EVALUATION OF ANTIDANDRUFF FORMULATIONS 143 Tabulated data of the type shown often cannot withstand the statisticJan's onslaught, but they are meaningful to the clinicJan when they reflect ob- served individual trends. If the majority of subjects respond in a partic- ular manner, and an arithmetic average of all subjects confirms the majority trend, the change is probably real. Despite the apparent requirement that an antidandruff formulation be an effective cleansing agent and have demonstrable antibacterial powers, it is often found in practice that such products are not the most satisfactory for treating seborrheic individuals. Preparations such as the bland hair dressing shown in the preceding table are often most satisfactory thera- peutically. These questions arise is all dandruff the same and what type of individual has a susceptibility to this seborrheic state ? It is known that Seborrhea capiris may be just an early clinical sign of some other skin conditions or it may remain an entity in its own right. Not known is the percentage of individuals with seborrhea that go on to develop other skin conditions or with what frequency other diseases have an associated dan- druff condition. Such knowledge might help explain why antidandruff formulations are not uniformly effective. During the past few years, ! have taken particular note of the patients with dermatoses possibly related to Seborrhea capiris who have come to my office for treatment and have now made an analysis of these records. In addition to the seborrheic diatheses shown in Fig. 1, one finds dandruff associated with baldness, acne vulgaris, psoriasis, and infantile ezcema (Fig. 3). I have excluded from my study the minor number of hair loss cases whose cause can be determined and for which therapy is often effective. For example, these cases are those of alopecia due to psychic or physical trauma (a. areata, a. totalis), systemic disease (Lupus erythe- matosis) and specific infection (Tinea capiris). However, by far the major number of alopecia cases are those of male and female pattern baldness, and, for treatment of these, little can be done. Most of us associate dan- druff with ache vulgaris because it, too, is a disease of the pilo-sebaceous system. Psoriasis is probably a hereditary disturbance in fat metabolism, yet we have a condition known as seborrheic psoriasis, and psoriatic scalp lesions are of very frequent occurrence. Infantile eczema, on the other hand, is almost entirely of alle.rgic origin, yet it very frequently first presents itself as "cradle cap." An analysis of data taken from my office records of appropriate patients with these particular dermatoses seen during 1960 and 1961 is given in Table IV. There were 90 individuals with male or female pattern alopecia. Eighty-three % of these patients had dandruff, the men even more than the women. There were 94 individuals with ache, but despite the fact that this is a pilo-sebaceous disorder, only 42 % had dandruff. Similarly, of the 15 cases of psoriasis, only 46 % had dandruff.

144 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS .c.., '3. •'""•-. • . ... : Figure 3.--Dermatoses related to seborrhea (dandruff). (A) alopecia. (B) acne. psoriasis. (D) infantile eczema. ?..ii¾i.... ,:,..¾•.,...::':.- -'.. 5.'¾, :... :... ? :•'• • ,--.. .•.... .., ß . ß •.:,% • .. ., ,: •. ,...•.' ....... •..'• :..- ,. . ..,-•.,,,.• (c) Eight infants with facial or body eczema attributable to a food allergy all had dandruff. Finally, there were 16 adults with severe seborrhea who