Canad. M. A. J.
July 15, 1958, vol. 79
R:SUME
Le numero du 15 novembre 1957 de ce journal contenait
les r6sultats d'une enquete menee au sujet des coupes par
cong6lation. La communication que voil?a offre la deuxieme
tranche de ce travail.
De son application 'a 1218 cas consecutifs oiu l'on soupcon-
nait le neoplasme ou dont le diagnostic etait obscure, il
ressort que l'examen histologique extemporane offrit
l'occasion d'ameliorer la conduite du traitement chez un
bon nombre de malades. L'examen macroscopique ne permit
de poser le diagnostic que dans 72.25% des cas alors que
les coupes par cong6lation atteignirent une precision diag-
nostique de 98.36%.
PITYRIASIS CAPITIS (DANDRUFF)
A CLINICAL EVALUATION OF
THREE REMEDIES CURRENTLY
EMPLOYED IN THE PROPHYLAXIS
AND TREATMENT OF A COMMON
SCALP DISORDER
A. P. CASPERS, M.R.C.S.(Eng.),
L.M.C.C. (McGill ),* St. Jean d'Iberville, Que.
THE TROUBLESOME, persistent, irritating and annoy-
ing complaint known as dandruff is familiar to
both the specialist in dermatology and the general
practitioner. This common condition of the scalp
is characterized by the presence in greater or lesser
quantity of dry, white scales which, after the hair
is brushed, fall on to the clothing, the shoulders
and other parts of the body.
ETIOLOGY
It was previously believed that the pityrosporon
of Malassez (Pityrosporum ovale), a lipophilic
pleomorphic fungus allied to the monilias, was the
cause of dandruff and of seborrhaeic eruptions.
The recent work of Martin-Scote has thrown con-
siderable doubt upon this concept, and the pity-
rosporum is now regarded in the light of a harmless
saprophyte. The white scales are believed to be
simply flakes produced in excess from the horny
layers of the skin, and arising probably as a pro-
tective response to low-grade infection.
It has frequently been noted that many patients
with dandruff have a low basal metabolic rate and
consume excessive quantities of sweets, starches
and fats, alcoholic drinks, chocolate, cream, butter
or milk. These items appear to aggravate the
complaint and there is evidence that in certain
instances a deficiency of vitamin B may exist. In
some the disease appears to represent a "sensitiza-
tion" response to a low-grade infection from staphy-
lococcal and streptococcal organisms, and it is
well known that the bacillus of acne and Staphy-
lococcus epidermidis albus may be found in the
scales as well as the pityrosporon.
-vJ.a
sn slqUl
WiS Jl4dSOH JoBUT4U;a1UjjVd;a(
'k1ojO18U!
-J9A!1F9IInawOUaseS 'sooA200jaa0( A10J3?O(0 'MOIIX.S
'A-,0jjaj
CASPERS: PITYRIASIS CAPITIS (DANDRUFF) 113
Les lesions qui se pretent le mieux 'a cette technique
sont les neoplasmes du sein, de la thyroide, de l'endometre,
des voies gastro-intestinales et urinaires, de la peau, des
ovaires, du cerveau et du poumon. Elle peut 6galement
s'appliquer a toutes les metastases et particulierement a
celle des ganglions lymphatiques, mais n'offre que peu
d'int&et dans les cas oiu l'on soupgonne le cancer in situ
du col ou, toujours d'apr'es les auteurs, dans le diagnostic
des lymphomes indolents. La malignite des neoformations
des glandes salivaires est difficile a etablir. Une compa-
raison du degre de precision diagnostique de l'examen
macroscopique et de l'examen histologique extemporane
termine cet article.
PATHOLOGY
When stained, the scales of dandruff are fre-
quently found to contain groups of spores of vary-
ing shapes-oval, round, dumb-bell or gourd-shaped.
This organism is the pityrosporon of Malassez and
its disposition within the scales is similar to that of
Microsporon furfur in pityriasis versicolor. In asso-
ciation with the pityrosporon are found the bacillus
of acne and Staphylococcus epidermidis albus.
