THERAPY OF TINEA CAPITIS—The Value of X-Ray Epilation

Roentgen ray epilation, which is at present the most important single weapon against M. audouini infection of the scalp, should not be withheld except in special circumstances, from a child who has the disease. It can quickly cure the disease and halt spread from one child to another. Harmful sequelae and medicolegal complications can be averted by competent use of the method and simple precautions.The Keinbock-Adamson technique of epilation can be recommended without hesitancy, provided it is carried out meticulously in every detail, and administered by an operator of suitable training and experience in roentgen therapy of the skin.     

An estimate of the magnitude of random errors in the DS86 dosimetry from data on chromosome aberrations and severe epilation

An analysis of the proportion of cells with chromosome aberrations in cultured blood lymphocytes from A-bomb survivors in Hiroshima and Nagasaki reveals that the dose-response relationship using DS86 assigned dose is significantly steeper in the subsample of individuals who reported severe epilation after the bombings than in those who did not report severe epilation. This effect is due either to random errors in the DS86 dose assignments or to individual differences in sensitivity to radiation, or to both. In this paper, working within a class of dosimetry error models, we estimate the magnitude of random dosimetry errors which would be required to account for all of the difference in the observed dose response between people who did and did not report severe epilation under the assumption that random dosimetry error is the only cause of the effect. We conclude that random dosimetry errors in the range 45 to 50% of true dose are necessary to explain completely the difference in dose response between the two epilation groups. We discuss evidence that the contribution of individual differences in radiation sensitivity to the observed epilation effect is likely to be small, so that random dosimetry errors may be the major cause of this effect.     

Epilation for Minor Trachomatous Trichiasis: Four-Year Results of a Randomised Controlled Trial

BackgroundTrachomatous trichiasis (TT) needs to be managed to reduce the risk of vision loss. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. Here we report the four-year outcome and the effect on vision and corneal opacity.

Methodology/ Principal Findings

1300 individuals with minor TT were recruited and randomly assigned to quality trichiasis surgery or repeated epilation using high quality epilation forceps by a trained person with good near vision. Participants were examined six-monthly for two-years, and then at four-years after randomisation. At two-years all epilation arm participants were offered free surgery. At four-years 1151 (88.5%) were re-examined: 572 (88%) and 579 (89%) from epilation and surgery arms, respectively. At that time, 21.1% of the surgery arm participants had recurrent TT; 189/572 (33%) of the epilation arm had received surgery, while 383 (67%) declined surgery and had continued epilating (“epilation-only”). Among the epilation-only group, 207 (54.1%) fully controlled their TT, 166 (43.3%) had minor TT and 10 (2.6%) had major TT (>5 lashes). There were no differences between participants in the epilation-only, epilation-to-surgery and surgery arm participants in changes in visual acuity and corneal opacity between baseline and four-years.

Conclusions/ Significance

Most minor TT participants randomised to the epilation arm continued epilating and controlled their TT. Change in vision and corneal opacity was comparable between surgery and epilation-only participants. This suggests that good quality epilation with regular follow-up is a reasonable second-line alternative to surgery for minor TT for individuals who either decline surgery or do not have immediate access to surgical treatment.     

Analysis of the DS86 atomic bomb radiation dosimetry methods using data on severe epilation

This report presents a reanalysis of the Hiroshima and Nagasaki data on severe epilation as an acute radiation effect using both the new DS86 and the old T65D dosimetries. The focus of the report is on several aspects of the data which have previously been examined by Jablon et al (ABCC TR 12-70, 1970) and Gilbert and Ohara [Radiat. Res. 100, 124-138 (1984)]. The report examines the uniformity of epilation response across shielding category, across sex and age, and in terms of interactions between city, sex, age, and shielding category; it also investigates the apparent relative biological effectiveness (RBE) of neutrons in the DS86 dose compared with the T65D dose, using both within- and between-city information. In addition the report discusses evidence for nonlinearity in epilation response. The epilation response function exhibits nonlinearity in terms of both a marked increase in slope at about 0.75 Gy, and then, beginning at about 2.5 Gy, a leveling off and eventual decrease in response. The principal conclusions of the report are as follows. The use of the DS86 dosimetry rather than T65D increases the apparent RBE of neutrons compared with gamma dose from approximately 5 to 10. At these values of RBE the slope of the dose response, in a middle range from 0.75-2.5 Gy, is about 165% greater using DS86 than T65D. With respect to the interactions of sex, city, and shielding method, the size and significance of virtually all nonuniformities in epilation response seem using T65D are also evident with DS86. Additionally it seems difficult to find any evidence that DS86 is an improved predictor of epilation response over T65D. Finally, the fact that the nonlinearity in dose response and apparent actual downturn in epilation occurrence rate at the high end of dose is more striking with DS86 than with T65D is found to be due primarily to the common practice of truncating all T65D doses to 600 rad.     

Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial

Background

Trachomatous trichiasis can cause corneal damage and visual impairment. WHO recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomised studies for minor trichiasis (Methods and Findings1,300 individuals with minor trichiasis from Amhara Regional State, Ethiopia were recruited and randomly assigned (1∶1) to receive trichiasis surgery or epilation. The epilation group were given new forceps and epilation training. The surgical group received trichiasis surgery. Participants were examined every 6 months for 2 years by clinicians masked to allocation, with 93.5% follow-up at 24 months. The primary outcome measure (“failure”) was ≥five lashes touching the eye or receiving trichiasis surgery during 24 months of follow-up, and was assessed for noninferiority with a 10% prespecified noninferiority margin. Secondary outcomes included number of lashes touching, time to failure, and changes in visual acuity and corneal opacity.Cumulative risk of failure over 24 months was 13.2% in the epilation group and 2.2% in the surgical group (risk difference = 11%). The 95% confidence interval (8.1%–13.9%) includes the 10% noninferiority margin. Mean number of lashes touching the eye was greater in the epilation group than the surgery group (at 24 months 0.95 versus 0.09, respectively; p<0.001); there was no difference in change in visual acuity or corneal opacity between the two groups.

Conclusions

This trial was inconclusive regarding inferiority of epilation to surgery for the treatment of minor trichiasis, relative to the prespecified margin. Epilation had a comparable effect to surgery on visual acuity and corneal outcomes. We suggest that surgery be performed whenever possible but epilation be used for treatment of minor trichiasis patients without access to or declining surgery.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00522912","term_id":"NCT00522912"}}NCT00522912 Please see later in the article for the Editors'' Summary     

REPORT OF AN OUTBREAK OF RINGWORM OF THE SCALP DUE TO M. AUDOUINI

Experience in Los Angeles County with an outbreak of ringworm of the scalp caused by M. audouini, and a review of the literature have led to the following conclusions:Diagnosis: The Wood''s lamp is an indispensable piece of equipment in case finding. While M. audouini infection is often characteristic in appearance, there are frequent variations. Culturing on Sabouraud''s medium (glucose-agar) is a requirement for positive diagnosis. Most surveys show an infection ratio of six or seven boys to one girl.Treatment: X-ray epilation provides the best prospect for cure in the shortest time. Manual epilation can be employed but is less efficient and more disagreeable. Shaving the scalp every seven to ten days is helpful in preventing the spread of the infection but is not a satisfactory substitute for epilation. The most effective topical application is an ointment containing 5 per cent salicylanilide in carbowax 1500. All treatment should be conducted under trained supervision for constancy and thoroughness. Hormone therapy is in general to be discouraged.Control: With proper supervision of treatment and adequate protective covering of the scalp, there need be no loss of school time after treatment has been instituted. Enlistment of the barbers of the community in refusing to serve clients with obviously infected scalps, and properly sterilizing instruments is important. Cutting instruments can be satisfactorily sterilized in petroleum oil at 100° C. without detriment to the instruments. Complete discipline must be maintained on school grounds with regard to exchange of headgear between children.     

Dissecting cellulitis of the scalp

Dissecting cellulitis of the scalp or perifolliculitis capitis abscedens et suffodiens is a rare, chronic, progressive, suppurative disease of the scalp of unknown etiology. It is characterized by painful nodules, purulent drainage, burrowing interconnecting abscesses, and cicatricial alopecia. The pathogenesis is unknown, although it is probably related to follicular occlusion, secondary infection, and deep inflammation. Black men in their second to fourth decade are predominantly affected. Treatment varies from systemic antibiotics to incision and drainage, x-ray epilation of the affected areas, systemic steroid administration, and surgical excision. Our experience with four patients with extensive scalp disease is presented. Wide excision of the affected areas and splitthickness skin graft are favored as our treatment of choice.     

Skin response to X-irradiation in the guinea-pig.

