Diseases Of The Scalp And Hair
( Originally Published 1927 )
Baldness among youthful and middle-aged per-sons is nowadays rather common, and the most usual cause for this condition is dandruff. Because of the important and frequent relationship between hair loss and dandruff, the latter will now receive our attention.
Dry Dandruff.—Description.—There are two forms of dandruff, a dry variety and an oily one. The outstanding features of the dry form (seborrhea sicca) are dryness of the scalp, dryness and absence of the natural brilliancy of the hair, scaling, which may be in powdery form, in layers, or heaped up, and itching. The scales often prove a source of great annoyance, for not only do they adhere to the scalp and cling to the hair, but in many instances may be found on the collar and shoulders of the outer garments.
Children between the ages of two and six seldom suffer from this form of dandruff, as it usually first appears at or just before puberty and may persist with periods of improvement throughout life. It is more frequent among men than women. Persistency in the treatment of dry dandruff is often rewarded by a permanent cure, and seldom does marked baldness result unless the condition is very severe or long neglected.
Causes.—Before considering the host of causes which either directly or indirectly may be responsible, let us remember this very important fact, that the life of hair depends mainly on the preservation of its nutrition, i.e., its blood supply. Any condition or disease, either of the body or of the scalp, which interferes with this function usually causes the hair to fall. A certain amount of baldness is to be expected with many of the prolonged fevers, with an impoverished state of the blood, and with such devastating diseases as syphilis and tuberculosis. Overwork, mental and nervous strain, and bad hygienic surroundings exert similar, unfavorable influences on the hair.
The continual use of hair brushes with metallic or coarse bristles and of fine-toothed combs, the repeated application of hair dyes, "restorers," elixirs, pomades and tonics may result in hair loss because they foster the presence of dandruff through their power of irritating the scalp. Washing the scalp too often or with unsuitable soaps, solid or liquid, and the neglect to thoroughly re-move the soap from the scalp may also produce irritation and thus favor the development of this condition. Many commercial shampooing mixtures contain too much material which causes a lather (free alkali) and are absolutely injurious.
Suggestions for Prevention and Treatment.—Success in the management of dandruff depends upon the elimination of any of the causes which favor its appearance. Mild cases usually do well with local applications. The following ointment has proven to be one of the best. Its formula is as follows:
White wax drachms 7
Adherence to the following suggestions is advised when applying this cream. The applications are to be made by a skilled operator, if possible.
The front and back of the scalp are to be laid out into eight parts and a very small amount of ointment massaged into each portion. This cream is to be used nightly for three successive nights and, on the fourth day, the scalp is to be washed with tar soap and water, and after drying, the ointment is to be again applied.
For the next seven to ten days, the cream is to be used every other day and, at the end of this period, the scalp is to be washed as previously. After this washing, the applications are to be made three times a week and the scalp again washed at the end of two weeks. The number of applications should be reduced, and the time between them lengthened until the ointment is used about twice a week and the washings about once every two to three weeks.
Severe or long-neglected dandruff requires the services of an expert, as local applications, tonics and regulation of one's life may be necessary to ward off the tendency to hair loss.
Oily Dandruff.—Ordinarily the scalp presents the first evidences of this affection, but there are instances where the earliest characteristic changes are seen upon the nose and forehead. The features peculiar to oily dandruff are an oily and greasy appearance of the scalp and hair, and shiny and oily condition of such parts as the forehead and nose. The oiliness appears first on the front part of the scalp and unless checked, it advances to the back and eventually to the entire scalp. This form of dandruff is much to be feared as it is capable of causing widespread baldness. A peculiarity here noticed is that the oiliness leaves those regions where the hairs are lost and is replaced by an increased sweating.
Causes.—It is a common observation that this affection advances more rapidly and its symptoms are more severe in those under thirty. Among the elderly, it advances rather slowly, its symptoms are slight and it often passes unnoticed until a certain amount of baldness results. Oily dandruff is rare among women. It appears most frequently during youth and is rare in childhood and old age. The exact cause of this condition is not definitely known. It is probable, however, that it is due to a germ.
Suggestions for Treatment.—Oily dandruff is rather difficult to cure. Continuous and proper treatment can hold it in check but it is very apt to reappear if treatment is stopped too early. Applications to the scalp are most important. This includes frequent washing with soap and water or with a solution of tincture of soap bark; in severe cases daily washing may be necessary. Lotions are more beneficial than ointments and only those pre-scribed by a specialist should be used.
It is needless to state that in addition to the care of the scalp, the general health and the hygienic surroundings of the patient should be investigated and, if need be, corrected. It is possible that in some cases, reduction in the amount of fat-producing foods such as butter, cream, and oils may have some influence on reducing the oiliness of the skin.