The condition is sometimes termed "seborrhoeic",
since it was believed by Hebra that these individual
scales were composed of dried sebum. The in-
vestigations of Sabouraud revealed that in all cases
these scales are composed of horn cells and that
even when they appear greasy, the moisture is due
not to sebum but to serum. An especially greasy
skin is not essential for their appearance, even
though it is commonly found that dandruff occurs
in patients who have actual seborrhcea.
The pathological and histological findings are
those of a low-grade inflammatory process.
CLINICAL FEATURES
Upon the scalp, the least severe phase is known
as pityriasis sicca and takes the form of a dry,
branny, flaky desquamation accompanied by a
profuse number of fine powdery scales. At first
confined to small patches, the condition spreads
rapidly to involve larger areas. Pityriasis steatoides
-an oily type of dandruff-may or may not be
associated with erythema and an accumulation of
thick crusts. Characteristically commencing on the
vertex and frontal region, there is a tendency for
the hair of the affected part to fall out, with pro-
gressive recession thereafter. This type of dandruff
is often associated with premature baldness in
men. More extensive and severe "seborrhaeic" erup-
tions are encountered with widespread greasy
scaling patches, exudations, crustings and even
psoriasiform eruptions. In extreme cases the entire
scalp is covered with a dirty greasy crust having
an offensive odour. Cradle cap is the name given
to the condition in infancy clinically associated
with accumulated epithelial debris and brownish-
yellow scaling lesions on the scalp.
 114 CASPERS: PITYmRASIS CAPInIS (DANDRUFF)
DIAGNOSIS
In my experience the two principal diseases
which may be confused with dandruff are: (1)
psoriasis; (2) tinea capitis (in children).
1. In psoriasis there may be a diffuse involvement
of the whole scalp; alternatively, and more com-
monly, several dist-inct patches occur. Psoriasis
patches always have sharp, definite edges; patches
of dandruff have indefinite margins which tend to
fade away imperceptibly into normal skin.
Naturally, when the whole scalp is involved, these
features show only at the margin of the hairy scalp.
"Corona psoriatica", a less commonly encountered
form, is characterized by a red-festooned border to
the hair margin on the forehead. An examination of
the rest of the body frequently reveals the typical
lesion of psoriasis with its sharply defined patch
of erythema covered by silvery scales, which, when
scraped off, reveal a classical picture of small
bleeding points at the exposed tops of the under-
lying capillary loops.
2. Tinea capitis may be differentiated by the
presence of dull broken hairs which fluoresce under
Wood's light. The finding of the fungus by micro-
scope clinches the diagnosis. Secondary syphilis
may rarely manifest itself as papules appearing
closely set on the forehead-the so-called "corona
veneris". A complete examination of the subject
should reveal other signs of syphilis, and the
Wassermann reaction is positive in most instances.
Should the disease take on a more acute phase
(seborrhceic dermatitis), there will be areas of
erythema and painless weeping. This is probably
due to secondary infection, and the disorder then
has to be differentiated from acute or chronic
streptococcal dermatitis of the scalp and lupus
erythematosus.
In the differential diagnosis from seborrhaeic
dermatitis, pityriasis rosea may cause confusion.
It has a characteristically symmetrical distribution
and develops quite rapidly to produce the clinical
picture. Psoriasis may at times require exclusion
whilst lupus erythematosus is differentiated by the
presence of dry scales, a sharp outline, a butterfly
pattern and horny plugs. Moniliasis, syphilis and
neurodermatitis must also be considered.
COMPLICATIONS
There is a tendency for dandruff to spread from
the scalp to the ears and on to the neck. Associated
dry scaly areas are often found on the face. Com-
mon complications are furunculosis, impetigo and
fissures of the post-auricular folds, the corners of
the lips and the nares. The patient with dandruff is
liable to lose his hair on the temples and vertex at
an early age. Pre-existing acne is often aggravated
by an associated pityriasis capitis, and a low-grade
bilateral conjunctivitis may also exist as a result of
the scales falling into the eyes.
