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One of the most frequently impacted locations by psoriasis is the scalp. It is seen in about 80% of psoriasis cases worldwide, and its treatment is challenging. To compare the efficacy and safety of excimer light versus topical methotrexate (MTX) 1% hydrogel in treatment of scalp psoriasis. This randomized prospective intra-patient comparative study was carried out on 30 patients with scalp psoriasis. Lesions were divided randomly into two areas: Area A and Area B. Area A received biweekly sessions of 308-nm excimer light and Area B received topical MTX 1% hydrogel once daily for 3 consecutive months. Psoriatic Scalp Severity Index (PSSI), itching score, patient satisfaction and dermoscopic red dots and white scales were used for assessment at the baseline, at the end of treatment protocol and 1 month after the last treatment session. Both treatment modalities induced significant improvement in PSSI, itching score and dermoscopic red dots and white scales (p < 0.001 for each). The mean percentage of improvement of PSSI was 75.82 ± 33.72 in Area A and 74.19 ± 31.64 in Area B with non-significant difference between both areas (p = 0.763). Moreover, the mean percentage reduction of itching score was 77.40 ± 24.61 in Area A and 67.67 ± 34.94 in Area B with non-significant difference between both areas (p = 0.430). Additionally, a notable improvement in dermoscopic red dots and white scales was observed in 83.3% of patients in Area A and in 60% in Area B at the end of treatment protocol with non-significant difference between both areas (p = 0.518) (p = 0.436). Marked patient satisfaction was noticed in both areas with non-significant difference between both areas (p = 0.433). 308-nm excimer light and topical MTX 1% hydrogel are equally safe and effective treatment options for scalp psoriasis with minimal side effects.

Actinic keratosis is a common precursor to squamous-cell carcinoma. Several topical treatments are effective but require weeks of application. In four randomized trials, topical treatment with ingenol mebutate for 2 to 3 days was effective in clearing actinic keratoses. Actinic keratoses are premalignant lesions that are common in light-skinned populations worldwide. 1 In the United States, the most common form of lesion-directed therapy for actinic keratoses is cryosurgery, although other locally ablative therapies are used. 2 In addition to potential scarring, recurrence rates are high with some of these treatment approaches. 3 Other treatments for actinic keratosis are applied to an entire field of sun-damaged skin, and many studies have shown the emergence of clinically visible actinic keratoses after application. These treatments include imiquimod, fluorouracil, diclofenac, and photodynamic therapy. 1 Drawbacks to the self-applied topical field therapies currently available include a long duration . . .

