ECZEMA OF THE SCALP. 
BY 
J. ABBOTT CANTRELL, M.D., 
PROFESSOR OF DISEASES OF THE SKIN IN THE PHILADELPHIA POLYCLINIC AND 
COLLEGE FOR GRADUATES IN MEDICINE, DERMATOLOGIST TO THE 
PHILADELPHIA HOSPITAL AND TO THE SOUTHERN 
DISPENSARY, PHILADELPHIA. 
FROM 
THE MEDICAL NEWS, 
March 30, 1895. [Reprinted from The Medical News, March 30, 1895.J 
ECZEMA OF THE SCALP, 
By J. ABBOTT CANTRELL, M.D., 
PROFESSOR OF DISEASES OF THE SKIN POLYCLINIC 
AND COLLEGE FOR GRADUATES IN MEDICINE, DERMATOLOGIST 
TO THE PHILADELPHIA HOSPITAL AND TO THE SOUTHERN 
DISPENSARY, PHILADELPHIA. 
Occurring upon the scalp, eczema is usually 
found to be of the erythematous, the vesicular, or 
the pustular variety, and the treatment will depend 
somewhat upon the condition present, whether it is 
of long standing or of only a few days’ duration, the 
age of the patient, as well as his natural and daily 
habits. 
The erythematous variety is very likely to be of 
long standing; it is more usually found in those 
of middle or advanced life, and is usually connected 
with the same condition as it occurs upon the face— 
in fact, spreading from the face. When this variety 
does attack the scalp, and when not in connection 
with the disease as existing upon the face, it is 
usually seen in patches, which may be single (the 
general rule) or multiple. These are found to be 
very irregular in outline; the disease may even 
attack the whole scalp, and no part escape. When 
this takes place the condition is usually very dis- 
agreeable, as well to the patient’s friends as to him- 
self. It attacks all of the hairy part of the scalp; 
here may be a dry condition, or it may consist en- 2 
tirely of the moist variety of the disease. If it is 
the latter, this, with the scratching and tearing of 
the patient for relief, gives rise to a very distressing 
condition. The presence of blood due to the 
scratching and the natural discharge of the disease 
bring about a matted and crusted condition of the 
hair that causes the patient much discomfort. 
The vesicular variety usually occurs at or near 
the temporal region, immediately above the ear 
and in the occipital space. The lesions, if seen 
early, are found to be discrete and distinct; but if 
allowed to proceed for some time before coming 
under the physician’s observation, they will be 
found coalesced and covered with a conglomerate 
crust. There may be a few discrete vesicles around 
the borders of the patch; the part will be itchy and 
feel disagreeable, and the patient will scratch or 
tear at the part and cause the flow of blood as well 
as serum; the hair becomes matted, the parts in- 
flamed and somewhat edematous. From this we 
are likely to find the part bulged out to some ex- 
tent from the normal position of the head. When 
this variety occurs in the occipital region it is 
usually found in connection with or caused by 
pediculi, for, owing to the great amount of hair that 
is usually found in this locality, the part is warm 
and consequently sought by these parasites, so that 
in a short time there will be found a very bad con- 
dition, with a foul-smelling odor. This variety is 
likely to be found in the very young or the very 
aged. 
The pustular type is usually a disease of childhood, 
rarely, as a rule, being witnessed in those of more 3 
mature years. These lesions are seen scattered 
throughout the scalp, and thus differ very much 
from those of the vesicular variety, which is more 
likely to form patches. Pustular lesions do not coa- 
lesce, but are found to be distinct and discrete, each 
being remote from its nearest neighbor. There may 
be only a few (the usual rule), being seen in great 
numbers in only a few cases, although new ones are 
continually forming. They are mostly found at 
the openings of the hair-follicles, where the dis- 
charge mixes with that from the gland. Occurring 
in those of very tender years they rupture early, 
soon becoming crusted, so that from the color of 
the pus and its combining with the secretion of the 
sebaceous glands, there results a greenish yellow 
crust, which, if not removed early, will collect in 
one large mass, matting the hair, and, in fact, 
binding it down so closely to the scalp that it can 
hardly be lifted up at all. In fact, one would al- 
most think it would break rather than bend. 
Naturally the inflammation will be increased by 
leaving these crusts in this position, and they thus 
cause great pain and suffering. This variety is 
likely to undergo spontaneous involution—that is, 
it may disappear without treatment or cause—an 
unusual termination, however, of the disease. 
The usual condition is that in which we are con- 
fronted with enlargement of the glands in both the 
vesicular and pustular types. The glands may in- 
crease in size and become almost as large as an 
ordinary furuncle, but in only rare instances do 
these glands break down. Those usually affected 
are the post-cervical and the occipital, and in very 4 
aggravated cases those of the preauricular region 
may also be involved. Sometimes both the vesicular 
and pustular varieties become so aggravated that 
they resemble the ordinary plica polonica. 
