ALOPECIA IN WOMEN : ITS CLINICAL FORMS AND PROBABLE CAUSES 443 of the sebaceous glands. The values of urinary 17-ketosteroids determined in 15 patients were within normal limits. In four patients increased values of androsterone (ranging from 4.54 to 7.06 mg/24 hr) were found by chromato- graphic separation of the total urinary 17-ketosteroids. At present, direct measurements of testosterone excretion values are being carried out in female patients with diffuse alopecia. Parallel deter- minations of oestrogens and gonadotropin levels are also being performed. (Received .' loth April 1964.) REFERENCES (1) R. Sabouraud Les maladies sdborrhdiques (243-248) (1902) (Masson & Cie., Paris). (2) L. McCarthy Diagnosis and treatment of diseases of the hair 492 (1944) (C. V. Mosby Company, St. Louis). (3) E. Juster Presse todd. 56 252 (1948). (4) H. T. Behrman The Scalp in Health and Disease 177 (1952) (C. V. Mosby Company, St. Louis). (5) E. Ludwig Hautarzt 13 338 (1962). (6) E. Ludwig Parfiimerie u. Kosmetik 43 373 (1962). (7) F. Tenchio Dermatologica 115 743 (1957). (8) M. Sannino and D. Montemurri Minerva dermatol. 32 (Suppl.) 97 (1957). (9) E. Sidi and Bourgeois-Spinasse Presse mid. 66 1767 (1958). (10) M. Binazzi and T. Wierdis Giorn. ital. dermatol. e sifilol. 96 243 (1960). (11) O. Braun-Falco and H. Zaun Arch. hlin. u. exptl. Dermatol. 215 165 (1962). (12) M. B. Sulzberger, V. H. Witten and A. W. Kopf A.M.A. Arch. Dermatol., 81 556 (1960). (13) A.M. Kligman A.M.A. Arch. Dermatol. 83 175-198 (1961). (14) E. Ludwig Arch. klin. u. exptl. Dermatol. In press. (15) M. Binazzi and T. Wierdis Ann. dermatol. syphilig. 89 382 (1962). (16) S. Rothman, see Th. B. Fitzpatrick A.M.A. Arch. Dermatol 84 687 (1961). (17) J. B. Hamilton Ann. N.Y. Acad. Sci. 53 708 (1951). (18) W. Montagna Ann. N.Y. Acad. Sci. 83 362 (1959). (19) J. B. Hamilton and H. Terarda, in R. B. Greenblatt The hirsute female 20 (1963) (Charles C. Thomas, Springfield, Ill.). (20) M. A. Smith and R. S. Wells Arch. Dermatol. and Syphilol. 89 95-98 (1964). (21) •¾. Zimmermann Chemische Bestimmungen yon Steroiden in K6rperfiiissigkeiten 63 {1955) (Springer, Berlin). (22) E. Dingemanse, L. Huis, T. in Veld and S. L. Hartogh-I•atz f. Clin. Endocrinol. and Metabolism 12 66 (1952). (23) D. Ahrens Z. Vitamin-Hormon-u. Fermentforsch. 12 15 (1961). DISCUSSION MR. N.J. VAN ABBE : I see no reference in your paper to the mechanical effect on the hair of women--to what has been called traction alopecia. Does this not account for a number of cases of female alopecia ? THE LECTURER: Traction alopecia is a well defined clinical entity and occurs mainly in the pony style. Such cases were carefully excluded. I would like to add that traction alopecia will occur without all the other accompanying symptoms which I mentioned. MR. N.J. VAN ABBE: Concurrently with loss of hair, as described, one might expect changes in the growth rate and probably in the hair diameter. Can you comment ? THE LECTURER: You are perfectly correct. The reduction in the number

444 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS of hairs, as in common baldness, is usually accompanied by a narrowing of their diameter and some deficiency in colour, which means that dark hair becomes somewhat lighter. MR. L. DEADMAN: Have you any experience with the different types of hair brushes ? Is it true that nylon, as distinct from bristle, hair brushes as used by women tend to accentuate the effect which you described ? THE LECTURER: This question ought to be directed at Mrs. Saville who wrote about the obnoxious effect of some nylon bristles. At any rate, the repercussions of using such brushes concern only the texture of the hair present, and may enhance trichorrhexis nodosa and splitting of the hair, but it will have no effect whatsoever on the growth of hair. MR. L. DEADMAN: You did not actually question any of your patients concerning this point ? THE LECTURER: No. MR. M. R. OLIVER: Was it determined during the tests whether the decrease in the diameter of the hair follicle related to the original hair follicle or to a secondary one growing later ? THE LECTURER: No attempt was made to make this distinction. DR. B. LANGE: Do you have any idea how frequently alopecia in women occurs ? What is the percentage ? THE LECTURER: The rate of occurrence of diffuse alopecia in the general population is unknown at the moment, but we all feel that female alopecia is more frequent than is generally realised. MR. J. M. BLAKEWAY: Do you think that the distribution of these three types in your panel of 102 patients paralleled in any way their distribution in the whole population ? THE LECTURER: I do not know. MRS. H. BUTLER: Have you any evidence that treatment with oestrogens or related compounds, either by mouth or by application to the skin, would .either prevent or improve the condition ? THE LECTURER: We tried to treat all these women, at least with local preparations containing oestrogens and we know that a certain amount of oestrogens is absorbed by the scalp. We regret not to have seen any significant improvement. We feel that when there is some increased testosterone production we have to try to diminish the androgen secretion. This succeeds best with the administration of small doses of prednisolone. Favourable results were obtained in hirsutism, where there was an increased release of the androgens produced by the adrenal cortex. MRS. H. BUTLER: Did the treatment with oestrogen effect the results of urinary analysis for steroids ?