Skin reaction to X-irradiation has been studied in the albino guinea-pig; early response in limited-field irradiations of the flank is comparable to that commonly seen in rodents, swine and man, and is dose-dependent with a dynamic range from mild erythema to moist desquamation. The peak early skin reaction is seen between 14 and 21 days after irradiation, and declines before 30 days except at the highest doses used. Fractionation of the X-ray dose at 24 hours results in a 'sparing' of about 340 rad. Permanent partial epilation is detectable at doses in excess of 1400 rad, and complete epilation at 1 year occurs in 50 per cent of irradiated fields at 1740 rad. Twenty-four hour two-dose fractionation results in a 'sparing' of about 500 rad for epilation. Palpable dermal 'fibrosis' is detectable at 3 months after irradiation in fields given more than 2070 rad, and at 1 year after irradiation in fields given more than 1800 rad; 50 per cent of fields showed palpable 'fibrosis' at 1 year at 1930 rad. Unlike domestic swine and man, skin fields in the guinea-pig showed no dimensional contraction after X-ray doses which produced gross early skin damage.     

An experience of pubic hair reconstruction using free temporoparietal fasciocutaneous flap with needle epilation

Lack of pubic hair may cause suffering for pubescent and adult patients; thus, rapid and precise reconstruction is required for their mental health. We reported pubic hair reconstruction for burn alopecia using a free temporoparietal fasciocutaneous flap transfer with needle epilation. Fourteen months after the reconstruction, an acceptable aesthetic result was obtained, and our patient is satisfied with her reconstructed pubic hair. We conclude that reconstruction using a free temporoparietal fasciocutaneous flap with needle epilation is a useful method for selected patients.     

The observed relationship between the occurrence of acute radiation effects and leukemia mortality among A-bomb survivors

In an analysis of a follow-up study of a fixed population of 73,330 atomic bomb survivors in Hiroshima and Nagasaki, the slope of an estimated dose response between ionizing radiation and leukemia mortality was found to be steeper (P less than 0.002), by a factor of 2.4, among those who reported epilation within 60 days of the bombings, compared to those who did not experience this sign of acute radiation exposure. The strength of this empirical finding as evidence of biological association in individual radiosensitivity for these two end points is studied here. The major factor complicating the interpretation of this finding as evidence of such an association is the degree of imprecision of the radiation dosimetry system used in assignment of radiation doses to the A-bomb survivors. Using models recently suggested for dealing with dosimetry errors in epidemiological analysis of the A-bomb survivor data, the sensitivity of the apparent association between leukemia mortality and severe epilation to the assumed level of dosimetry error is investigated.     

RADIATION THERAPY OF RINGWORM OF THE SCALP

A recent epidemic of tinea capitis in children has revived a considerable interest in the methods of treatment of this disease.The most efficacious form of therapy for M. audouini infections is roentgen epilation.The various methods of x-ray treatment are briefly presented and compared. A modification of the four-point technique is shown to offer a simple yet safe method of curing ringworm of the scalp. Results with this method compare favorably with the best of those reported by the use of other methods.Cure was effected by this method in all of a group of 125 cases.     

Estimating the risks for offspring of first-cousin matings. An approach.

Effects of parental consanguinity on morbidity and mortality can be estimated from observations on families ascertained through a child with a disease or defect, provided that appropriate corrections are made for the ascertainment bias. The risk of first-cousin parents having a child with a recessively inherited disease appears to be low (less than 1%). Data obtained by this approach suggest that the increased infant mortality associated with inbreeding (upon which calculations of lethal equivalents are based) may result in part from environmental differences between consanguineous and nonconsanguineous matings, which may be changing. Thus estimates of the number of lethal equivalents in a population can change as the environment changes.     

Possible selection effects for radiation risk estimates in Japanese A-bomb survivors: reanalysis of acute radiation symptoms data

An earlier analysis examined the possibility of bias in the Life Span Study (LSS) cohort by studying Japanese A-bomb survivors with bomb-related acute injuries and those without such injuries (Stewart and Kneale in Int J Epidemiol 29:708–714, 2000). The authors reported significantly higher radiation risks, both for cancers and non-cancers, among those survivors with acute injuries compared with those without. The risks were reported to be particularly large among survivors aged <10 or ≥55 years of age at the time of bombings. The aim of this paper is to examine these findings more closely using the LSS acute effects data. All the analyses were carried out using Poisson regression. Relative risk models were fitted with adjustment for sex and other factors. Significant differences in relative risk between survivors with epilation and burns and those without epilation and burns are found for leukaemia. There is also some evidence for heterogeneity in the leukaemia risk between survivors with two or more acute injuries and those with no injuries, but the evidence is disappeared when survivors with one or more injuries are compared with those without injuries. For solid cancers, cardiovascular disease and all deaths combined, the risks do not differ to a statistically significant extent between survivors with and without injuries. There is no statistically significant heterogeneity in risk across age-at-exposure categories for survivors with injuries. For all deaths combined, relative risk estimates and their uncertainties are significantly higher for survivors exposed at ages <10 years when compared with other exposure ages, but risks are not significantly raised for survivors exposed at ≥55 years of age. With the exception of leukaemia, the findings from the present work are inconsistent with those of Stewart and Kneale.     

