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We assessed the characteristics of Neisseria meningitidis pharyngeal carriage in a cohort of ‘men having sex with men’, including patients with pharyngeal Neisseria gonorrhoeae infection. In the period 2017-2019, among all the oropharyngeal samples tested for gonorrhoea from MSM attending a STI Clinic in Bologna (Italy), we randomly selected 244 N. gonorrhoeae-positive samples and 403 negatives (n=647). Pharyngeal specimens were tested for N. meningitidis presence, by the detection of sodC gene. N. meningitidis-positive samples were further grouped by PCR tests for the major invasive genogroups (i.e., A, B, C, W, and Y). A molecular assay, targeting capsule transporter gene, was used to determine meningococcal capsular status. Overall, 75.8% (491/647) of samples tested positive for sodC gene, indicating a pharyngeal meningococcal carriage. Meningococcal colonisation was significantly more frequent in younger subjects (P=0.009), with no association with HIV infection. Non-groupable meningococci represented most of pharyngeal carriages (about 71%). The commonest N. meningitidis serogroup was B (23.6%), followed by C (2.1%), Y (1.8%) and W (1.1%). Meningococci were often characterized by the genetic potential of capsule production. Interestingly, a negative association between N. meningitidis and N. gonorrhoeae was found: pharyngeal gonorrhoea was significantly more present in patients without meningococcal carriage (P=0.03). Although preliminary, our data added knowledge on the epidemiology of meningococcal carriage in MSM communities at high risk of gonococcal infections, gaining new insights into the interactions/dynamics between N. meningitidis and N. gonorrhoeae.

Cr, Fe, Rb, Ba and U were determined by inductively coupled plasma sector field mass spectrometry (ICP-SFMS) in various sections of the 3,270 m deep ice core recently drilled at Dome C on the high East Antarctic plateau as part of the EPICA program. The sections were dated from 263 kyr bp (depth of 2,368 m) to 672 kyr bp (depth of 3,062 m). When combined with the data previously obtained by Gabrielli and co-workers for the upper 2,193 m of the core, it gives a detailed record for these elements during a 672-kyr period from the Holocene back to Marine Isotopic Stage (MIS) 16.2. Concentrations and fallout fluxes of all elements are found to be highly variable with low values during the successive interglacial periods and much higher values during the coldest periods of the last eight climatic cycles. Crustal enrichment factors indicates that rock and soil dust is the dominant source for Fe, Rb, Ba and U whatever the period and for Cr during the glacial maxima. The relationship between Cr, Fe, Rb, Ba and U concentrations and the deuterium content of the ice appears to be similar before and after the Mid-Brunhes Event (MBE, around 430 kyr bp). Mean concentration values observed during the successive interglacials from the Holocene to MIS 15.5 appear to vary from one interglacial to another at least for part of the elements. Concentrations observed during the successive glacial maxima suggest a decreasing trend from the most recent glacial maxima (MIS 2.2 and 4.2) to the oldest glacial maxima such as MIS 14.2, 14.4 and 16.2, which could be linked with changes in the size distribution of dust particles transported from mid-latitude areas to the East Antarctic ice cap.

Cu, Zn, As, Cd, Ph and Bi were determined by Inductively Coupled Plasma Sector Field Mass Spectrometry (ICP-SFMS) in seventy-seven sections of the 3270 m deep ice core drilled at Dome C at an altitude of 3233 m on the East Antarctic plateau as part of the European Program for Ice Coring in Antarctica (EPICA). The depth of the section ranged from 2368.85 m (263.6 kyr BP) to 3062.13 m (672.0 kyr BP). When combined with data previously obtained for the upper part of the core, it gives a detailed record of past natural variations in the concentrations of these heavy metals during the last eight climatic cycles from the Holocene back to Marine Isotopic Stage (MIS) 16.2. Concentrations of all metals are found to have strongly varied. For Cu, Pb, Bi and possibly Zn concentrations appear to be closely linked with climate conditions, with high values during glacial maxima and much lower values during interglacials. The situation is less clear for As and Cd, for which variations are less clearly linked with climate conditions. Rock and soil dust appears to be the main source of Cu, Zn, Bi and Pb during glacial maxima, and a significant source for these metals during interglacials while, As, Cd and Bi present a more complex inputs from several sources, with a particularly significant impact of volcanism. (c) 2008 Published by Elsevier B.V.

