ALOPECIA Treatment

The premature loss of hair, which affects the crown of the head and the temporo-frontal regions in men and in women only the crown, is not amenable to treatment.

Alopecia areata is often hereditary and is probably due to a biochemical abnormality connected with the activity of the hair follicles causing them to become dormant either temporarily or permanently. Since the nature of the disturbance is not understood there is no means of knowing how long it will last in any individual patient. Bad prognostic signs are onset of the condition before puberty, a family history of total alopecia, and dystrophy of the nails. The immediate prognosis can be determined by pulling the hair at the edge of the patches ; if it comes away easily and painles'sly the process is spreading. In those liable to the disease attacks can be precipitated by emotional stresses for example by bereavements and motor accidents, but some weeks may elapse before alopecia develops. No treatment has any regularly predictable effect, except the use of corticosteroids. Injections into the lesions are useful when the disease is localized. The application of betamethasone valerate or fluocinolone acetonide ointment with polythene occlusion can be helpful in very widespread cases. Oral treatment may have to be continued indefinitely, and the few occasions on which it might be justifiable are discussed elsewhere. It is probable that improvement, occurring during the various kinds of treatment commonly employed—such as ultra-violet light, scalp massage, painting with solutions of iodine or of lactic acid—is merely incidental; the natural history of the disease is usually towards resolution. When indicated by the emotional state of the patient a sedative such as phenobarbitone 30 mg. twice daily should be given. Painting with Thorium X is not recommended.

The hair may fall out—a defluvium of hair—following some toxic illnesses (especially pneumonia and influenza), in thyrotoxicosis, during the use of certain drugs such as heparin and cyclophosphamide and after parturition. This does not require treatment; the hair can be expected to grow again completely. In myxosdema the hair is dry and scanty but this does not justify the administration of thyroxin to everybody who complains of loss of hair.

The preceding forms of alopecia must be distinguished from the rarer ones in which there is scarring of the scalp. Here there is destruction of the hair follicles and there is no hope whatever of any regrowth of hair. Reference to a dermatologist is desirable, however, as it may be possible to arrest the disease. It is also important to remember that alopecia areata can be closely imitated by secondary syphilis, and that alopecia with scaling and pustulation may be due to ringworm.

In any form of loss of hair it is advisable to avoid unnecessary brushing and combing of the hair and to prohibit massage, since these measures in themselves can cause considerable loss if carried to excess. Hairbrushes with natural bristles are less traumatic than those with nylon bristles particularly the square-ended variety, the sharp angles of which tear the hair in brushing. If dandruff is present, the scalp should be shampooed once or twice weekly using cetrimide solution or soap spirit B.P.C. to which has been added 2 per cent. of oil of cade. For local application 2 per cent. of salicylic acid and 2 per cent. of precipitated sulphur in emulsifying ointment B.P. can be applied by rubbing in gently (making partings with a comb for the purpose if the hair is thick) or salicylic acid and mercuric chloride lotion B.P.C. can be sprinkled on- and worked in gently with the finger tips.