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According to their carbon chain purchase 40/60 mg levitra with dapoxetine free shipping, phenolic compounds can be divided into 16 major classes [9] discount 40/60mg levitra with dapoxetine free shipping. This classification is useful from the nutritional view point cheap levitra with dapoxetine 40/60mg free shipping, to the extent that the metabolic fate in the gastrointestinal tract and the physiological effects of each group will depend largely on their solubility characteristics buy 40/60 mg levitra with dapoxetine overnight delivery. Insoluble phe nolic compounds are not digested and may be partially or fully recovered quantitatively in the feces, while a part of the soluble can cross the intestinal barrier and be found in the blood, unchanged or as metabolites [3]. The antioxidant activity of food phenolic compounds is of nutritional interest, since it has been associated with the potentiation of the promoting effects of human health through the prevention of several diseases [11]. Additionally, in some cases, these compounds may also be used with therapeutic purposes due to their pharmacological properties [12]. Many phe nolic compounds with low molecular weight, such as thymol, are used in medicine as anti septic due to its toxicity [7]. However, the antioxidant activity of phenolic compounds depends largely on the chemi cal structure of these substances [2]. Among the phenolic compounds with known antiox idant activity, flavonoids, tannins chalcones and coumarins as well as phenolic acids are highlighted. Flavonoids are important constituents of the human diet [14, 15], and are the most widely distributed phenolic compounds in plant foods and also the most studied ones [10]. Additionally, free hydroxyl groups in position 3 of ring C and in position 5 of ring A, together with the carbonyl group in position 4, are also important for the antioxidant activity of these compounds [16]. However, the effective ness of the flavonoids decreases with the substitution of hydroxyl groups for sugars, being the glycosides less antioxidants than their corresponding aglycons [17]. Tannins Tannins are phenolic compounds of molecular weight from intermediate to high (500-3000 D) [3] and can be classified into two major groups: hydrolysable tannins and non-hydrolysa ble or condensed tannins [18]. There is a third group of tannins, phlorotannins, which are only found in brown seaweeds and are not commonly consumed by humans [19]. The hydrolysable tannins have a center of glucose or a polyhydric alcohol partially or com pletely esterified with gallic acid or hexahydroxydiphenic acid, forming gallotannin and el lagitannins, respectively [20]. However, they may also be oxidatively condensed to other galoil and hexahydrox ydiphenic molecules and form polymers of high molecular weight. The best known hydro lysable tannin is the tannic acid, which is a gallotannin consisting of a pentagalloyl glucose molecule that can additionally be esterified with another five units of gallic acid [10]. The condensed tannins are polymers of catechin and/or leucoanthocyanidin, not readily hy drolyzed by acid treatment, and constitute the main phenolic fraction responsible for the characteristics of astringency of the vegetables. Although the term condensed tannins is still widely used, the chemically more descriptive term "proanthocyanidins" has gained more ac ceptance. These substances are polymeric flavonoids that form the anthocyanidins pig ments. The proanthocyanidins most widely studied are based on flavan-3-ols (-)-epicatechin and (+)-catechin [5]. Although the antioxidant activity of tannins has been much less marked than the activity of flavonoids, recent researches have shown that the degree of polymerization of these sub stances is related to their antioxidant activity. In condensed tannins and hydrolysable (ella gitannins) of high molecular weight, this activity can be up to fifteen to thirty times superior to those attributed to simple phenols [16]. Chemical structures of hydrolysable tannin (A) and non-hydrolysable or condensed tannins (B). The phloretin and phloridzin are characteristics of apples, as well as the chalconaringenin is characteristic of tomatoes and arbutin of pears. In some species of plants, the main pigments of yellow flowers are chalcones [21]. Like the other phenylpropanoids, coumarins constitute a class of secondary metabolites of plants derivatives from cinnamic acid by cyclization of the side chain of the o-coumaric acid [22]. Although the data are still limited, it is known that chalcones and coumarins have antioxi dant activity [23]. Phenolic acids Phenolic acids can be divided into two groups: benzoic acids and cinnamic acids and deriva tives thereof. The benzoic acids have seven carbon atoms (C -C ) and are the simplest phe6 1 nolic acids found in nature. Cinnamic acids have nine carbon atoms (C -C ), but the most6 3 commonly found in vegetables are with seven. These substances are characterized by hav ing a benzenic ring, a carboxylic group and one or more hydroxyl and/or methoxyl groups in the molecule [24]. The general formulas and names of the main benzoic and cinnamic acids are found in Fig ures 7 and 8, respectively. Among the cinnamic acids, p-coumaric, ferulic, caffeic and sinapic acids are the