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Background: Melanotic neuroectodermal tumor of infancy (MNTI) is a rare clinically benign, pigmented, tumor of neural crest origin which commonly occurs in the maxilla. It is a rare tumor that may pose difficulty in differentiating from other malignant round cell tumors., Case Presentation: A 5-month-old Ethiopian infant presented with a mass on his forehead. A wide excision of the lesion was done and subjected to histopathologic evaluation. The histologic and immunohistochemistry for synaptophysin studies confirmed that the infant was having MNTI. The patient was followed and there was no sign of recurrence at the 6th and 9th months of follow-up., Conclusion: MNTI should be considered as a differential diagnosis for tumors occurring in the head region in infants and prolonged follow-up may be needed to check for possible recurrence of the tumor., (© 2024. The Author(s).)

Background: Epidermal nevus sebaceous, commonly known as the nevus sebaceous of Jadassohn, is a congenital sebaceous hamartoma. It typically manifests as a single yellowish plaque across the head and neck and is composed of sebaceous glands. It commonly occurs during infancy and grows during puberty. Usually, it follows a benign course; however, in a few cases, it can be malignant. This is the case of a 13-year-old child with verrucous plaques on the temple and scalp., Case Report: We report the case of a 13-year-old boy with a steadily developing hyperpigmented verrucous plaque on the scalp and ipsilateral side of his face. A dermoscopic examination revealed ridges and fissures in a cerebriform pattern with yellowish-gray globules and a papillary appearance. Physical examination and laboratory tests revealed no abnormalities. Biopsies were taken from the scalp and temple area, and the findings were consistent with the diagnosis of nevus sebaceous. The patient was referred to a plastic surgeon for a staged excision., Conclusions: We describe a unique example of a sebaceous nevus that affected the scalp and ipsilateral side of the face. As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs. This example of multiple verrucous plaques is an exception., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Rusia K et al.)

Competing Interests: Conflicts of interest Disclosures including pharmaceutical and device product(s): Murad Alam has no financial interests to declare in relation to the content of this article, and has not received payment or stock from Bonti, AbbVie, or any related organization. Domenico Vitarella, at the time of study conduct, was an employee of Bonti Inc and held Bonti stock prior to its acquisition by Allergan, an AbbVie Company. Wajdie Ahmad, at the time of study conduct, was a cofounder and chief operating officer of Bonti Inc and held Bonti stock prior to its acquisition by Allergan, an AbbVie Company. Susan Abushakra, at the time of study conduct, was a cofounder and chief medical officer of Bonti Inc, was co-inventor on several BoNT/E (EB-001) patents, and held Bonti stock prior to its acquisition by Allergan, an AbbVie Company. Cheri Mao is a former employee of AbbVie. Mitchell F. Brin is an employee of, and owns stock/stock options in, AbbVie. This product (BoNT/E; EB-001) is not labeled for the use under discussion.