Tissue-specific regulation of junctional communication in the skin of mouse fetuses homozygous for the repeated epilation (Er) mutation

Mouse embryos homozygous for the repeated epilation (Er) gene have abnormally developed skin characterised by hyper-proliferation and incomplete differentiation of the epidermis. In this report, we have studied the patterns of junctional communication in the skin of these mutants to see if the loss of control of proliferation/differentiation is associated with any altered patterns of communication. Using the dye-injection technique we have shown that, compared to normal skin, junctional communication among dermal cells of Er/Er mutants is greatly reduced and the frequency of dermal-epidermal communication is, on the other hand, increased. These results support our previously proposed model, which suggests that selective regulation of junctional communication can be a component of proliferative control in a complex tissue.     

Protective effect of thallium against the formation of selenium cataract in rats

A simultaneous administration of thallium and cataractogenic dose of selenite to young rats protects the animals against the development of selenium cataract but does not prevent the transient epilation caused by thallium.     

Change in the activity of epidermal chalones during skin reaction to the effect of a carcinogen and epilation]

The biological activity of an epidermal G2-chalone extracted from the rat back skin was found to decrease 1 to 2 days after the treatment with methylnitrosourea (a carcinogen), and one day after the epilation. Results of quantitative recording and morphological analysis of the skin serving as the source of chalones, pointed to different mechanisms which underlay this effect.     

Laser hair removal: where are we now?

The hair removal market is evolving rapidly. The goal has always been long-term epilation. Success is dependent on understanding hair biology and physiology and on knowledge of laser physics, skin optics, and tissue preservation with respect to these emerging laser technologies. These topics will be reviewed, as will specific categories of laser systems in the hair removal arena and the clinical aspects of laser hair removal today.     

Utility and efficiency of linked marker genes for genetic counseling. II. Identification of linkage phase by offspring phenotypes

For a linked marker locus to be useful for genetic counseling, the counselee must be heterozygous for both disease and marker loci and his or her linkage phase must be known. It is shown that when the phenotypes of the counselee's previous children for the disease and marker loci are known, the linkage phase can often be inferred with a high probability, and thus it is possible to conduct genetic counseling. To evaluate the utility of linked marker genes for genetic counseling, the accuracy of prediction of the risk for a prospective child with a given marker gene to develop the genetic disease and the proportion of families in which a particular marker locus can be used for genetic counseling are studied for X-linked recessive, autosomal dominant, and autosomal recessive diseases. In the case of X-linked genetic diseases, information from children is very useful for determining the linkage phase of the counselee and predicting the genetic disease. In the case of autosomal dominant diseases, not all children are informative, but if the number of children is large, the phenotypes of children are often more informative than the information from grandparents. In the case of autosomal recessive diseases, information from grandparents is usually useless, since they show a normal phenotype for the disease locus. If we use information on the phenotypes of children, however, the linkage phase of the counselee and the risk of a prospective child can be inferred with a high probability. The proportion of informative families depends on the dominance relationship and frequencies of marker alleles, and the number of children. In general, codominant markers are more useful than are dominant markers, and a locus with high heterozygosity is more useful than is a locus with low heterozygosity.     

Ethical issues in recommending and offering fetal therapy

Fetal therapy should be offered and recommended for a viable fetus when these criteria are met: invasive therapy is reliably judged to have a high probability of being life-saving or of preventing serious and irreversible disease, injury, or disability for the fetus and for the child it can become; such therapy is reliably judged to involve low mortality risk and low or manageable risk of serious disease, injury, or disability to the viable fetus and the child it can become; and the mortality risk and the risk of disease, injury, or disability to the pregnant women is reliably judged to be low or manageable. When one or more of these criteria are not satisfied, intervention is experimental and can only be offered, not recommended, on the basis of benefit to future patients and the autonomy of the pregnant woman.     

TONSILLECTOMY IN THE ALLERGIC CHILD

Edema is the chief factor in enlargement of tonsils of children with allergic disease.In the absence of infection tonsillectomy and adenoidectomy are contraindicated in the allergic child except when obstruction is present.Infection produces one of two distinct patterns when it influences allergic states, the pattern depending upon the nature of the infectious disease.Chronic infection of the upper respiratory tract in the allergic child produces a pattern simulating that of acute respiratory infection.If, in the presence of infected tonsils and adenoids, management of the allergic state does not produce results, tonsillectomy and adenoidectomy are indicated. Management of the allergic disease must be continued postoperatively.Whether infection is present or absent, allergic disease can be controlled only through competent management of it.