The occurrence of seborrhceic dermatitis or
seborrhoeic eczema-sheets of red, inflamed, weep-
Canad. M. A. J.
July 15, 1958, vol. 79
ing skin on the scalp, neck and flexures-probably
represents a "sensitization dermatitis" due to the
skin's having become sensitized to the organisms.
TREATMENT- LocAL
Dandruff is undoubtedly an infectious condition
and hairdressing establishments represent a potent
source of infection. Those patients fortunate enough
to have escaped dandruff in infancy usually
succumb to the attentive ministrations of the
average hairdresser, whose methods are frequently
those most calculated to transfer the infection (via
the medium of contaminated brushes and combs)
from one customer to the next.
PERSONAL OBSERVATIONS OF BENZALKONIUM
CHLORIDE PRoDuCrs
Since my arrival in Canada in 1955 I have
treated many patients suffering from dandruff. At
first I relied upon the solutions recommended by
Roxburgh6 in his excellent book "Common Skin
Diseases". Here the head is washed thoroughly
with spirit soap or with soapless shampoo and-
preferably-soft water, once or twice a week.
Thereafter the following lotion is applied each
night or morning. It is shaken on all over the head
and well brushed in.
PF Salicylic acid .................... 4.0 gr. XX.
Mercury perchloride.............. 0.1 gr. Y2
Castor oil....................... 1.0 'T V.
Oil of lavender................... 1.0 'U V.
Rubbing alcohol to............... 100.0
For men the lotion may be made into a brillian-
tine by increasing the castor oil to 30 minims or
more. Solutions made up for women should not
contain castor oil, and if the woman has very
fair or white hair the mercury perchloride should
also be omitted since it has a tendency to darken
the hair (particularly when permanent waving is
undertaken).
Although I obtained many successes with this
solution I felt conscious of its limitations-
especially when using it on women. Men tolerated
it well but the more sensitive scalps of women
often reacted to this lotion and on occasion the
patient complained of stinging and discomfort of
sufficient degree to prevent her continuing treat-
ment. Attempts to modify the solution led to dis-
appointment and a falling off of results. An addi-
tional disadvantage lay in the need for this lotion
to be employed for an indefinite period. Rubbing
alcohol requires a fresh prescription for each
bottle and although both eau de Cologne or bay
rum could be substituted, it was my experience
that they did not hold the castor oil in solution.
For these reasons a change was made to selenium
sulfide shampoo suspension. Fair results were
obtained and the clinical impression was formed
that this type of -shampoo had a characteristic
odour, was rather messy, sometimes disagreeable
Canad. M. A. J.
July 15, 1958, vol. 79 CASPERS: PITYRIASIS CAPITIS (DANDRUFF) 115

to the patient, and likely to make the hair oily, even TABLE I.-PITYRIASIS CAPITIS (DANDRUFF)-
when not used excessively. CLASSIFICATION OF RESULTS OF TREATMENr
Although satisfactory results had been obtained Mild Moderate Severe
degree degree degree
with the foregoing, it seemed that each had dis-
,

advantages rendering it unacceptable for continual Rapid improvement...... 4 days 8 days 12 days
use. What I sought was a product cosmetically
Moderate improvement. . . 6 days 12 days 18 days
Slow improvement........ 10 days 20 days 30 days
acceptable, non-greasy and non-irritant to the +
+ +
scalp which would rapidly control the condition.