Background: Frontal fibrosing alopecia (FFA) is a cicatricial alopecia affecting the frontotemporal hairline. Given that this scarring, immune-mediated follicular destruction most commonly affects postmenopausal Caucasian women, researchers have postulated that there are hormonal and genetic components; however, the etiology of FFA is still unknown. Recently, dermatologists have reported cases of FFA as being potentially caused by cosmetic products, such as sunscreen and shampoo. Therefore, this systematic review and meta-analysis intend to be the first to analyze the relationship between FFA and cosmetic/personal care products and treatments, including sunscreen, moisturizer, foundation, shampoo, conditioner, hair mousse, hair gel, hair dye, hair straightening/rebonding, chemical/laser facial resurfacing, aftershave, and facial cleanser., Methods: The Cochrane, PubMed, EMBASE, and Medline (Ovid) databases were searched for the relevant studies from the date of inception to August 2022. Case-control, cross-sectional, and cohort studies examining the effects of cosmetic/personal care product use on FFA, available in English full-text, were included. Analyses were performed using Review Manager, version 5.4. Results were reported as an odds ratio (OR) with a 95% confidence interval (CI); p values < 0.05 were considered significant., Results: Nine studies were included in our quantitative analyses, totaling 1,248 FFA patients and 1,459 controls. There were significant positive associations found for FFA and sunscreen (OR 3.02, 95% CI 1.67-5.47; p = 0.0003) and facial moisturizer (OR 2.20, 95% CI 1.51-3.20; p < 0.0001) use. Gender sub-analyses demonstrated a positive association for FFA and facial moisturizer in men (OR 5.07, 95% CI 1.40-18.32; p = 0.01), but not in women (OR 1.58, 95% CI 0.83-2.98; p = 0.16). Both gender sub-analyses were significantly positive for the association with facial sunscreen (Male OR 4.61, 95% CI 1.54-13.78, p = 0.006; Female OR 2.74, 95% CI 1.32-5.70, p = 0.007). There was no association found for a facial cleanser (OR 1.14, 95% CI 0.33-1.52; p = 0.51), foundation (OR 1.13, 95% CI 0.83-1.55; p = 0.21), shampoo (OR 0.49, 95% CI 0.22-1.10; p = 0.08), hair conditioner (OR 0.81, 95% CI 0.52-1.26; p = 0.35), hair mousse (OR 1.37, 95% CI 0.75-2.51; p = 0.31), and hair gel (OR 0.90, 95% CI 0.48-1.69; p = 0.74), hair dye (OR 1.07, 95% CI 0.69-1.64; p = 0.77), hair straightening/rebonding (OR 0.88, 95% CI 0.08-9.32; p = 0.92), hair perming (OR 1.41, 95% CI 0.89-2.23; p = 0.14), facial toner (OR 0.51, 95% CI 0.12-2.21; p = 0.37), or aftershave (OR 1.64, 95% CI 0.28-9.49; p = 0.58)., Conclusions: This meta-analysis strongly suggests that leave-on facial products, facial sunscreen and moisturizer, are associated with FFA. While the association with facial moisturizer did not persist when stratifying for female populations, gender sub-analyses remained significant for a facial sunscreen. There was no significant relationship found with hair products or treatments. These findings suggest a potential environmental etiology in the development of FFA, particularly UV-protecting chemicals., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest.

Heterotopic ossification (HO) refers to the mature lamellar bone structure that develops locally in soft-tissue sites. Heterotopic ossification is known to occur mainly in the traumatic area or the muscle and joint capsule after surgery such as total hip arthroplasty or total knee arthroplasty. The pathophysiological cause of HO is not precisely known, but it seems to be related to some genetic predisposition. Craniomaxillofacial HO is rare and, in several reported cases, is primarily related to previous surgeries involving the masticatory muscles. The authors report on a patient who underwent endoscopic removal of a bone mass in the forehead. He completely denied any history of forehead trauma or surgery. There were no scars, trauma, or surgical marks found on the patient's forehead. Preoperative magnetic resonance imaging showed that the mass was granuloma, but histological examination after surgical removal confirmed it as HO., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

Protein profiling offers an effective approach to characterizing how far epidermis departs from normal in disease states. The present pilot investigation tested the hypothesis that protein expression in epidermal corneocytes is perturbed in the forehead of subjects exhibiting frontal fibrosing alopecia. To this end, samples were collected by tape stripping from subjects diagnosed with this condition and compared to those from asymptomatic control subjects and from those exhibiting androgenetic alopecia. Unlike the latter, which exhibited only 3 proteins significantly different from controls in expression level, forehead samples from frontal fibrosing alopecia subjects displayed 72 proteins significantly different from controls, nearly two-thirds having lower expression. The results demonstrate frontal fibrosing alopecia exhibits altered corneocyte protein expression in epidermis beyond the scalp, indicative of a systemic condition. They also provide a basis for quantitative measures of departure from normal by assaying forehead epidermis, useful in monitoring response to treatment while avoiding invasive biopsy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Karim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests

Competing Interests: Conflicts of interest The authors declare no conflicts of interest.