Oily Skin (Scurf, Seborrheic Eczema, Dermatits seborncceica).—Description.—In the en. tire domain of skin diseases, there are but few conditions with a course or migratory tendency as definite as that shown by "oily skin." The scalp, al. ways the first affected, shows merely increased scaling which may remain as the sole evidence of disease for an indefinite period. Then either gradually or suddenly and for no known reason, the scaling increases, the hair loss becomes sufficiently marked to be noticeable, the itching becomes rather intense, and reddish patches make their appearance. These changes furnish the first clew that this condition is active and about to spread. The reddish patches are covered with scales which are oily, greasy, soft and loosely attached, features due to an increase in the amount of oily material. Such patches may either cover the entire scalp, appear in areas here and there, or extend over the forehead beyond the hair line, forming the so-called "dandruff crown," usually a most disfiguring sight.
Not content with its invasion of the scalp, this disease usually spreads downward, either choosing the route behind the ears or that in front of the ears. After having gained a foothold on the face, certain areas such as the eyebrows, the mustache and beard region, and the folds between the nose and the corner of the lip are selected as the location for its reddish patches with their soft, yellowish, greasy scales, so characteristic of this disease.
In its further progress downward, the neck usually escapes and the disease settles on such areas as the breast bone, the armpits, the groin and the rectum, and here also, the patches display the same features described above. While the itching is usually moderately severe, it may be entirely absent. As a rule, the longer "oily skin" disease re-mains uncured, the more certain is it to return.
Cause.—In all probability some form of germ is responsible for this disease and its ability to pro-duce this condition is possibly aided by any circumstance which tends to lower the body vigor.
Suggestions for Treatment.—It is important that the parts affected be cleansed with cold cream, olive oil, or starch water, and under no circumstances should soap and ordinary water be used in such areas. Outdoor life and the avoidance of fried foods, sweets, and fatty foods should be encouraged. The general health and the digestion should be looked after and such treatment as necessary advised by a physician. Increasing scaliness of the scalp, regarded as one of the signs of oncoming activity, should always receive prompt attention.
Baldness. — Description. — Before discussing the forms of hair loss, let us acquaint ourselves with the normal appearance of the hair and scalp, as early recognition of any abnormality usually makes possible a rapid and efficient cure.
Normal hair is smooth and glossy, and its ends are blunt. When taken between the fingers it should be neither greasy nor dry and when rubbed against each other, a slight crackling sound should be produced.
The normal skin of the scalp should be white, smooth, neither greasy nor humid and should not soil or moisten the examining fingers. It should feel tense and resistant when grasped by the fingers; difficult to take hold of and not easily separated from the underlying skull bones.
Difficulties with the growth of hair may be experienced at practically any age. Let us begin with the baby after birth. The hair on the baby's scalp may be thin, develop only in certain areas, or be long delayed. Only rarely does one see complete absence of hair. Such a condition is usually due to an inherited taint and is accompanied by a delay in the appearance of the teeth or some defect in them.
Hair loss between the ages of twenty and twenty-five is known as premature baldness. When-this follows such acute fevers as typhoid, influenza, etc., little or no worry need be felt, as regrowth usually follows restoration of health. But the baldness which comes on without any apparent cause, is usually rather serious. It begins quite innocently with the loss of a few hairs from time to time, re-placed in each instance by a shorter and finer growth. Later on, these fall and the regrowth is not quite as luxuriant. Finally, as this continues, the hair of the entire scalp may be lost. This affection occurs in both sexes, although less frequently in women than in men.
Causes.—There is a growing belief that most cases of premature baldness are caused by dandruff and statistics seem to confirm this impression, for 75 per cent of all persons suffering from premature baldness have dandruff.
Hair Loss in Youth.—We have been informed that germs probably play an important r6le in dandruff, especially the oily type. The germs en-ter the hair sacs and after remaining there for some time, increase in number and form a sort of layer which separates the hair from the wall of the sacs. Then follows an increased activity of the oil glands, with a great increase in the amount of oil, and finally a shrinking of that part of the hair which furnishes nourishment. This invasion by the germs is undoubtedly helped by such conditions as city life, insufficient exercise, excessive meat diet, heredity, etc., for hair loss is rare among savages and much less common among the country folks than among those living in cities.
Hair Loss in Aged.—More or less baldness among the aged is natural. It begins with a gradual thinning of the hair, noticed first on the top of the scalp, traveling to the temples and finally to the front of the head.
The explanation for the hair loss among the aged is rather interesting. If the healthy scalp of a young or middle-aged person be examined, a thick layer of fat will be found between the scalp and the skull, and to this layer the under surface of the skin covering the scalp is attached rather loosely. When baldness develops, this fat layer becomes thinner, the scalp more firmly attached to the skull and therefore less movable and more tense; the hair follicles gradually shrink and finally disappear entirely. This form of baldness first appears on the top of the head because there the hair follicles disappear the earliest.