Volume 2 of "New Products Index"4 covering for 30 days or longer before being brought under
pharmaceutical specialties marketed in Canada up control was evaluated as "slow improvement".
to July 15, 1956, listed details of Sabol, a product In connection with the foregoing Tables IIA,
which appeared to fulfil all criteria. Subsequently IIB and IIC, it should be noted that:
I wrote to the company to request trial samples. 1. No particular remedy was reserved for any
In the evaluation that followed, patients were particular type of case. Patients as they attended
divided into three groups of 34 patients per group, were allotted remedies in sequence. For example,
treated with: (a) the salicylic acid lotion; (b) a the first patient in this survey of 102 cases was
proprietary preparation containing selenium sul-
fide; (c) Sabol. treated with salicylic acid lotion, the second with
The results of investigations of these 102 patients selenium sulfide, and the third with Sabol, whilst
the fourth patient in the series reverted to salicylic
are summarized in Tables IIA, IIB and IIC, whilst
Table I represents a yardstick for evaluating these acid lotion.
tables. For example, dandruff of moderate degree, 2. Each of the Tables IIA, IIB and IIC elaborates
brought under control within eight days, was re- principally results on males. This was unavoidable
corded in Table I as showing "rapid improvement". as the whole assessment was carried out at a
Conversely, severe dandruff requiring treatment Royal Canadian Air Force Station.
TABLE IIA.-SALICYLIc ACID LOTION
Improvement Degree of
Total No. pityriasis
of patients Patients None Slow Mod. Rapid capitis Side effects Comments
34 Male 1 x Severe Male
2 x Moderate One man complained of
3 x Severe stinging of scalp.
28 4 x Mild
men 5 x Moderate
6 x Severe
7 x Severe Stinging of scalp
8 x Moderate
9 x Moderate
10 x Moderate
11 x Mild
12 x Moderate
13 x Mild
14 x Moderate
15 x Mild
16 x Moderate
17 x Moderate
18 x Severe
19 x Severe
20 x Moderate
21 x Mild
22 x Moderate
23 x Severe
24 x Moderate
25 x Mild
26 x Mild
27 x Mild
28 x Severe
0 6 12 10
6 Female 1 x Severe Stinging of scalp Female
women 2 x Severe All women improved
3 x Severe rapidly. Two women
4 x Severe patients complained of
5 x Severe Stinging of scalp stinging of scalp.
6 x Severe
0 0 0 6
ASSBSSMENT-Good.
A rather crude but effective preparation; effective in all cases surveyed.
Liable to cause stingingoof the female scalp.
116 CASPERS: PITYRIASIS CAPITIS (DANDRUFF) Ca n.Ad. M. J.
Jtuly 15, 1958, vol. 79

S1
TABILE 11B. SELENIUM1 SUFIDE
I 10 piovemnllod. Deqree of
10otal N\o. pityrisuis
of patieWN11 I'a1ieot.t N'one Slow JI10(d. Rapid capitis Side effects Cotitnenits
34 Male 1 x Sever e
2 x Moderate
28 3 x Moderate
litlel 4 x Moderate
5 x Sever e IEX(e*.live oiliness 'Thrllee ien (omllp)lainIed
6 x Moderate of excessive oiliness.
7 Moderate
8 x ModeIrate
9 x Moderate
10 Moderate
11 x Moderate Elxcessive oiliness
12 x Mild
13
14
x x Mild
Moderate
15 x Moderate
16 x Sever e
17 x Moderate
18 x Moderate
19 x Severe
20 x Moderate Excessive oiliness
21 x Moderate
22 x Mild
23 x Moderate
24 x Moderate
25 x Moderate
26 x Moderate
27 x Sever e
28 x Moderate
0 6 20 2
6 Femiiale 1 x Severe
wN omen 2 x Sever e Clonsidered by
3 Moder ate patient to be
4 x Moder ate "messy". Onie womnan consi(lered
5 x Moderate it n;iessv.
6 x Mild

1 3 2 0
Ass1.;,s.S1ENT- Fair/.
The least effective of the three p)el)alationls surveyed. Liable to cause excessive oiliniess of the scalp) duriing treatment.

EVALUATION OF RESULTS rapidly, 20 (71.4%°) miioderately and 6 (21.46/c)

Salicylic acid lotion (Table IIA).-The total of
34 patients was composed of 28 men and 6 women.
Of the men, 8 had a severe degree, 13 a moderate
degree and 7 a mild degree of pityriasis capitis.
