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Reprinled froJII Ihe /'lrchi?'l'S of Dcrllwlology and Sy/Jhilology
December, 1929, VoJ. 20, N. 797-803
THYMOL AND CINNAMON OIL IN THE TREATMENT
OF RINGWORM OF THE SC-\LP *
LYLE B. KINGERY, M.D.
Clinical Professor of Dermatology, University of Oregon Medical School
PORTLAND, ORE.
At the annual meeting. of the American Dermatological Association
in 1924, under the title of "Mycotic Paronychia and Dermatitis," the
results of a study demonstrating the etiology, pathology and symp-
tomatology of what apparently was at that time a new clinical entity
were reportecl,1 In addition, this investigation included the successful
therapeutic management of the disease by the use of certain essential
oils--a use apparently entirely new for a group of drugs long familiar
in pharmacologic texts. Such a strikingly favorable therapeutic response
on the part of a disease that is representative of a group containing
many members refractory to ordinary remedies seemed worthy of
further investigation. This was undertaken, and the results were
reported at the meeting of this association three years later, in 1927.2
The latter study, while admitting the vast discrepancy often existing
between laboratory experimentation and clinical application, still seemed
to demonstrate a superiority on the part of the essential oils over time-
honored remedies in their ability to kill and inhibit the growth of a large
group of known mycotic invaders of the skin and viscera. vVith these
experiences in mind, the former an apparent specificity with reference
to a mycotic disease of the skin and nailbed, and the latter an undoubted
fungicidal and fungistatic superiority in vitro, clinical trial in certain
of the well known mycotic diseases seemed properly in order.
Before the advent of the use of the x-rays and thallium acetate,
ringworm of the scalp presented perhaps one of the most unsatisfactory
therapeutic problems. Treatment at best was prolonged and disagreeable,
and in a considerable percentage of cases the cure was a spontaneous
one at puberty. Begun by Freund 3 in 1897, improved by Sabouraud and
Noire 4 in 1904, and finally perfected as nearly as possible by MacKee,5
*Read at the Fifty-Second Annual Meeting of the American Dermatological
Association, San Francisco and Del Monte, Calif., July 1-3, 1929.
1. Kingery, 1.. B., and Thienes, C. H.: Mycotic Paronychia and Dermatitis,
Arch. Dermat. & Syph. 11:186 (Feb.) 1925.
2. Kingery, 1.. B., and Adkisson, A.: Certain Volatile Oils and Stearoptens
as Fungicides, Arch. Dermat. & Syph. 17:499 (April) 1928.
3. Freund, 1..: Wien. med. W chnschr. 47: 856, 1897.
4. Sabouraud, R, and Noire, H.: Presse med. 12:825, lS04.
5. MacKee.: X-Rays and Radium in Treatment of Diseases of the Skin,
Philadelphia, Lea & Febiger, 1921, p. 602.
1*
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2 3
Early results of the foregoing treatment are shown in table 1. A
brief analysis of this table would seem to emphasize a single outstanding
12. The solution is composed of gutta percha 10 Gm., lead carbonate 10 Gm.,
chloroform to make 100 Gm. After thorough agitation decant the clear liquid.
The preparation is therefore a solution of gutta percha in chloroform.
3. Constant wearing and frequent changing of a washable cap.
4. Biweekly soapsuds shampoo.
5. The application three times daily of a solution of gutta percha B. P. C.p con-
taining one half of 1 per cent thymol and 1 per cent oil of cinnamon. In cases in
which this resulted in irritation, the frequency of the applications was decreased.
Apparent
Immediate
Results
All lesions covercct
by early growth
of hair; no signs
of clinical ac-
tivity
Completely invo-
luted; bair com-
pletely returned
Completcly invo-
luted; hair com-
pletely returned
Completely invo-
lutcd; hair re-
turned in all
lesIons
Completely invo-
luted; no inflam-
matory reaction;
hair returning- in
lesIons
Inflammation SUb-
siding; no signs
of clinical activ-
ity
Inflammatory re-
action SUbsiding;
no new lesions
Clinically inactive:
no new lesions
Clinically inactive:
no new lesions;
hair returning
Clinically, some
in1provement;
microscopically
negativc (dispen-
sary)
Clinieally inactive:
no inflammation;
microscopically
negative
No clinical activ-
ity; 11air return·
ing on alJ
patches; micros-
copically negative
F 0/ 4/28 10/ 2/23
F 0/ 4/28 11/22/28
M 12/28/27 3/15/28
F 11/22/28 1/26/20
M 2/ 3/28 4/15/28
M 1/25/28 4/30/28
F 10/ 5/28 10/11/28
M 2/14/28 3/14/28
F 8/11/28 8 /20/28
Last
Treatment Examina-
Sex Begun tion
M 12/12/27 3/28/28
M 3/ 1/28 3/10/28
M 11/22/28 1/12/20
4 yrs.
6 YI'S.
6 yrs.
7 yrs.