Background: Wrinkles appear with aging, producing an aged impression, but the mechanism of wrinkle formation has not yet been fully elucidated. We recently reported that subcutaneous fat infiltrates into the dermal layer with aging and impairs skin elasticity, but the contribution of this process to wrinkle formation is still unclear., Purpose: We aimed to clarify the contribution of dermal fat infiltration to wrinkle formation by analyzing the relationship between them in the forehead of female volunteers., Methods: We measured the severity of fat infiltration in the forehead of 29 middle-aged female volunteers by means of ultrasonography. Fixed wrinkles present when the eyes were closed and wrinkles transiently formed when the eyes were open were evaluated using a photograph-based 6-grade evaluation system for each type of wrinkle., Results: Fat infiltration at the forehead area was observed similarly to that in the cheek area as we reported previously. We found that opening the eyes induced the formation of stable transient wrinkles, the grade of which was significantly related to fat infiltration severity. Furthermore, fat infiltration was also significantly related to the severity of fixed wrinkles. Moreover, the severity of transient wrinkles was significantly related to that of fixed wrinkles., Conclusions: Our results suggest that fat infiltration into the dermal layer enhances transient wrinkle formation during facial expression by impairing the ability of the skin to resist deformation, thereby promoting fixed wrinkle formation. Therefore, fat infiltration is a critical cause of wrinkle formation., (© 2023 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.)

Background: Dermatofibromas are common skin tumors that typically occur on the extremities and trunk and demonstrate benign behavior, frequent recurrences, and very rare metastasis. Facial dermatofibromas are rare and not well studied . We analyzed clinicopathologic features of facial dermatofibromas., Design: Considering the rarity of the condition, we conducted a cohort study and a systematic review. We queried medical records of a single tertiary care center for dermatofibromas from January 1, 2000, to July 1, 2021. A systematic review of multiple databases was conducted through October 27, 2021, to include studies reporting facial dermatofibromas. Random-effects meta-analysis was used to estimate pooled odds ratio and proportions with associated 95% confidence interval (CI)., Results: The cohort study identified 2858 cases of dermatofibromas, of which, 23 cases from 18 patients were on the face (1%). The mean age was 52.7 ± 17.8 years. Fifty-six percent of the cases were women. The most common location was the forehead (6 cases). The mean follow-up was 54 months. Forty-four percent of the cases had subcutaneous involvement, and 39% were the cellular type. Margins were positive in 89% of the cases, recurrence rate was 22%, and no metastases were observed. The systematic review included 10 studies (119 patients). Meta-analyses showed that facial dermatofibromas were 2% of all dermatofibromas (95% CI: 1%-3%). The local recurrence rate was 14% (95% CI: 6%-26%). Facial dermatofibromas with subcutaneous involvement were more likely to recur [odds ratio 4.53 (95% CI: 1.12-18.24)]. Before histopathologic examination, clinical differential diagnosis included dermatofibromas in only 9% of the cases (95% CI: 2%-19%)., Conclusion: Facial dermatofibromas are rare and are difficult to fully excise. Cellular type and subcutaneous or muscular involvement are common in these cases and tend to have higher local recurrence rate than other nonfacial dermatofibromas. Wider excisions might be necessary for complete excision., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center., Methods: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP)., Results: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates., Conclusions: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.

Background: The study was designed with the purpose of showing the potential advantages of the VITOM-3D assisted paramedian forehead flap for nasal reconstruction., Methods: A 72 years-old female patient presented to our department with a wide left nasal defect. On her clinical history she referred a basal cell carcinoma of the left nasal skin treated with multiple excision in another center without reconstruction. On clinical examination, we observed the absence of the left nasal tip, columella, upper lateral and lower lateral cartilage. In our experience the paramedian forehead flap based on supratrochlear artery is a feasible reconstruction (Shokri, T., et al). The first surgeon (Dr. Placentino) along with the head and neck team decided to reconstruct the nasal defect assisted by the 3D 4 K exoscope (VITOM®; Karl Storz, Tuttlingen, Germany)., Results: The goal of reconstruction is to carefully evaluate the nasal defects and rebuild the nose as close as possible to its original shape with the multilayer technique, creating the internal lining, the intermediate bony-cartilage structure and external skin. (Kim, I.A., et al). The exoscope allowed us to reconstruct the inner layer with the mucoperiostal septal flap, middle layer with auricular cartilage and the external skin through the elevation of the paramedian forehead flap. The flap is elevated from cranio-caudal direction including skin, subcutaneous tissue, frontalis muscle and associated fascia or periosteum. Donor site was primarily closed with the exception of a small defect. Post-operative period was uneventful, and after a period of 4 weeks when vascularization was complete, the patient underwent pedicle excision. At the recent 6 months follow-up, the flap had healed completely with the shape of nose restored with good symmetry., Conclusion: High-definition (4 K), three-dimensional (3D) exoscope are being used to perform a growing number of head and neck surgeries (Bartkowiak, E., et al). However, the use of the 3D exoscope in the nasal reconstruction has not been previously described. In our opinion the potential advantages of this technique are, firstly, to achieve a better magnification and to improve the vision of anatomical structure that leads to a better functional and aesthetic result, secondly, to reduce surgical times. High-definition allowed us to highlight the scar tissue and preserve as much healthy tissue as possible. In addition, we underline the use of the exoscope for a better remodeling of cartilage., (Copyright © 2022 Elsevier Inc. All rights reserved.)

