow-up data were collected from 16 patients with non-metastatic primary scalp angiosarcoma treated in the Department of Plastic and Reconstructive Surgery of Zhongda Hospital, Southeast University from September 2002 to June 2013. According to the seventh edition American Joint Committee on Cancer (AJCC)TNM staging system for soft tissue sarcomas (2010), staging of scalp angiosarcoma was performed for the 16 patients. Statistical analysis was carried out by the Kaplan-Meier method for survival rates and by the Log-rank test for survival curve. The Cox regression model was used for multivariate regression analysis. Results Of the 16 patients, 4 had stageⅠangiosarcoma, 4 stage Ⅱangiosarcoma, and 8 stage Ⅲ angiosarcoma. The tumor usually began as ecchymosis-like lesions on the head or face in early stage, and progressed into dark red infiltrative plaques, nodules and ulcers which easily ruptured and bled in later stage. Histopathological examination showed generalized vascular proliferation and infiltration with high histological morphological diversity. Cytologic atypia was commonly seen. The median time to recurrence was 15 months, and local recurrence occurred in 7 patients. The median time to metastasis was 20.5 months, and distant metastasis was observed in 8 cases, including 4 cases of pulmonary metastasis, 2 lymph node metastasis, 1 liver metastasis and 1 bone metastasis. The survival time was 33.0 ± 4.4 months (median, 32 months)in 4 patients with stage Ⅰangiosarcoma, 24.0 ± 7.9 months(median, 15 months)in 4 patients with stage Ⅱangiosarcoma, and 23.9 ± 3.9 months (median, 24 months)in 8 patients with stage Ⅲ angiosarcoma. Additionally, the survival time was 23.4 ± 5.2 months(median, 21 months), 24.4 ± 5.7 months(median, 24 months)and 35.8 ± 9.7 months(median, 26 months) in 5 patients receiving surgical treatment alone, 7 patients receiving surgical treatment and radiotherapy, and 4 patients receiving surgical treatment, radiotherapy and immunotherapy, respectively. Conclusions Surgical treatment combined with radiotherapy and immunotherapy may serve as the first-choice treatment for scalp angiosarcoma. Tumor size and treatment regimens are main factors influencing prognosis of scalp angiosarcoma.

Lupus erythematosus profundus of the scalp in five children / 中华皮肤科杂志

Objective To investigate clinical and pathological features of lupus erythematosus profundus (LEP)of the scalp in children.Methods A retrospective study was carried out on 5 children with LEP.The clinical and histopathological features,treatment and prognosis of LEP were analyzed.Results The 5 children with LEP included 2 boys and 3 girls with a median age at onset of 5 months (range,2-38 months) and a median clinical course of 15 months (range,4-72 months).Clinically,the patients presented with arc-shaped or circular purple atrophic plaques on the scalp complicated by alopecia.The occipitalia and tempora were the most commonly involved sites.Antinuclear antibodies (ANA) and extractable nuclear antigens (ENAs) were negative in all the patients.Main histopathological changes were hyaline degeneration of the fat,mucin deposition and local aggregation of lymphocytes in fat lobules.Of the 5 patients,2 were treated with oral prednisone (1.5-2 mg/kg/day),1 with oral hydroxychloroquine (5 mg/kg/day),1 with oral prednisone (1.5 mg/kg/day) combined with hydroxychloroquine (5 mg/kg/day),and another 1 with topical halometasone cream and 0.03％ tacrolimus ointment.Lesions were remissed after 2-3 months of treatment,and subsided with growth of new hairs after 6 months.No recurrence was observed during a 1.5-year follow-up.Conclusion Prednisone and hydroxychloroquine are markedly effective for LEP,and pediatric patients with LEP may be treated by topical highpotency glucocorticoids and calcineurin inhibitors.

Lichen planopilaris epidemiology: a retrospective study of 80 cases

AbstractBACKGROUND:Lichen planopilaris is a frequent presentation of primary cicatricial alopecia. Scalp distribution characterizes the main clinical presentations: classic lichen planopilaris, frontal fibrosing alopecia and Graham-Little Piccardi-Lassueur Syndrome (GLPLS).OBJECTIVE:Description of the clinical, dermoscopic and histopathological findings of Lichen planopilaris in public and private practices.METHOD:A retrospective observational study was performed by reviewing medical records of patients with lichen planopilaris.RESULTS:Eighty patients were included, 73 (91,25%) were female. Prototype II was seen in 53 (66,25%) patients. Classic lichen planopilaris was seen in 62,5% of the cases. Frontal fibrosing alopecia was seen in 31% of the patients and only one patient presented Graham-Little Piccardi-Lassueur Syndrome (GLPLS). Scalp lesions were scattered throughout the scalp in 47 (58,75%) of the patients, while 24 (30%) presented mainly central scalp lesions, 29 (36,25%) presented marginal lesions and only 4 (5%) patents had vertex lesions.CONCLUSIONS:Clinical presentation of Lichen planopilaris varies. To recognize the heterogeneity of the clinical appearance in lichen planopilaris is important for differential diagnosis.

Black women’s hair: the main scalp dermatoses and aesthetic practices in women of African ethnicity

Abstract:Afro-ethnic hair is different from Caucasian and Asian hair and has unique features. Ethnic hair is more prone to certain conditions or diseases. Such diseases are not only related to the fragile inner structure of the hair, but also to the cultural habits of hairstyles that often exert traction forces upon the pilosebaceous follicle. Women with African hair subject their hair to chemical treatments such as hair straightening and relaxing, and thus modify the structure of their hair shaft, making it more susceptible to damage. For this reason, hair complaints are common among black women and represent a diagnostic challenge to the dermatologist, requiring a thorough clinical examination of the hair and scalp, and a detailed medical history of the patient. The purpose of this review is to warn of the potential side effects and sequelae related to hairstyles and hair treatments used by black women, and to highlight the major diseases that affect this ethnicity.

Goya and tinea favosa

A case of a tinea favosa involving the scalp of a child represented in the painting "Boys climbing a tree" (Muchachos trepando a un árbol), by Francisco Goya y Lucientes, with pictorial representation of favic scutula and consequent alopecia.

Primary essential cutis verticis gyrata - Case report

Cutis verticis gyrata is characterized by excessive formation of scalp skin. It may be primary (essential and nonessential) or secondary. In the primary essential form it presents only folding skin formation on the scalp, mimicking cerebral gyri, without associated comorbidities. We report a rare case of a 28 year-old male patient with primary essential cutis verticis gyrata.

Cutaneous larva migrans on the scalp: atypical presentation of a common disease

Cutaneous larva migrans is a pruritic dermatitis due to the inoculation of helminths larvae in the skin, and it often occurs in children in tropical and subtropical areas. The authors describe an atypical case of cutaneous larva migrans in a 11 year-old child with scalp involvement, an unusual topography for this lesion.