Essentials of Diseases of the Skin Part 45

Alopecia.

(_Synonym:_ Baldness.)

What do you understand by alopecia?

By alopecia is meant loss of hair, either partial or complete.

Name the several varieties of alopecia.

The so-called varieties are based mainly upon the etiology, and are named congenital alopecia, premature alopecia and senile alopecia.

Describe congenital alopecia.

Congenital alopecia is a rare condition, in which the hair-loss is usually noted to be patchy, or the general hair-growth may simply be scanty. In rare instances the hair has been entirely wanting; in such cases there is usually defective development of other structures, such as the teeth.

Describe premature alopecia.

Loss of hair occurring in early and middle adult life is not uncommon, and may consist of a simple thinning or of more or less complete baldness of the whole or greater part of the scalp. It usually develops slowly, some months or several years pa.s.sing before the condition is well established. It is often idiopathic, and without apparent cause further than probably a hereditary predisposition. It may also be symptomatic, as, for example, the loss of hair, usually rapid (_defluvium capillorum_), following systemic diseases, such as the various fevers, and syphilis; or as a result of a long-continued seborrh[oe]a or seborrh[oe]ic eczema (_alopecia furfuracea_).

Describe senile alopecia.

This is the baldness so frequently seen developing with advancing years, and may consist merely of a general thinning, or, more commonly a general thinning with a more or less complete baldness of the temporal and anterior portion or of the vertex of the scalp.

What is the prognosis in the various varieties of alopecia?

In those cases in which there is a positive cause, as, for instance, in symptomatic alopecia, the prognosis is, as a rule, favorable, especially if no family predisposition exists. In the congenital and senile varieties the condition is usually irremediable. In idiopathic premature alopecia, the prognosis should be extremely guarded.

How would you treat alopecia?

By removing or modifying the predisposing factors by appropriate const.i.tutional remedies, and by the external use of stimulating applications.

Name several remedies or combinations usually employed in the local treatment.

Sulphur ointment, full strength or weakened with lard or vaseline; a lotion of resorcin consisting of one or two drachms to four ounces of alcohol, to which is added ten to thirty minims of castor oil; and a lotion made up as follows:--

[Rx] Tinct. cantharidis, .................. f[dram]iv Tinct. capsici, ...................... f[Oz]j Ol. ricini, .......................... f[dram]ss-f[dram]j Alcoholis, .... q. s. ad ............. f[Oz]iv. M.

The following is sometimes beneficial:--

[Rx] Resorcin, ............................ gr. lx.x.x Quininae (alkaloid), .................. gr. xv Ol. ricini, .......................... [minim]v-[minim]xx Alcoholis, ........................... f[Oz]iv.--M.

Another excellent formula is:

[Rx] Resorcin, ............................ gr. lx.x.x-cxx Ac. carbolici cryst., ................ gr. xx Spts. myrciae, ........................ f[Oz]iv.--M.

And also the various other stimulating applications employed in alopecia areata (_q. v._).

Other measures of value are: Faradic electricity applied daily for five minutes with a metallic brush or comb; daily ma.s.sage, with the object of loosening the skin and giving more freedom to cutaneous and subcutaneous circulation; and the application, two or three times weekly, of static electricity by means of the static crown electrode.

(The application selected should be gently--not rubbing--applied daily or every second or third day, according to the case; if a lotion, moistening the parts with it; if an ointment, merely greasing the parts.

Shampooing every one to three weeks, according to circ.u.mstances.)

Alopecia Areata.

(_Synonyms:_ Area Celsi; Alopecia Circ.u.mscripta.)

What do you understand by alopecia areata?

[Ill.u.s.tration: Fig. 37. Alopecia Areata.]

Alopecia areata is an affection of the hairy system, in which occur one or more circ.u.mscribed, round or oval patches of complete baldness unattended by any marked alteration in the skin.

Upon what parts and at what age does the disease occur?

In the large majority of cases the disease is limited to the scalp; but it may invade other portions of the body, as the bearded region, eyebrows, eyelashes, and, in rare instances, the entire integument.

It is most common between the ages of ten and forty.

Describe the symptoms of alopecia areata.

The disease begins either suddenly, without premonitory symptoms, one or several patches being formed in a few hours; or, and as is more usually the case, several days or weeks elapse before the bald area or areas are sufficiently large to become noticeable. The patches continue to extend peripherally for a variable period, and then remain stationary, or several gradually coalesce and form a large, irregular area involving the entire or a greater portion of the scalp. The skin of the affected regions is smooth, faintly pink or milky white, and at first presents no departure from the normal; sooner or later, however, the follicles become less prominent, and slight atrophy or thinning may occur, the bald plaques being slightly depressed.

[Ill.u.s.tration: Fig. 38. Alopecia Areata--complete hair loss.]

Occasionally, usually about the periphery and in the early stages, a few hair-stumps may be seen.

What course does alopecia areata pursue?

Almost invariably chronic. After the lapse of a variable period the patches cease to extend, the hairs at the margins of the bald areas being firmly fixed in the follicles; sooner or later a fine, colorless lanugo or down shows itself, which may continue to grow until it is about a half-inch or so in length and then drop out; or it may remain, become coa.r.s.er and pigmented, and the parts resume their normal condition. Not infrequently, however, after growing for a time, the new hair falls out, and this may happen several times before the termination of the disease.

Are there any subjective symptoms in alopecia areata?

As a rule, not; but occasionally the appearance of the patches is preceded by severe headache, itching or burning, or other manifestations of disturbed innervation.

State the cause of alopecia areata.