A survey of tinea capitis five years after treatment by x-ray epilation.

Microsporon ringworm infections of the scalp are at present relatively uncommon in this country; this applies particularly to M. audouinii infections. Wheq they do occur the most reliable treatment is still by total epilation with X-rays (Beare and Cheeseman, 195I), but some examples of M. canis infection are more conveniently treated in this way. A review of the late results of epilation of patients with microsporon ringworm between 1945 and 1947 has been recorded. Diagnosis was made by means of clinical examination, including the use ofWood's light, and direct microscopy. Routine cultures were not made at that time to differentiate between the two common types of infection. During the years 1945-47 a total of 365 children, all over five years of age, were epilated, using the Kienbock-Adamson technique (I907-09), in which five exposures were made, each of 400 r. at 75 kV without filtration. Topical application of fungicides was continued after X-ray treatment until the hair had completely fallen, a close-fitting cotton or linen cap being worn during this period. All cases were observed after epilation until two examinations under Wood's light at an interval of three weeks had failed to reveal fluorescence of any hairs. In no case was it necessary to repeat epilation owing to failure of this method of treatment. During 1953 a letter was sent to the parent or guardian of each child requesting that they should attend for examination: I28 attended, 28 replied giving reasons for non-attendance, two had died, 57 were returned through the dead letter office, while no reply was received from the remaining 150. From replies given by patients, or their parents, there was no evidence of thinning of the hair following regrowth. Although the majority reported that the new hair was curly, this was not a permanent change. In 20 cases the hair was reported to be coarser, and in seven cases to be finer. Lightening of the hair occurred in five children and darkening in A8. The latter finding is in keeping with normal changes in childhood. All patients and their parents were satisfied with the results of treatment and none had received further treatment by any method. On examination the scalps of all the patients were found to be clinically free from ringworm and did not show any fluorescing hairs under Wood's light. There was no evidence of alopecia, atrophy, pigmentation or telangectasia following radiotherapy, although there were local areas of baldness from Kerion in two patients. One child exhibited recent alopecia areata, five had scars from lacerations and ii scars following boils on the scalp. Of the 28 who replied but did not attend, one stated that there was local baldness at the site of the ringworm, while the remainder reported that the hair and scalp were apparently normal. No complaint regarding the treatment was received from the patients at any time.