134 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS ences were to be noted. Changes of color are brought about by many factors and the natural and sudden graying of 'the hair are explained by many theories that have not been at all proved. Probably the greatest amount of recently recorded work done on any phase of the hair prob- lem has been done on the effect of vitamins, etc., on the graying of the hair. In a recent summary in the Nutritional Review (8), it was noted that the causes of achromo- trichia are not well understood. Both dietary deficiencies and hor- monal disturbances have been im- plicated. A deficiency of panto- thenic acid is known to result in graying of the hair in rats and other experimental animals and there is evidence that additional factors in- cluding para-aminobenzoic acid may at times be involved. On the other hand, the many studies that have been made, give us little reason to believe that human achromotrichia is caused by a dietary deficiency. In man, the process of graying and of aging are frequently associated and there is a popular belief that graying may b• accelerated by emotional stress. It is not sur- prising therefore, that hormonal control of the graying process should have been suspected even though direct experimental evidence has in a large measure been lacking. This confused picture has been somewhat clarified by Ralli, et al., who have shown that even in experimental animals rendered gray by a defi- ciency in pantothenic acid, adrenal- ectomy will bring about the restora- tion of the original color of the hair. It appears that hormone balance, dietary deficiency, and possibly mineral and water balances may in- fluence the production of melanin or its deposition in the l•air and skin. The hormonal control must be particularly strong since =drenal- ectomy overcomes the effect of a pantothenic acid deficient diet. It is not yet clear, however, whether the various factors operate through single or separate mechanisms and the nature of these processes is not well defined. The tendency to production of hairs of a finer, more silky character in advanced life, is caused by sebor- rhea according to Sabouraud (Sa) and is not a natural phenomenon of normal hair growth as was once supposed. This is explained as being due to a mechanical plugging of the follicles. The matter of pre- mature alopecia, therefore is a very complicated one in which probably many factors come in to plash. Studying the fundamentals and going back to the mechanism of the replacement of the hairs which are constantly being shed, therefore, would seem to be the logical ap- proach to the solution of this prob- lem. The question whether the vascular supply controls this me- chanism and the factors that might influence or control the vascular supply is therefore of the utmost interest and importance. Wright, et al. (Sb) studied seborrheic der- matiris and found the administra- tion of vitamin B0 (pyridoxine) re- suited in definite impro.vement and

THE DERMATOLOGIST LOOKS AT THE HAIR PROBLEM 135 occasionally in complete disappear- ance of this type of eruption when other standard measures of treat- ment had failed. Probably the last word has not been said in the matter of sham- pooing and certainly we are chang- ing radically in our views as to what is the best type of preparation to cleanse and wash the hair. The sulfonated oils which get us away from the alkaline soaps,. are un- doubtedly an improvement in some respects but they unquestionably have certain disadvantages, chiefly the fact that they do not lather well and that they are extremely drying to the hair in most cases. It is not my purpose to go into the dangers attendant to hair wav- ing or hair straightening except to point out that bad results have been reported from the cold wave and also to draw attention to the fact that hair waving usually causes changes in color of the hair but especially if other preparations are being used in the hair and scalp at the same time. It is probable that the number of cases of alopecia areata we see following the waving of the hair, may be purely coinci- dental. It might be a distinct ad- vantage to examine the hair and scalp under a wood light before waving, as a protective measure to the patient as it would give an ex- cellent idea as to the condition of the hair and its suitability for waving. I do not have in mind ruling out the possibility of a fungus infection, which would be unlikely in an adult, but it would give the operator fairly definite data as to whether the indi- vidual had been using other chem- icals on the hair that had not been thoroughly washed out. An ex- amination of the hair with the wood light after the wave would give you a good picture of what damage had been done to the hair, and might be a good check on the operator. Mild dermatitis venanata of scalp in fairly sharply localized patches with temporary hair loss due to breaking off of hair at a level close to the skin is not an infrequent sequella. Cotter (9) in 1946 reported that the number of cases in which a toxic reaction has been observed from the "cold wave" process using thiogly- colic acid appear to be on the in- crease. He reported in detail 5 cases from a large group because in these it had been possible to demon- strate their lesions in the laboratory. He showed that severe allergic reac- tions can result in sensitive persons from thioglycolic acid. Those indi- viduals with anemias and allergic disturbances are most vulnerable. In the majority of cases recovery occarred without permanent damage to the liver when the exposure was promptly terminated. In those cases in which the acid acted as a systemic poison as well as an aller- gen the first signs of trouble were to be found in the blood count, the elevation of the alkaline phospha- rase, the change in the ratio of free to esterified cholesterol, and the appearance of a positive cephalin flocculation test. The danger of using celluloid combs in water waving are too well