most com mon in nature [24]. Phenolic acids may be about one-third of the phenolic compounds in the human s diet [24]. In general, the hydroxylated cinnamic acids are more effective than their benzoic acids counterparts [16]. Despite the antioxidant activity of phenolic compounds and their possible benefits to human health, until the beginning of the last decade, most studies on these substances occurred in relation to their deleterious effects. Although phenolic compounds are traditionally considered antinutrients, and until the moment as non-nutrients because deficiency states are unknown for them, in recent years they have been seen as a group of micro-nutrients in the vegetable kingdom, which are important part of human and animal diet. Researches have also suggested that regular consumption of phenolic compounds directly from plant foods may be more effective in combating oxidative damage in our body than in the form of dietary supplement [26]. This can be explained by the possible synergistic inter actions among food phenolic compounds, increasing the antioxidant capacity of these sub stances.. This way, the content of phenolic compounds and the antioxidant power of a wide variety of plant foods have been investigated. Sources and their antioxidant power Table 1 shows the mean content of total phenolic compounds (mg/ 100 g of sample) of some plant foods. As can be seen in Table 1, phenolic compounds are widely distributed in plant foods. It is known that the abundant phenolic com pounds in red wine are anthocyanin [6, 52]. The green and black teas have been extensively studied, since they may contain up to 30% of their dry weight as phenolic compounds [53]. It has about 7% of the dry weight of the grains [24] and 15% of the dry instant coffee as phenolic compounds [54]. Although in some studies a few statistically significant correlations were found between the levels of total phenolic compounds and antioxidant power of foods, in others the total phe nolics content of samples was highly correlated with the antioxidant capacity. On the other hand, there are still no standard methods and approved for determining the antioxidant power in vitro. The several available tests for this purpose involve different mechanisms of antioxidant defense system, from the chelation of metal ions to the measure of preventing oxidative damage to biomolecules, and offer distinct numerical results that are difficult to compare.

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Abscesses tend to be warm buy levitra with dapoxetine 40/60 mg free shipping, painful buy discount levitra with dapoxetine 40/60mg on-line, and may cause Abscesses fever in the affected cow generic 40/60mg levitra with dapoxetine otc. Seromas are unusual adjacent to the udder but would give similar signs of swelling buy cheap levitra with dapoxetine 40/60 mg on line. How- Etiology ever, seromas usually do not enlarge as much as a hema- Udder abscesses may appear anywhere in the mammary toma in this location, and progressive anemia would not tissue or adjacent to the glands. Clinicians should be reluctant to scesses can form secondary to mastitis with abscessation, aspirate known hematomas for fear of introducing as is typical of mastitis caused by Arcanobacterium pyogenes. Most udder abscesses harbor typical contaminants Following natural or surgical drainage, the abscess such as A. Usually be either distinct or indistinct from gland parenchyma antibiotic treatments are unnecessary. Palpation of the swelling may be painful Thrombophlebitis and Abscessation of the Milk to the affected cow. Thrombophlebitis of the mammary vein is an usually is normal, and the abscesses tend to be well- occasional complication of venipuncture at this site encapsulated. It should only be used under considerable du- sion may be located if aspiration and drainage are nec- ress even in grade cattle. A thick capsule around the abscess is usually to phlebitis from the use of contaminated needles or sub- observed. As with all cases of thrombophlebitis there is a A conservative approach usually is rewarded by even- risk of embolic spread, potentially causing endocarditis or tual natural rupture and drainage of the abscesses in nephritis. This has been standard treatment because the inciting attempted venipuncture, antiinammatory practitioners fear lancing anything in the udder because and antimicrobial therapy is indicated. Con- nary attention is often only sought after abscessation has servative treatment probably still is the safest. The only already occurred, at which time the goal of therapy should risk from conservative therapy is the same for neglected be surgical drainage followed by antimicrobial therapy. Treatment of valuable cattle may include rifampin under appropriate extra-label drug use guidelines. Udder Cleft Dermatitis Etiology Udder sores are foul-smelling areas of moist dermatitis that result from pressure necrosis of skin associated with periparturient udder engorgement and edema. Common A locations include the skin reection between the medial thigh and dorsal attachment of the lateral udder, on the ventral midline immediately adjacent to the median sep- tum of the foreudder, and on the median septum of the udder either between the forequarters or in the fold that is centered between the four quarters. Pressure