Definition And Description

Alopecia areata is an affection characterized by the loss of hair from the scalp or other parts. The affection commences by small circumscribed, usually round patches, which gradually enlarge, until contiguous ones unite. The parts most frequently affected are the scalp and region of the head, though all parts of the body may be affected, and all of the hair be shed.

Diagnosis

The only affections with which alopecia areata is liable to be confounded, are trichophytosis capitis and syphilis. In the former the apparently bare places are in reality found to be covered with a short, hairy stubble, from 1/16 inch to 1/8 inch in length, plentifully interspersed with fine farinaceous scales. In alopecia areata, on the other hand, the patch is abso, lutely bald, sometimes slightly elevated and injected, more frequently depressed and pale, and without scales. The bald patch itself is surrounded apparently healthy hair. In syphilis the loss of hair is usually diffuse and rapid, more rarely intermingled with circumscribed patches. The scalp is sometimes slightly injected, but not elevated. The concomitant symptoms should enable the diagnosis to be made without difficulty.

Etiology

The causes of alopecia areata are not definitely known. A few, chiefly French authors, believe that it is due to a fungus, which they call the Microsporon Audouini, and hence classify the affection with the Phytoses, or diseases depending on vegetable paras it The majority of observers do not accept this view, but believe that the affection is due to a circumscribed asthenia, depending on defective innervation. For further discussion of this question see 87, 289.

Treatment

The methods of cure recommended by writers arc somewhat biassed by their views as to the etiology of the affection. oh usually recommend that the bald patch and a little of the surrounding hair be shaved with a razor two or three times a week, and that an ointment of turpeth mineral (Hydrargyri Sulphas Flava), about 1 to 30, be rubbed into the bald patch daily. Others, who regard the disease as a localized neurasthenia, apply the strongest stimulants. The author has usually adopted the following plan: If the patches have not yet acquired a large size, the marginal hairs for 1/16 inch to 1/8 inch are carefully cpilatcd. This done, the further treatment will depend on whether the patch is apparently congested and slightly elevated, or whether depressed and pale. If in the former case, I have found a local application of nux vomica of great service. From ss. to j. of the fluid extract to an ounce of simple or rose-water ointment, may be thoroughly rubbed into the aft parts once or twice a day. Another convenient application consists of equal parts of tincture of nux vomica and castor-oil, or a two per cent. solution of strychnia in oleic acid.

On the other hand, if the scalp is pale and depressed, an active stimulant is required. and for this purpose I am in the habit of using the ordinary Collodium cum Cantharide of the pharmacopoeia. This being applied sometimes blisters, but quite as frequently fails to. If it blisters, the next dressing will be a little simple cerate until the blister has healed. This is followed by a mild stimulating application, as castor-oil with a little tincture of cantharides or spirits of rosemary, or a lotion or ointment of corrosive sublimate, one to two grains to the ounce, or the turpeth oint-ment above mentiond. If, at the end of two weeks or so, there is sign of new hair, the cantharidal collodion is again applied. When new hair begins to appear, it is usually quite fine and delicate, and of a much lighter color than normal. As soon as it shows itself the razor may be brought into requisition, and used two or three times a week, mild stimulants to the scalp being continued. In addition to the drugs inentioned, I have sometimes used croton-oil, cardol, ammonia, and other substances having an analogous action.

Those who do not regard the affection as parasitic, are in the habit of employing internal in conjunction with local treatment. Personally, I use, and I think with advantage, arsenic, nux vomica, Iron, quinia, phosphorus, and sulphur. Occasionally cod-liver oil is indicated in children, more rarely in adults. In all cases generous diet and proper hygienic surroundings should be secured.

When the affection has already gained much headway, and the great part of the scalp is denuded, extensive blistering is out of the question, or 10 if employed at all, portions from an inch to an inch and a half square should be treated successively. Patients in this condition are often disposed to wear a wig or a cap. This should be discouraged as much as possible, and free exposure of the scalp to the air and light insisted on. In summer exposure to the direct rays of the sun is of decided service, the period of exposure of course depending on the ability of the patient to endure it without the induction of headache or other disagreeable symptoms.

As previously stated, the affection sometimes progresses until universal alopecia results. This condition, however, is rare and in general unnecessary. The writer does not recall a case treated after the manner described in which the advance of the disease was not stopped, and in the very great majority of cases the hair can be restored to its normal condition.

Herra recommends the application of alcoholic solutions of the various essential oils, veratria, tincture of veratrum, aconite, cantharides, capsicum, etc. Although considering the affection to be a trophoneurosis, he says nothing concerning constitutional treatment.

Wilson's favorite application is ammonia mixed with camphor and chloroform. He states that the "constitutional treatment should consist in the adjustment and regulation of the functions of digestion and assimilation, and where no other special conditions are to be fulfilled, the adoption of a tonic regimen, and the administration of tonic remedies. Of these last arsenic bears the palm, and may be advantageously prescribed in doses of two to four minims" (of Fowler's sol.) "three times a day, directly after food, and in any convenient vehicle."