Disease of the Hair.
Diseases of the hair may be divided into those of Augmented and Diminished Formation, Abnormal Direction, and Alternation in Physical Aspect.
Augmented growth may be congenital, of varying extent, from small localized growths, such as little hairy moles, to the extensive tracts covering more or less of the body, as in the “hairy man” described by Mr. Crawford. Stimulation has a tendency to augment the growth of hair, if the formative power is normal. During convalescence a freakish, reactionary growth, in odd and unusual places, sometimes takes place.
Diminished formation of hair is partial or general, comparative (thinning) or absolute (alopecia). It may be congenital, accident, or normal (senile).
When the hair is lost entirely from a part, this is called alopecia, or baldness. Parasitic disease and atrophy of the bulbs are the most usual causes of localized baldness; syphilis, violent emotion, atrophy of the scalp, and senility are most efficient in producing an absolute or a great amount of baldness. The total loss of hair is sometimes seen in early life.
Alopecia areata is an affection characterized by circumscribed patches of baldness on the scalp or other hairy parts of the body.
It usually commences with a single sport, rarely noticed until it has attained a diameter of perhaps the third of an inch. This spot gradually increase in size, and others make their appearance to the number, in some instances, of a dozen or more. As the several spots increase in size, they encroach on each other until they finally coalesce and form patches of considerable size, and if unchecked may denude the entire scalp.
The spots themselves are absolutely deprived of hair, the short stubble met with in Trichophytosis being absent. As a rule, the normal hue of the skin is preserved, but occasionally we meet with cases in which a slight congestion is apparent. Some times the reverse is the case, and the affected portions appear to have a lessened blood supply.
Although most frequently met with on the scalp, and usually confined to this region, the disease may invade the beard and eyebrows, axillary and public hairs, and, in fact, cases have been observed in which apparently every hair of the body has fallen.
The cause and progress of the affection vary. In some cases they proceed by gradual steps to entire denudation of the scalp, while in others spontaneous recovery and regrowth of the hair may be observed. The new hair that comes in, either spontaneously or as the result of treatment, is usually fine and silky, and very much lighter in color than the surrounding healthy hair, and may even by entirely colorless. This early growth is not very viable, and the hairs are gradually supplanted by others stronger and more normal in appearance, until finally the formerly bald patch is to be in no way distinguishable from the surrounding hair.
Diagnosis-There is, or should be, no difficulty in diagnosis, as there is no other affection that presents the features or circumscribed and progressive patches of baldness.
Prognosis-When cases are met with the earlier stages, and are subjected to judicious treatment, the prognosis is almost invariably good. In cases in which it has progressed further, the prognosis is less favorable, although the increase of the area of baldness can generally be stopped, even if the hair can not be brought back to the already affected portions. Cases, however, in which total baldness has already occurred may usually be regarded as hopeless.
Etiology-The nature and causes of alopecia areata are unknown. On the one side, there are those who maintain that it is purely trophoneural affection; and on the other, those who are equally satisfied that it is of microbian origin. The specific microbe, however, has not been determined with any certainty, and the chief support of the parasitic theory lies in the fact that the disease frequently appears in certain series of cases as if it were spread by contagion. Perhaps both theories are right, and that two entirely different disease exist, included under the same name-one of them nervous in origin, and the other parasitic.
Fragility of the hair, seen oftentimes about the beard, is explained by the attack of fungi, or by such causes as lead to insufficient nourishment of the hair, whereby its fibres are ill- formed, and tend to undergo degeneration.
Senile baldness is due to an atrophy of the structures generally, it commences on the crown of the head, the hair first turning gray; the scalp is dry, thinned, loses its subcutaneous fat, and the follicles become indistinct. In some people this change takes place at an early age; it is either an hereditary or physical peculiarity.
General thinning of the hair is most likely to occur under conditions which lower the vital energy of the patient. The scalp generally is scurfy and dry. This is in all probability due to the sluggish action which goes on. The usual sebaceous matter is not secreted; the follicles become choked by retained fatty and epithelial matter, and the formation of the hair is interfered with. This is also the case in eruptive disease and in syphilis.
The loss of hair in all these cases is an evidence of the working of some debilitating cause; it is not remediable to the most perfect extent without the use of constitutional remedies.
The hair in cases of thinning and baldness is often dry, brittle, and twisted or split up. This results from the peculiar absence of moisture; in its turn from the diminished activity of the circulation of the scalp; in its turn again, from the general debility of the system.
The various other alterations in physical aspect come under the head of Parasitic Disease.
Treatment-The removal of superfluous hair may be accomplished by shaving, epilation, depilation, bleaching and electrolysis; of these agents electrolysis is far the preferable. This is easily done by introducing a fine, needle-shaped electrode into the papilla and connecting it with a galvanic battery. Any acid battery of from four to eighteen cells will be sufficient. The positive electrode is taken in the hand. From 25 to 50 hairs may be removed at one sitting, being careful not to remove hairs near together.
In the case of total loss, much good my oftentimes be done. In the first place, all syphilitic taints require treatment. Then debility of all kinds must be removed. In the cases which occur from a failure of the reproductive function of hair-forming apparatus, local stimulation is necessary whenever any downy hairs are visible; if these be absent, the scalp atrophied from disease, and white and shining, little good will be done. If there be oedema, or any tension, though the follicles are distinct, tincture of iodine applied over diseased parts every two or three days is of service. Shaving the downy-haired scalp is also beneficial.
I have used the following application with excellent results.
Rx. Quiniae Sulph., dr.jj.
Bay Rum, z3 v.
Ol. Rosemary, dr. iv.
Tinct. Cantharis, z3 j.
Glycerine, 3 jss.
M. Sig: Rub into the scalp every morning with a small sponge. Some may prefer the following; Rx. Carbolic acid,
Tinct. Iodine, aa z3 iij.
M. Sig: Apply once a week with a brush.
The principal internal remedy is Phosphorous, and the next Natrum mur. Others may be indicated for alopecia in general, as follows;
Aloes-when the hair comes out in lumps, leaving bald patches.
Arsen-When it falls out in circular patches. Calc carb-When th4e bald spots are on the temples.
Carbo veg-Falling off of hair after severe illness, or after parturition.
Fluor. ac-When there is a syphilitic taint.
Graphites-Bald spots on sides of the head.
Helleb.-Falling off of hair from eyebrows and pudendum.
Hepar-Bald spots on the head, after headaches.
Kali carb-Dry hair rapidly falling off with much dandruff.
Mancinella-Falling off of the hair after severe acute diseases.
Phos-Falling out in tufts.
Phosphorusac-Alopecia as a result of debility. hair Vinca minor-The hair falls out in single spots, and white hair grows there.