All responded to salicylic acid lotion; 10 men
(35.7%c) responded rapidly, 12 (42.8%o) moder-
ately and 6 (21.4%) slowly. Of this series of 28
male patients, only one recorded discomfort and
stinging of the scalp when applying the solution.
It is interesting to note that the 6 women all had a
severe degree of pityriasis capitis and all responded
rapidly to salicylic acid lotion. Two women of the
series of 6 complained of stinging of the scalp. It
is thought that the more rapid control of the com-
plaint in women was, in part, attributable to
higher standards of personal hygiene and cleanli-
ness and more conscientiouis carrying out of instruc-
tions.
Proprietary product containing selenium sulfide
(Table 1IB).-The total of 34 patients was com-
posed of 28 men and 6 women. Of the men, 5 had
a severe degree, 20 had a moderate degree and 3
a mild degree of pityriasis capitis. All responded
to the proprietary product containing selenium
stlfide. Two men patients (7.1,% ) responded
slowly. Of the series of 28 men three (10.7%)
complained of excessive oiliness; two of these had
a moderate degree of pityriasis capitis, one a severe
degree. Of six women also treated, two had a severe
degree, three a moderate degree and one a mild
degree of pityriasis capitis. Of these six patients one
failed to respond to treatment. Of the remainder,
two responded moderately well and three re-
sponded slowly; none responded rapidly. One of
the series (with a moderate degree of pityriasis
capitis) complained of the irritation of the pro-
prietary product.
Proprietary product containing benzalkoniun
chloride (Sabol) (Table IIC).-Of the 34 patients
30 were men. Of the latter, eight had a severe
degree, 18 a moderate degree and four a mild
degree of pityriasis capitis. All responded to the
proprietarv product containing benzalkonium
chloride (Sabol); 15 (50%4c) responded rapidly,
14 (46.6%) moderately and one (3.3%v) slowly.
None of the men complained about this prepara-
tion. Four women were also treated; one had a
severe degree, the remainder a moderate degree
of pityriasis capitis; in two cases response to Sabol
wvas rapid and in two moderate.
Canad. M. A. J.
July 15, 1958, vol. 79 CASPERS: PITYRIASIS CAPITIS (DANDRUFF) 117

TABLE IIC.-BENZALKONIUM CHLORIDE (SABOL)

Improvement Degree of
Total No. pityriasis
of patients Patients None Slow JMod. Rapid capitis Side effects Comments
34 Male 1 x Moderate Male
2 x Mild No adverse side effects.
3 x Moderate
4 x Moderate
5 x Moderate
30 6 x Severe
men 7 x Severe
8 x Severe
9 x Moderate
10 x Mild
11 x Moderate
12 x Moderate
13 x Moderate
14 x Moderate
15 x Severe
16 x Moderate
17 x Severe
18 x Moderate
19 x Moderate
20 x Mild
21 x Severe
22 x Severe
23 x Moderate
24 x Moderate
25 x Severe
25 x Severe
26 x Moderate
27 x Moderate
28 x Moderate
29 x Mild
30 x Moderate
0 1 14 15
4 Female 1 x Moderate Female
women 2 x Moderate No adverse side effects.
3 x Moderate
4 x Severe
0 0 2 2
ASSESSMENT-Very good.
The most effective preparation of all-cosmetically acceptable, non-greasy and non-irritant.
No adverse side effects encountered in the group of patients surveyed.
All patients (male and female) responded to treatment, the majority demonstrating a rapid improvement-even in cases
classed as "severe".

CONCLUSIONS ing the patient to keep the sQlution out of the

A. Proprietary product containing benzalkonium
chloride.-Analysis of Table IIC supports the clini-
cal impression that the product Sabol is not only
the most effective but also the most -esthetically
acceptable of the three preparations evaluated. All
male and female patients responded to treatment,
the majority showing a rapid improvement even in
cases classed as "severe"; only one (3%v) responded
slowly. None of the men or women had any com-
plaints to make concerning the preparation. It is
interesting to note that the female patient, a Royal
Canadian Air Force nursing sister, classed as
having severe pityriasis capitis, had previously
employed a selenium sulfide preparation for three
months without relief. Response was moderately
rapid when she changed over to the proprietary
product containing benzalkonium chloride (Sabol).