A 72-year-old man with a history of squamous cell carcinoma presented to the Portland VA with forehead discoloration. He was initially diagnosed with actinic damage and prescribed topical treatment. However, he returned to clinic months later with a large, violaceous forehead plaque. Upon biopsy, he was diagnosed with blastic plasmacytoid dendritic cell neoplasm (BPDCN), a rare hematological malignancy. This case report illustrates the importance of keeping BPDCN in the differential diagnosis for ecchymotic plaques that fail to respond to first line therapy.

Despite a significant increase in reported cases of frontal fibrosing alopecia (FFA) in literature, discussion about the possible role of environmental factors, instruction for diagnosis and guideline for treatment, are limited. The review aims to provide a detailed synthesis of this condition that could be used by clinicians in their practise. Whether single-centre or multi-centre, studies of more than 60 cases less than 5 years old were mainly taken into consideration. Results obtained were that FFA affects mainly postmenopausal Caucasian women; the most common comorbidities are hyperlipidaemia, arterial hypertension, osteoporosis, hypothyroidism, depression, alongside dermatological disorders such as atopic dermatitis, rosacea, seborrheic dermatitis and androgenetic alopecia. Autoimmune, genetic, hormonal (e.g. estrogen deficiency, pregnancy, lactation, HRT and raloxifene) and environmental (e.g. daily use of facial sunscreens and less frequent use of hair dyes and shampoo) hypotheses were proposed for pathogenesis, as well as association with various predisposing factors (patient's health-social profile, disease's history and comorbidities). Clinical presentation of FFA can be divided into 3 specific patterns, each with a different prognosis. Diagnosis is usually made clinically with the use of trichoscopy; however, scalp biopsy remains the gold standard. The condition is regarded as a variant of lichen planopilaris (LPP) due to the similarity of the prominent histopathological findings, but the clinical image is distinct and therapeutic options vary. 5α-reductase inhibitors, intralesional steroids, and hydroxychloroquine provide the highest level of evidence for the treatment of FFA. The conclusion is that a better understanding of the disease is crucial for proper disease management.

En coup de sabre is an unusual variant of localized scleroderma characterized by its distinct location involving the frontoparietal region of the forehead and scalp. The authors describe a rare case of en coup de sabre in a 3-year-old boy whose disease onset was at 12 months of age. This article presents the clinical manifestations of continuous changes in the lesion photographed over time. The clinical presentation, laboratory results, and radiological findings together with a brief discussion of the management of the disease are discussed.

Squamous cell carcinomas with widespread invasion of the skull, meninges and brain parenchyma are extremely rare. Herein, we present an 86-year-old man with an 18-year history of sunburn who developed a large osteodestructive SCC that invaded through the frontal bone, frontal sinuses, and the dura mater. No neurological signs or symptoms or distant metastasis were noted. Such cases arise through patient neglect or lack of access to care and pose many challenges as lack of symptoms tend to deceive patients from seeking medical advice. Urgent aggressive treatment by a multidisciplinary team is paramount to achieving a successful outcome.