Platelet‐rich plasma (PRP) as a treatment for male pattern hair loss was investigated in a randomized, placebo‐controlled study in which 20 men received PRP on half of their scalp and placebo on the other. Patients received 3 treatments at 30‐day intervals. Hair regrowth was quantified by a blinded evaluator using computerized trichograms. Patients were followed for 2 years; study endpoints were hair regrowth, hair dystrophy as measured by dermoscopy, burning or itching sensation, and cell proliferation as measured by Ki‐67 evaluation. At the end of three treatment cycles, clinical improvement was seen in several parameters. Four of 20 patients experience continued hair loss and required retreatment. Platelet‐rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery, and preliminary evidence suggests that it might have a beneficial role in hair regrowth. Here, we report the results of a randomized, evaluator‐blinded, placebo‐controlled, half‐head group study to compare, with the aid of computerized trichograms, hair regrowth with PRP versus placebo. The safety and clinical efficacy of autologous PRP injections for pattern hair loss were investigated. PRP, prepared from a small volume of blood, was injected on half of the selected patients' scalps with pattern hair loss. The other half was treated with placebo. Three treatments were administered to each patient at 30‐day intervals. The endpoints were hair regrowth, hair dystrophy as measured by dermoscopy, burning or itching sensation, and cell proliferation as measured by Ki67 evaluation. Patients were followed for 2 years. Of the 23 patients enrolled, 3 were excluded. At the end of the 3 treatment cycles, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 33.6 hairs in the target area, and a mean increase in total hair density of 45.9 hairs per cm2 compared with baseline values. No side effects were noted during treatment. Microscopic evaluation showed the increase of epidermis thickness and of the number of hair follicles 2 weeks after the last PRP treatment compared with baseline value (p < .05). We also observed an increase of Ki67+ keratinocytes in the epidermis and of hair follicular bulge cells, and a slight increase of small blood vessels around hair follicles in the treated skin compared with baseline (p < .05). Relapse of androgenic alopecia was not evaluated in all patients until 12 months after the last treatment. After 12 months, 4 patients reported progressive hair loss; this was more evident 16 months after the last treatment. Those four patients were re‐treated. Our data clearly highlight the positive effects of PRP injections on male pattern hair loss and absence of major side effects. PRP may serve as a safe and effective treatment option against hair loss; more extensive controlled studies are needed. Significance Platelet‐rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery, and preliminary evidence suggests that it might have a beneficial role in hair regrowth. Here, the results of a randomized, placebo‐controlled, half‐head group study to compare the hair regrowth with PRP versus placebo are reported. Hair regrowth was quantified by a blinded evaluator using computerized trichograms. The safety and clinical efficacy of autologous PRP injections for pattern hair loss were investigated. Of the 23 patients enrolled, 3 were excluded. At the end of the 3 treatment cycles, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 33.6 hairs in the target area and a mean increase in total hair density of 45.9 hairs per cm2 compared with baseline values. No side effects were noted during treatment. The data clearly highlight the positive effects of PRP injections on male pattern hair loss and absence of major side effects.

Background The purpose of this study was to compare the effects of scalp nerve block (SNB) and local anesthetic infiltration (LA) with 0.75% ropivacaine on postoperative inflammatory response, intraoperative hemodynamic response, and postoperative pain control in patients undergoing craniotomy. Methods Fifty-seven patients were admitted for elective craniotomy for surgical clipping of a cerebral aneurysm. They were randomly divided into three groups: Group S (SNB with 15 mL of 0.75% ropivacaine), group I (LA with 15 mL of 0.75% ropivacaine) and group C (that only received routine intravenous analgesia). Pro-inflammatory cytokine levels in plasma for 72 h postoperatively, hemodynamic response to skin incision, and postoperative pain intensity were measured. Results The SNB with 0.75% ropivacaine not only decreased IL-6 levels in plasma 6 h after craniotomy but also decreased plasma CRP levels and increased plasma IL-10 levels 12 and 24 h after surgery compared to LA and routine analgesia. There were significant increases in mean arterial pressure 2 and 5 mins after the incision and during dura opening in Groups I and C compared with Group S. Group S had lower postoperative pain intensity, longer duration before the first dose of oxycodone, less consumption of oxycodone and lower incidence of PONV through 48 h postoperatively than Groups I and C. Conclusion Preoperative SNB attenuated inflammatory response to craniotomy for cerebral aneurysms, blunted the hemodynamic response to scalp incision, and controlled postoperative pain better than LA or routine analgesia. Trial registration Clinicaltrials.gov NCT03073889 (PI:Xi Yang; date of registration:08/03/2017).

•The scalp block reduces hemodynamic response to pin head holder application in infratentorial craniotomies.•The scalp block and local anesthetic infiltration both reduce hemodynamic response to skin incision.•The scalp block also reduces postcraniotomy pain intensity. The most painful stages of craniotomy are the placement of the pin head holder and the skin incision. The primary aim of the present study is to compare the effects of the scalp block and the local anesthetic infiltration with bupivacaine 0.5% on the hemodynamic response during the pin head holder application and the skin incision in infratentorial craniotomies. The secondary aims are the effects on pain scores and morphine consumption during the postoperative 24h. This prospective, randomized and placebo controlled study included forty seven patients (ASA I, II and III). The scalp block was performed in the Group S, the local anesthetic infiltration was performed in the Group I and the control group (Group C) only received remifentanil as an analgesic during the intraoperative period. The hemodynamic response to the pin head holder application and the skin incision, as well as postoperative pain intensity, cumulative morphine consumption and opioid related side effects were compared. The scalp block reduced the hemodynamic response to the pin head holder application and the skin incision in infratentorial craniotomies. The local anesthetic infiltration reduced the hemodynamic response to the skin incision. As well as both scalp block and local anesthetic infiltration reduced the cumulative morphine consumption in postoperative 24h. Moreover, the pain intensity was lower after scalp block in the early postoperative period. The scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration.