Continuing use of this product revealed one mild
disadvantage in everyday use, its liability to set
up a low-grade conjunctivitis if it gets into the
eyes. This does not often- occur, as the container
carries instructions in French and English caution-
eyes and to rinse them out at once with water if
it should accidentally gain entrance. The container
also carries detailed directions for application of
the solution. The hair is first wetted thoroughly and
between 1/4 and 1/2 oz. of the solution is massaged
into the scalp for 2-3 minutes. After rinsing, the
procedure is repeated, a final rinse is made and the
hair dried and brushed. In practice it is important
to advise the patient that he will not work up a
good shampoo until he has rinsed the hair a second
time and made a further application of the solution.
If this is not done, he will use excessive quantities
of the solution and will experience much difficulty
in working up a good lather. The patient should
also change the water in the basin before finally
rinsing the hair. As pityriasis capitis often flares up
after a visit to a hairdresser, patients should
shampoo their hair with Sabol at the earliest con-
venient time after one of these visits, preferably
within the first 12 or 24 hours.
B. Salicylie acid lotion.-The evaluation would
suggest that this rather crude but effective prepara-
118 CASPERS: PITYRIASIS CAPITS (DANDRUFF)
tion is more effective in women than men. Un-
fortunately it is liable to cause stinging and
irritation to the female scalp. The better results
obtained with women may in part have been
attributable to higher standards of personal hygiene
and their more conscientious carrying out of
instructions.
C. Proprietary product containing selenium sul-
fide.-This preparation appeared to be the least
effective of the three. Although all men responded
to treatment, only two responded rapidly and the
majority improved only moderately rapidly, or
slowly. Three patients (two with a moderate
degree and one with a severe degree of pityriasis
capitis) complained of excessive oiliness of the
scalp during treatment. One of the six women
failed to respond at all, and no woman responded
rapidly to treatment. One patient complained of
the messiness of the preparation.
Local treatment.-This has been dealt with to
some extent in the evaluation of the three fore-
going remedies. From time to time the disease
may take on a more acute phase (seborrhaeic
dermatitis) with areas of erythema and even
weeping. It is possible that these acute outbreaks
are due to secondary infection. It has been noted
for some years2-5 that cetrimide appears to be an
effective application in cases of seborrhzea and
recently, within the United Kingdom, the Pharma-
ceuticals Division of Imperial Chemical Industries
Ltd. have introduced under the trade name Cetav-
lon P.C. (P.C. = pro capite), a lotion concentrate
containing 17.5%o cetrimide as an active principle.
Speirs and Brotherwood7 reported the effect of this
preparation on 26 cases taken from their practice
in south-east London, and concluded that Cetavlon
P.C. was an effective, safe and pleasant preparation
for use against seborrhceic dermatitis.
It is well known that seborrhoeic dermatitis as a
complication of pityriasis capitis often benefits
from ultraviolet light. In such instances it is ad-
vantageous to wash the scalp on the day before
application, with mild erythema exposures given
thereafter at intervals of five to seven days to the
top and sides of the scalp.
General treatment.-Within recent years the
value of constitutional measures in the treatment
of pityriasis capitis has been questioned, and fre-
quently it is held that such measures are of no
value whatsoever. It is my own impression that
general measures have a very definite place in the
over-all treatment of this troublesome condition.
Many patients with pityriasis capitis or frank
seborrhaeic dermatitis have low basal metabolic
rates, or on questioning admit to consuming an
excess of carbohydrates, fats or alcohol. In some
instances a deficiency of vitamin B has also been
noted. It is therefore my practice to supplement
local treatment with general measures. Alcohol,
chocolate and large amounts of cream, butter, milk
and sweets are forbidden, and any suspected
vitamin B deficiency is rectified. In severe cases
July 15,1958, vol. 79
the patient is also advised to avoid activities which
increase perspiration and sebaceous activity.
