Diagnostic and therapeutic approach to scalp dysesthesia: A case series and published work review

Scalp dysesthesia may be underrecognized but is an important condition which requires special management strategies. Through our case series of four patients, we have noted that patients were frequently misdiagnosed with seborrheic dermatitis and failed standard treatment. However, patients did benefit from low doses of oral pregabalin and a topical compound of amitriptyline, lidocaine and ketamine. Oral antihistamines and topical corticosteroids did not work sufficiently on their own but added value when used in conjunction with analgesic agents. Our experience and published work also suggest the association of cervical spinal changes, psychiatric disorders, and other environmental and habitual factors.     

Pyoderma gangrenosum of the scalp treated with cyclosporine A

A 56‐year‐old woman presented with an ulcer, with a depth of 9 mm, on the vertex and frontal parietal regions of the scalp. The lesion had a round shape (diameter, 7 cm), with clear‐cut margins and vertical borders sinking vertically to a bottom that was entirely covered with purulent fibrinous yellowish matter and greenish colored necrotic tissue. Other numerous small roundish ulcers were present next to the large ulcer. These had irregular margins with a yellowish fibrinous bottom ( Fig. 1 ). The patient reported the appearance of two small ulcers on the left and on the right frontal parietal regions about 1 year earlier. These had been treated locally with antimicrobials and antiseptics with no result. During the 2 months prior to our evaluation, a few small round‐shaped ulcers had appeared on the scalp. These had progressively increased in size and number.

Figure Figure 1  Open in figure viewer PowerPoint Large ulcer with clear‐cut margins, covered by purulent fibrinous matter, and other small roundish ulcers     

Seborrhoeic dermatitis of the scalp treated with a tar/zinc pyrithione shampoo

Seventy patients with seborrhoeic dermatitis of the scalp, participated in a double-blind clinical trial using a tar/zinc pyrithione shampoo versus a placebo shampoo. Fifty-seven patients were evaluated after 6 weeks of treatment. Seventeen of twenty-seven using active shampoo and seven of thirty who used the placebo had no itching or scaling at the conclusion of the trial (P9 < O.01). No significant differences between the active and placebo shampoos were found for the parameters of erythema, seborrhoea and excoriations.     

Dissecting cellulitis of the scalp treated with rifampicin and isotretinoin: case reports

Dissecting cellulitis of the scalp, or perifolliculitis capitis abscedens et suffodiens, is an uncommon chronic suppurative disease of the scalp manifested by follicular and perifollicular inflammatory nodules that suppurate and undermine, forming intercommunicating sinuses, and leading to scarring alopecia. Treatment generally fails to obtain a permanently successful result; thus, many therapeutic options have been proposed. We report 4 cases of dissecting cellulitis of the scalp successfully treated with oral rifampicin and oral isotretinoin. To our knowledge, this is the first report of oral rifampicin used concomitantly with oral isotretinoin in this disease entity. We also present a brief review of the literature on the topic.     

Additional effect of grenz rays on psoriasis lesions of the scalp treated with topical corticosteroids

In a double-blind study comprising 17 patients with symmetrical psoriasis lesions of the scalp, the combination of grenz ray treatment and topical steroid showed a faster clearing than with the topical steroid alone. The results also indicate a longer remission time with the combination therapy compared to grenz rays alone. Therefore both the faster clearing and the longer remission time with the combination therapy, as compared to our previous study of grenz ray treatment of scalp psoriasis, are probably due to the additional effect of steroid therapy, on grenz rays.