necrosis associated with udder edema is en- hanced by frictional injury and chang with limb and udder movement. The abraded skin oozes serum, which, coupled with the omnipresent skin hair, leads to moist dermatitis. Finally, opportunistic anaerobic bacteria such as Fusobacterium necrophorum and A. The or- ganisms cause the smell that distresses milkers each time they get close to the udder hence the name udder rot. Signs B A fetid odor similar to that found in septic metritis or re- tained placenta emanates from areas of moist dermatitis in the groin area or more commonly the ventral median area of the udder. In the worst cases, large patches of skin (10 to 30 cm in length) may be peeled off. In some rst-calf heifers, groin infec- tions can be so severe that lameness may occur. A, Necrotic udder sore in the right groin inguinal area of a rst-calf heifer that had bilateral lesions. B, Necrotic udder sore between the forequarters of a cow positioned Diagnosis in dorsal recumbency in preparation for abomasopexy. The combination of necrotizing fold dermatitis and malodorous discharge in a postpartum cow is sufcient for the diagnosis of udder fold dermatitis. Other compounded reme- Treatment dies have been recommended for the treatment of udder Although the principles of treatment are straightfor- cleft dermatitis, but given the current drug compounding ward, client compliance may be lacking because of time regulations of the U. Patients that have devel- For dairies that request therapy, a commercially avail- oped cleft fold pyodermas secondarily to udder edema able topically applied wound spray (Granulex Aerosol should be treated with diuretics (furosemide, 1 mg/kg) to Spray, Pzer Inc. Diuretics are calciuretic and kaluretic, so cessfully by eld veterinarians for the treatment of udder during diuretic treatment of postpartum cows, calcium cleft dermatitis. If the inguinal lesions are causing severe periods of recumbency occur mostly in cattle with very lameness, surgical debridement can speed healing. Such sores often are located where the medial hock makes Udder Dermatitis contact with the udder. Lesions initially are reddened, Etiology ooze serum, and then slough, leaving a necrotic crater- Udder dermatitis may be associated with a multitude of like lesion in the udder. The clinical signs of infectious dermatitis vary with the Chemical causes of udder dermatitis include irritants causative agent. Staphylococcal dermatitis causes a dif- in bedding such as hydrated lime, ammonia from urine, fuse folliculitis with small raised tufts of hair joined with copper sulfate, or formaldehyde from foot baths. Pustules may be apparent in the Physical causes of udder skin inammation include worst cases. Usually only one or a few cows in the herd sunburn, frostbite, and pressure necrosis caused by de- are affected, but occasionally outbreaks of pustular der- cubitus. Plucking these tufts Staphylococci and streptococci occasionally cause a of hair or crusts may reveal purulent material on the un- diffuse miliary folliculitis or pustular dermatitis named derside of the crust or adjacent skin. Other areas of ring- worm infection usually are identied during inspection Signs of the cow. Herpes mammillitis lesions coexist on the Signs vary with specic etiology of the lesions. Recognition of bullae or and physical teat skin dermatitis is characterized by ex- vesicles in early cases is imperative to diagnosis. Multiple vesicles pearance to that found in other species, and the cow and pustules from 1. Af- been observed on the udder of lactating cows, and le- fected skin is warm, painful, and may have vesicles or sions have been observed in farm workers. Multiple cows in the herd may show Treatment signs simultaneously and resent milking procedures Treatment for chemical dermatitis only requires gentle because of painfully burned skin. Signs may be present washing of the udder with warm water and removal of on only one side of the udder if the cow preferentially the offending agent from the cow s skin. Frostbite occurs during extreme winter cows may be sensitive to a chemical despite the majority cold mostly in free stall barns and mostly in peripar- of cows in the herd being exposed to the same chemical turient cows with udder edema that already compro- yet remaining unaffected. Patchy areas of skin on the teats udder to remove residual chemical followed by applica- and udder become cool, discolored, swollen, and then tion of aloe or lanolin products is recommended. Frostbite must be Physical causes of dermatitis are best treated by pre- differentiated from herpes mammillitis. Cool water netic factors certainly exist, and bull stud services some- compresses followed by aloe or lanolin ointments to times grade production sires by probability of udder deter skin cracking and peeling caused by dryness are edema in their female offspring. Periparturient cows in free stalls during ex- clude cardiac conditions, caudal vena caval thrombosis, treme cold are at greatest risk because free stall beds mammary vein thrombosis, and hypoproteinemia resul- usually are poorly bedded for warmth. Physical exami- has occurred, careful sharp debridement of necrotic tis- nation and serum chemistry screens may be helpful in sue and protection against further injury are the only the evaluation of such individuals.