3 yrs.
7 yrs.
7 yrs.
3 yrs.
4 yrs.
22 mos.
2'h Yrs.
Age
2'h yi·s.
6 wks.
4 wks.
2 mos.
1 mo.
3 mos.
3 to 4
weeks
1 week
4 wks.
7 wks.
Several
weeks
2 to 3
montbs
Duration
Several
'Jjleeks
TABLE l.-El1Irly Results of T1'eatment
Single
Multiple
Multiple
Single
Single
Multiple
Multiple
Single
Multiple
Multiple
Eruption
2 lesions
Multiple
lesions;
1 kerion
Dog?
Dog
Cat
Source
?
Scbool
Otber
cbildren
Persian
cat
?
Scl100l ?
6
10
11
12
Case
point of interest, that of a uniformly favorable response to treatment.
In case 11 the patient presented numerous lesions over the scalp, one
definitely of the kerion type. Treatment was augmented in this case by
boric compresses applied three times daily. Response to treatment was
much the same in all the other cases. At the time of the first weekly
6. Buschke: Experimenteller Beitrag zur Kenntnis der Alopecie, Berl. klin.
Wchnschr., 1900, no. 53, p. 1235.
7. Cicero: Tratamiento de las tinas por el acetato de talio, Rev. de puebla,
1919, no. 8; reference in Peter: Secundo congreso sudamericano de dermatologia
y sifiligraphia de Montevideo, Arch. f. Dermat. & Syph. 150:438 (Oct.) 1921.
8. Peter: Arch. f. Dermat. u. Syph. 150:438 (Oct.) 1921.
9. Ritter: Dermat. Gesellsch., February, 1927; reference in Dermat. VVchn-
schr. 85:955, 1927.
10. Artz: Wien. Dermat. Gesselsch., January, 1927; reference in Dermat.
W chr;schr. 84: 834, 1927.
11. Felden, B. F.: Epilation with Thallium Acetate in the Treatment of Ring-
worm of the Scalp in Children, Arch. Dermat. & Syph. 17:182 (Fcb.) 1928.
1. Clipping of the hair to the extent of IV, inches (3.8 em.) around the border
of the lesions when only one or two lesions were present.
2. Clipping of the hair of the entire scalp when the disease was generali7ed.
roentgen treatment now offers a management of these cases which has
made the disease a rarity in some localities in which formerly the infec-
tion was constantly present in considerable numbers. This method of
treatment, however, is still a highly technical procedure; it is difficult to
carry out in the extremely young, and in spite of every precaution
roentgen injuries still occasionally occur.
Somewhat similar comment may be made on the treatment with
thallium acetate. Unquestionably, tremendous strides have been made
with the use of thallium acetate since Buschke's 6 experimental report
in 1900. Not only has he continued to add to the knowledge of this
particular use of the drug, but others, including Cicero 7 and Peter,S
Ritter 9 and Artz,IO have likewise made important contributions. That
the drug is highly successful in certain hands is shown more recently
by the comprehensive report of FeldenY Yet with this, as with roent-
gen therapy, there are possible objections. The dosage must be com-
puted with extreme accuracy; increasing dangers exist as the age of the
patient nears puberty; reactions of various types are not unknown, and
even permanent undesirable effects are occasionally recorded.
vVith these points in mind relative to the present methods of treat-
ment, and encouraged by the clinical trial and laboratory experiences
already related, the following study was undertaken. In it are included
tw~lve cases of ringworm of the scalp in patients seen between October,
1927, and November, 1928, in private practice and in the dispensary.
vVith the exception of one case presenting acutely painful and inflam-
matory pustular lesions, the group represented clinically the Microsporon
type of invasion. With two exceptions, the clinical diagnosis was sub-
stantiated by microscopic examination. In these two, there is no record
of this having been done. The patients are representative of every
social status. Each patient has been treated in practically the same
manner. The measures carried out were as follows:
Fig. 1 (case 3).-Appearance at time of first examination (small lesions due to
pyogenic infection).
Fig. 2 (case 3) .-Appearance four months later.
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observation, practically every case showed a definite cessation of activity.
In no case were new lesions encountered. Inflammatory reaction was
rapidly disappearing, and formerly active lesions gave definite clinical
signs of regression. Subsequent observations made regularly or other-
wise, according to the type of patient, revealed a continuation of these
signs of involution. Some patients were seen twice a week and others
weekly, for a period of from eight to ten weeks. The course seemed
much the same in all cases; i.e., early regression and a continuation of
involution until complete restoration of hair was obtained.
