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 ?

ALOPECIA IN WOMEN : ITS CLINICAL FORMS AND PROBABLE CAUSES 445 THE LECTURER: This was never investigated. MR. ]3. N. ]3LOCH: You mentioned that the first two types of alopecia are usually accompanied by oiliness of the scalp. Is it your experience that the same happens in male alopecia ? THE LECTURER: Yes. Oiliness of the scalp is a constant symptom .accompanying common male baldness as well as all the types of female baldness, but there are also exceptions. MR. L. DEADMAN: IS there any evidence of remission in pregnancy in lhe younger age groups ? THE LECTURER: Yes, the beneficial influence of pregnancy is very ,evident. During pregnancy, and especially in the last months of pregnancy, hair fall is stopped, oiliness is reduced and the female hair finds itself in .an optimum condition which unfortunately does not last after delivery. MR. A. HERZKA: IS there any relation between alopecia in women, and the number of previous pregnancies ? THE LECTURER: I cannot answer this question. I only wish to mention ihat in the first type we have a lot of younger women with no previous pregnancies. It is my personal belief that previous pregnancies are not a deciding factor. DR. A. W. HOLMES: How would you assess the effect of a treatment ? THE LECTURER: We can consider the daily loss of hair, and the number •)f hairs per unit area. The decrease in the number of hairs lost daily does not truly reflect the improvement, because we have seen many female patients with very sparse hair who do not complain about loss of hair at all. They lose a very small, quite normal, number of hairs, but these lost hairs do not seem to be replaced satisfactorily. We have to determine the number of hairs per unit area before and after treatment, and we propose to develop a simple instrument which will permit a comparatively easy count of the number of hairs, which is the only deciding criterion. MR. A. PERRY: Did the patients which you treated show any other forms of masculinity ? Obviously baldness is a masculine trait, and are these patients rather masculine ? THE LECTURER: In the majority of cases, particularly in the first type, there are no other signs of male behaviour or of male traits. Masculine traits are found particularly in the third type, but clear-cut male traits like hirsutism are, in general, rather exceptional. I would like to emphasize that every hirsute female is likely to have some endocrine disturbance, and I am convinced that a high degree of diffuse alopecia is as indicative of some endocrine trouble as hirsutism.