3. DISEASES OF THE HAIR AND HAIR-FOLLICLES
(Hypertrophy of the hair; Superfluous hair; Trichauxis; Polytrichia; Hirsuties; Hairiness).
Definition. A condition in which there is an excessive or abnormal growth of the hair, either as regards age, sex, region or degree.
Symptoms. This abnormality may be congenital or acquired, and of limited or general distribution. Congenital hypertrichosis is rare, the partial variety being less so than the general. When hair appears upon a pigmented or elevated base, constituting a hairy nevus, the common type is seen. It is usually localized especially over the sacrum. Fine white downy hair is normally found over most of the cutaneous surface except the palms, soles, last phalanges of the fingers and toes, eyelids, glans penis and prepuce. When this fine hair becomes hypertrophied or pigmented or both, it is more vigorous in the parts where hair growth is ordinarily pronounced. It may be extreme enough to constitute that rare condition known as general hairness.
Acquired hypertrichosis is mild as compared with the foregoing and is usually local, although rarely, general acquired hirsuties has been observed. The local variety in women is more active at puberty and at the menopause. Although pilary hypertrophy may be very slight or strong enough to resemble masculine hairs, the cases that demand treatment are usually influenced by the locality of the overgrowth. Hence it is that women with hairs upon the upper lip, chin, cheeks, neck and breasts are usually those who seek the dermatologist. Pilary hypertrophy may involve the trunk and extremities as well as the face. Sometimes two, and even three hairs, have been observed emerging from a single follicle, but in most cases these conditions are examples of hair splitting.
There are two conditions, most interesting to the oculist, in which hair deviates from the normal direction in which it should grow. Trichiasis consisting in the congenital or acquired displacement of the hairs of the eyelids so that they are directed backward and rub the eyeball and distichiasis, representing the development of a double row of lashes, the inner of which are directed backward onto the eye. Both of these conditions may result from chronic inflammation of the eyelids and their treatment concerns an oculist only.
Etiology. Local influences such as exposure to the sun and wind, continued applications of heat and moisture, the use of pilocarpin or other hair stimulants, together with often repeated local friction may predispose to excessive hair growth. The application to the face of grease alone is probably an imaginary rather than a real causal factor in most cases. Heredity is the most apparent cause, even in cases that develop in later life. The condition is more noticeable in brunettes than in blondes and is found more commonly in some nationalities than in others. Excessive hair growth may occur in the climacteric period, occasionally associated with a decided change in voice and manner. Temporary growth of hair has been noted in pregnancy, from delayed or suppressed menstruation and from injuries; occasionally excessive hair growth in normal situations has followed a severe sickness, in which cases the hair seems to have proposed at the expense of the general system.
Prognosis. The exact degree of success to be expected from the electric treatment for excessive hair growth is in proportion to the number of hairs, the age of the patient and the skill of the operator. All other methods of removal, except in a few cases where the X-rays may be used, are temporary expedients.
Treatment. General hypertrichosis cannot be treated because the tax on the operator’s time and patience is beyond endurance. It is only to remove the cosmetic blemish that treatment is essential from any standpoint. Moderate growth of hair on the face or other parts should be removed by electrolysis. This must be carefully done for unskillful attempts do more harm than good, often causing increased growth. As a rule, hairs near together should be removed at the same sitting, but not more than twenty to forty, so as not to exhaust the patient and cause undue local inflammation. Although thirty to fifty hairs may be destroyed in an hour, I have found that this is too great a tax on the operator and the patient. Only stiff coarse hairs should be removed. Lanugo hairs should never be touched, not only because they cannot be destroyed, but because stimulation tends toward their further development. While sensitive patients may feel pain from electrolysis it is usually bearable and is felt less at successive sittings. I seldom find it necessary to use a local anesthetic but if it is essential, cataphoresis of cocain is the best method. Brushing the surface with a 10 to 20 per cent. solution of cocain in alcohol, or dipping the needle in oleate of cocain each time before it is inserted, present no advantages over the first mentioned method.