Abstract: Meningiomas are the most common primary central nervous system tumors. These tumors predominantly arise from the neural crest-derived meningothelial cells of the arachnoid dural layer. Intracranial meningiomas are stratified with the World Health Organization classification of tumors. Cutaneous meningiomas present rarely and have their own criteria classification (Lopez classification) of 3 types. The first type is congenital. The second consists of ectopic soft-tissue meningiomas. The third involves tumors that extended into the dermis or subcutis that include the neuroaxis. We present a case of a 56-year-old woman with 4 facial tumors that clinically seemed to be cutaneous cysts or lipomas. She reported a history of surgical resection of an intracranial meningioma on the left forehead scalp line 15 years ago. A recent surgical resection of a glabellar tumor revealed a glistening white mass. Pathologic examination revealed a poorly circumscribed mass in the deep dermis and subcutaneous area with sheets of epithelioid and plasmacytoid tumor cells with nuclear pleomorphism. Mitotic figures and necrosis were also evident. Immunohistochemistry revealed positivity for epithelial membrane antigen, p63, and ERG. The tissue had negative staining for p40, CK7, SOX10, CD68, SMA, desmin, and CD34. The patient's medical history was remarkable in that these tumors had only been growing for several months. Brain magnetic resonance imaging demonstrated widespread tumors in bilateral frontal lobes, skull, orbits, and sinuses. Considering the transcranial extensions and 15-year recurrence time, she was diagnosed with a recurrent atypical brain meningioma type II and cutaneous meningioma Lopez type III., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Advanced cutaneous squamous cell carcinoma of the head and neck (CSCCHN) is associated with poor outcome despite multimodality therapy. Comprehensive risk stratification may pinpoint the most suitable adjuvant treatment. This study aimed to evaluate the outcomes of surgically treated locoregional CSCCHN and to identify prognostic indicators of treatment outcomes., Methods: We retrospectively analyzed disease variables, pathologic characteristics, and management in association with treatment outcomes of all consecutive advanced CSCCHN patients who underwent surgical resection at Tel Aviv Sourasky Medical Center., Results: From 2008 to 2018, 74 patients met the inclusion criteria. Only perineural invasion (PNI) was significantly associated with worse overall survival (OS) ( P  = .001). Location within the facial "mask areas" was significantly associated with pathologically negative cervical disease ( P  = .001). Forty-seven patients underwent adjuvant radiation therapy (RT) which significantly improved OS and disease-free survival versus surgery alone ( P  = .025 and P  = 0.035, respectively)., Conclusion: PNI was associated with worse OS in surgically treated advanced CSCCHN. Adjuvant RT conferred better outcomes despite high risk features.

Injection of soft tissue fillers for esthetic purposes is considered a relatively simple, minimally invasive procedure. Although rare, significant complications exist and may occur in the setting of both non-medical grade and medical-grade silicone fillers, administered by untrained or trained providers . We report a case of a 61 y/o male with an unusual case of foreign body granulomas arising on his forehead and periorbital region for the past 3 years. He had no drug allergies or history of trauma. He only recalled administration of "Botox" near the affected area 20 years ago, although he acknowledged being unsure of the nature of the substance. Examination showed bilateral, periorbital, edematous plaques, with subcutaneous nodules on the forehead. Punch biopsy showed multiple vacuoles surrounded by collagen bundles in the dermis, a histiocytic infiltrate, and multinucleated giant cells. Based on clinicopathological correlation, a diagnosis of foreign body granuloma related to silicone filler injections was made. He was treated with intralesional steroids and doxycycline 100 mg twice daily with complete resolution. Physicians should acknowledge this potential complication of silicone fillers and should inquire about their use with close-ended questions. We also review the diagnostic and therapeutic challenges faced by physicians when encountering this diagnosis.