To improve quantitative interpretation of ice core aeolian dust records, a systematic methodological comparison was made. This involved methods for water-insoluble particle counting (Coulter Counter and laser-sensing particle detector), soluble ion analysis (ion chromatography, and continuous flow analysis), elemental analysis (inductively coupled plasma mass spectroscopy at pH 1 and after full acid digestion), and water-insoluble elemental analysis (proton induced X-ray emission). Antarctic ice core samples covering the last deglaciation from the EPICA Dome C (EDC) and the EPICA Dronning Maud Land (EDML) cores were used. All methods correlate very well amongst each other, but the ratios of glacial age to Holocene concentrations, which are typically a factor ~100, differ between the methods by up to a factor of 2 with insoluble particles showing the largest variability. The recovery of ICP-MS measurements depends on the digestion method and is different for different elements and during different climatic periods. EDC and EDML samples have similar dust composition, which suggests a common dust source or a common mixture of sources for the two sites. The analysed samples further reveal a change of dust composition during the last deglaciation.

It and Pt are siderophile elements that are considered proxies of meteoric material of cosmic origin entrapped within polar ice layers. However, volcanic and anthropogenic fallouts have the potential to perturb their characteristic extraterrestrial signature even in remote polar areas. Here we show a record of Ir and Pt concentrations in snow samples collected from a 2.7 m pit, which was dug at Summit (Central Greenland), and covered five years from winter 1991 to summer 1995. A well-defined peak of Pt, and a spike of Ir, were found at the base of the snow pit record. These maxima occur in close concurrence with large concentration peaks in Al, Ag, Cd and Hg. Dating of the snow layers together with some geochemical evidence suggests that these peaks originated from the fallout to Greenland of volcanic ash emitted by the nearby Hekla volcano (Iceland), during the eruption of January-March 1991. Interestingly, an anomalous peak of methane sulfonic acid (MSA) in Greenland snow also corresponds to the Hekla ash fallout. This might point to an early biomass production in the North Atlantic Ocean during the first half of 1991, which was possibly stimulated by the fertilizing action of the Hekla ash fallout to seawater. During the following years (1992-1995) the global atmosphere was under the influence of the large perturbation produced by the eruption of Mt. Pinatubo (Philippines) in June 1991. Relatively high Ir and Pt concentrations with super-chondritic ratios are recorded especially during summer 1993. We discuss if this can be interpreted as the possible stratospheric input of Pinatubo's aerosol or fallout of extraterrestrial origin. During the same period the snow pit record was also influenced by the advection of air masses enriched in Pt with respect to In One possibility is that this additional Pt contribution originated from widespread emissions into the troposphere produced by vehicles equipped with catalytic converters. In any case, Pt concentration levels found in recent Greenland snow are about two orders of magnitude lower than previously thought, pointing to a much lower anthropogenic contamination of the Arctic regions from Pt. This challenges the concept of an important hemispheric contamination of Pt from vehicles equipped with catalytic converters. Published by Elsevier B.V

Pb and Ba concentrations and Pb isotopic compositions are reported for firn core and snow pit samples from Victoria Land, Antarctica, dating from 1872 AD to 1994 AD. From variations in Pb/Ba ratios and Pb isotopic compositions, two periods of major Pb enhancements were identified, from 1891 to 1908 AD and from 1948 to 1994 AD. The earlier pollution event is attributed to Pb emissions from non-ferrous metal production and coal combustion in the Southern Hemisphere and is in excellent agreement with coincident pollution inputs reported in firn/ice cores from two other regions of Antarctica, at Coats Land and Law Dome. Using Pb isotopic systematics, it was calculated that ~50% of Pb deposited in Victoria Land in 1897 originated from anthropogenic emission sources. The more recent period of Pb enhancements, from 1948 to 1994 AD, corresponds to the introduction and widespread use of gasoline alkyl Pb additives in automobiles in the Southern Hemisphere, with anthropogenic Pb inputs averaging 60% of total Pb but with large uncertainty. Intra- and inter-annual variations in Pb concentrations and isotopic compositions were evaluated in snow pits samples corresponding to the period 1991–1994. Substantial variations in Pb/ Ba and 206Pb/207Pb ratios were detected but the absence of a regular seasonal pattern for these parameters suggests that the transport and deposition of aerosols to the Antarctic ice sheet are complex and vary from year to year.

Nitrogen isoelectronic impurities in GaAs1-yNy are fully passivated by H irradiation from N dilute to the alloy limit. Photoluminescence measurements show that (i) for y = 0.01, the GaAs1-yNy band gap blueshifts toward that of the N-free material with increasing H dose. Thermal annealings restore the optical properties GaAs1-yNy had before hydrogenation. Finally, theoretical results on H equilibrium positions are reported and a mechanism for N passivation by H is given.

As it is well-known, during secondary syphilis, it is possible to observe a systemic involvement of the treponemal infection. The visceral localizations are rarely observed, and they usually present themselves as asymptomatic or with aspecific symptoms. This report concerns a case of a homosexual patient who referred to us in order to perform blood tests for the main sexually transmitted diseases (HIV, HBV, HCV, TPEIA). Moreover, he reported a history of palmo-plantar erythematous desquamative lesions, spontaneously resolved. For this reason all the serological tests for syphilis have then been performed. Once the diagnosis of recent syphilis was made, and the antibiotic therapy with penicillin begun, the patient reported to have fever, abdominal pain and diarrhoea. The gastroenterological consultation highlighted the presence of a chronic active granulomatous colitis, but excluded an inflammatory or autoimmune aetiology. Because of this findings, and also because of additional histopathological examinations of the colon, the diagnosis of recent syphilis with intestinal involvement was made. The present case report confirms, once again, how the nickname ''great imitator'' is appropriate for calling syphilis. It highlights moreover that, as the incidence of syphilis is arising, in the presence of intestinal symptoms of unknown origin in patients with a history of unprotected sexual intercourse, syphilis should always be comprised among the possible diagnoses.

Although far less common now than in the past, syphilis continues to pose a danger to public health and should not be overlooked. In this study, we evaluated the presence and characteristics of syphilis in a group of patients attending an STI Clinic in the North of Italy. A retrospective study was carried out, analysing the data from the 5609 subjects who attended the STI Clinic of St. Orsola-Malpighi Hospital (Bologna) for syphilis screening from January 2016 to December 2017. Globally, 692 patients (12.3%) were found positive for treponemal tests, with a significant difference between males and females (16.6% vs 4.1%; P

Ureaplasma urealyticum (UU), Ureaplasma parvum (UP), Mycoplasma hominis (MH) and Mycoplasma genitalium (MG) are the most common Mollicutes of the female genital tract. Although many studies have addressed their possible role in the vaginal ecosystem, many aspects remain to be elucidated. The aim of this study was to evaluate the vaginal presence of ureaplasmas/mycoplasmas in women with different clinical conditions. By means of quantitative PCR assays, the prevalence and load of each Mollicute were assessed in different groups of pre-menopausal women: 'healthy' (n=29), women with bacterial vaginosis (BV) (n=21), patients with Chlamydia trachomatis (CT) infection (n=25) and subjects with vulvo-vaginal candidiasis (VVC) (n=23). Globally, UP was the most prevalent Mollicutes in the vagina (67.3%), followed by MH (14.3%), UU (9.2%) and MG (3.1%). The presence of UU and UP was almost never associated. MH showed a significantly higher prevalence and higher bacterial loads in BV-positive women (P

Neisseria gonorrhoeae is one of the most prevalent sexually transmitted pathogen with the vast majority of reported cases diagnosed at urogenital sites. While urethral gonococcal infections in men usually present with penile discharge and dysuria, pharynx and rectal infections are often asymptomatic. The Centers for Disease Control and Prevention recommend that sexually active men who have sex with men (MSM) be screened at least annually for urethral, pharyngeal and rectal gonorrhea, considering sexual exposure history, and every 3 to 6 months if higher-risk behaviours are reported. However, despite CDC's guidelines screening recommendations, low rates of testing among MSM are reported, such as urethral-only screening which may entail missing pharyngeal and rectal gonococcal infection. We present a case report of gonorrhea with multiple anatomic sites infection in a young MSM. Inspite of clinical presentation involving urogenital symptoms only, a sexual history based valutation allowed to detect asymptomatic pharyngeal and rectal infections.

