New Treatment of Dry Itchy Scalp
One of the first indications of infestation is intense itching. Pruritus indicates infestation of about two months' duration. The lice are difficult to see in clean individuals who have only a minor infestation. Yet they can be abundant and easily, seen in malnourished individuals with poor hygiene. Nits can be confused with dandruff and may be distinguished from it with a magnifying glass. Also dandruff falls from the hair easily whereas nits firmly attach to it. It should also be distinguished from seborrhea, psoriasis, the shafts which cover the hair in the pityriasis sicca or from the residual particles of hair spray. On examination of hairy skin, it is possible to see lichenification and severe scratching marks and erythema, especially in the occipital or retroauricular regions (Fig. 41.4). If a white cloth is place under the head of an infested child and a fine-toothed comb is drawn through the hair, lice, easily nits or ova, and a black powder-like lice...
Tinea versicolor, common in young adults, is a relatively asymptomatic superficial skin infection caused by the lipophilic organism Pityrosporum orbicuiare (also termed Malassezia furfur). The lesions, which usually have a follicular origin, are small, hypopigmented-to-tan macules with a branlike furfuraceous scale the macules are distributed predominantly on areas of the body predisposed to seborrhea, such as the upper trunk, neck, shoulders, and face.
The casual agent is Malassezia furfur (Pityrosporum). Three serotypes have been characterized A, B, and C, but the clinical presentation is identical for all serotypes (Br J Dermatol 1993 129 533-540). The micelial pathogenic form (M. furfur) is frequently seen associated with excessive sweating, increased sebum secretion, synthetic clothing, the application of oils, and topical or systemic glucocorticoids. Also constitutional factors such as genetic predisposition, Cushing's syndrome, diabetes and immunodeficiency are important. But it is not usually present in AIDS where seborrheic dermatitis is frequently seen. M. furfur is capable of inducing an inflammatory response with a mild lymphocytic CD4+ infiltrate. Specific antibodies and the capacity to activate complement have been demonstrated.
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