Background: Dutasteride has been proposed as an effective therapy for frontal fibrosing alopecia (FFA)., Objectives: We sought to describe the therapeutic response to dutasteride and the most effective dosage in FFA compared with other therapeutic options or no treatment., Methods: This was a retrospective observational study including patients with FFA with a minimum follow-up of 12 months. Therapeutic response was evaluated according to the stabilization of the hairline recession., Results: A total of 224 patients (222 females) with a median follow-up of 24 months (range 12-108 months) were included. The stabilization rate for the frontal, right, and left temporal regions after 12 months was 62%, 64%, and 62% in the dutasteride group (n = 148), 60%, 35%, and 35% with other systemic therapies (n = 20), and 30%, 41%, and 38% without systemic treatment (n = 56; P = .000, .006, and .006, respectively). Stabilization showed a statistically significant association with an increasing dose of dutasteride (88%, 91%, and 84% with a weekly treatment of 5 or 7 doses of 0.5 mg [n = 32], P < .005). Dutasteride was well tolerated in all patients., Limitations: Limitations included the observational and retrospective design., Conclusions: Oral dutasteride was the most effective therapy with a dose-dependent response for FFA in real clinical practice compared with other systemic therapies or no systemic treatment., (Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: PrabotulinumtoxinA-xvfs (Jeuveau), a botulinum toxin type A, was approved by the Food and Drug Administration for the temporary improvement in the appearance of moderate-to-severe glabellar lines in February 2019. This article will review phase II and III clinical trials to assess the efficacy, safety, and clinical application of this novel, aesthetic-only drug., Data Sources: A systematic literature review was performed using the terms "glabellar lines AND prabotulinumtoxinA" in the PubMed database. ClinicalTrials.gov was searched to identify nonpublished studies., Study Selection and Data Extraction: Articles written in English between November 2019 and June 2020 discussing phase II and phase III clinical trials were evaluated., Data Synthesis: By the primary efficacy end point on day 30, more patients achieved a greater than 2-point improvement on the Glabellar Line Scale (GLS) at maximum frown compared with baseline on day 0. The proportions of participants who responded to treatment with prabotulinumtoxinA were 67.5% and 70.4% versus 1.2% and 1.3% in placebo groups across 2 identical clinical trials ( P < 0.001). Patients receiving prabotulinumtoxinA experienced greater improvement in GLS at maximum frown on day 30 (87.2%) compared with onabotulinumtoxinA (82.8%) and placebo (4.2%; P < 0.001). PrabotulinumtoxinA was well tolerated across all studies., Relevance to Patient Care and Clinical Practice: This review provides a detailed analysis of the safety and efficacy of prabotulinumtoxinA-xvfs and includes special considerations to help guide patients and clinicians., Conclusion: PrabotulinumtoxinA is a safe and effective new addition to the repository of available treatments for the appearance of glabellar lines.

Lipomas are common benign tumours that can occur in most parts of the body. Lipomas arising from the deep temporal fat pad, found between the two layers of the deep temporal fascia, are rare, however; there has been only one documented case report to our knowledge. We describe a second case arising from the temporal fat pad in a patient treated at our unit, having previously reported the first one, and discuss the relevant anatomy and management.

Background: Children with forehead port-wine stains (PWSs) are at risk of Sturge-Weber syndrome (SWS). However, most will not develop neurologic manifestations., Objective: To identify children at greatest risk of SWS., Method: In this retrospective cohort study of children with a forehead PWS, PWSs were classified as "large segmental" (half or more of a contiguous area of the hemiforehead or median pattern) or "trace/small segmental" (less than half of the hemiforehead). The outcome measure was a diagnosis of SWS., Results: Ninety-six children had a forehead PWS. Fifty-one had a large segmental PWS, and 45 had a trace/small segmental PWS. All 21 children with SWS had large segmental forehead PWSs. Large segmental forehead PWSs had a higher specificity (0.71 vs 0.27, P < .0001) and a higher positive predictive value (0.41 vs 0.22, P < .0001) for SWS than any forehead involvement by a PWS., Limitations: Retrospective study at a referral center., Conclusion: Children with large segmental forehead PWSs are at highest risk of SWS., (Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Direct incision (DI) for forehead lipoma removal has a considerable risk of damaging the vertical vessels and leaving a visible scar., Objective: To evaluate the usefulness of the hairline incision (HI) in minimizing scars and neurovascular damage., Patients and Methods: Retrospective analysis was done for 30 patients with forehead lipomas who underwent excision between 2011 and 2019 at the Severance Hospital of the Yonsei University Health System, Seoul, Korea. Fourteen patients underwent DI, and 16 underwent HI. Comparison of the cosmetic outcomes, complications, and patient's subjective satisfaction was performed., Results: In the HI group, superior cosmetic outcomes, including patients' subjective satisfaction and photographic assessment findings, were observed. In the DI group, there were 2 cases of skin necrosis with scarring change and 3 cases of recurrence. Periorbital edema was the most common complication in the HI group, which spontaneously resolved within 1 week., Conclusion: Hairline incision using a loupe should be considered as a first-line treatment in the removal of forehead lipomas, because it enables complete removal of lipoma with few complications and minimal scarring. Validation of our treatment algorithm requires further exploration.