Aim. Pilomatrixomas are slow-growing benign, deep dermal or subcutaneous tumours deriving from hair matrix cells. The ultrasonographic findings have recently been defined and correlated with the histopathology of the pilomatrixoma. Some authors have reported the sonographic diagnosis of pilomatrixoma as a useful, non invasive test with an elevated diagnostic accuracy. Methods. A retrospective study was carried out on 30 cutaneous nodules, clinically diagnosed as pilomatrixomas, observed in 26 children, during a 3-year period, at the Unit of Paediatric Dermatology. The aim of the study was to evaluate the accuracy of ultrasound examination both in the diagnosis and in the follow-up of pilomatrixomas. All the lesions were submitted to one or more ultrasound scans at the Unit of Radiology of the University Hospital ''S. Orsola-Malpighi'' in Bologna. Results. Of the 30 clinically suspected pilomatrixomas, ultrasound examination supported the clinical diagnosis in 29 instances (96.6%). Surgical excision and histopathological analysis was necessary only in one patient. The other patients were monitored for 1 year with clinical examinations and sonographies, thus avoiding the need for surgical asportation in 90.9% of cases. Conclusion. In conclusion we observed that ultrasound not only represents a procedure useful for the diagnosis of pilomatrixoma, but is also a valid aid in following up the course of the lesion, without surgical intervention.

ObjectivesLymphogranuloma venereum (LGV) is an STI caused by Chlamydia trachomatis serovars L1-L3. In Europe, the current epidemic is caused mainly by L2b genovariant, although increasing cases associated with other L2 variants have been reported. Here, we assessed the distribution of rectal LGV genovariants among men having sex with men (MSM) in Italy.MethodsFrom 2016 to 2020, all the anorectal swabs collected from MSM attending the STI Clinic of St. Orsola-Malpighi Hospital in Bologna and positive for C. trachomatis were stored. LGV infection was confirmed by a pmpH PCR, and, subsequently, a fragment of the ompA gene was amplified and sequenced. Sequences were aligned to reference strains representing different LGV variants.ResultsLGV cases accounted for one-third of all chlamydial rectal infections with a total prevalence of 4.1% (76/1852). Total number of LGV cases per year remained constant. LGV was mainly found in symptomatic patients (>65%), older than 30 years, with a high burden of other STIs (63.7% HIV-positive, 35.5% with concurrent rectal gonorrhoea, 19.7% with early syphilis). A decreasing trend in HIV-LGV co-infection was noticed over time. Three main LGV genovariants were detected (L2f, 46.1%; L2b, 23.0%; L2-L2b/D-Da, 16.9%), together with other known L2b variants (mainly L2bV2 and L2bV4). Two novel L2b ompA variants with non-synonymous single-nucleotide polymorphisms were found. Over time, the percentage of L2f cases dropped gradually, with a significant increase in L2-L2b/D-Da cases (p=0.04).ConclusionsIn our area, LGV is endemic among MSM with different circulating genovariants. Active surveillance and genotyping programmes are needed to reduce re-establishing of LGV infection.

The oropharynx represents a crucial site for the emergence of multi-drug resistance in Neisseria gonorrhoeae. The mosaic penA alleles, associated with decreased susceptibility to cephalosporins, have emerged by DNA recombination with partial penA genes, particularly those from commensal pharyngeal Neisseria species. Here, we investigated the prevalence of the mosaic structure of the penA gene in the oropharynx of men who have sex with men testing negative for pharyngeal gonorrhoea. From January 2016 to June 2018, 351 gonorrhoea-negative men who have sex with men attending a sexually transmitted infection clinic in Italy were enrolled. Pharyngeal swabs underwent a real-time polymerase chain reaction (PCR) for the detection of the mosaic penA gene. In case of positivity, PCR products were sequenced and searched against several sequences of Neisseria strains. Overall, 31 patients (8.8%) were found positive for the presence of the mosaic penA gene. The positivity was significantly associated with previous cases of pharyngeal gonorrhoea (relative risk [RR]: 3.56, 95% confidence interval 1.44–8.80) and with recent exposure to beta-lactams (RR: 4.29, 95% confidence interval 2.20–8.38). All penA-positive samples showed a high relatedness (90–99%) with mosaic-positive Neisseria strains. Our data underline that commensal Neisseria species of the oropharynx may be a significant reservoir for genetic material conferring antimicrobial resistance in N. gonorrhoeae.