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Young people (probably order levitra with dapoxetine 40/60 mg without a prescription, mostly from ethical minorities) that already drop out from the school (in certain cases those with high risk sexual behaviours) were missed generic 40/60mg levitra with dapoxetine. As far as total fertility rate is considered levitra with dapoxetine 40/60 mg without a prescription, again the consensual clinical and health policy- makers feeling is that the rate is higher for several ethical minorities and among some of the lowest socio-economic levels buy generic levitra with dapoxetine 40/60 mg on line. Indeed, it is accepted that fertility rate is often higher among these sub-groups. This indicator should be considered together with the mean maternal age at first childbirth, because usually it is accepted that the first one is one of the consequences of the second one: if a woman has her first childbirth at the end of her twenties, most probably she will not have many children. However, in Poland, an extremely low fertility rate coexists with a relatively young maternal age at the first childbirth (24. Whatever the relationship between these two indicators is, the total fertility rate in the eight countries considered in this study ranged from 1. Under an epidemiologic and Public Health perspective, having the first term pregnancy after 30 years old is a recognized increased risk factor for breast cancer. This indicator by no way necessarily reflects direct contraceptive failure due to both induced abortion and intended pregnancy among some adolescents. But, anyway, the reasons for such a huge discrepancy among different Member States have to carefully be analyzed and critically understood in the context of specific health and cultural contexts and environments of each region, community and country. In certain cases the same disease can affect more than one single recommended indicator. Also, mean age at first intercourse and contraceptive use at first intercourse can be linked with age-specific birth rate in teenagers. Contraceptive failure is obviously related to induced abortion, two important indicators of sexual morbidity, even when the induced abortion is safe, legal and rare. As already mentioned, mothers are increasingly delivering their first child at older ages. Maternal and fetal problems are well known: increased incidence of dystocic deliveries (e. More difficult to evaluate in all its extension is the morbidity linked to an unpleasant sexual life. Sexual and reproductive health is an important measure of the general health and social well being of a population. Moreover, the scope of sexual and reproductive health extends across the life span (from adolescence to the ageing) and across several Public Health domains. In order that sound evidence based politics can be taken on these issues, some more evidence based knowledge and wisdom is needed, overcoming existing ignorance and misconceptions. This can be done with small adaptations and will be a reliable approach to teenagers specific needs and autonomy. Monitoring reproductive health in Europe what are the best indicators of reproductive health? Factors associated with teenage pregnancy in the European Union countries: a systematic review. Special issue of European Journal of Obstetrics & Gynecology and Reproductive Biology 111 Suppl 1:S5- S14, 2003. Gissler M, Dumitrescu A, Addor V: Improving the performance of National Health Information Systems: the 2002-2003 reform in Finland from an international perspective. Monitoring health in Europe: opportunities, challenges, and progress Eur J Public Health 13 (supplement 3): 1-4, 2003. The generic term for such indicators is health expectancies and they are summary measures of population health combining information on survival with the prevalence of a health measure (Robine 2006). The most common health measure used is disability, producing disability-free life expectancy. Background to health expectancies Research on health expectancies dates back to the 1960s. Being independent of the size of populations and of their age structure, health expectancies allow direct comparison of the different groups that make up populations: e. Since that time health expectancies have been increasingly used in developed countries to assess the evolution of a population s health status, in particular that of older people (Robine et al. However comparison between countries remained almost impossible due to national differences in the morbidity data collected, particularly in the study design, the health concepts used and the wording of questions. In total 10 instruments were proposed with their exact wording in English (Box 1). The set allows in theory the computation of many health expectancies covering the totality of the conceptual framework of the measurement of population health. Similar methodology was used in the development of the 10 health indicators: a systematic review of the literature on the concept and wording of questions and their previous use in surveys. Do you suffer from (have) any chronic (long-standing) illness or condition (health problem)? For the past 6 months or more have you been limited in activities people usually do because of a health problem? Ultimately 9 indicators