ALOPECIA AREATA (Area Ceisi-Pdade) In this affection, in which without assignable cause and without any noticeable change of the scalp, the hair falls out, circumscribed roundish foci make their appearance.
'Usually the hair falls out first in a small annular disk, at the margin of which the hair breaks off, so that only small stubs and comedo-like bits remain in the sebaceous glands. The hair easily comes out when pulled, and the affection extends peripherally. New disks are formed which may become confluent and spread over the entire scalp. Gradu ally new unpigmented thin hair appears, which gradually acquires pig ment and grows stronger. On the other hand the unpigmented hair may fall out again and again, until at last the final firm crop has been secured. In this way the affection may last for months before it is con trolled. Aside from this benign form there is a malignant one in which within a few weeks the hair of the entire body may be lost.
Alopecia is found in children of all ages, but is comparatively rare (in Germany it is much rarer than in France). Sabouraud distinguishes three forms in children: (1) In the first form the hair falls out slowly, reappearance also occurs slowly but only after five or six months. The affection commences with a spot, on which the skin looks atrophic, dry, somewhat desiccated (peladoide etre unique avee atropho clermie excessive). (2) The second benign form seems to be contagious, occurs in families endemically without known cause; there arc six to eight foci of the size of a quarter; reappearance of hair in six to seven weeks (peladoide familiale en petite,: aires multiples). (3) The true alopecia. It eommences bilaterally at the oceiput, spreads in secondary plaques over the head, is sharply symmetrical, lasts a considerable time, is eured spontaneously- at puberty, persists sometimes for years and is not contagious.
there are two opposite opinions, one favoring the nervous trophoneurotic and the other the parasitic theory, which is particularly upheld by Sabouraud. For both views there are
proofs and therefore alopecia probably has more causes than one (a nervous and a parasitic) which is also the opinion held by myself. Of interest for the etiology of alopecia are the experiments of Joseph (appearance of bald foci after cutting the second cervical nerve in cats) and the experiments of Giovanni, Buschke, etc. (appearance of alopecia after internal administration of thallium acet.).
The prognosis of alopecia areata is better in children than in adults, as the hair nearly always reappears on account of the absence of malig nant conditions.
Treatment should be irritative and antiparasitic. The former effect is attained by massage and the faradic current. Atnong the chem ical agents painting with balsam of Peru, tincture veratri, china( canthar ides, capsici, argent. nitr. 1: 15 with tincture of iodine or pure carbolic acid have an irritative effect.
The antiparasitic remedies, which should be applied together with the former, are the following: chrysarobin Et,3 to 10 per cent. oint ment or dissolved in alcohol or chloroform, as a 30 per cent. ointment or its substitute, curobin. A very good effect is attained by washing the head with sublimate, forrnalin or naphthol soap. The following treatment has given the best results in my hands: The scalp is washed daily with disinfecting soap and afterwards rubbed with an irritative ointment about 1 ern. beyond the margin of the affected place. The fol lowing ointnient is serviceable. Chime cantharides, eapsici aa 3.0 Gtn. [45 gr.), balsam of Peru 0.5 Gni. (71 gr.), ung. leniens ad 30 Gm. (1 oz.). Resides twice or three, times a week in the evening the places are painted with chrysnrobin or eurobin solutions, for instance eurobin 1.0 Gni. (15 gr.), acetone 30 Gm (1 oz.), or inunetion with the chry.sarobin ointment stick, followed by the application of a cap to be kept in place over night.