Being familiar with the tendency to recurrence and the ease with
which many apparent cures may change in a few weeks to a repetition
of the original involvement, a further effort was made definitely to estab-
TABLE 2.-Resltlts of Inquiries
Case Apparent End-Results
Letter: Hail' conlpletcIy returned for past several ll10nths: no recurrence; observation
period approximately thirteen montlls
Exanlination: Hair completely returned; clinieally and microscopically negative; observa-
tion period approximately one year
3 Examination: Hair COlllplctely returned; clinically and lllicroscopicaHy negative; obscrva·
tion period approximatelY one year (see figs. 1 anti 2)
J Personal communication: Hair completely returned for several months. Letter: No
recurrence; obseTvation period ap·pl'OXimHtcl~T ten montllS
;) E'xanlination: Hail" completely returned; clinically and Inicl'oscopically negative; obser·
vation period approximately ten months
Lett€'1': Hair completely returned, but other treatment reported necessary; parents
disgruntled
Exan1ination: IIair completely returned; cIinically and microscopically negative; observa-
tion period six months
8 Examination: Hair cOlupletely returned; clinically and microscopically negative; observa·
tion period six months
Examination: Hair completely rcturncd; clinically and microscopically negative; observa-
tion period six months
10 Examination (dispensary): Hair rcturning; microscopically ncgative; no l'ecurrc~ce; olJsel'·
vfltion period five months
11 Examination: Hair returning; no recurrence; clinically and microscopically negative; obsfl'-
vatioll peTiod approximately fom- months (see fig'. 3)
12 Exan1ination: Hair returning; microscopically negative; observation period approximately
four months
lish apparent clinical cures which seemed assured at the last opportunity
of seeing the patient. vVith this in mind, follow-up letters were sent to
the parents of each patient in the series. In these letters, the parents
were earnestly requested to return the patient for personal examination,
\Vhen this was impossible, they were asked to answer the following
questions:
1. Did the eruption completely heal under the treatment given?
2. How long was tI,e child treated?
3. Has the condition ever reappeared?
4. 'vVere other medicines used? I f so. what?
5. Does tI,e scalp appear entirely healthy now ~
0. Has all of the hair returned?
The results of these inquiries are seen in table 2. Analysis of this
table would seem to furnish still further encouraging information.
Primarily, one failure is noted; case 6 which, according to table 1,
seemed to give promise of favorable response after ten days' treatment,
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Fig. 3 (case 11) .-A, appearance two weeks after treatment was begun. The
large lesion, which was of the so-called kerion type when first seen, is now rapidly
involuting. B, light scarring by previous pustular lesions; otherwise, the hair is
returning over all the lesions. This picture was taken two and one-half months
after A.
could not be brought to the office. Personal communication with the
parents, however, established the facts that no other treatment had been
used, that clinical cure, including complete return of hair, had taken
place, that there had been no recurrences and that these results had
existed for a period varying from one year to four months. It would
not seem unfair, therefore, to assume that in these patients, as well as
in those examined microscopically, clinical cure had occurred.
is reported as a complete failure necessitating the use of other
remedies. In addition, the mothel' expressed definite personal dissatis fac-
tion at the general conduct of the case. Apparently, therefore, the question
of treatment and cure must remain in doubt, as a personal examination
was impossible. It is to be noted further that it was possible to examine
eight of the remaining patients microscopically, with uniformly negative
results. The children had complete restoration of hair, and these findings
had existed at periods varying from one year to four months after
treatment was begun. For various reasons, the three remaining patients
COPYRIGHT, 1929
AMERICAN 1vIEDICAL ASSOCIATIOX
535 NORTH DEARDORN STREET
CHICAGO
COMMENT
In the foregoing paragraphs are related the results of treatment of
twelve patients with tinea capitis treated exclusively with thymol and
cinnamon oil. Eight were clinically and microscopically well in periods
varying from four months to one year; three, according to letters from
the parents, have enjoyed complete restoration of hair and no recurrence
of symptoms over approximately equivalent periods. In the light of our
present knowledge of the disease, it would seem fair to assume that these,
likewise, were clinical cures. In the remaining case the mother of the
patient, in spite of an apparently favorable response while under obser-
vation, reports the necessity of using other remedies. As far as it has
been possible to learn, in no case has there been a permanent alopecia,
and the remarkable simplicity of the method obviates any necessity of
discussing the possibilities of temporary or permanent untoward effects.
vVhether or not this method offers advantages over that suggested by
Lieberthal 13 or the older, more complicated methods of treatment remains
for a more comprehensive clinical trial to determine. Yet data furnished
herein would seem to merit the method favorable consideration and more
widespread clinical application.
13. Liebertha1, E. P.: Treatment of Microsporen Infection of the Scalp.
Arch. Dermat. & Syph. 18: 97 (July) 1928.
CONCLUSIONS
1. In this paper are related the results of a clinical trial of drugs the
fungicidal and fungistatic activities of which were previously demon-
strated in vitro.
2. This trial would seem to furnish presumptive evidence of a similar
activity so far as ringworm of the scalp is concerned.
3. While the evidence provided is far too limited to be exclusive,
should the above experience be duplicated in other clinics and with a
greater variety and number of cases, it would seem that this simple
method of treatment might well stand favorable comparison with the
older and more complicated ones now in vogue.
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