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Background COVID-19 is associated with a wide range of skin manifestations. Objective To describe the clinical characteristics of COVID-19-associated skin manifestations, and explore the relationships between the six main cutaneous phenotypes and systemic findings. Methods Twenty-one Italian Dermatology Units were asked to collect the demographic, clinical and histopathological data of 200 patients with COVID-19-associated skin manifestations. The severity of COVID-19 was classified as asymptomatic, mild, moderate, or severe. Results A chilblain-like acral pattern significantly associated with a younger age (p, There are six main COVID-19-related cutaneous phenotypes, but only the chilblain-like acral pattern significantly associated with younger age. After adjusting for patient age, there was no spectrum of COVID-19 severity in relation to cutaneous phenotypes, although the longer-lasting chilblain-like acral pattern significantly associated with milder disease.

Global public health is currently dealing with the explosive spread of the novel Coronavirus disease 2019 (COVID‐19) [1].This new type of viral pneumonia, spread from its first focus in Wuhan (Hubei, China) to across all the world, until a pandemic condition was declared.Clinically. the most common symptoms of the disease are cough and fever. More than 80% of patients have asymptomatic to moderate disease, but about 15% get severe pneumonia and 5% develope a multi‐organ failure [2].

Background.Chlamydia trachomatis (CT) is the agent of the most common bacterial sexually transmitted infection worldwide, with a significant impact on women’s health. Despite the increasing number of studies about the vaginal microbiome in women with CT infections, information about the composition of the anal microbiome is still lacking. Here, we assessed the bacterial community profiles of vaginal and anal ecosystems associated or not with CT infection in a cohort of Caucasian young women. Methods. A total of 26 women, including 10 with a contemporary vaginal and ano-rectal CT infection, were enrolled. Composition of vaginal and anal microbiome was studied by 16S rRNA gene profiling. Co-occurrence networks of bacterial communities and metagenome metabolic functions were determined. Results. In case of CT infection, both vaginal and anal environments were characterized by a degree of dysbiosis. Indeed, the vaginal microbiome of CT-positive women were depleted in lactobacilli, with a significant increase in dysbiosis-associated bacteria (e.g., Sneathia, Parvimonas, Megasphaera), whereas the anal microbiota of CT-infected women was characterized by higher levels of Parvimonas and Pseudomonas and lower levels of Escherichia. Interestingly, the microbiome of anus and vagina had numerous bacterial taxa in common, reflecting a significant microbial ‘sharing’ between the two sites. In the vaginal environment, CT positively correlated with Ezakiella spp. while Gardnerella vaginalis co-occurred with several dysbiosis-related microbes, regardless of CT vaginal infection. The vaginal microbiome of CT-positive females exhibited a higher involvement of chorismate and aromatic amino acid biosynthesis, as well as an increase in mixed acid fermentation. Conclusions. These data could be useful to set up new diagnostic/prognostic tools, offering new perspectives for the control of chlamydial infections.

In this study we assessed the prevalence and predictors of pharyngeal infections due to Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in a cohort of patients attending an STI Clinic. From January 2016 to September 2018, 893 patients attending the STI Clinic of St Orsola-Malpighi Hospital (Bologna, Italy) and reporting unprotected oral sex were enrolled. A pharyngeal swab for the molecular detection of CT and NG was collected from each patient. Positive CT samples were further genotyped by an omp1 gene PCR. A total of 134 cases of gonorrhea (15%) and 34 chlamydial infections (3.8%) were detected in the pharyngeal site, with no significant differences between males (all men who have sex with men [MSM]) and females. More than 90% of the infections were completely asymptomatic, suggesting that symptoms were not predictors of a pharyngeal infection ( P = 0.7). On the contrary, a history of sexual contacts with a partner positive for CT and/or NG ( P