The scalp microbiome represents an array of microorganisms important in maintaining scalp homeostasis and mediating inflammation. Scalp microbial dysregulation has been implicated in dermatologic conditions including alopecia areata (AA), dandruff/seborrheic dermatitis (D/SD), scalp psoriasis (SP) and folliculitis decalvans (FD). Understanding the impact of scalp microbial dysbiosis gives insight on disease pathophysiology and guides therapeutic decision making. Herein we review the scalp microbiome and its functional role in scalp conditions by analysis of metagenomic medical literature in alopecia, D/SD, SP, and other dermatologic disease. Increased abundance of Malassezia, Staphylococcus, and Brevibacterium was associated with SD compared to healthy controls. A higher proportion of Corynebacterium, actinobacteria , and firmicutes are present in AA patients, and lower proportions of Staphylococcus caprae are associated with worse clinical outcomes. Decreased prevalence of actinobacteria and Propionibacterium and increased firmicutes, staphylococcus, and streptococcus are associated with scalp psoriasis. Studies of central centrifugal cicatricial alopecia (CCCA) suggest scalp microbial composition contributes to CCCA’s pro-inflammatory status. The most common organisms associated with FD include methicillin-resistant S. aureus and S. lugdunensis . Antifungals have been a mainstay treatment for these diseases, while other alternatives including coconut oils and shampoos with heat-killed probiotics have shown considerable potential efficacy by replenishing the scalp microbiome.

Background Headlice are prevalent worldwide, with a higher burden in rural, lower-middle income settings. They can cause intense itchiness, discomfort, and secondary bacterial infections with potentially serious consequences. Ivermectin is efficacious against headlice, and is also being evaluated as a malaria vector control tool. In this study, we explored risk factors for headlice, and assessed the efficacy of ivermectin mass drug administration (MDA) designed for malaria against headlice. Methods We conducted an open-label, assessor-blind, cluster-randomized controlled trial in Mopeia, Mozambique. A single dose of ivermectin was given monthly to eligible humans or humans and livestock (humans: 400 μg/kg, livestock: 1% injectable 200 μg/kg) in 3 consecutive months during the rainy season. The control group received albendazole (humans only). Thirty-nine clusters (13 per arm) were randomly selected for the nested assessment of headlice prevalence. 1341 treated participants were followed up at least once, 1, 2 and 3 months and 382 untreated (ineligible) participants at 3 and 6 months after the first MDA round. Headlice diagnosis was determined by scalp examination. Logistic regression was used to identify risk factors for headlice at baseline, and to estimate the treatment effect at each time point. Results A total of 1309 participants were included in the main analysis assessing ivermectin MDA efficacy, and 1332 in the risk factor analysis. The baseline headlice prevalence was 11%. Risk factors included living with a household member with head itch [adjusted odds ratio (a OR ) = 48.63, 95% confidence interval ( CI ): 28.7–82.3, P -value < 0.0001], being female (a OR  = 2.25, 95% CI: 1.33–3.80, P -value < 0.01), and using surface water as the main water (a OR  = 2.37, 95% CI: 1.12–5.33, P -value = 0.04). The treated population receiving ivermectin had significantly lower odds of having headlice at 3 months compared to those receiving albendazole (a OR  = 0.19, 95% CI: 0.04–0.91, P -value = 0.04). There was no indirect effect on headlice among children ineligible for treatment. Conclusions In a highly endemic setting, mass drug administration with ivermectin significantly reduces headlice infestation prevalence among those who receive the drug for three sequential months. The lack of effect among untreated, ineligible children implies that additional interventions would be needed to interrupt local transmission. Trial registration This study is registered with ClinicalTrials.gov (NCT04966702). Graphical Abstract

