Primary osteoma cutis--multiple café-au-lait spots and woolly hair anomaly

Genetic Hair Disorders: A Review

Hair loss in early childhood represents a broad differential diagnosis which can be a diagnostic and therapeutic challenge for a physician. It is important to consider the diagnosis of a genetic hair disorder. Genetic hair disorders are a large group of inherited disorders, many of which are rare. Genetic hair abnormalities in children can be an isolated phenomenon or part of genetic syndromes. Hair changes may be a significant finding or even the initial presentation of a syndrome giving a clue to the diagnosis, such as Netherton syndrome and trichothiodystrophy. Detailed history including family history and physical examination of hair and other ectodermal structures such as nails, sweat glands, and sebaceous glands with the use of dermoscopic devices and biopsy all provide important clues to establish the correct diagnosis. Understanding the pathophysiology of genetic hair defects will allow for better comprehension of their treatment and prognosis. For example, in patients with an isolated hair defect, the main problem is aesthetic. In contrast, when the hair defect is associated with a syndrome, the prognosis will depend mainly on the associated condition. Treatment of many genetic hair disorders is focused on treating the primary cause and minimizing trauma to the hair.

Soft-tissue osteoma of the thenar eminence

The development of osteoma in soft tissues without a direct contact with the adjacent osseous and articular structures is a very rare event. The involvement of the hand is even rarer, with only two previous cases reported so far. A 25-year-old man presented with a painless solid mass in the thenar region of his right palm, which appeared almost 2 years ago and showed a progressive enlargement in the last months. Under regional anesthesia an excisional biopsy was performed and the histopathological evaluation of the lesion confirmed the diagnosis of soft tissue osteoma. The postoperative follow-up period was uneventful without any complication or recurrence. Following a brief period of hand physiotherapy the patient has returned to normal daily activities.

Prognosis and Management of Congenital Hair Shaft Disorders without Fragility-Part II

Hair shaft disorders are characterized by congenital or acquired abnormalities of the hair shaft. The objective of this study was to review the literature regarding the prognosis and treatment options for hair shaft disorders. We used keywords in the search engines PubMed and Medline to identify all publications in English related to the prognosis and management of hair shaft disorders. Data were extracted from 96 articles that met search criteria. Findings were limited to case reports and small case series, as no studies were found. Disorders that improve in childhood include pili torti, trichorrhexis invaginata, woolly hair, and pili trianguli et canaliculi. Others, such as trichorrhexis nodosa, monilethrix, pili annulati, and pili bifurcati, improve with minoxidil. Oral retinoids have been found to improve hair abnormalities in trichorrhexis invaginata and monilethrix. There is no specific treatment for congenital hair shaft abnormalities. Gentle hair care is the mainstay of care for hair shaft disorders associated with fragility. Practices for gentle care include no brushing, backcombing, chemical products, tight braids, heat exposure, or mechanical grooming. Furthermore, any inherited or congenital disorder requires genetic counseling as part of management.

Soft-tissue osteoma of the hand: case report

A soft-tissue osteoma is rare. Only 1 previous case involving the hand has been published. We report a 66-year-old man with a soft-tissue osteoma of the palm that was treated by marginal excision.

Treatment of primary miliary osteoma cutis with incision, curettage, and primary closure

BACKGROUND

Primary miliary osteoma cutis is characterized by de novo bone formation in skin without a known associated or pre-existing cutaneous disorder. These lesions often develop on the face and cause cosmetic concern.

OBJECTIVE

Multiple treatments have been attempted, including topical and systemic agents and surgical techniques. The ideal treatment modality should be simple and effective with minimal side effects.

METHODS

The technique of scalpel incision over visible lesions, curette extraction of bony fragments, and primary suture repair was used to remove multiple lesions of primary miliary osteoma cutis on the cheeks of an affected patient.

RESULTS

This surgical technique resulted in a significant reduction of visible and palpable lesions and a smoother surface contour with minimal scarring.

CONCLUSION

This surgical technique offers a simple but effective method for removal of multiple bony fragments in primary miliary osteoma cutis with minimal side effects.

The diagnostic value of café-au-lait macules

Single café-au-lait macules (CALMs) are common in the pediatric population and in most children represent a normal finding. It is important to recognize whether the presence of multiple CALMs in a particular patient is normal or indicates an association with a multisystem disorder. This article addresses issues concerning the prevalence, genetics, and natural history of CALMs in the general population and reviews disorders in which CALMs are present as a characteristic trait.

Familial osteoma of the cranial vault

A case of solitary osteoma of the parietal skull is described in a mother and her 12-year-old son. There were no other craniofacial or dysmorphic features and there was no history of previous cranial trauma or inflammatory process and no radiographic evidence of other skeletal lesions in both patients. Family history was otherwise unremarkable. Gardner syndrome was ruled out by excluding other associated clinical abnormalities and by family history. The clinical and radiological features of the patients' osteomas were different from those of Albright hereditary osteodystrophy, fibrodysplasia ossificans progressiva, progressive osseous heteroplasia and familial ectopic ossification. To the author's knowledge this is the first case of the familial presentation of osteomas.

Sonographic findings in aneurysmal bone cyst in children: correlation with computed tomography findings

PURPOSE

This study compares the value of sonography and computed tomography (CT) in assessing fluid-fluid levels (FFLs) in aneurysmal bone cysts (ABCs) in children.

METHODS

Five children 4-13 years old with ABC in pubis, humerus, fibula, calcaneus, and ilium-ischium were studied between January 1995 and December 1996. Plain radiography, sonography, and CT were performed.

RESULTS

FFLs were visualized equally or better with sonography than with CT.

CONCLUSIONS

We propose that sonography be used to complement plain radiography in the prebiopsy assessment of expansile bone lesions with cortical bone thinning because the presence of FFLs is characteristic of ABC. CT and/or magnetic resonance imaging could be used in indeterminate cases and in complex anatomic locations. Such an approach would save time and reduce costs and discomfort to children.