Pharyngeal gonorrhoea is a common sexually transmitted infection among 'men having sex with other men' (MSM). Neisseria gonorrhoeae (NG) pharyngeal infections are usually characterized by the absence of symptoms, acting as an important reservoir for their further spread. To the best of our knowledge, no information about the composition of the pharyngeal microbiome during an ongoing NG infection is currently available. Therefore, in this study, we characterized the pharyngeal bacterial community profiles associated with NG infection in a well-selected cohort of HIV-negative MSM reporting unsafe oral intercourse. A total of 70 pharyngeal swabs were considered, comparing non-infected subjects (n = 45) versus patients with pharyngeal gonorrhoea (n = 25) whose microbiota composition was analyzed from pharyngeal swabs through sequencing of hypervariable V3-V4 regions of the 16S rRNA gene. The pharyngeal microbiome of all subjects was dominated by Prevotellaceae, Veillonellaceae and Streptococcaceae families. Patients with pharyngeal gonorrhoea harboured a pharyngeal microbiome quite similar to negative subjects. Nevertheless, when looking to less-represented bacterial species (relative abundance approximately 1% or less), an imbalance between aerobe and anaerobe microorganisms was observed in NG-infected patients. In particular, the pharyngeal microbiome of NG-positive individuals was richer in several anaerobes (e.g. Treponema, Parvimonas, Peptococcus, Catonella, Filifactor) and poorer in various aerobe genera (i.e. Pseudomonas, Escherichia), compared to non-infected controls. No significant differences were noticed in the distribution of commensal Neisseria species of the oropharynx between NG-positive and negative subjects. Metabolic variations induced by changes in the microbiome abundance were assessed by a functional prediction of the bacterial metabolic pathways: a more abundant involvement of D-glutamine and D-glutamate metabolism, carbohydrate metabolism, as well as a greater activation of the energy metabolism was observed in patients with pharyngeal gonorrhoea compared to non-infected individuals. Information about the bacterial composition of the pharyngeal microbiome in case of gonorrhoea could shed light on the pathogenesis of the infection and open new perspectives for the prevention and control of this condition.

We report the first case of reactive arthritis associated with lymphogranuloma venereum (LGV) in an Italian human immunodeficiency virus-negative woman with urogenital and rectal Chlamydia trachomatis L2 serovar infection. The LGV-associated arthritis has to be considered even when classic symptoms of arthritis are missing and in case of asymptomatic or cryptic LGV localizations.

We report here a new case of neutrophilic figurate erythema of infancy in a 1-year and 9-month-old white boy. Neutrophilic figurate erythema of infancy is a rare inflammatory dermatosis which is part of the figurate inflammatory dermatoses of infancy and is considered a variant of annular erythema of infancy. The disease is clinically characterized by annular erythematous lesions, sometimes with a polycyclic configuration, and histologically by a dermal neutrophilic infiltration with leukocytoclasia. Differential diagnosis mainly includes clear-cut severe diseases with a well-known etiology, such as neonatal lupus erythematosus and its variant erythema gyratum atrophicans transiens neonatale, erythema chronicum migrans and erythema marginatum rheumaticum, and diseases of unknown origin and with less clear limits, such as erythema annulare centrifugum and its variant familial annular erythema. Anamnesis, laboratory findings, clinical features, and histology allow the correct diagnosis and therefore, having excluded severe diseases, parents should be reassured as neutrophilic figurate erythema of infancy, as the annular erythema of infancy, is a benign disease, in most cases unassociated with other conditions and usually self-limiting over a few months, even though a chronic course may rarely occur. Our case was characterized by a chronic persistent course and by a complete resolution of the lesions only during febrile episodes.

Background: Syphilitic alopecia (SA) is mainly described in single case reports, and there are only a few epidemiological studies. Objective: To investigate the clinical and dermoscopic features of SA in patients with secondary syphilis and to record its actual prevalence. Methods: All patients with a diagnosis of secondary syphilis were clinically and trichoscopically evaluated in search of hair and scalp alterations. Results: Five of 12 patients (41.6%) diagnosed with secondary syphilis had SA. The ‘moth-eaten' pattern was detected in 4 patients (80% of cases): 1 had ‘essential' SA, whereas 3 patients had ‘symptomatic' SA. The ‘diffuse' SA pattern was found in 1 patient. Trichoscopy of the ‘moth-eaten' areas showed that alopecia is mainly due to a reduction in the number of terminal hairs. One patient with secondary syphilis showed trichodynia that regressed completely after antibiotic therapy. Limitations: The small number of patients included and the fact that none of our patients accepted to be biopsied in an affected area. Conclusion: Since SA appears to be present much more frequently than reported in the literature, when secondary syphilis is suspected, the patient should be examined for the presence of signs compatible with SA and the scalp should be examined by dermoscopy.