A galvanic battery of sixteen to thirty cells, as needle-holder, a fine needle (steel, iridoplatinum or jeweler’s broach), the necessary cords, an electrode, a rheostat, a milliamperemeter and epilation forceps comprise the apparatus needed. The holder should not include an interrupter because the current must be broken at the positive electrode and not at the needle. A magnifying lens attached to the needle holder, or magnifying spectacles, may assist the operator. According to the sensitiveness and thickness of the skin and the size of the hair-follicles, the strength of the current will vary from 1/4 to 1 1/2 milliamperes, 3/4 being the average. The positions of the patient and the operator should be that of the greatest ease for both, with a good natural or artificial light. The hairs to be removed may be cut off within a quarter of an inch of the surface which is sponged with alcohol. The stub of hair left is then grasped with the forceps and gently pulled outward in a line with its natural growth and at the same time the needle attached by means of the needle-holder to the negative pole of the battery is passed down beside the hair and on a line with it into the bottom of the follicle. Little or no force is used in inserting the needle; if rightly directed it slips easily into the depth of 1/16 to 1/4 of an inch, according to the depth of the follicle. The patient, who has held the handle of the sponge electrode connected with the positive pole in one hand, may now connect the electric circuit by placing the palm of the other hand upon the sponge. Evidence of electrolytic action will soon show by the appearance of bubbles of froth and the current is broken, after twenty to thirty seconds’ duration, by the patient removing the hand from the sponge before the needle is withdrawn. Then the hair will come away with very slight traction from the forceps. Hot water applications are used immediately afterward or, if there is much soreness, 1 part of arnica to 10 each of alcohol and water, or a mild boric acid ointment may be applied. A small papule or wheal appears at the site of the removal, but by the second day only a small point remains which is gradually transformed into a minute scar.
The only other method for removing the hairs permanently is the X-rays. This agent should be used on facial cases of a very severe and disfiguring type only, but it is my routine treatment for excessive hair growth of the extremities. A few exposures will not suffice, although nothing greater than a mild erythema should ever be produced. Freund recommends about twenty treatments with a high tube, insisting on supplementary treatment for a year and a half to insure permanency. I consider ten minutes as the usual maximum time and eight inches the minimum distance used at each exposure. It is well to bear in mind the dangers of pigmentation, wrinkling and telangiectases. Although the treatment is quicker, less painful to the patient and not so tedious for either the patient or operator, it must always be employed with skill and caution. Recently I have had as good results from the massive dose method as I formerly experienced with the fractional X-raying. The so-called unipolar X-ray tube, applied directly to the surface has benefitted a number of my cases, especially those showing extensive but fine growth.
The other methods of removal embrace shaving, cutting, extraction with tweezers, or the use of a depilatory. The first three methods present no advantages from any standpoint and, while the depilatories will not permanently arrest the growth of the hair and are liable at any time to inflame the skin, they are occasionally demanded. I have always tried to dissuade patients from applying them to the face, but in many instances they are the simplest method with which to remove hair from the arms and legs. If demanded, the following may be effective; equal parts of the yellow sulphid of arsenic and quicklime mixed with enough hot water to make a paste which may be spread upon the skin with a spatula and when dry or when burning is experienced, it may be removed with the same instrument; or 25 to 50 per cent. of pure barium sulphid mixed with zinc oxid powder or equal parts of starch and zinc oxid. This is applied and removed in the same manner as the first prescription. These depilatories can be repeated as needed and they will be needed because this method is only a modification of shaving. If irritation of the skin results, a mild ointment can be applied, or if the inflammation is slight, it can be hidden by a simple dusting powder. In a number of cases, especially in those having a dark growth or where there is an aversion to any of the before-mentioned treatments, hydrogen peroxide applied daily on a compress, gradually increasing from a 50 per cent. solution to full strength, certainly bleaches and, if combined with equal parts of adrenalin chlorid (1-1000), may retard the growth as well.