Thursday, 27 December 2012
Saturday, 22 December 2012
Tuesday, 18 December 2012
Thursday, 6 December 2012
PEDICULOSIS/ LICE INFESTATION
Lice are wingless, flattened, blood-sucking
insects that are survive as surface parasites on birds and mammals.
Pediculosis
is a term used to denote infestation by Pediculus
capitis (head louse), Pediculus
humans (body louse), or Phthirus
pubis (pubic louse). The bites of lice are painless and difficult to
detect. The clinical signs and symptoms are the result of the patient’s
reaction to the saliva and anticoagulant injected into the dermis by the louse
at the time of feeding. Depending on the degree of sensitivity and previous
exposure, the feeding sites produce reddish rash hours to days after feeding.
Itching
(Pruritus) is the most common symptom of any type of pediculosis.
Lice
cannot jump or fly. Pets are not vectors (carriers of insect). Diagnosis is
made by seeing the lice or their eggs.
Lice
feed approximately five times each day by piercing the skin with their claws,
injecting irritating saliva, and sucking blood.
Lice
are active and can travel very fast. That is why they can be transmitted so
easily. The life cycle from egg to hatching of the insect, and then laying new
egg is approximately 1 month.
NITS/LICE EGGS
The
female lays approximately six eggs, or nits, each day for up to 1 month, and
then dies. The louse incubates, hatches in 8 to 10 days, and reaches maturity
in approximately 18 days. Nits are 0.8 mm long and are firmly cemented to the
bases of hair shafts to close to the skin to acquire adequate for incubation.
Nits are very difficult to remove from the hair shaft.
Clinical manifestations
Lice
infestation of the scalp is most common in children. An average patient carries
less than 20 adult lice. A small minority of patients can have more than 100
lice in the scalp. Scratching causes inflammation and secondary bacterial
infection, with boils (pustules), crusting, and lumps in the neck (cervical lymphadenopathy).
The
eyelashes may be involved, causing redness and swelling. Examination of the
back of scalp shows few adult organisms but many nits. Nits are cemented to the
hair, whereas dandruff scale can be easily moved along the hair shaft. Head
lice can survive away from the human host for about 3 days, and nits can survive
for up to 10 days.
Transmission
The main
source of transmission is direct skin to skin contact. Other sources like hats,
brushes, combs, earphones, bedding, furniture is common. Head lice do not carry
or transmit any contagious infection.
Diagnosis
Lice
are suspected when a patient complains of itching in a localized area without
an apparent rash. The itching tends to very severe sometimes. Scalp and public
lice will be apparent to those who carefully examine individual hairs. They are
not apparent with only a cursory examination.
Finding
nits does not indicate active infestation. Nits may persist for months after
successful treatment. Live eggs reside within a quarter inch of the scalp.
COMBING
Combing
the hair with a fine-toothed “nit,” or detection, comb is effective for
detecting and removing live lice. The comb is inserted near the crown until it
touches the scalp, and then drawn firmly down. The teeth of the comb should be
0.2 to 0.3 mm apart to trap lice. The entire head of hair should be examined
for lice after each stroke. It usually takes 1 minute to find the first louse.
Lice and nits can be seen easily under a microscope and a hand lens.
Wood lamp examination
Live
nits fluoresce and can be detected easily by Wood’s light examination, a
technique that is especially useful for rapid examination of a large group of
children. Nits that contain an unborn louse fluoresce white. Nits that are
empty fluoresce gray.
MANAGEMENT STRATEGY
Infestation
is most common among children 3-12 years of age and their parents.
Identification of live lice is the gold standard of diagnosis; however, finding
nits alone in a patient who has not been treated also warrants treatment. Nits are easier to spot, especially at the
nape of the neck and behind the ears. Hatched nits are white; unhatched nits
are brown. Detection combing of wet hair with a fine-toothed nit comb allows for efficient recovery of
lice and nits for diagnosis.
Examination
for nits and lice via nit combing
Nit
combing is four times more efficient than and twice as fast as direct visual
inspection.
