Sir.—I read with interest the article "Prepubertal Gynecomastia Associated With Estrogen-Containing Hair Cream" by Edidin and Levitsky (Journal 1982;136:587-588). The authors state that, to their knowledge, scalp inunction has not been reported as a cause of prepubertal gynecomastia. I draw the attention of interested readers to the report by Whittle and Lyell1 in 1948.
Whittle and Lyell1 described a 5-year-old girl in whom total alopecia developed after chickenpox. She was given 0.5% diethylstilbestrol ointment by scalp inunction throughout 13 weeks. After ten weeks, vaginal bleeding, deep pigmentation of the areolae, and breast enlargement developed in the patient. Whittle and Lyell1 calculated that she would have received 2.7 mg of diethylstilbestrol daily if all of it was absorbed through the scalp. The signs regressed in the patient after cessation of the inunction.