Scalp diseases are a common issue affecting patients’ self-esteem and quality of life. Currently, trichoscopy is the foundation of diagnostics; however, it does not always provide sufficient sensitivity and specificity. In uncertain cases, scalp biopsy remains the gold standard, though it is an invasive method and not well accepted by patients. In recent years, new non-invasive diagnostic methods have been developed and modernized. This article discusses imaging techniques, emphasizing their development over time as well as their advantages and limitations in the diagnosis of scalp dermatoses.

To investigate the safety and clinical efficacy of AA-PRP injections for pattern hair loss. AA-PRP, prepared from a small volume of blood, was injected on half of the selected patients’ scalps with pattern hair loss. The other half was treated with placebo. Three treatments were given for each patient, with intervals of 1 month. The endpoints were hair re-growth, hair dystrophy as measured by dermoscopy, burning or itching sensation, and cell proliferation as measured by Ki-67 evaluation. At the end of the 3 cycles of treatment, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 18.0 hairs in the target area, and a mean increase in total hair density of 27.7 ( number of hairs/cm2) compared with baseline values. Microscopic evaluation showed the increase of epidermis thickness and of the number of hair follicles two weeks after the last AA-PRP treatment compared to baseline value (P<0.05). We also observed an increase of Ki67+ keratinocytes of epidermis and of hair follicular bulge cells and a slight increase of small blood vessels around hair follicles in the treated skin compared to baseline (P<0.05).

Traumatic Brain Injury (TBI) is a common reason for pediatric emergency visits, though few cases lead to intracranial injury. This study evaluates the Infant Scalp Score (ISS) as a predictor of clinically significant TBI (ciTBI) and its role in guiding CT scan decisions for children under two at Al-Zahra and Kashani hospitals. This prospective, observational study analyzed patient outcomes using statistical modeling, including ROC curve analysis to determine optimal ISS cut-offs. Among 161 pediatric head trauma cases, 124 underwent CT imaging, identifying TBI in 25 cases (20.2%). CT decisions were guided by clinical judgment, institutional protocols, and physician discretion, with 30-day follow-up via phone consultation. ISS was calculated based on age, hematoma size, and location, classifying hematomas as small (< 1 cm), medium (1–3 cm), or large (> 3 cm). Data analysis in SPSS 25 utilized descriptive statistics and correlation tests to examine ISS-CT associations. A total of 161 pediatric patients (57% male, mean age 20.4 ± 9.8 months) with blunt head trauma were included. Among 124 children (77%) who underwent CT, 25 (20.2%) showed TBI, with 7 cases (4.34%) meeting ciTBI criteria. Hematomas ≥ 3 cm were significantly associated with higher TBI risk (OR = 3.67, p  = 0.02). ISS ≥ 6 exhibited moderate predictive performance (AUC: 0.76, 95% CI: 0.62–0.85), increasing CT scan likelihood (OR = 1.73) and TBI detection (OR = 2.83). ISS ≥ 7 showed improved predictive power (AUC: 0.89, 95% CI: 0.72–0.94), reinforcing its role as the minimum predictive cut-off for ciTBI ( p  = 0.04). Overall, ISS demonstrated strong diagnostic accuracy (AUC = 0.876, 95% CI: 0.326–0.901), supporting its utility in guiding CT decisions and enhancing pediatric head trauma management. The Infant Scalp Score (ISS) effectively predicts TBI in children under two years old. ISS ≥ 6 identifies high-risk patients, while ISS ≥ 7 provides greater predictive accuracy, reinforcing its role in risk stratification. Larger hematomas (> 3 cm) further elevate TBI risk, emphasizing the importance of ISS in guiding CT scan decisions and reducing unnecessary radiation exposure.