In chronic alopecia areata the infection of the hair-follicle is a permanent one; acute alopecia areata is a localized acute seborrhoea; alopecia decalvans is a gen eral chronic seborrhoea. R. Sabouraud (Ann. de l'Inst. Past., Feb., '97).
Alopecia probably due to autoinfec tion, the poison—"trichotoxicon"—being absorbed by the blood from the air-wes ides of the lungs. The poison would then be elaborated during decomposition of organic matter normally present in respired air. Parker (Med. Record, July 13, 1901).
These opinions of Sabouraud are not at present accepted by dermatologists generally.
Prognosis. — In senile alopecia the prognosis is unfavorable, the chances of cure being practically nil.
In alopecia following acute general diseases, on the contrary, the prognosis is generally good, and the hair soon re covers its former state, though in some cases seborrhoea persists and requires careful treatment to prevent relapse of the alopecia.
In serious chronic diseases, however, such as phtbisis or cancer, the prognosis is unfavorable.
The alopecia of convalescence is tem porary and reparable; entire repair of the loss occurring in young people; after forty years of age the hair is rarely reproduced in its integrity. Fournier (La Med. Mod., Dec. 11, '90).
[By no means is this always the ease in youth in my experience. A. VAN HARLINGEN, Assoc. Ed., Annual, '92.] Syphilitic alopecia, when not due to a local lesion, is only temporary and is soon recovered from by an appropriate specific and hygienic treatment. When due to a local lesion the alopecia may be incurable if the hair-follicle has been destroyed.
Syphilis never causes permanent and complete baldness. Properly treated, it is accompanied by extensive alopecia in only one case in twenty. Fournier (L'Union Med., Dec. 4, '90).
Premature idiopathic alopecia is usu ally looked upon as beyond treatment.
Treatment. — Premature Idiopathic, Senile, and Congenital Alopecia. — In these varieties general treatment is of importance. Arsenic and iron, continued for a long time and in small doses, alter nately, should precede all the methods resorted to. (E. Besnier.) A tonic treatment should be given where the nervous system seems to be at fault. The following pill should be taken thrice daily:— B. Strychnine sulphate, grain.
Reduced iron, Quinine bisulphate, of each, 1 grain. For one capsule.
When starvation of the nerves seems to be present, the compound syrup of the hypophosphites (Fellows's) is ordered in 1-drachm doses, thrice daily, with 7,„, grain sulphate of strychnia in each dose. Doses of '/, to '/, grain of muriate of pilocarpine in a powder, daily, at bed time, in water, are also of use. Ohmann Dmnesnil (New Orleans Med. and Surg. Jour., July, 92).
Mercuric bichloride or calomel inter nally, alternately with tincture of ignatia amara, 30 drops daily in three doses, or sulphurous acid, internally, are also rec ommended. (Shoemaker.) Excesses of any nature should be re frained from, and any habit or occupa tion tending to depress the general vital process be counteracted.
Alopecia should be treated not only by local application. but by remedies which influence the entire system. Strong sul phur-baths of thirty to forty minutes, followed by massage for ten or twenty minutes and hot spray for three to five minutes, are useful. A half-pint of sulphur-water should be taken morning and evening, while iodine tincture and hot sulphur-water should he sprayed over the scalp. Ferras (Annales de Derm. et do Syph., vol. iv, No. 10, '94).
Resorcin is of great service in the treatment of alopecia. (Bulkley.) Brocq recommends the following methods of using this remedy:— 4 Resorcin, 1 1/2 grains. Hydrochlorate of quinine, 3 grains. Pure vaselin, 1 ounce.
This is to be applied to that part of the scalp which is devoid of hair or from which the hair is rapidly falling. If the falling of the hair persists it is well to incorporate with it 5 to 15 minims of the tincture of cantharides, or to use the following: 4 Resorcin, 3 grains.
Hydrochlorate of quinine, 5 grains. Precipitated sulphur, 30 grains. Pure vaselin, 1 ounce.
Should these preparations produce much irritation of the scalp, an oint ment composed of 20 grains of borax to 100 of vaselin should be applied. After the irritation is relieved, weaker prepa rations of resorcin and quinine can be employed, of which the following is an example:— I: Salicylic acid, 5 grains.