were chosen: chronic morbidity (global and detailed); activity limitation (global); perceived health (global); physical and sensory functional limitations; personal care activities; household care activities; other activities; and mental health. Indeed it is crucial that even if existing 293 items are taken from current European Surveys, existing translations are not automatically taken but that new translations following a standard scientific protocol are undertaken. However 2003-2004 was a transitional period, during which data were provided by national sources with post- harmonisation giving a break in series. Considerable disparities are evident between the European Member States in the level of chronic morbidity reported by the population. The reported prevalence in women is higher than that for men within every Member State though the gender gap varies from 2. However men and women give the same picture of the diversity of chronic health problems reported in Europe. Briefly this entails applying the age and gender specific prevalence of chronic morbidity, presented in the previous section, to the life table for the corresponding years of the survey from which the prevalence data were obtained. The gender gap in life expectancy at age 65 within Member States in 2005 was only 2. There appeared to be little relationship between the increase over the period 1995 -2005 and life expectancy at age 65 in 1995 for either men or women. Thus there was no evidence that Member States with the highest life expectancies at the beginning of the period were showing signs of reaching a maximum value. On average increases in the later period were marginally greater than those in the early period. Increases in the two periods remained constant in Austria, Portugal, Sweden and United Kingdom in men and Austria in women. In Lithuania for both men and women life expectancy at age 65 declined in the period 2000-2005. Years with chronic morbidity at age 65 Applying the prevalence of chronic morbidity within age groups to the life tables gives the expected years spent with chronic morbidity. As with most health measures women spend a greater number of years but also a greater proportion of their remaining longer life with chronic morbidity. The evidence from Europe does not appear to support that Member States with longer life expectancy have longer healthier life expectancy or rather that they have less life expectancy with chronic morbidity.

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Tufted folliculits is sometimes considered a localized vari- ant of follicultitis buy levitra with dapoxetine 40/60 mg line. Dissecting cellulitis may present as part of the so-called follicular occlusion triad that includes acne conglobata and hidradenitis suppurativa and is seen primarily in black men discount 40/60mg levitra with dapoxetine. The lesions typically start as small papules or pustules on the back of the neck but can progress to larger hypertrophic scars or keloid-like plaques; occasionally there are coexisting sinus tracks and pus purchase levitra with dapoxetine 40/60 mg with amex. It has been postulated that mechan- ical irritation levitra with dapoxetine 40/60mg fast delivery, injury during short haircuts, and inammation from impaction of short curved hair may trigger the problem. However it has recently been suggested that folliculitis keloidalis is a primary scarring alopecia based on the histopathologic appearance of early lesions (45). Erosive pustular dermatosis is a rare disorder in which patients are described as having a large, asymptomatic, boggy plaque on the scalp with supercial crusts and pustules. The lesions are seen most commonly in the elderly with extensive actinic or traumatic skin damage (46). Acne nectrotica is another rare, relapsing disorder seen in adults that is characterized by papulopustules in the frontal hair line and seborrheic areas that heal with hemorrhagic crusts and eventual punched-out varioliform scars (47). The biopsy should be taken from the active border of hair loss where some hairs still remain. A 4-mm punch biopsy is adequate and must include subcutane- ous fat to ensure sampling of the entire follicular unit and any anagen follicles. Routine staining with hematoxylin and eosin is recommended as a standard evaluation. Direct immunouorescence is of value in histopathologically inconclusive cases, with a high specicity and sensitivity for chronic cutaneous lupus erythematosus and a high specicity but low sensi- tivity for lichen planus (51). The North American Hair Research Society characteristic categorization is advocated as a provisional classication method. Typical histopathologic features seen in biopsy specimens of patients with lymphocytic and neutrophilic are listed in Table 2. With these common goals, patient and clinician can work together to determine the best treatment regimen and to evalu- ate its efcacy over time. The therapeutic strategy is generally based on (i) the degree of inam- matory inltrate on biopsy (sparse, moderate, dense), and (ii) clinical assessment of disease. The treatment guidelines listed below are not meant to be exhaustive, but instead reect the practices of the author. Lymphocytic Topical/intralesional therapy Topical anti-inammatory agents are considered the mainstay