Partial Alopecia Due to Thallium
W. R. HUBLER, M.D., Corpus Christi, Texas
During the past two and one-half years, I have
observed 13 cases of slight to moderate alopecia
from the ingestion of thallium. The first five were
in small children who had eaten varying amounts
of a cake-crumb roach killer containing thallium.*
During this period there were approximately 40
reported cases of thallium poisoning in small chil-
dren in Corpus Christi from the same preparation.
Legal action was taken by the County Medical
Society to force the manufacturers of the roach
killer to include a bitter-tasting substance to make
the cake-crumb preparation less attractive to chil-
dren. Since this has been done, I have seen only
two cases of thallium alopecia in children. I have,
however, observed six cases of slight to almost
complete diffuse alopecia in women. The diagnosis
was proved in all cases by spectroscopic examina-
tion of the patient's urine for thallium. If it had
not been for the previously mentioned "epidemic"
of hair loss, I might never have suspected these
women of having hair loss due to thallium. In none
of my cases was there any ataxia, tremor, or other
toxic manifestation of thallium poisoning.1 Careful
investigation has failed to reveal the source of the
thallium in these cases. None of the women used
any insect poisons known to contain thallium. The
Health Department has suggested several possible
sources of thallium in these cases :
(a) Ingestion of bread made with flour which
might have been accidentally contaminated with a
thallium insecticide.
Submitted for publication Feb. 25, 1959.
* "Echols Roach Killer," available in all the
Corpus Christi supermarkets, is made by saturating
crushed cookies or cake crumbs with a 2% aqueous
solution of thallium, which is tasteless.
A New Shampoo for Seborrheic Dermatitis
LEONARD V. KORNBLEE, M.D., New York; ARTHUR H. GLADSTEIN, M.D., Astoria, N. Y.,
and PAUL LAZAR, M.D., Chicago
Experience with N-trichloromethylmercapto-4\x=req-\
cychlohexane-1,2-dicarboximide has proved it to
be an effective and safe remedy for seborrheic
dermatitis.1 Keeping the chemical in permanent
solution has been a technical problem which may
have decreased its effectiveness. For the first time,
Submitted for publication Jan. 26, 1959.
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(b) Thallium dust (insect powder) present on
the tops of cansof food.
(c) Contact t with or ingestion of thallium used
by professional exterminators. The exterminators
are not supposed to use thallium in their pesticides,
but this has not been enforced.
All of my adult patients were women. Perhaps
this was because the average man does not pay
close attention to mild or moderate hair loss,
ascribing it to the natural course of events. The
duration of "falling hair" before the diagnosis was
made varied from one to four months. The cessa¬
tion of hair loss and the beginning of regrowth
usually occurred in four to eight weeks after the
first visit. The duration of the symptoms would
make me suspect that more than one small dose
of thallium was ingested by some of the patients.
The purpose of this note is to call attention to
the possibility that unexplained hair loss in adults
may be due to thallium ingestion. Perhaps it is
commoner than has been realized, particularly in
warmer sections of the countr}7 where insecticides
are used to a greater extent. The diagnosis is
easily proved by spectroscopic examination of the
urine.
1510 S. Brownlee Blvd.
\s=d\Thallium may be absorbed through the un-
broken skin.
REFERENCE
1. Chamberlain, P. H., et al.: Thallium Poison-
ing, Pediatrics 22:1170-1182, 1958.
the chemical in stable solution has been incorporated
in a detergent shampoo* which contained also,
sodium tetrathionate, a source of sulfur, and
p-chloro-xylenol,2,3 an antibacterial agent. Each
of these chemicals has been used and tested ex-
*
The shampoo, Clear Liquid Enden, was sup-
plied by Helene Curtis Industries, Inc.
 Subjects
Moderate
Good
Excellent
Response
Total
tensively and demonstrated to be nontoxic, as well
as low in sensitizing potential.
A total of 210 patients from private practice
(135 females and 75 males), ranging in age from
8 months to 73 years, used the shampoo for a
period of eight weeks each. Every person was
examined on at least three or four occasions during
this period and again two weeks or more after
use of the shampoo was discontinued.
Good to excellent results were noted from its
use in 161 (76.5%) of those treated; 45 (21.4%)
had improvement which was not sustained despite
continued therapy, and 4 (1.9%) were considered
failures. The unsatisfactory results occurred in
persons with very thick, adherent scales (psori¬
asis?), a situation not generally well handled by
dandruff treatment shampoos. When recurrence
was evident, signs and symptoms were noted 10
to 14 days after the shampoo was discontinued.
No primary irritation, allergic reactions, or
chemical incompatibilities were observed. Excessive
oiliness was seen in three instances. This dis¬
appeared after one week, though the patients con¬
tinued to use the shampoo.
Azure Lunulae
IRVING L. LEFF, M.D., Buffalo
Bluish discoloration of the nails has been reported
in different conditions and under a variety of cir-
cumstances. The whole nail is discolored in
argyria 1,2 after prolonged use of quinacrine hydro-
chloride,3 in paronychia caused by Pseudomonas
aeruginosa,4,5 and on exposure to sunlight following
soaking in bichloride of mercury.6 Discoloration in
argyria occurs in association with involvement of
skin and mucous membranes and does not disappear
with the passage of time in contrast to the latter
three circumstances where removal of the cause
Submitted for publication Jan 22, 1959.
From the Medical Service of the Buffalo Vet-
erans Administration Hospital.
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The study was conducted independently in the
private practices of three different physicians in
widely separated areas. Control studies on 37
persons showed the combined formulation to be
superior to the detergent shampoo alone. The
preparation is as effective as any of the available
dandruff treatment shampoos, more pleasant cos-
metically than most and is a worthwhile adjunct
remedy for the treatment of seborrheic dermatitis.
104 S. Michigan Ave., Chicago (3).
REFERENCES
1. Ball, F. I. : A New Treatment for Sebor-
rheic Dermatitis, A. M. A. Arch. Dermat. & Syph.
71:696-698, 1951.
2. Zondek, B., and Finkelstein, M.: Blood Con-
centration of p-Chloro-Xylenol in Man Following
Percutaneous, Parenteral and Rectal Application,
Proc. Soc. Exper. Biol. & Med. 61:200-203, 1946.
3. Colebrook, L. : The Disinfection of the Skin,
Bull. War Med. 2:73-79, 1941.
is followed by gradual disappearance of the dis-
coloration.
Bluish coloration limited to the lunule of the
nail was noted by Campbell, in 1931, following use
of phenolphthalein.7 The fate of the discoloration
in this case with the passage of time is not men-
tioned. More recently, Bearn and McKusick ob-
served the phenomenon in two cases of Wilson's
disease8 and reported a third case seen by Dr. I.
Herbert Scheinberg.
These latter cases exhibited classic clinical and/or
chemical evidence of Wilson's disease with low
serum copper and ceruloplasmin, elevated urinary
copper and amino acids, and increased urinary cop-