A Consideration of Roentgen Therapy in Producing Temporary Depilation for Tinea Capitis

Since 1943, ringworm of the scalp has been epidemic along the eastern seaboard of the United States. MacKee and his associates estimate 5,000 cases in the city of New York (1). An unofficial figure for Philadelphia is 13,000 cases in 1945. In Hagerstown, Md., and adjacent rural communities, out of a total of 8,657 children examined, 565 (479 boys and 86 girls) were infected. Approximately the same number of boys and of girls were examined, yet the incidence was six times as high in boys as in girls (2). There is reason to believe that the epidemic is now abating on the coast, but that the condition will be present endemically in a much higher proportion than formerly, the endemic foci being ready to disseminate the disease widely again if the precautions now in effect in the schools are relaxed. There is every indication, too, that the disease is spreading rapidly inland. Microsporum audouini is the principal fungus in this epidemic. The infection is spread by infected hairs, and the principal places of contact are the home, the school, the playground, the theatre, and the barber shop, the home and the barber shop being the most likely. It is uncommon for only one child in a family to have the disease; usually all between the ages of four and nine will be infected, due to the indiscriminate interchange of headgear, combs, and brushes. In the Hagerstown epidemic, involved hairs were found in the combs, brushes, scissors, and electric clippers of many of the barber shops, and it is noteworthy that about 65 per cent of the boys had the infection in the "clipper area" only (2). A similar percentage was found in our series, and the location has led many to regard contact with high-back, piled-fabric chairs, often seen in theatres, as the chief offender. In Hagerstown, however, the backs of the seats in the children's favorite motion picture theatres proved to be apparently free of infected hairs (2). The earliest appreciable lesion is a minute, rounded, scaly patch upon the hair-bearing scalp, the usual location being just within the hair-line at the nape of the neck. The base of the lesion is reddened and hyperemic, but the scales are whitish or grayish in color. The patch slowly increases in diameter, but there is no tendency for involution at the center of the lesion, as in the common types of ringworm infection on other portions of the body. The involved hair shafts become dry and brittle and, in the course of a few days or weeks, many of these hairs break off, leaving a partially bald area studded with broken hairs. A variable degree of itching is present, and excoriation of the lesion may predispose to a secondary infection, such as cellulitis and furuncles and occasionally carbuncles. We have observed deep carbuncles as much as 3 inches in diameter, with multiple draining sinuses. Only rarely is the disease limited to the scaly patches.