Meningioma is the most common intracranial benign tumor in adults. Hyperostosis accompanies about 4.5% of meningiomas. The authors report a rare case of hyperostotic meningioma that may have been misdiagnosed as giant osteoma.A 42-year male visited our clinic due to an egg-sized, hard mass on his left forehead. The mass suspected to be giant osteoma was about 4.2 × 4.0 cm sized, hard, non-movable, and non-tender. But based on radiologic findings, the mass was diagnosed as meningioma with extensive hyperostosis.Without neurologic symptoms, the diagnosis of meningioma associated with hyperostosis can be challenging and be misdiagnosed as fibrous dysplasia and osteoma by simple examination without enhanced CT and MRI.Therefore, although osseous lesions are strongly suspected to be osteomas, surgeons should consider other diagnoses, and if necessary, use contrast enhanced CT or MRI to differentiate these bony lesions.

Histoplasmosis is a systemic fungal infection caused by Histoplasma capsulatum, a dimorphic fungus that spreads commonly by contamination of soil with bird and bat droppings. The infection remains latent in most patients until manifested by reduced immune status, for example, HIV/AIDS, corticosteroid/immunosuppressive therapy or in solid organ transplant recipients. Tuberculosis and histoplasmosis may cooccur rarely in HIV and the clinical resemblance of both diseases may hinder identification of patients' harbouring dual infection, especially in regions non-endemic for histoplasmosis. We report a case of disseminated histoplasmosis with disseminated tuberculosis in an incidentally detected patient with HIV-positive who presented with reports of fever and skin rash for 10 days. The Mantoux positivity and CT of chest and abdomen revealing multiple necrotic lymph nodes coupled with bone marrow and skin biopsy divulging histoplasmosis and tuberculosis helped us clinch the concurrent infection., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Scleromyxedema (rare cutaneous mucinosis), is characterized by the formation of lichenoid papules and presence of Serum monoclonal IgG in most cases, or all; after repeated testing., Patient Concerns: The patient is a 51-year-old male presented with thick, disfiguring elephant-like erythematous skin folds over the forehead, papular shiny eruptions over ears and trunk and waxy erythematous papules over arms and hands without dysphagia or respiratory or neurologic symptoms DIAGNOSIS: : Skin biopsy from right arm was consistent with scleromyxedema. Serum cryoglobulin was reported negative. Complete blood count and routine blood biochemistry were normal. Thyroid function tests were normal. Serum protein electrophoresis and immunofixation showed monoclonal band of 14.5 g/L typed as IgG lambda., Interventions: Our patient was refractory to lenalidomide however improved clinically on immunoglobulins infusions on monthly basis without change in the MGUS level., Outcomes: NGF analysis revealed approximately 0.25% Lambda monotypic plasma cells in the bone marrow expressing CD38, CD138, and CD27 with aberrant expression of CD56 and were negative for CD45, CD19, CD117, and CD81. We also detected 0.002% circulating plasma cells (PCs) in peripheral blood., Conclusion: The immunophenotype of circulating tumor cells (CTCs) remain close to the malignant PCs phenotype in the BM. Hence, we report NGF approach as a novel diagnostic tool for highly sensitive MRD detection in plasma cell dyscrasias including scleromyxedema.

