Senile Alopecia.—Senile alopecia may begin at 45 or 50 years. The hairs first become gray, then white, dry up, and their root atrophies. They finally fall, while the scalp shows the signs of senile cutaneous atrophy.
This form usually begins at the vertex, rarely at the temples.
Senile and precocious alopecia is usu ally severe and progressive. It is con fined to the antero-superior portion of the scalp, beginning on the top of the cranium and moving forward, leaving a little tuft of hair above the forehead. The posterior and lateral portions of the scalp preserve their hair almost, or quite, intact. Fournier (La Med. Mod., Dec. 11, '90).
Alopecia Following Acute and Chronic General Diseases. — Though usually not marked, alopecia. in these cases may be intense and general. Seborrhoea is fre quently present concomitantly. The alopecia is not especially localized; it affects uniformly the scalp, thinning out the hair.
The alopecia of convalescence pro gresses rapidly, being produced in the course of a few weeks. It generally affects all parts of the scalp equally, and rarely results in complete baldness.
Cachectic alopecia occurs in the course of pulmonary phthisis, cancer, cirrhosis, malaria, scorbutus, diabetes, etc. It affects the entire scalp impartially. The remaining hairs are dry, lustreless, and brittle, often breaking off before falling out. Fournier (La Med. Mod., '90).
Syphilitic Alopecia. — This variety of alopecia is usually found in irregular thinned-out patches or streaks over al most all the scalp. The hairs are dry and their roots are atrophied; they fall out rapidly. Every degree may be ob served, from simple thinning of the hair to general alopecia of the body. Some seborrhoea of the scalp is frequently present. The eyebrows are frequently thinned.
In some cases syphilitic alopecia is due to secondary or tertiary lesion of the scalp.
Syphilitic alopecia occurs in the third to the sixth month of the disease, or, rarely, in poorly treated cases, at the end of one or even two years. It comes early in the disease or not at all.
There are two forms of syphilitic alopecia: the symptomatic, accompanied either by pustulo-crustaceous, "acnei form" lesions, forming the little brown ish or blackish crusts so common in the scalp from the third to the sixth month of syphilis, or, more rarely, by a very slight pityriasis-like eruption, sometimes only to be distinguished by a lens; the idiopathic, which is the most common, and which, in reality, is accompanied by a lesion. (Giovaninni and Darien.)
There is a proliferation in the hair bulb, and the fallen hair is often found to be atrophied at its root. There is no itching, redness, nor other symptom oc curring in connection with syphilitic alo pecia, other than the mere falling of the hair. It is asymmetrical, affecting any locality by chance. Sometimes the fall of hair is diffused, resulting in a general thinning; at other times it occurs in patches; occasionally both forms occur together. Fournier (L'Union Med., Dec. 4, '90).
Premature Idiopathic Alopecia.—This form of alopecia may begin early. The falling hairs are replaced by smaller hairs, which in their turn fall out, until finally only a smooth, shining scalp is left.
Frequently, besides the fringe of hair always left at the back of the head a small tuft of hair is left at the anterior portion of the scalp, just above the middle of the forehead. (Jackson.) Two cases of alopecia universalis ob served in male adults presenting the sequel of iridochoroiditis. In one case the ocular disease appeared subsequent to the loss of hair; in the other it pre ceded it by about a year. Froelich (Re vue Med. de la Suisse Rom., Dec., '90).
Case of complete generalized alopecia combined with partial anesthesia and analgesia in a man 20 years old. Bissett (Maritime Med. News, Feb., '94).
Etiology. — Alopecia following acute and chronic general diseases is due to le sions of the hair caused by the disease, aided by neglect of the hair during ill ness. It occurs most frequently after typhoid fever, the eruptive fevers, espe cially scarlatina, and, less frequently, erysipelas. The severer phlegmonous diseases and typhus are followed by alo pecia, as also occasionally severe acci dents, haemorrhages, and pregnancy. Many vinen lose their hair after a perfectly normal labor. (Fournier.) All prolonged debilitating influences; excessive work, intellectual labor espe cially; genital excesses, overindulgence at the table, watching, and late hours may give rise to alopecia. Excessive intellectual work, however, is less likely to produce alopecia than the other forms of excess.