SUMMARY
The problem of pityriasis capitis is surveyed. A
discussion of the etiology of the condition is followed
by an account of the pathology, clinical features, diag-
nosis, and complications of this annoying complaint.
Local and general treatment are considered, and the
scope and value of the latter are considered in rela-
tion to the former. Mention is made of the effectiveness
of benzalkonium chloride in local treatment, and results
of personal investigations are elaborated.
The opinions expressed in this paper are those of the
author and do not necessarily reflect the views of the
R.C.A.F. I acknowledge gratefully the ready co-operation
received from Frank W. Homer Ltd. and their kindness
in forwarding me samples for clinical appraisal. My grati-
tude is also extended to Squadron Leader P. Laird Gibbs,
M.D., Senior Medical Officer, R.C.A.F. Station, Goose Bay,
Labrador, for his encouragement and advice in the com-
piling of this work.
REFERENCES
1. ANDREWS, G. C.: Diseases of the skin, 4th ed., W. B.
Saunders Company, Philadelphia, 1954, p. 168.
2. HODGES, J. P. S.: Lancet, 2: 225, 1951.
3. MARTIN-SCOTr, I.: Brit. J. Dermat., 64: 257, 1952.
4. HUGHES, F. M., editor: New Products Index, Vol. 2,
Canadian -Pharmaceutical Association, Toronto, 1956,
p. 68.
5. NEVILLE-SMITH, C. H.: Lancet, 2: 314, 1951.
Idem: Ibid., 1: 1016, 1952.
6. ROXBURGH, A. C.: Common skin diseases, 10th ed., H.
K. Lewis & Co. Ltd., London, 1955, p. 158.
7. SPEIRs, R. J. 0. AND BROTHERWOOD, R. W.: Practitioner,
179: 78, 1957.
8. YATER, W. M.: Fundamentals of internal medicine, 3rd
ed., Appleton-Century-Crofts Company Inc., New
York, 1949, p. 1113.
R.SUMEJ
Les pellicules sont composees de cellules de la couche
cornee qui se detachent de l'epiderme par l'action d'un
processus infectieux 'a bas bruit contracte le plus souvent
dans les salons de coiffure. Le pityriasis sec et le st6atoide
envahissent peu a peu le cuir chevelu et menent a la
calvitie precoce. Le diagnostic differentiel de cette affection
comporte le psoriasis et le tinea capitis. Les complications
qu'elle peut entrainer comportent la furonculose, l'impetigo,
les fissures des plis post-auriculaires, des coins du nez et
des levres.
Dans sa recherche d'un traitement satisfaisant l'auteur
fit l'essai d'une formule 'a base d'acide salicylique, de
perchlorure de mercure, d'huiles de ricin et de lavande, le
tout dissous dans l'alcool 'a friction. Cette preparation
demande un usage prolong6 et produit une sensation de
brculure sur une peau irritee. II passa ensuite a l'emploi
d'une solution de sulfure de sel6nium dont les propriet6s the-
rapeutiques n'etaient pas suffisantes a faire accepter l'odeur
caracteristique et la tendance 'a rendre la chevelure huileuse.
Une solution de chlorure de benzalkonium vendue dans le
commerce sous le nom de Sabol (marque deposee) donna
les meilleurs resultats avec le moins d'inconvenieRt. Les cas
les plus rebels s'ameliorerent rapidement. L'auteur met les
malades en garde contre la conjonctivite qui peut resulter
du contact de ce produit avec les yeux. II fait aussi mention
de l'emploi d'une lotion 'a base de cetrimide (17.5%)
vendue sous le nom de Cetavlon (marque deposeee). En
plus du traitement topique, l'amelioration de l'etat general,
la correction d'un metabolisme basal insuffisant et l'obser-
vance d'un regime approprie enrichi de vitamin B peuvent
contribuer au bien-etre du sujet et ne doivent pas etre
neg lges.