Background: Pathogenic mechanism that determines the localization of vitiligo patches and thus a patterned distribution in patients with nonsegmental vitiligo has remained poorly elucidated. A distributional similarity of the vitiligo patches with Blaschko's lines has been documented in patients with segmental vitiligo, both isolated segmental vitiligo and mixed vitiligo but never in cases of nonsegmental vitiligo., Methods: Distribution of nonsegmental vitiligo patches on face and neck regions was assessed and compared with Blaschko's lines and also with embryonic pigmentary segments on the face., Results: This study has documented distributional similarity of the nonsegmental vitiligo patches on face and neck with Blaschko's lines and the "embryonic pigmentary segments" among 154 (58.6%) cases. Patches around the palpebral and other fissures like periorbital, perinasal, perioral, and periaural were more common. In addition to the vitiligo patches, the spared areas were also found to respect the embryonic segmental outlines and follow the Blaschko's lines., Conclusion: Distributional pattern of the individual nonsegmental vitiligo patches along the Blaschko's lines and embryonic pigmentary segments suggests that mosaicism might control the susceptibility to the disease process in a patterned manner., Limitation: No genetic testing could be performed to confirm the hypothesis. Evaluation of nonsegmental vitiligo was done only on the face and neck areas., Competing Interests: None

Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular lesion, typically found in the skin, consisting of a papillary proliferation of endothelial cells intimately related to a thrombus; it appears to be a rare variant of an organizing process. IPEH very rarely develops in the periocular region, with fewer than 20 such cases currently reported in the English language literature. We describe one of the largest ever case series of this uncommon lesion occurring in the periocular region and discuss its clinical features, imaging characteristics, and surgical management.

Background : The forehead is one of the most frequent sites of botulinum toxin (Bont-A) application. To date, few data are available about the anatomy of the frontalis muscle. Its anatomy is highly heterogeneous in Caucasian people. Consequently, personalized treatments with botulinum toxin-A (Bont-A) are needed to obtain good esthetic results and to reduce side effects. Recently, a study on cadavers found four anatomical shapes of the frontalis muscle, corresponding to four horizontal wrinkle patterns in live patients. Objective : To perform a personalized, reproducible, and safer treatment with Bont-A of the forehead, by classifying patients according to four specific anatomical shapes of the frontalis muscle related to skin wrinkle patterns during contraction. Methods : We treated four patients classified according to the four anatomic types (I, II, III, and IV). The patients' forehead was divided into 21 areas and matched with 4 horizontal wrinkle patterns. Detecting different activities of the muscle in the different areas of the forehead, treatment injections were performed with a different dose, dilution, and at different anatomical layers (intramuscular or intradermal) per point. Conclusions : We confirmed four different wrinkle patterns after forehead contraction according to the anatomical shape of the frontalis muscle. This allows us to perform a tailored treatment with Bont-A. Nevertheless, some patients with atypical patterns still need "ad hoc" treatment.

Background: Frontal fibrosing alopecia (FFA) is a distinctive form of primary lymphocytic cicatricial alopecia and predominantly occurs in postmenopausal women. The condition is increasing in prevalence worldwide. However, there is a paucity of information regarding FFA in Asians because of a lack of published literature. We aimed to describe the demographics, clinical and trichoscopic features, and treatment outcomes of FFA in Asian patients., Methods: We conducted a retrospective clinical study including patients diagnosed with FFA. Data regarding demographics, clinical and trichoscopic findings, and treatment outcomes were collected. The data were analyzed using descriptive statistics., Results: Fifty-six Thai patients with FFA met the inclusion criteria. There were 54 females (96.4%) and two males (3.6%), and the average age of disease onset was 51.3 ± 6.3 years. All patients presented with frontotemporal hairline recession, and 49 patients (87.5%) experienced eyebrow loss. Trichoscopy in 35 patients revealed follicular dropout, perifollicular erythema, and lonely hair in 35 (100%), 29 (82.8%) and 26 patients (74.2%), respectively. Disease stabilization was superiorly observed in patients treated with a combination of topical corticosteroids and hydroxychloroquine or finasteride (79.3% and 73.3%, respectively)., Conclusion: Our study presents the largest series of FFA in Asians and reports mixed clinical patterns between Caucasian and African patients. Combination therapy of topical corticosteroids and hydroxychloroquine or the use of topical corticosteroids and finasteride may halt the progression of FFA in Asians., (© 2019 The International Society of Dermatology.)