FIRST-LINE THERAPIES
·
Malathion 0.5%
lotion
·
Permethrin 1%
cream rinse
·
Carbaryl
0.5% lotion
OTHER
THERAPIES
Ø
Topical crotamiton
10%
Ø
Nit picking
-
Bug Busting (wet combing)
Ø
Lindane 1%
Ø
Oral Ivermection
Ø
Topical lvermection
Ø
Trimethoprim /Sulfamethoxazole
Ø
Levamisole
Ø
Fomite control
Ø
Head shaving
Launderable
items (worn clothing and used bedding, towels, scarves, and hats) should be
placed in a dryer at 60°C for 10 minutes. Brushes, combs, and hair ornaments
can be placed in hot water (60°C or more) for 10 minutes. Non-launderable items (i.e, certain stuffed animals) should
be placed in a bag for 3 days (not 15 days, as eggs laid off a host will
probably not hatch close enough to a host to obtain their first blood meals).
Cloth
furniture and rugs should be vacuumed. Fumigation of the home is not required.
Contacts
of all detected cases, including classmates, should be screened. Empiric
therapy for close household contacts is also recommended. Those likely to have
had head-to head contact with the index case in the previous 4-6 weeks should
be identified and screened. Children should not be excluded from school for
head lice as the infestation often has been around for month prior to its
detection. Hair grows 1cm per month, and lice lay eggs close to the scalp where
it is moist and warm. Nits detected 2 cm from the scalp represent a 2 months old
infestation. Therapy within a week of the detected infestation is more reasonable.
Dr Arika Sethi
Dr Pradeep Sethi
http://www.directhairtransplantation.com
Labels:
hair care,
hair grooming,
lice treatment,
nits treatment
Location:
Gurgaon, Haryana, India
Hair Replacements, Hairpieces and Wigs
A
hair replacement (hair system or hairpiece) is partial synthetic or natural
hair prosthesis that covers a part of the scalp which is bald, whereas a wig
which covers the entire scalp. A wig is worn usually by women whereas the men
prefer to wear a cap because of persistence of the hair at the back and sides
of the head (occipital and temporal fringe in men with male patterned
baldness).
Hair
replacements can be attached to the scalp through a variety of mechanisms. They
are summarized below:
· Glue adhesives: provide more durable bonding and can be used to keep a replacement in place for upwards of a month.
· Hair weaving: uses existing hair to provide anchorage to the hair system through inter-weaving the two together. Weaving can also provide a month of time for a hair replacement to remain in place before maintenance is required.
· Hair clips: Hair replacement is secured with several sets of little combs that clip to a person’s hair.
These
hair replacements require maintenance like:
· Coloring
· Repairing
· Replacing
· Bonding it back on scalp
Hair styling requires special sensitivity and
technique to provide proper blending and is usually carried out in specialized
salons where men who wear hair replacements can feel more comfortable in that
environment dedicated to their needs.
The
benefits of hair replacement are that:
· They can provide immediate gratification as
opposed to a hair transplant that requires 6 months or beyond to see the result
· Look more denser that the look after a single sitting of hair transplant
· Less expensive
· It is a good option in individuals with cannot undergo hair transplant because of underlying systemic diease like cardiac problem, coagulopathies etc.
· Individual with extremely poor density in the donor areas
· Look more denser that the look after a single sitting of hair transplant
· Less expensive
· It is a good option in individuals with cannot undergo hair transplant because of underlying systemic diease like cardiac problem, coagulopathies etc.
· Individual with extremely poor density in the donor areas
The
disadvantages are:
· The maintenance requires a lot of labor and time investment. In contrast the transplanted hair don’t require much extra care
· The hair of the artificial replacement don’t undergo growth
· The wearer is under a constant fear of displacement of the hairpiece
· The wearer may develop social inhibition due the risk of being “caught”
These
hair replacements provide cover up for a patient who is has undergone hair transplant for the transition phase (i.e. the phase when the growth of
transplanted hair has not started yet). Such persons should understand two
things:
· Hair transplant cannot provide the very low hairline as that of a hair replacement
· They need to make some adjustment in the way a hair replacement is worn after the hair transplant
Nevertheless,
most people seeking hair transplant are willing to compromise hair density and
selecting the hair transplant only of the front and top of the scalp. They also
accept the exposed, bald vertex for the freedom of having their natural hair.
They must understand the limitations and advantages of hair transplantation
after proper and thorough counseling by their physician.
