CANITIES

983

CANITIES

Synonyms.—Grayness of the hair; Gray hair; Whiteness of the hair; Atrophy
of the hair pigment; Trichonosis discolor; Poliosis; Poliothrix; Hoariness.

Symptoms.—Canities, or graying of the hair, may be congen­
ital or acquired, usually the latter. Congenital grayness is somewhat
rare, and almost invariably is observed limited to one or several tufts or
patches on the scalp; exceptionally general grayness or whiteness is met
with, but is then merely a part of that condition known as albinism, and
which is described elsewhere. In congenital patchy canities there is
often a striking hereditary history, the affection (so-called poliosis cir-
cumscripta hereditaria) extending through several generations, as in the
examples recorded by Godlee,¹ Morgan,² Strieker,³ and others.

Acquired canities, or graying of the hair, is most commonly a con­
sequence of advancing years (canities senilis), although it is also ob­
served in young and middle-aged adults (canities præmatura). In
most instances the development is a gradual one. It may either involve
all the hairs, or practically so, a slow and scarcely perceptible progress
toward general grayness taking place; or, what is probably more usual,
scattered hairs first showing the change, new ones being added to these,
and so until all are involved in the process. In other instances certain
parts of the scalp show the depigmentation first, especially toward the
temporal region, and, indeed, several parts may gradually grow gray,
while others remain but little changed from the original color. Various
conditions are, therefore, observed, from those of localized areas to more
or less general, and from slight blanching to complete grayness or white­
ness. As described in alopecia areata, the new-growing hairs in that
disease are light colored, and sometimes remain as whitish locks for some
time or almost indefinitely. Blanching also not infrequently ensues in
the hairs of vitiligo patches. In ordinary graying of the hair the loss
of pigment takes place, as a rule, slowly, and the hairs are often noted,
on close examination, to be speckled with gray and various shades from
this to the original color. The blanching is probably most commonly
noted, in the beginning, at the new-growing portion, although excep­
tionally the distal ends exhibit the graying changes first. In some
instances, too, after a certain degree of grayness or gray sprinkling has
ensued, it is apparently stationary for a time, at least; as a rule, however,
the blanching is progressive, though it may be scarcely perceptible from
month to month. The scalp hairs are usually the first to show the gray­
ing tendency; later the bearded parts share in the blanching, although
considerable time often elapses after the beginning scalp grayness before
the beard change is especially observable. On the other hand, in some
instances the bearded parts suffer first. Still later the eyebrows, and
finally the other general surface hairs, may undergo depigmentation also,
but it is ordinarily slight and often long deferred.

The question of the possibility of sudden graying of the hair is one
that has been considerably discussed, and still has many doubters,

¹ Godlee, Med. Times and Gaz., 1884, i, p. 180 (four generations).

² Morgan, Brit. Med. Jour., 1890, ii, p. 85 (four generations).

³ Stricker, Virchow’s Archiv, 1878, vol. lxxiii, p. 623 (six generations).

984                      DISEASES OF THE APPENDAGES

but the various instances reported by competent observers indicate
that such can take place. Apart from historic cases, such as Henry IV, of
France, Marie Antoinette, and a few others, which, however, must, I
believe, be accepted with considerable reservation as to striking sudden­
ness, there are now to be found in medical literature a number of examples
in which the change to grayness was noted to occur within the space of a
few hours or days (Landois, Raymond, Laycock, Brown-Séquard, and
others).¹

Ringed Hair (Synonyms: Pili annulati (Karsch); Leukotrichia annu-
laris; Trichonosis versicolor; Fr., Canitie annellée; Ger., Ringelhaare).—
Ringed hair, or ring-like grayness, is an extremely rare condition, first
described by Karsch,² and subsequently by E. Wilson,³ characterized
by alternate narrow, ring-like, white and pigmented bands, the lat­
ter usually being the normal color of the hair, whereas the gray or
white segments result from some obscure pathologic changes or from
intermittent arrest of the pigment-producing process. The bands are
usually extremely narrow—in Wilson’s case the white segment being
about ¹/₁₀₀ of an inch in width, and the dark or normal segment about
twice as broad. In Karsch’s patient, and also in the 2 observed by
Crocker⁴ and the 1 by Unna,⁵ the pigmented and decolorized parts were
somewhat irregular. Brayton⁶ recently reported 1, and Galloway⁷ 2
instances, similar to the uniform ring type described by Wilson. McCall
Anderson’s⁸ case was also regular in the band-like formation, about one
line in width, and was observed in a girl aged nine and a half, apparently
of short duration, and disappearing after cutting of the hair and the use
of a stimulating pomade. Excepting the ring-like aspect detected on
close examination, the hairs show no other changes, their shaft being
usually of normal and uniform thickness; in this respect it differs from
monilethrix with which it might otherwise be confounded, and further
also by the fact that heredity seems to play no part; in Galloway’s cases,
however,—two brothers aged eight and ten,—it appeared to have been
congenital. Various explanations have been given for this peculiar
condition, but beyond that it seems attributable to the presence of gas­
eous material or air-bubbles nothing definite is known. In the reported
instances—but several in number—the affection involved the scalp hair,
with the exception of one of Crocker’s cases, in which the mustache was
the part affected and existed conjointly with trichorrhexis nodosa.