of treatment for lymphocytic scarring alopecia and can be used exclusively for limited disease, or for maintenance/remission. The vehicle chosen for the scalp varies, depending on the needs and hairstyles of the patients with topi- cal solution or foam preferred by many white patients and ointment or oil preferred by many blacks. Nonsteroid topical anti-inammatory cream or ointment (tacrolimus, pimecrolimus) can be compounded in a lotion to provide an alternative treatment. Tier 3 treatments are typically reserved for patients that have active disease and have failed Tiers 1 and 2. Injections are directed at the active border, where signs of inammation or a posi- tive anagen hair pull is present. Hydroxychloroquine has been used worldwide as an anti-malarial, but is also an established steroid-sparing antilymphocytic medication. Given its safety and low side-effect prole, hydroxychloroquine is considered to be the rst line systemic treatment for lymphocytic mediated alopecia. The usual starting dose is 200 mg twice daily, with the expecta- tion that the medication will start to take effect after 8 10 weeks, and will be continued for 6 12 months (48). As an al- ternative for patients who do not tolerate hydroxychloroquine, doxycycline or minocycline at doses of 50 100 mg daily can be used. Acitretin: Acitretin is considered a rst-line treatment for cutaneous lichen planus based on a blinded placebo-controlled study (54,55). Mycophenolate mofetil is an immunomodulating medication known to inhibit activated T cells. Given its effectiveness, tolerability, and safety prole, it has been advocated as the preferred second-line treatment for patients with persistent symptoms and hair loss after a 3 6 month trial of hydroxychloroquine (48). Supplemental topical antibiotics: mupirocin, clindamycin, isotretinion 146 Mirmirani as interferon-gamma responsible for macrophage activation (56). CsA is also known to cause hypertrichosis, which is likely mediated by hair keratinocyte differentiation as well as retarda- tion of catagen. Oral prednisone can be used to rapidly diminish the inammatory signs and symptoms, however given the side-effect prole, it is not considered for long-term use and is used only as a temporary or bridge treatment. Neutrophilic Recognizing the central role of Staphylococcus aureus, treatment regimens aimed at eradication of bacterial carriage have provided a signicant improvement of outcome. It must be noted how- ever, that repeat cultures may be needed to determine the offending bacteria, since the predomi- nant bacteria may change over time. Culture material is obtained from intact pustules, or from extracted hair bulbs or biopsy specimens. A regimen of clindamycin 300 mg twice daily and rifampin 300 mg twice daily for 10 weeks has been shown to be effective in inducing a sustained remission, although further courses may be needed (17,57). The addition of topical mupirocin to the nares for staphylococcal eradication or for longer duration of remission may be advisable. Topical clindamycin solution can be prescribed for ongoing treatment/prevention of recurrence. Other antistaphylococcal antibiotics such as erythromycin, cepahlosporins, trim- ethoprim sulfamethoxozole, or a uoroquinolone with or without concomitant rifampin are variably effective. Dramatic improvements in dissecting cellulitis have been reported with use of isotretinoin, especially if the disease is found in tandem with other features of the so-called follicular occlusion triad. Small starting doses with slow escalation to avoid ares are recom- mended, but with a goal of treatment dose of 1 mg/kg/day for at least 5 months although a longer treatment course may be required (48). If dissecting cellulitis is seen unaccompanied, or if there is a strong suppurative component with growth of S. If the predominant morphology is that of pustules crusting and sinus tracts then topical and/or oral antibiotics should be emphasized in the treatment regimen. Antibiotics are often combined with intralesional corticosteroids for treatment of concomitant inammatory papules or hypertrophic scars. Current surgical treatments consist of scalp aps, reduc- tion procedures with or without prior tissue expansion, and autologous hair transplantation; these procedures are often combined or done serially (58). Patients with traumatic types of alopecia are generally seen to be the most appropriate candidates for surgery since there is little likelihood for progression of hair loss. There are no studies to determine the optimal period of quiescence before undertak- ing surgery; some have advocated 6 9 months, while others have waited 3 years (58,59). Other limitations to surgical hair restoration include the lack of appropriate donor sites and atrophy of the recipient area. The future of Cicatricial Alopecia 147 surgical hair restoration may lie in cloning hair follicles, thus providing an unlimited supply of donor grafts; technological advances will likely make this a reality in the next decade. Surgical treatment may also play a role in providing symptomatic relief for patients with suppurative, boggy, pus-lled lesions, or sinus tracts. Incision and drainage of these types of lesions may relieve symptoms and hasten healing.

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