There are some situations in which a patient wearing
the hairpiece can consider undergoing hair transplant like:
Great
advances have been made to increase the natural look of hairpieces today. Unlike
the older hairpieces that were thick, synthetic, and poorly shaped which looked
like “hairy rug”, today’s thin, laced front hair replacements are made of
natural hair and almost undetectable.
The
reason modern hair replacements look less obvious is that the hairs are woven
through a transparent mesh base that attaches to the scalp that can simulate
natural hair emanating from the scalp. Another reason is that they contain
significantly fewer hairs (closer to the natural hair density).
Dr Arika Sethi
Dr Pradeep Sethi
http://www.directhairtransplantation.com
Tuesday, 27 November 2012
SCARRING - CICATRICIAL ALOPECIA
SCARRING/CICATRICIAL ALOPECIA
Definition and
introduction
A large
number of scalp disorders may destroy the hair follicles and result in scarring
(cicatricial) alopecia. These include diseases that primarily affect the hair
follicles as well as diseases that affect the deeper layers of skin (dermis) and
secondarily cause follicular destruction.
Once
established, cicatricial alopecia is a permanent condition that cannot be reversed
by treatment. For this reason, it is very important to diagnose the hair or
scalp disorders that may produce cicatricial alopecia as soon as possible in
order to start a specific treatment and avoid diffuse follicular destruction.
The
differential diagnosis between the diseases that cause cicatricial alopecia
requires a biopsy (pathological examination). A scalp biopsy is therefore
mandatory in all cases of cicatricial alopecia. The causes are summarized
below:
Follicular diseases
·
Lichen planopilaris
·
Discoid lupus erythematosus
·
Keratosis follicularis spinulosa decalvans
·
Folliculitis decalvans
·
Traction alopecia
Dermal fibrosis
·
Localized scleroderma
·
Radiodermeatitis
·
Pemphigoid
·
Chemical or physical injuries
·
Burns
The
aim of treatment is to avoid further scarring and it is necessary to explain
clearly to the patient that the hair that has been lost will not grow again.
Surgical treatment of cicatricial alopecia includes excision of the scarring
area tissue expansion or hair transplantation.
Lichen planopilaris
Lichen
planolilaris is the most common cause of cicatricial alopecia.
Patients
usually seek medical advice because they have noticed one or several patches of
hair loss. A certain degree of itching is frequently reported. The clinical
examination reveals a variable number of poorly circumscribed bald patches.
Discoid lupus erythematosus
Diagnosis
of ‘discoid lupus erythematosus’ is strongly suggested by the presence of redness
(erythema), prominent hair roots (follicular hyperkeratosis), thinning of skin
(atrophy) and small blood vessels (telangiectasia).
Folliculitis decalvans
This
term is utilized a spectrum of scalp disorders characterized by painful acute
inflammatory changes with or without pustules. Relapsing inflammatory episodes
result in cicatricial alopecia and tufted folliculitis.
Although
the bacteria Staphylococcus aureus
may frequently be isolated from the pustules, folliculitis decalvans is not an infective condition, but
possibly represents an abnormal host response against staphylococcal antigens
or toxins.
Keratosis follicularis spinulosa decalvans (KFSD)
This
inherited condition usually becomes evident in infancy. Follicular papules are
also evident on the eyebrows and cheeks. Alopecia, which is more prominent in
the vertex, usually develops after puberty.
Its severity
varies considerably in different patients.
Brocq pseudoarea
Brocq
pseudoarea is not a separate entity, but represents the cicatricial outcome of
lichen planopilaris. The scalp presents multiple irregular bald atropic areas, but
no signs of inflammation.
Involvement of the beard area has also been
reported.
Localized scleroderma
Localized
scleroderma of the scalp presents as a slowly progressing irregular patch of
hair loss. The skin often shows a certain degree of erythema or pigmentation in
the absence of follicular keratosis or scaling. The patch is often not
completely bald, but presents some vellus or intermediate hairs.
Serve
atrophy with involvement of the hypodermis and muscles is a feature of fronotoparietal
linear scleroderma (‘encoup de sabre’).
Hair transplantation is a good
treatment option for its management. However, there are some factors that
reduce the chances of survival of the implanted grafts:
·
Poor blood supply
·
Fibrosis of deeper layers of skin
The
following are the differences in hair transplant technique in such cases:
1.
