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.

446 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTSX MR. A. W. PoN•) ß Did you carry out any biopsies of femal•e-balding scalps ? Do the vascular and histological changes parallel those which• occur on bald male scalps ? T•E L•C?URER ß We performed a few histological examinations,of female • scalps, but we were unable to find any significant deviations-, in their- vascularization. M•. L. DF.t•DMA• ' IS scalp massage a good or a bad thing ?' T•E LECTURER' It will by no means be harmful, anti may be useful,. but the extent of its being useful is questionable. MR. A. FOSTER ß Is the onset of the alopecia characterized by an acceler- ated loss of hair, or is it just a failure of the replacement of the, usual shedder hair ? Is there a relationship between the two ? ThE LECTURER' There is no doubt that there are patients with an: accelerated hair cycle, who shed their hair early, but replace it completely• and there are patients who do not complain of hair loss, bul where the- sparseness of their hair is permanently increasing. Even pronounced daily loss of hair should never be confused with alopecia, and increased • 10ss of hair should not necessarily be considered as a symptom which inevitably leads to alopecia. MR. B. N. B•ocH ß Did any of your female patients suffer from vitamive deficiency, such as vitamin A ? THE LECtUReR ' We never looked for vitamin deficiency because it is our belief that today, at least in Europe and in our own co'ua•y,. vitamin, deficiency based on malnutrition may be excluded. In addition,, prior to visiting our clinic these patients were usually treated by their' •octors,. albeit unsuccessfully, with high doses of all kinds of vitamins. This appears to provide the evidence that there is no underlying vitamin deficiency. DR. H. W. H•oTT ß We heard that this hair condition is irreversible, but you would probably agree that the condition improves in the sense that the fall-out stops. Has any work, such as urinary analysis, been done oa patients in whom the hair fall has stopped in order to determine, if there is some other factor which has perhaps not yet been recognized as, a reason for this condition ? T•E LECTURER: The only abnormal finding which we etetected' was an increased excretion of androgens, and we know from the hirsute patients, in whom increased urinary androgen values were found, that this increased excretion can be influenced and diminished. If similarly increased values of urinary androgens will be found constantly in female patients with diffuse alopecia, there will also be some hope of therapeutically intt.uencing this disorder.