The treatment of these conditions must consist 
in both internal and external medication. Occurring 
in either a child or an adult, the natural secretions 
of the body must necessarily receive proper atten- 
tion; the intestinal canal must be kept clear of all 
accumulations; the kidneys must act in a normal 
manner; the patient must have the normal amount 
of sleep; he should wear proper clothing during 
the waking and the sleeping hours, both in winter 
and in summer; he should eat carefully selected food, 
and in normal quantity. If a child, it naturally 
must be given a milk-diet at all times, and there 
must be no change from this rule. Care should be 
taken that he is not given potatoes, an article which 
mothers usually think a child can eat and digest. 
If an adult, he should refrain from certain foods, 
especially those that cause intestinal derangements, 
such as fried food, pastries, stewed fruits, and pork, 
no matter of what kind or cooking. He should be 
allowed as much bland food as he may want, so that 
he does not overload his stomach, and this will 
consist of all green fruits, roasted or stewed meats, 
a few potatoes, either white or sweet, tomatoes and 
all those articles of diet that have a tendency to 
operate upon the intestinal movements or increase 
the flow of urine, such as cabbage when uncooked, 
spinach and kale. While this list is not a full one 
of what the patient may or may not have, it gives a 
general idea of what is necessary for his comfort,  5 
and the nearer we keep to these lines the better the 
result will be. 
If the patient should be one whom it would be 
advisable to give a laxative or a diuretic at any- 
time, one of the following methods may be carried 
out. I am usually in the habit of giving a tonic 
aperient, and one on which I mostly rely is as fol- 
lows : 
R.—Magnessii sulphatis . . 3j. 
Ferri sulphatis . . . 3ss. 
Acidi sulphurici dil. . . f£j. 
Sodii chloridi . . . gr. x. 
Infusi quassiae . q.s. ad. f^iv.—M. 
My usual plan is to begin with one tablespoonful 
of this mixture every morning about one-half hour 
before breakfast, in a goblet of water, which, pre- 
ferably, should be warm. Should this prove insuffi- 
cient to move the bowels properly I usually repeat 
the dose immediately before the evening meal. If 
the kidneys are not secreting freely, I have one-half 
dram of potassium acetate added to the morning 
dose. When this does not give the proper amount 
of urinary secretion I give the potassium salt every 
three hours, in doses of from ten to thirty grains. 
Should there be any complication, this also receives 
the necessary attention. Carlsbad, Friedrichshall, 
and Hunyadi water may be better borne than the 
formulae given, or cascara sagrada will take the 
place of any or all. 
The general condition may demand a tonic; if 
so, no better advice can be secured than that sug- 
gested by the disease itself. This must be decided 6 
upon in each case, as no general rule can be adopted 
to govern this portion of the treatment. 
In infants the first step in the treatment will be 
the use of something to remove the accumulated 
crust, which may be accomplished by either sweet- 
oil or a starch poultice, preferably the former, if it 
suffices. This should be used first, owing to the 
early rupturing of the pustules and the discharge of 
their contents, as the crusts and admixture with the 
sebaceous secretion obscure the state of the inflam- 
mation. After the removal of the detritus, then 
and then only can we fully appreciate the actual 
condition. Such remedies as resorcin, or calomel, 
or acetanilid will undoubtedly give the most prompt 
relief, and the best manner of applying them will 
be as follows : They may be given in ointment-form 
with petrolatum, or the ointment of zinc oxid in 
the proportion of twenty grains to the ounce, applied 
twice or thrice daily, the part being covered with 
some dressing that prevents the little patient from 
irritating the part by scratching and tearing. 
Should there be pediculi in connection with the 
disease I usually advise the use of the fluid extract 
of staphisagria in the proportion of to gvj of 
dilute acetic acid, and then the application of the 
ointments named. I never, as a rule, advise the 
cutting of the hair. 
When occurring in the adult it may be the best 
advice to use first a dressing of the lotio nigra of 
the Pharmacopeia, or a wash of a saturated solution 
of boric acid in water; this should be applied for 
at least one-half hour at each dressing, to remove 
the accumulations of the part and to some degree 7 
to make an alteration in the degree of inflammation, 
following this with the use of some drug that has 
astringent properties, such as one of those men- 
tioned when referring to the scalp of a child. We 
may use one of a more stimulating character in 
those cases that show some chronicity, such as 
salol, salicylic acid, or even phenol. I prefer at 
times to employ a very strong ointment in the more 
chronic cases, using from ten to forty grains of salol 
or salicylic acid, and adding ten grains of phenol 
to the ounce, thus getting rid of the disease and 
giving the patient relief from the itching that is 
always present. 
315 South Eighteenth Street. The Medical News. 
Established in 1843. 
A WEEKL YMEDICAL NE WSPAPER. 
Subscription, $4.00 per Annum. 
The American Journal 
OF THE 
Medical Sciences. 
Established in 1820. 
A MO NTHL Y MEDICAL MAGAZINE. 
Subscription, $4.00 per Annum. 
COMMUTA TION RA TE, $7.so PER ANNUM. 
LEA BROTHERS CO. 
PHILADELPHIA.