¹Landois, “Das plötzlich ergrauende Haupthaar,” Virchow’s Archiv, 1866, vol.
xxxv, p. 575 (patient with delirium tremens—hair changed in one night); Raymond,
Revue de Méd., 1882, ii, p. 770 (woman—as a result of sudden financial disaster—
changed in one night, and subsequently fell out); Laycock, Brit, and For. Med.-Chir.
Review, 1861, vol. i, p. 458 (a Sepoy, turned gray in one-half hour); Brown-Séquard,
Archives de Physiol., 1869, p. 442 (noticed that several of his own beard hairs daily
changed to white).

² Karsch, quoted by Landois, loc. cit.

³ E. Wilson, Trans. Royal Soc’y London, 1867, vol. xv, p. 406.

⁴ Crocker, Diseases of the Skin (1 case); Brit. Jour. Derm., 1893, p. 175 (second
case).

⁵ Unna, Histopathology, p. 1046.

⁶ Brayton, Indiana Med. Jour., 1897-98, vol. xvi, p. 10.

⁷ Galloway, Brit. Jour. Derm., 1896, p. 437 (case demonstrations).

⁸ McCall Anderson, Diseases of the Skin.

CANITIES

985

Other Color Changes.—In connection with canities the other color
changes, in some instances spontaneously, in others as the result of the
ingestion or local action of a few drugs, which have been exceptionally
observed, may be referred to. In a case described by Smythe,¹ in a
man aged forty-seven, the hair, which was of light color up to the age of
thirty-five, began to gray, but not uniformly, over the scalp; those hairs
which did not undergo this change turned to almost a jet-black color;
at the same time his skin assumed a pigmented hue. Reinhard² observed
periodic change of color from a reddish blonde to a light yellow in an
epileptic idiot boy following violent outbursts of temper, the change
occurring in about two days, apparently beginning at the distal ends and
affecting almost all the hair, and again returning to the normal color
in the course of a week or so. A striking example of change of color re­
sulting from drug ingestion is that reported by Prentiss,³ occurring in a
young, blonde-haired woman, with pyelonephritis with anuria, after the
administration of pilocarpin hypodermically, the color change being first
observed after the twelfth day; under the continued administration of
the drug the hair gradually became almost a pure black, the later pig­
mentation increasing even after the pilocarpin was stopped. It is not
impossible that the disease itself had some influence, inasmuch as no other
instance of hair coloration from this drug has been since reported.

It is well known that severe illness or strong emotion is exceptionally
responsible for color change other than blanching, as in Reinhard’s
case, already cited, and also in those reported by Rayer, Beigel, and
Smyly, quoted by Jackson.⁴ In 2 cases of Alibert’s of hair fall after
fever, cited by Rayer, in one blonde hair Was replaced by black, and
in the other brown hair was replaced by red. Beigel’s case was similar
to the former; and in Smyly’s patient suppurative disease of the left
temporal bone was followed by change of color from a brownish to a
reddish yellow in the hair of the opposite side. Such instances are,
it is true, exceptional, but similar examples, though few in number, are
to be found in literature.

Those rare anomalous cases of green hair, blue hair, and other unusual
colors encountered are due to the local action of chemicals or drugs
coming in contact with the hair either through occupations, as in workers
in copper, cobalt, indigo, etc, or as a result of some medical or tonsorial
application. Of the latter may be mentioned the yellowish-red or brown
produced by chrysarobin, the yellowish or yellowish-red tinge in light-
haired individuals following careless or prolonged use of resorcin hair
tonics—in fact, these are in the same class with the ordinary hair-dyes
occasionally resorted to. Closely allied to these is the yellowish tinge
sometimes seen in jaundice patients.

Etiology.—The causes of canities have in a measure already
been touched upon. Almost all cases are the result of age, some pre­
maturely. In the latter a strong hereditary tendency is usually noted.

¹ Smythe, Arch. Derm., 1880, p. 246.

² Reinhard, Virchow’s Archiv, 1884, vol. xcv, p. 337.

³ Prentiss, Pkilada. Med. Times, July 2, 1881, p. 609.

⁴ Jackson, Diseases of the Hair and Scalp, p. 74.

