Definition And Description

Trichophytosis capitis is a disease of early life, occurring among infants and children, and never, so far as the author's experience goes, among adults. It is characterized by the appearance upon the scalp of one or more small, round, white, scaly patches, apparently deprived in part or wholly of hair. The patches extend in a centrifugal manner with greater or less rapidity. They increase in size, and others appear in the neighborhood, and if the disease is unchecked, soon fuse together until more or less of the scalp is involved, when the appearances noticed in the smaller patches are observed over the whole surface. The ultimate result, if unchecked by treatment, is involvement of the entire scalp, with destruction of the hair-follicles and permanent loss of hair.

On close inspection, the apparently bald portions of scalp in the early stages of the disease are found in reality to be covered with innumera-ble short hair-stumps projecting a little above the surface. The appearance of this short stubble is very peculiar. The broken hairs do not resemble closely clipped healthy ones of the same length, but are lustreless, and of lighter color than the neighboring normal hair. Their extremities are rough and often brush-like, due to splitting up of the shaft, and separation of the fibres by the spores of the trichophyton. some-times a few hairs of normal length will be scattered over the affected surface.

The affection is exceedingly contagious, the most so of any of the phyto-parasitic diseases of the skin, and is frequently conveyed by the use of hats, brushes, etc, which have been previously used by persons affected with the disease. It is also probable that the spores may be con-veyed tome little distance through the air, as the affection sometimes spreads rapidly in schools, even where ordinary precautions are employed. If a patch commence near the border of the scalp, by farther extension it may spread down upon the forehead, temples, or neck, in which case the portion beyond the scalp presents the features peculiar to Trichophytosis corporis,

Diagnosis

In its early and advancing stages little or no difficulty should be experienced in the diagnosis. The circular shape and the broken hairs are sufficiently characteristic, and are not met with in any other affection of the scalp. In the stage of decline, however, especially after a case has been subjected to treatment, recognition of the affection may be more difficult. Under these circumstances the microscopical appearances of the hairs will be sufficient to determine the matter.

Prognosis

This variety of trichophytosis is very difficult to cure, especially if the disease have gained any headway. It can, however, be cured by appropriate and persistent treatment.

Treatment

The principle that underlies the treatment of trichophytosis capitis is the same that prevails in the management of Favus. This is to destroy the fungus in situ. Of the various methods that have been proposed to accomplish this end, the following two may be regarded as the most reliable.

The first method may be designated as that of Bazin. It may be carried out as follows: Epilate the affected patches as carefully as possible, and apply a solution of corrosive sublimate, as in the treatment of favus. Owing, however, to the disorganized and fragile condition of the hair-stumps, thorough epilation is exceedingly difficult, as in many cases the slightest traction on the stumps causes the root to break, leaving a portion of it remaining in the follicle. Epilation, however, must be attempted and carried out with as much gentleness and care as possible, and after the removal of as many hairs as is practicable, the parasiticidal lotion should be employed. As, in all probability, many of the roots of fractured hairs will remain in their follicles after the first attempt at epilation, it will be necessary to wait until they have grown out again and are capable of being extracted, parasiticides being employed in the interim. Epilation must then be renewed, and as often as necessary. These cases require the closest attention, as the disease is rarely eradicated, when extensive, in leas than from three to six months. Premature suspension of treatment will inevitably be followed by relapse.

The second method of treatment, and one that is perhaps more successful than that just given, is the one recently (1876) recommended by Ladreit de Lacharriere. It consists in the application of croton-oil to the affected surface in such a manner that a pustular inflammation of the follicles shall be induced. This loosens the hair and destroys the fungus. A careful trial of this method has satisfied me that it is of decided service, but it is rendered still more efficient by combining it with epilation. It may be carried out as follows: Melt together equal parts of croton-oil and white wax. When the mass is fluid pour it into a hollow cylinder made of paper, and about one-half inch in diameter. When cold it acquires a convenient and suitable consistency. Epilation is then resorted to, and in as thorough a manner as possible, after which the mixture of wax and oil is rubbed into the patch. This will usually excite the requisite degree of inflammation. After this has subsided careful microscopical examination of the hairs should be made, and the epilation and oil again employed, if necessary. In very young children the foregoing application will prove too irritating, and its strength should be reduced. In which case equal parts of croton-oil, cocoa-nut-oil, and white wax, melted together, will give a stick of suitable consistence and milder in its action. By the persistent and intelligent use of these means the trichophytosis will be ultimately cured