Suggestions for the Treatment of Premature Baldness.—Since the underlying cause of premature baldness is usually dandruff of the oily type, the suggestions given for combating the oily dandruff are here equally valuable. Outdoor life, exposure of the scalp to sunlight, a restricted meat diet, and avoidance of excessive mental work are valuable precautionary measures. Daily finger massage of the scalp is distinctly useful, as is also the application of the hair brush, not too vigorously, but just enough to produce a reddening and slight warmth of the scalp. The advice of a skin specialist should be sought at the earliest possible moment, for with the introduction of the modern methods for treating such conditions, the outlook for success is much more hopeful.
The hair loss following acute fevers is usually easily remedied by any of a number of tonics, but only those prescribed by a physician should be used.
Patchy Hair Loss (Alopecia areata).—Description.—Patchy hair loss is the name applied to that form of hair fall which usually comes on suddenly and always in patches. These patches have sharp borders, are round in shape and vary in size from that of a coin to that of the palm of the hand. The skin of the bald part is smooth, soft, dead white and without any evidences of hair. In some cases the hair loss develops suddenly in a few hours, and. in others it is gradual, extending over a period of days or weeks.
The time required for the restoration of the hair varies greatly, regrowth seldom occurring in less than a few months. In children and very young persons the hair usually returns, but in adults the baldness may persist, at times, in spite of treatment. When regrowth occurs, the patches are first covered by fine, downy, whitish hair, which later becomes coarse and of the same shade as the rest of the hair.
Cause.—Hair loss in patches is usually caused by nervous shocks such as fright, prolonged anxiety, etc., and may also follow injury to the skull.
Suggestions for Treatment.—The successful treatment of this condition requires tonics for the general system as well as local applications. These should be carried out under the direction of a specialist.
Grayness of the Hair (Canites).—Description.—Graying of the hair usually happens after birth (acquired) though, in rare instances, it may be inherited. One expects this condition in those of advanced years but it is not unusual in comparatively young people. All the hair may become gray or white, or a few such may be found here and there over the scalp. The hair of the temples is usually the first to show the graying, followed by that on the top of the head. The loss of the coloring matter is usually permanent, although there are cases on record in which the color of the hair changes with the seasons or with the condition of health. Graying or whitening of the hair usually comes on slowly and in the course of years, but can be acquired in a few months or weeks.
Cause.—Loss of the normal color of the hair may follow fevers, especially scarlet fever and typhoid fever, also mental shock, intense fear or anxiety, neuralgia, physical exhaustion, etc.
Suggestions for Treatment.—There is no permament cure for graying of the hair; however, temporary restoration of color may be had through the application of certain dyes which are comparativeIy harmless. These should be applied by one trained in that particular work.
NOTE: Before the application of any hair dye, the hair should be washed thoroughly with soap and water. Commercial dyes which contain cyanide of potash or lead are to be avoided, as they may cause severe inflammation or lead poisoning in the latter case.
Hair Dyes. Harmful Effects.—It can be said that most dyes and bleaches cause some harm to the scalp, for after a few applications the hair usually becomes dry and lifeless, grows less luxuriantly and the ends break off. The growth of the hair, however, is not seriously hindered, unless an inflammation of the scalp results.
The dyes not only affect the hair but also cause, in many persons, a slight puffing of the eyelids and a trifling rash on the forehead and neck, after each application. This slight rash is of importance as it serves as a warning of an impending inflammation of the scalp if their use is continued.
It has been intimated that the aniline dyes are far from harmless. Their application may cause a rash (weeping eczema) which, while usually limited to the scalp, may spread over the greater part of the body. A very severe inflammation, closely resembling that of erysipelas, may also at-tack the scalp and even the face. The absorption of these dyes may affect the general health, causing sleeplessness, dizziness, stomach upsets, diarrhea, and poor eyesight. Indeed, several instances of death, following their use, have been reported. The habit of moistening dyed hair with the lips should be discouraged, for by so doing, a person runs the risk of poisoning.
Types of Dyes.—The vegetable dyes are the least likely to harm but the results they give are neither as beautiful nor as permanent as those obtained from the more dangerous aniline dyes. The popularity of the aniline dyes is due to the simplicity of application, great permanency of results, and the greater choice of color range.
Suggestions for Application.—The commonly used hair dyes consist, as a rule, of combinations of an aniline substance known as paraphenylen dianine and peroxide of hydrogen, in various pro-portions. These ingredients must be applied in combination for, if used separately, the risk of irritation to the scalp and of possible poisonous absorption is greatly increased. After the dye has been in contact with the scalp for a time, depending upon the effect desired, it must be thoroughly washed out with soap and water.