986

DISEASES OF THE APPENDAGES

Fevers or other serious illnesses frequently are the turning-point toward
beginning grayness. There is no question but that excessive mental
work, prolonged anxiety, worry, nervous shock, and other nervous dis­
turbances have an influence in some cases. Reference has already been
made to instances of sudden blanching so produced. Other examples
following neuralgia, operations, etc., in which the graying has been
more or less localized, have also been noted by various observers. The
most important factors in the general run of cases, however, are heredity
and advancing years. In rare instances, it is true, an explanation of
the graying is entirely lacking, as in an instance reported by Ledermann¹
in a man aged twenty-four, in whom in a space of six weeks the hair of
the scalp, beard, thorax, left axilla, and pubis turned gray, the patient’s
health being good and no hereditary tendency.

Pathology.—Grayness is the result of some lack of pigment
production in the hair-papilla, or due to the presence of air in the cortical
portion; in many cases both factors are probably operative. Pincus²
states that in the earliest stage of canities the pigment gradually leaves
the under layers of the papilla, and is to be found only in the outer
layers, and later is produced only by a portion of the latter, which finally,
in complete blanching, fails entirely. Ehrmann,³ who has contributed
valuable papers on the pigment-producing process of the skin, believes,
on the contrary, that the pigment is formed, but that there is defective
transmission, owing to the absence of transferring cells. Michelson⁴
suggests that it might also be assumed that it is not the papilla which
has lost the power of producing pigments, but the hair-cells which have
lost the capacity of imbibing it, and this pigment, he further adds,
intended for the hair, may be taken up again and deposited elsewhere,
thus possibly accounting for the abundance of pigment in the senile skin.
It is known, however, whatever the amount of pigment contained in the
hair, that the color is materially influenced by the quantity of air or air-
bubbles inclosed in the substance and cortical portions. It has been found
that some gray hairs often contain considerable pigment, but that it is
obscured by air, especially in the cortical layers. Indeed, Wilson and
Landois have indicated that in this fact is to be found the explanation
of sudden blanching—for some reason there is a rapid formation or col­
lection of air-bubbles, especially between the cells of the cortical layers,
which renders the hair opaque and white, the contained pigment being
obscured.

Prognosis.—Canities is usually progressive and permanent, al­
though there are exceptional instances on record where there has been a
return of color. For example, the case quoted by Jackson, of a man
whose scalp hair and beard changed from black to white and the reverse

¹ Ledermann (case demonstration before Berlin Derm. Soc’y), ref. in Annales, 1895,
p. 697.

² Pincus, Virchow’s Archiv, 1869, vol. xlv, p. 129; see also Archiv, 1872, vol. ii,
p. 1.

³ Ehrmann, Allg. Wien. med. Zeit., 1884, p. 331; Archiv, 1885, vol. xii, p. 507,
and 1886, vol. xiii, p. 57.

⁴ Michelson, “Anomalies in the Coloration of the Hair,” Ziemssen’s Handbook of
Skin Diseases, p. 433.

ALOPECIA

987

three times in thirty years, the change to gray being rapid, while that to
black again requiring four or five years. Wilson,¹ Leonard,² and others
also cite cases where there has been a return to the original color. In
some instances of graying after an acute disease and neuralgia in persons
still young the hair has been noted to become again pigmented. These
all are, however, to be considered as curiosities of dermatology, the rule
of permanency in graying of the hair being practically absolute.

Treatment.—There is really no treatment for canities, unless the
use of hair-dyes for its concealment can be so called. In former years
these were quite generally resorted to, but at the present time are entirely
out of fashion. I have never advised them, although others have.
McCall Anderson³ states that a good black can be produced by the con­
joint use of a corrosive sublimate solution, 2 grains (0.135) to the ounce
(32.), and one of sodium hyposulphite, 1 dram (4.) to the ounce (32.),
the former being applied and followed by the latter. The nitrate of
silver dye is perhaps that most commonly employed; a plain solution,
1 to 3 per cent, strength, will produce a black color, the hair being thor­
oughly moistened with it and dried in the sunlight. Kaposi⁴ gives the
following formulae: For a black dye: R. Argenti nitratis, gr. lxxv (5.);
plumbi acetatis, gr. xv (1.); aquæ cologniensis, Mxv (1.); áquæ rosæ,
rosæ, q. s. ad f3iij (96.). For a brown color: R. Pyrogallol, gr. xl (2.65);
aquæ cologniensis, Mlxxv (5.); aquæ rosæ, 3iij (96.). Leonard gives
the conjoint use of these two solutions—No. 1: R. Bismuth, citrat.,
3j (32-); aquæ rosæ, aquæ destillat., ää f3ij (64.); alcoholis, f3v (20.);
ammoniæ, q. s. No. 2: R. Sodii hyposulphit., 3xij (48.); aquæ dest.,
3iv (128.). No. 1 is to be applied in the morning and No. 2 the same
evening.

But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy!

Also, please consider sharing our helpful website with your online friends.