The density of the implanted grafts is lesser
2.
A session of trial grafting of 100/150 grafts
can be performed to look for the survival of implanted grafts. If the growth is
good the transplanting the complete bald area can be attempted
3.
The angle of insertion of grafts is less acute
4.
The amount of tumescence anaesthesia
administered is less
5.
Adrenaline is avoided in the anaesthetic
solution.
Alopecia Areata
Alopecia areata
Introduction
Alopecia areata is a non-scarring form of hair loss that usually beings with round patch.
It can involve any hair-bearing area of the body and is characterized
histopathologically by peribulbar lymphocytic infiltrates. Cases of mild
involvement show a marked tendency to spontaneous regrowth of hair. With the
exception of androgenetic hair loss, alopecia areata is by far the most
frequently occurring form of hair loss.
Etiology and associated diseases
The
exact cause of this disorder is not known. It is thought to be caused by
autoimmunity against our own hair follicles (roots). An association with other
autoimmune disorders like vitiligo, pernicious anaemia, thyroid disorders has
been reported.
Clinical features
A
well defined patch of hair loss (usually coin shaped) develops on any part of
the scalp. Grey hair may be seen growing from the patch. This patch may resolve
on its own without any treatment. Sometimes, it starts increasing in size and
new patches develop. This is called progressive alopecia and requires urgent
intervention by a dermatologist.
Sometimes,
it may spread to involve eyelashes, eyebrows and body hair.
When
alopecia areata involves the hairline (front, sides or back), then that pattern
is called ophiasic pattern.
Alopecia
totalis is the term used to denote the loss of all scalp hair
Alopecia
universalis is the term used to denote the loss of all body hair
Necessary therapeutic measures
Appropriate
information on the course and prognosis of alopecia areata is needed. The
patient should be informed that a spontaneous remission is always possible. In
mild forms characterized by some round patches there is an 80% probability that
spontaneous regrowth will occur within a period of 1 or 2 years. In cases of
more extensive or total hair loss the prognosis is considerably less
favourable, but a spontaneous regrowth of hair is never excluded.
Psoralen and ultraviolet A (PUVA) treatment
PUVA
treatment with oral application of 8-methoxypsoralen can be categorized as effective
but its practical applicability is rather limited because the UV light can no
longer reach the scalp when hair is regrowing. The same is true for the
‘PUVA-turban’ treatment.
Local injections of corticosteroids
In
exceptional cases of recalcitrant circumscribed bald patches, local injections
of corticosteroids may be considered. However, in cases of more pronounced
involvement this therapeutic approach is worthless.
Advice regarding prosthetic camouflage
In
case of extensive or total alopecia areata the question of applying a wig
should be discussed with the patient of applying a wig should be discussed with
the patient. It is important to realize that wigs made of artificial hair
appropriately fulfil the cosmetic requirements. Moreover, cleaning of a wig
made of artificial hair is much easier. On the other hand, wigs made of genuine
hair are more durable. For economic reasons it seems unjustified to demand that
the health plan should take over the costs for wigs made of human hair for all
patients with alopecia with alopecia areata.
Additional desirable measures
From
a psychological point of view, it is important that the dermatologist shows
commitment and offers the option of regular appointments. In this way the
patient will not feel left alone with his problems, and he will learn to cope
adequately with this disease which often tends to run a chronic course. In
exceptional cases, however, the psychological support that can be given by a
dermatologist may be insufficient, and in such cases the help of a specialized
psychologist should be considered. It is important, however, that the physician
and the patient himself both understand the aim of such psychological help.
Such inter views cannot be offered with the aim to elucidate the ‘cause’ or
‘meaning’ of alopecia areata, or to induce regrowth of hair. Rather, the
rationale of any psychosomatic approach is to offer support in coping with a
cosmetically devastating disease. Dermatologists should be aware that many
psychologists erroneously believe that their specialized knowledge and skills
enable them to induce hair regrowth in alopecia areata. In reality, such
psychosomatic approaches do not inhibit a spontaneous remission of alopecia
areata.
Dr Pradeep Sethi
Dr Arika Sethi
www.directhairtransplantation.com/
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