Definition And Description

Alopecia may be described as the partial or complete falling of the hair from the scalp or other portions of the body. This loss of hair may be quite sudden, occupying a few weeks only; or, on the other hand, it may be exceedingly gradual, and several years may pass before any particular region, the scalp for instance, becomes absolutely bald.

Etiology

Rapidly advancing alopecia is sometimes an accompaniment of syphilis, and will be particularly considered in connection with that disease. It also not unfrequently occurs during convalescence from the continued or eruptive fevers, after childbed, after erysipelas, and other acute diseases.

Chronic or slowly advancing alopecia may be the result of various debilitating causes, or may depend on pre-existing disease of the scalp, more particularly pityriasis (sometimes improperly termed Seborrhoea sicca*). It may also result from long-continued and imperfectly treated parasitic affections, as favus and trichophytosis. Lastly, it may be due to the ravages of age.

Diagnosis

There is, of course, little or no difficulty attending the diagnosis of alopecia per se; the variety of alopecia, however, from an etiological point of view, is not always so self-evident. In syphilis the fall of the hair is usually quite rapid, and there may be cither a uniform or generally diffused loss, or the hair may come out in patches, simulating an alopecia areata. The previous history and concomitant symp-usually render a diagnosis easy.+ Alopecia depending on recent acute disease is generally diffuse, the hair coming out quite readily when combed, but rarely becomes complete, ma new hair usually commences to grow before the old hair is entirely gone.

The alopecia resulting from a long-continued favus is exceedingly characteristic, but difficult to describe. The presence of the favus crusts and the history of the disease will enable the diagnosis to be made without difficulty.

* See 87, 198. + A couple of years ago a physician called upon ma with the request that I would prescribe for him the moat approved "hair tonic" that I knew of stating that for some weeks his hair bad been coming out to a degree that greatly annoyed him, as be feared he would lose it all. He could imagine no cause for the trouble. A glance at the scalp was sufficient to direct the line of inquiry into the right channel, and it was ascertained that the patient had been an unconscious sufferer from syphilis for several months. Appropriate treatment and other circumstances amply verified the diagnosis.

Slowly advancing premature alopecia, the result of pre-existing pityriasis, is, as a rule, easily recognized; the presence of an abundant "dandruff," or, if this condition has ceased, the history of its previous occurrence, is usually sufficient to establish its importance as an etiological factor.

Senile alopecia, of course, presents no difficulties in diagnosis.

Prognosis

In generalized syphilitic alopecia, and in that following acute illness, the prognosis is usually good. In alopecia dependent on pityriasis, the progress of the affection can usually be controlled, but if much advanced, the reacquirement of the original amount of hair is improbable. In senile alopecia the prognosis is unfavorable.

Treatment

Appropriate treatment necessitates, in the first place, the removal of the cause, if possible; in the second, attention to the general hygiene; third, constitutional treatment when indicated, and fourth, local measures. The first indication cannot always be fulfilled, as for instance, in senile alopecia. In other etiological varieties, however, it can, as in alopecia due to existing pityriasis. This condition must be remedied before we can hope to accomplish much in the way of improving the growth of the hair. In alopecia the general hygiene of the patient should never be overlooked, especially in cases occurring after fevers and debilitating diseases. Constitutional treatment of a specific character is of course requisite in the variety dependent on syphilis. In other cases it involves the employment of measures calculated to improve the general health when necessary, and also the use of internal remedies capable of promoting the growth of the hair, if any such remedies can be found. To positively assert that there are drugs which, internally administered, are capable of promoting an increased growth of the hair, is more than the author feels warranted in doing. He, however, cannot refrain from expressing the belief that he has seen decided benefit follow the employment of preparations of arsenic, nux vomica, phosphorus, and cod-liver oil. How these drugs act, if in reality they are efficient, is a question rather difficult to answer. Possibly as nerve-stimulants they may expend their force where it is most needed, or possibly as haematogenics they may act by improving the character of circulating fluid, and thus indirectly prove of service. Whether internal treatment is appreciably beneficial in alopecia, except in the syphilitic form, may, we think, be still considered an open question. Not so, however, with local treatment. On this our expectations must mainly depend.

One of the first points to be considered is the desirability of cutting the remaining hair close, or of shaving it off altogether. There is very little doubt that rapidity of growth is promoted by clipping, and that a thicker and stronger growth follows frequent shaving, and the only question to be decided is whether the inconvenience and discomfort that arises from a shaven scalp are not greater evils than those under which the patient is already laboring. In deciding this, each case must be judged by itself. In children it matters little whether the hair be shaved or not, unless they are of a particularly sensitive disposition and likely to be annoyed by the remarks of school-fellows and playmates. With ladies, and especially young ladies just entering society, a proposition to shave the scalp will meet with much disfavor, and should not be urged if there is a reasonable prospect of recovery without it. If shaving is decided on, it should be repeated every three or four days for several weeks or even longer, and until there appears to be a manifest improvement in the thickness of the growth, and in the strength of the individual hairs, it being understood that appropriate local treatment is pursued at the same time. If, however, shaving is omitted, local applications of a stimulating nature will be the main dependence. These will vary in activity according to the susceptibility of the skin and to the effect produced. It is best to commence with the milder class of applications. Sometimes they alone will suffice, and may even do better than stronger ones.