1/6. Perifolliculitis capitis abscedens et suffodiens.Perifolliculitis capitis abscedens et suffodiens (PCAS) is rare chronic, suppurative and inflammatory scalp disease. Its aetiology and pathogenesis is not completely understood. The treatment is usually difficult and often disappointing. We report a case of 29-year-old male who presented with tender, fluctuant nodules and abscesses, with draining pus and patchy alopecia on his scalp for 3 years. A skin biopsy from scalp lesions revealed features that are characteristic of perifolliculitis. Initially, the patient was treated with periodic incision and drainage of the scalp abscesses. The answer was very poor. When admitted to our department, isotretinoin was started at daily dose of 30 mg, because initially his cholesterol and triglyceride levels were mildly increased. When dose was reduced to 10 mg the levels of cholesterol and triglyceride remained normal. A response to treatment was excellent and rapid. The treatment of PCAS represents usually difficulties and frustration for both the patient and the physician. A long course of isotretinoin can be considered as one of the most effective treatment for PCAS.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Massive subgaleal hematoma following minor head trauma.A 23-month-old child developed massive head swelling secondary to a subgaleal hematoma several days following minor head trauma. When seen in the emergency department, the child was felt to be otherwise well and hemodynamically stable and was discharged with close follow-up. The hematoma subsequently resolved over the ensuing two weeks. This case represents an uncommon, but dramatic complication of minor head trauma and serves to illustrate the need for physicians to recognize this entity as well as manage it effectively. The major pitfalls in managing these patients are failure to recognize this entity and, particularly in the infant, failure to carefully assess the hemodynamic status.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Cutaneous myiasis.Although cutaneous myiasis remains uncommon in north america, any traveler to the tropics may return with this ailment. A history of travel to a tropical country, a persistent pruritic lesion resembling a boil but having a dark central punctum with seropurulent or serosanguineous drainage, and complaints of a crawling sensation in the area of the lesion should lead the physician to consider myiasis. Treatment is directed at prompt removal of the fly maggot by incision and extraction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Multiple pyogenic granuloma-like lesions following hair transplantation.Multiple pyogenic granuloma-like lesions occurring at punch graft sites are an unusual complication of hair transplantation heretofore unreported. While the etiology and pathogenesis of such lesions remain elusive, physicians performing hair transplantations should be aware of this potential sequela.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Complications of fiber implantation for baldness.Several methods of fiber implantation have been used to reduce pattern baldness, and similar results have been reported: fiber breakage, foreign-body reaction, infection and scarring. Since one method or another tends to predominate in different geographic areas, the physician often is unable to compare the results of the various methods. The two patients described in this article underwent different methods of fiber implantation; serious complications occurred in both. Fiber implantation is an unsafe technique and must be discouraged.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Isolated nodular cutaneous coccidioidomycosis. The initial manifestation of disseminated disease.Cutaneous manifestations of coccidioidomycosis may be divided into primary and secondary lesions. Since such lesions may be the only evidence of infection, the distinction is important. Primary (inoculation) lesions are rare. Secondary lesions develop from primary pulmonary disease, commonly. An isolated nodule on the scalp was the presenting sign of disseminated coccidioidomycosis in our patient. Because of the rarity of primary cutaneous coccidioidomycosis, cutaneous lesions due to it should alert the physician to the presence of disseminated disease. The clinical spectrum of such lesions is wide. Our patient was an elderly man with a hyperkeratotic scalp nodule clinically felt to be an actinic keratosis or an early squamous cell carcinoma. We suggest that patients with a travel or resident history in endemic areas be viewed with a high index of suspicion for skin lesions of cutaneous coccidioidomycosis. The advent of orally administered imidazole antifungal agents makes early and aggressive diagnosis of these lesions even more important.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |