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Alopecia of the unburned scalp
Copyright
0
1996
Elsevier
Bum Vol. 22, No. 3, pp. 250-251, 1996 Science Ltd for ISBI. All rights reserved Printed in Great Britain 0305-4179196 $15.00 + 0.00
ELSEVIER
030%4179(95)00115-S
Alopecia
of the unburned
I. J. S. Chow, C. Balakrishnan
scalp
and M. S. Meininger
Division of Plastic Surgery, Wayne State University
School of Medicine, Detroit, Michigan, USA
Alopecia of the unburned scalp, the temporary or permanent loss of hair, is a preventable complication. Patients at highest risk of developingalopeciaure those with burn encephalopathy and in a prolonged shock state. The occipital scalp is the most common site and head loculized pressure-induced ischaemia is the likely cause. Frequent repositioning and use of devices to decrease the pressure effect may decrease the incidence of this complication.
Burns,Vol. 22, No. 3, 250-251, 1996
ulceration of this area was noted only in two patients, and this healedspontaneously. Follow up at 6 months revealed significant areas of alopecia in some patients (Figure 7). Although the area of alopecia decreasedover time, small areas could still be detected at the end of 12 months (Figure2) in somepatients.
Discussion Alopecia, defined as no hair regrowth by 1 year, may be either temporary of permanent1T2.It has been reported postoperatively and following trauma. Localized pressure
Introduction Temporary or permanent hair losscan result from congenital or traumatic causes.It is often very distressingfor the individual and its correction is a difficult problem for the reconstructive surgeon. Postoperative alopecia can occur from prolonged immobilization. Although alopecia and its correction with various methods is described in the literature, a review did not reveal any report of alopecia in the unburned scalp. Although rare, we report the problem of alopecia possibly from localized pressure-induced ischaemia in bum patients with no familial tendency and/or no bums of the scalp.
Patients and results Patients admitted to the burn unit with significant bums with or without inhalation injury were followed up to determine the incidence and effect of hair loss. During a 2O-month period, five patients without a scalp bum who required endotracheal intubation and ventilatory support for inhalation injury, respiratory failure or head injury developed alopecia during their hospital stay. There were three female and two male patients, ranging in age from 27 to 71 years. The male patients did not have a family history of occipital baldness. Body surface area burned ranged from 18 to 45 per cent with an average ventilatory support of 14 days (range 11-42 days). Three patients sustained scaldsto the lower half of the body; one patient sustained flame bums to the right lower extremity, buttocks and abdomen following a motor vehicle accident; the other patient sustained flame bums to the chest and bilateral upper and lower extremities. At the end of the first week in hospital there was redness of the occipital scalp and, hence, the head was positioned on foam pillows to prevent a pressure effect. Superficial
Figure 1. Patient with alopeciaof the occipital area6 months after injury.
Chow et al.: Alopecia
of the unburned
scalp
251 a prospective study’ with a reduced incidence of postoperative alopecia. Initial signsand symptoms within the first week include focal occipitoparietal pain, inflammation and oedema, followed by ulceration and crusting. With relief of pressure, these areas healed with loss of hair. Histological studies’ in patients who later developed temporary alopecia have shown intravascular thrombosis, oedema, hair follicle necrosis and perivascular inflammation without vasculitis. Due to ethical reasons,no histological studies were carried out in our patients. As the alopecia involved only smallareasno reconstruction was carried out in any of these patients. The prognosis of postoperative alopecia seemsto be good with a low incidence of permanent alopecia. Other causes of alopecia, such as alopecia areata, pyoderma, kerion, seborrheic dermatitis, herpes simplex and contact dermatitis’, shouldbe consideredand excluded in making a diagnosisof postoperative alopecia. Although rare, alopecia can occur in bum patients from pressure necrosis. Frequent repositioning of the head and the prevention of pressureto a specific area of the scalp may decreasethe incidence. As most of these casesof alopecia are temporary, reconstruction of this deformity should be postponed.
References 1 Lawson N, Mills N, Oscher J. Occipital cardiopulmonary
alopecia following bypass. ] Thorac Cardovasc Surg 1976; 71:
342-347. z Ben-Amitai D, Garty B. Alopecia in children surgery. Pediafr Dermafol 1993; 10: 32-33. Figure 2. Persistent alopecia of the scalp 18 months after injury.
has been described as the likely cause’r3.Patients at highest risk for permanent hair loss include those who are intubated for over 24 h either for surgicalproceduresor due to their injury. Postoperative alopecia has been observed in adults and children following gynaecological or open-heart surgery, with an incidence ashigh as 14 per cent1p4.Frequent repositioning of the head in cardiac surgery patients every 30 minutes both intraoperatively and during recovery until extubation has been reported in
after cardiac
3 Boyer JD, Vidmar DA. Postoperativealopecia:a casereport and literature review. Cufis 1994; 54: 321-322. 4 Poma P. Pressure-induced alopecia: report of a case after gynecologic surgery. I Reprod Med 1979;22: 219-222.
necrosis
Paper accepted 2 August 1995.
Correspondence should be addressed to: C. Balakrishnan, Department of Surgery, Wayne State University School of Medicine, 4201St Antoine, Detroit, MI 48201,USA.
0
1996
Elsevier
Bum Vol. 22, No. 3, pp. 250-251, 1996 Science Ltd for ISBI. All rights reserved Printed in Great Britain 0305-4179196 $15.00 + 0.00
ELSEVIER
030%4179(95)00115-S
Alopecia
of the unburned
I. J. S. Chow, C. Balakrishnan
scalp
and M. S. Meininger
Division of Plastic Surgery, Wayne State University
School of Medicine, Detroit, Michigan, USA
Alopecia of the unburned scalp, the temporary or permanent loss of hair, is a preventable complication. Patients at highest risk of developingalopeciaure those with burn encephalopathy and in a prolonged shock state. The occipital scalp is the most common site and head loculized pressure-induced ischaemia is the likely cause. Frequent repositioning and use of devices to decrease the pressure effect may decrease the incidence of this complication.
Burns,Vol. 22, No. 3, 250-251, 1996
ulceration of this area was noted only in two patients, and this healedspontaneously. Follow up at 6 months revealed significant areas of alopecia in some patients (Figure 7). Although the area of alopecia decreasedover time, small areas could still be detected at the end of 12 months (Figure2) in somepatients.
Discussion Alopecia, defined as no hair regrowth by 1 year, may be either temporary of permanent1T2.It has been reported postoperatively and following trauma. Localized pressure
Introduction Temporary or permanent hair losscan result from congenital or traumatic causes.It is often very distressingfor the individual and its correction is a difficult problem for the reconstructive surgeon. Postoperative alopecia can occur from prolonged immobilization. Although alopecia and its correction with various methods is described in the literature, a review did not reveal any report of alopecia in the unburned scalp. Although rare, we report the problem of alopecia possibly from localized pressure-induced ischaemia in bum patients with no familial tendency and/or no bums of the scalp.
Patients and results Patients admitted to the burn unit with significant bums with or without inhalation injury were followed up to determine the incidence and effect of hair loss. During a 2O-month period, five patients without a scalp bum who required endotracheal intubation and ventilatory support for inhalation injury, respiratory failure or head injury developed alopecia during their hospital stay. There were three female and two male patients, ranging in age from 27 to 71 years. The male patients did not have a family history of occipital baldness. Body surface area burned ranged from 18 to 45 per cent with an average ventilatory support of 14 days (range 11-42 days). Three patients sustained scaldsto the lower half of the body; one patient sustained flame bums to the right lower extremity, buttocks and abdomen following a motor vehicle accident; the other patient sustained flame bums to the chest and bilateral upper and lower extremities. At the end of the first week in hospital there was redness of the occipital scalp and, hence, the head was positioned on foam pillows to prevent a pressure effect. Superficial
Figure 1. Patient with alopeciaof the occipital area6 months after injury.
Chow et al.: Alopecia
of the unburned
scalp
251 a prospective study’ with a reduced incidence of postoperative alopecia. Initial signsand symptoms within the first week include focal occipitoparietal pain, inflammation and oedema, followed by ulceration and crusting. With relief of pressure, these areas healed with loss of hair. Histological studies’ in patients who later developed temporary alopecia have shown intravascular thrombosis, oedema, hair follicle necrosis and perivascular inflammation without vasculitis. Due to ethical reasons,no histological studies were carried out in our patients. As the alopecia involved only smallareasno reconstruction was carried out in any of these patients. The prognosis of postoperative alopecia seemsto be good with a low incidence of permanent alopecia. Other causes of alopecia, such as alopecia areata, pyoderma, kerion, seborrheic dermatitis, herpes simplex and contact dermatitis’, shouldbe consideredand excluded in making a diagnosisof postoperative alopecia. Although rare, alopecia can occur in bum patients from pressure necrosis. Frequent repositioning of the head and the prevention of pressureto a specific area of the scalp may decreasethe incidence. As most of these casesof alopecia are temporary, reconstruction of this deformity should be postponed.
References 1 Lawson N, Mills N, Oscher J. Occipital cardiopulmonary
alopecia following bypass. ] Thorac Cardovasc Surg 1976; 71:
342-347. z Ben-Amitai D, Garty B. Alopecia in children surgery. Pediafr Dermafol 1993; 10: 32-33. Figure 2. Persistent alopecia of the scalp 18 months after injury.
has been described as the likely cause’r3.Patients at highest risk for permanent hair loss include those who are intubated for over 24 h either for surgicalproceduresor due to their injury. Postoperative alopecia has been observed in adults and children following gynaecological or open-heart surgery, with an incidence ashigh as 14 per cent1p4.Frequent repositioning of the head in cardiac surgery patients every 30 minutes both intraoperatively and during recovery until extubation has been reported in
after cardiac
3 Boyer JD, Vidmar DA. Postoperativealopecia:a casereport and literature review. Cufis 1994; 54: 321-322. 4 Poma P. Pressure-induced alopecia: report of a case after gynecologic surgery. I Reprod Med 1979;22: 219-222.
necrosis
Paper accepted 2 August 1995.
Correspondence should be addressed to: C. Balakrishnan, Department of Surgery, Wayne State University School of Medicine, 4201St Antoine, Detroit, MI 48201,USA.