DISORDERS OF THE SCALP 253 space pins or blades to combine large size with effective agglomerate break- down. The experience on which I base these observations does not all come from cosmetic applications, of course. Some of your problems are special ones. But the general rules that apply in such fields as pharmaceuticals, foods, plastics, ceramics, powder metallurgy, chemicals and others provide a pretty sound platform on which to work. TOPICAL AGENTS FOR TREATMENT AND PREVENTION OF DISORDERS OF THE SCALP By I•twiN W. LvBowE, M.D.* Presented November $, 1960, Seminar New England Chapter, Storrs, Conn. THE EAR•,•EST humans with whom we are acquainted, namely, the cave men and their apish forebears, possessed hair which covered the en- tire surface of the body. It protected them from the cold, the heat, the sun of the day, the rain and the wind, and also acted as a protective padding against traumatic injury. With the evolution and civilization of man, tie has been shedding his natural hairy covering to become increasingly hairless but with the maintenance of scalp hair. Because of the diminished need for scalp hair it is becoming sparse with the passing of time. The in- cidence of dermatological disturbances of the scalp hair has been increasing during the past decade. The relative increase in the incidence of seborrhea capiris and alopecia has been reported both in the male and in the female. The pathogenesis particularly of' seborrhea capitis is related to altera- tions of the physiology and function of the pilo-sebaceous apparatus. The related causes pertain to a combination of internal or constitutional varia- tions and contributing external or local factors. The internal causes are: (1) hormonal imbalance--disturbance of the relation of hormone secre- tion between androgen and estrogen. (2) impaired metabolism and nutrition. (3) dietary indiscretion such as excessive carbohydrate and lipid intake. (4) increased nervous tension. The external causes are: (l) biochemical changes of the cutaneous tissues of the scalp. (2) increased activity of the resident bacterial and fungal flora. * Assistant Professor, New York Medical College, Metropolitan Hospital Center, New York, N.Y.

254 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS (3) inflammatory and traumatic reactions following the imprudent use of topical irritants and sensitizers, and cosmetics. The hormonal imbalance manifests itself in a disturbed physiological relationship of androgen to estrogen secretion, usually with relative increase of androgen. The impaired metabolism is frequently associated with de- creased activity of the thyroid and the inability of the body to properly assimilate excessive carbohydrate and lipid food ingested, particularly animal and saturated fats. The oral intake of large and continuous amounts of iodine as a constituent of iodized salt and shell fish also play a role in disturbed sebaceous secretion. The biochemical changes of the scalp tissues may be projected because of an altered-ion concentration, reduced cutaneous circulation and the injurious effect of unsaturated lipids present in the sebum producing damaging effects of the sulfhydryl compounds contained in keratin with liberation of hydrogen peroxides. Flesch (10) has reported on the damaging effect of unsaturated com- pounds upon the hair of animals. In the normal genesis of keratinization of the epidermis there chronologi- cally occurs a progressive accumulation of a fine, microscopic epidermal scale which is invisible. This process is continuous unless disturbed by a constitutional imbalance and the internal and external causes mentioned previously. As a result, the accumulation of epidermal scales and debris becomes visible. This pathological process is manifested by the presence of irregular, white, greasy scales which appear on the scalp, the shoulders and sleeves of the clothing following brushing or combing of the scalp. Although no single pathogenic etiologic agent has been singled out, labora- tory studies by the author (1) have indicated that there is an accelerated growth of the resident staphylococcic genus and the pityrosporum ovule on the scalp. Because of the variety of etiological and contributing fac- tors, we believe that the most satisfactory approach to this problem is an attempt to control seborrhea capiris by local therapy, with additional at- tempts to correct the internal and external factors. Cosmetic acceptibility and nontoxicity are important considerations in the choice of a preferred topical agent. It is essential to rule out immedi- ately preparations which stain the hair or scalp, leave an offensive odor, or cause the hair to become unmanageable and oily. The author has pro- posed the following requirements for an ideal seborrheic therapeutic agent (2): this antiseborrheic agent should be nontoxic, have a mild keratolytic action, possess a wide fungicidal and bactericidal spectrum, reduce oiliness when necessary, relieve pruritis and must not be an irritant or allergen. After careful study of the methods which have been utilized in the topical treatment of seborrhea capiris, it has been ascertained that there exist basically four methods of application and utilization of seborrheic prepara- tions: