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Date posted: January 26, 2012

Dr Shivaji Gaur
The word alopecia comes from the greek`alopex’ which is laterally translated as`fox’s disease.
However today alopecia areata is define as hair loss in patches.
Absence  or loss of hair on scalp especially on head.
Alopecia is define as a hair loss disease that effect men , women and children.
The one set of hair loss is often  sudden ,random and frequently recurrent .
While the disease itself is not damaging to the person’s health ,coping with  hair loss can prove challenging.

Normal human hairs can be classified according to cyclical phases of growth:-

  • Anagen – Growth Phase
  • Catagen – Transitional phase
  • Telogen – Resting Phase 
  • The hair all over the body grow in cycles.During the growth phage called Angen,hair grow at the rate of approximately 1cm per month.
  • In young male the duration of anagen ranges from a few to several years for scalp hair. .
  • At the end of anagen phage the hair stop growing further and enter in to a relatively short transitional phage called catagen  and last approximately 3 week on human scalp .
  • Catagen phage lead to resting phage is called telogen which lasts 3 month .
  • At the end of the telogen phage ,the old hair fall and replaced by new hair , which follows same cycle once again. 

Epidemiology :
Prevalence figures show that alopecia affects approximately 1.7 percent of the population , including more than 4 million people in the United States and with both men and women being equally affected .

•  About 25% of patients have a family history disorder.

What cause of  Alopecia :
The  exact cause of alopecia is presently not known, although  it is generally, agreed  that it is a disease of the autoimmune system.
In addition there is believed to genetic component in some  cases and some studies have shown a link with stress.

An alopecia the affected hair follicle are mistakenly   attacked by own immune system (white blood cells), possibly due to chemical called cytokines resulting in the arrest of anagen(hair growth) stage and a move to the  telogen (resting ) phage where the hair are then abruptly shed.

 General information other cause of hair fall:

  • Today is fast moving world of competitive life.
  • Stress is seem important role in hair fall.
  • Stress especially emotional stress is major factor.
  • Even sudden acute stress also causes hair fall.
  • Hair also contributes in adding point of our personality.
  • The  grows from hair follicle, the number of which varies from individual to individual.

It divided by two types:-

A .External/Seasonal Causes:-
Winter excessive used of hair sprays and gel ,improper used of hair colouring agent,excessive used of electric hair curlers, dry indroor heating , infrequent washing of hair ,indequate rinsing hair after ,stress or anxiety.

B. Internal Cause:- 

  • Hormonal imbalance ,poor hygiene, allergic hypersensitivity.
  • Lack of rest,excessive consumption of sugar,fat starch, improper nutrition.
  • Hereditary predisposition .
  • Excessive perspiration,over active oil gland.

Classification of Alopecia:-   

A.Localised    

1.Non scarring :-  Alopecia Areata
Androgenic Alopecia
Tinea capitis
Traumatic -  (Trichotillomania)
(Traction )
(Cosmetic) 

2.Scarring:-  Iodiopathic

  • Developmental defect
  • Discoid lupus erythematosus
  • Herpes zoster
  • Pseudopelade
  • Lichen planus
  • Folliculitis decalvans
  • Radiotherapy 

B.Diffused:-    

  • Androgenic Alopecia
  • Telogen effluvium
  • Metabolic
  • Hypothyroidism
  • Hyperthyroidism
  • Diabetes mellitus
  • HIV diesese
  • Nutritional deficiency
  • Liver disease
  • Post-partum
  • Alopecia areata

C.Secondary  alopecia:-

A large number of diseases such as can produce hair loss on localized areas the scalp.

  • Morphoea
  • Lupus erythematosus
  • Tinea capitis
  • Lichen planus
  • Syphilis 

Lists below some common types of Alopecia :
Alopecia comes in several different forms. Listed below are the common types of alopecia and the characteristics of each type .

  1. Alopecia Areata  :- Used to describe hair loss occurring in  patches any where on the body.
  2. Alopecia Totalis :- Total loss of hair on the scalp.
  3. Alopecia Universalis:-Total loss of all hair on the body.
  4. Alopecia  Barbie:-Loss of facial hair (for a men) especially  in beard area
  5. Alopecia Mucinosa :-A type of which result in scaly patches. 

Androgenic Alopecia : Also known as Male Pattern Baldness.It is a thinning of the hair to an almost transparent state ,in both men and women .It is thought to be hereditary form of hair loss. 

The well known distribution (bitemporal and crown involvement) is as male pattern baldness.
It believed to be transmitted as an autosomal dominant character. 

7.Traction Alopecia :-Traction alopecia is usually due  to excessive pulling or tension on hair shafts as a result of certain hair styles (Selenium).It is seen more often in women .Prolonged traction alopecia can stop new hair follicles developing and lead to permanent hair loss.

8. Anagen Effluvium : This hair loss is generally caused by chemicals such as those used  treat cancer . Initially it cause patchy hair loss, which often then becomes total hair loss.

The good news is that when you stop using these chemical the hair normally grow back (usually about 6 month later ).

Other drugs also can cause hair loss . Many medicines used to treat even common disease can cause hair loss.

Investigation :-

  • FBC
  • ESR
  • UREA &ELECTROLYE
  • LFT
  • THYROID FUNCTION TEST
  • AUTO ANTIBODY PROFILE
  • TPHA(Treponema pallidum haemagglutinatin) test should be determine the cause of non scarring alopecia.
  • More specialised tests,inclueding the hair pluck test where up to 50 hairs are removed with epilating forceps to determine the anagen;telogen ratio,are seldom necessary. 

Mycological assessment:- This is advisable in cases of in localised hair loss with scaling .
A scalp biopsy, with direct immunofluorescence,  may help to confirm a diagnosis of Lichen planus of the or Discoid lupus erythematosus.

Clinical feature:- Alopecia areata is characerized rapid or complete loss of  hair is one or more round oval patches ,usually on the scalp.Commonly the patches  are from 1 to 5 cm in diameter. During the active stage of hair loss pathognomonic  `exclamation mark’ hair are seen (broken off 3 to 4cm long,which taper off toward the scalp).

Androgenic Alopecia:
It is due to androgenic stimulation of predisposed  hair follicles with reduction of anagen phage and increase in number of telogen follicles.

  • This cause terminal hair replaced by vellus hairs
  • The clinical manifestations depend upon  androgenic hormone.
  • The age of onset of varies in different individual.
  • But is does not start before puberty.

Miasmatic Diagnosis:-
Homoeopathy is based on nature’s law of cure and   treatment is done on the basis of Individualisation of patients and holistic approach of cure.
The psychosomatic disorders are one of the most important causes of hair loss.
Homoeopathy with its Holistic approach, considers the patient as a whole and so plays a very good role in treating psychosomatic disorders.

Psora

  • The skin usually dry,rough and unhealthy and discharges are scanty.
  • The diseases having itching ,burning sensation.
  • The lesion with irritation inflammation and due to hypersensitivity  reaction are psoric.

 Sycosis

  • The characteristic  sign are infiltrations, indurations and overgrowth.
  • The pain may be intense.
  • The discharges are having pungent and fishy odour.
  • The skin may be thickening ,scales, dark discolouration, warts moles naevi and hair growth .

Syphilis

  • The lesions of syphilis are characterized by granulation,degeneration and ulceration.
  • There are no sensation of pain and itching  or agonising pain < night is syphilitic in nature.
  • The discharges  are very offensive ,foul and putrid.
  • The eruptions may have brownish red or cooper colour spots and tendency for easy ulceration.

Tubercular/Pseudo-psora 

  • It is mixed presentation of psora and syphilis.
  • The specific lesions are tubercles, fibrosis and suppuration.
  • The pain are neuralgic, sharp piercing and twisting .
  • The discharges are purulent, yellow bloody or musty.
  • The skin may be translucent, fine, smooth having tendency of bruises and bleed easily.

Management/ Treatment :- Homoeopathic  treatment of different type of Alopecia:-

1. Alopecia Areata:-

  • In case lesions of Alopecia areata continue to increase in size or in number or if hair have not regrown in any even after three months.
  • Such cases should be treated immediately.
  • Syphilinum & Ustilago have been used for ALOPECIA TOTALIS and UNIVERSALIS.

2. Telogen effluvium or Diffuse Alopecia:-

  • The patient should be encouraged to clean the hair regularly with shampoo.
  • Cal.carb .,Cantheris Carbo.veg.,lyco.,Nat.mur.,Sepia.,Sec.cor., Sulpher are used in cases of falling hair after pregnancy and parturation.
  • Ars. & China are used in cases due to surgical shock and after haemorrhage respectively.
  • Nat.mur & Phos.acid are used in cases  with mental stress.
  • A nosode Typhoidinum can be used in cases of typhoid fever.

3.  Androgenic Alopecia or (Male pattern baldness):-

Ancardium .,Bac.carb.,fluoric.acid.,Graph.,Phos.,Silicea and Nat.mur., have been used for treatment for Male pattern baldness.

All these drugs are given on the basis of constitution of patient.

4.  Traction Alopecia:- 

  • Main steps of treatment lies in correction of hair styles to reduce  traction on the hair.
  • The early stage changes revert back after correction ,however, scarring hair does not regrow. 

5. Trichotillomania (Traumatic) or hair pulling Tics:-

  • Usually the patient is treated psychologically through repeated assurances and explanation
  • In a few cases who do not respond ,psychiatric advice is essential.
  • Bell., Lechesis.,Lil.tig and Tarentula are useful.           

5. Secondary  alopecia:-

  • Such types of alopecia do not required any special treatment because the Ultimate outcome depends upon the progress of the original.
  • In case of syphilis,  tinea capitis and lupus erythematosus where follicles are not distroyed,hair regrows when the original disease is treated properly.
  • However ,in condition like morphed, lichen planus, lupus vulgaris and mechanical trauma where the hair follicles are distroyed ,chance of regrowth of very poor. 

6.Premature greying of canities:- 

Greying of hair is physiological manifestation of the old age  which has no treatment expect dyeing. 
However many individual have been seen developing grey hair during their teens or even in childhood . 
Thought it is entirely a cosmetic problem,it has been seen having psychological effect on the individual.
However Lyco ., Graph ., Phos ., Phos.acid., Silicea ., Sul.acid.,Psorinum.,&Ars.alb  can be tried in cases of premature greying. 

Therapeutics of hair loss:-  Some common medicine discussed below.

1.Acid fluor:-

  • Itching of the head and falling to the hair after fever
  • Large patches entirely denuded of hair
  • New hair dry and break off .
  • Often hair matts at the end .
  • Baldness.

2. Arsenic:-

  • Touching of hair is painful .
  • Bald patch at or near the forehead  & sides.
  • Scalp cover with dry scabs and scales.
  • Looking rough and dirty.,extending to forehead, face and ear.
  • Brittle and stiff hair .
  • Dandruff . 

3. Arnica :-

  • Improve the blood circulation to the hair root.
  • This is turn hair fall and promotes hair growth.
  • It enriches the scalp with nutrients which help to cure and control dandruff.
  • It is natural scalp coolent and hence prevents scalp disease. 

4. Baryta carb :-

  • Hair fall from vertex and moustache.
  • Baldness especially on crown in young people.
  • Scalp very sensitive to touch agg from scraching & touch. 

5. Borax :-

  • Hair rough and horny.
  • Tangles at tips, sticks together.
  • If bunches are cut they reform.
  • Hair can’t be combed smooth-especially occiput, sides and ,vertex. temples., beared,nostrils. 

6. Cal carb:- 

  • Hair fall out especially when combing especially during confinement.
  • Dryness of hair ,great sensitiveness of scalp with yellow or white scabs on scalp.
  • Sensation of coldness of outer head. 

7. Carbo veg:-

  • Falling out of hair after severe disease.
  • Abuse of mercury with great sensitiveness of scalp to pressure.
  • Hair fall out more on back of head ,after severe illness or parturition.
  • Hair fall worse from warmth of head,cold sweat on forehead. 

8. Graphites :-

  • Even the on the sides of the head, vertex and nostrils falls out.
  • Dry ,tangled , matted or brittle hair.
  • Perspiration of scalp,greying of hair .
  • Dandruff ,like milk crusts. 

9. Kali carb:-

  • Alopecia after nervous fever.
  • Dry brittle hair,rapidly falling off from eyebrow,temples,beard, moustache and sides with
  • much dandruff.
  • Greying of hair. 

10. Lycopodium:-

  • Hair fall from temples and vertex.
  • Hair becomes grey early ;hair fall off after abdominal disease .
  • After parturition,with burning scalding ,itching of the scalp.
  • Especially on getting warm from exercise during the day.
  • Dandruff. 

11. Mancinella:-

  • Losing of hair after severe acute disease.          

12. Nat mur:-

  • Hair fall after nursing .
  • Hair fall out if touch :mostly on forepart of head ,bregma moustache, temples and beard .
  • Scalp very sensitive; face shining as if greasy .
  • Dandruff on occiput. 

13.Nitric acid:-

  • Hair fall from beard and vertex. 

14. Phosphoric acid:-

  • Hair fall after grief,anguish and debility especially from sides.
  • Gnawing grief changes hair of the young to grey.
  • Dry greasy and fluffy hair.
  • Hair fall from the sides. 

15. Phosphorus :-

  • Hair fall after mental emotion or sickness.
  • Round patches on scalp completely deprived of hair .
  • Falling of hair in large bunches on the tufts,occiput, forehead and on the sides above the ear.
  • The roots of hair seem to be dry .
  • The denuded scalp looks clear white and smooth.
  • Dandruff copious , fall out in clouds .
  • Itching of the scalp. 

16.Selenium:-

  • Hair fall off when combing, also of eyebrows, whisker,vertex eyelaches and genital.
  • Tingling itching on scalp.
  • Which feel tense and contracted.
  • Does not want hair touch. 

17. Sepia:-

  • Hair fall after chronic headaches and menopause .
  • Especially from vertex and occiput,worse when combing .
  • Itching of root of hair. 

18. Staphisagria:-

  • Hair fall out mostly from occiput and around the ear.
  • Hair pulls out without pain after the slight effort.
  • Eruption humid ,fetid and dandruff on scalp.  

19. Sulphur:-

  • Hair fall after parturition.
  • Hair fall from occiput and eyelashes .
  • Dandruff, hair dry ,falling of scalp sore to touch, itching violently  agg when getting warm in the bed and washing .
  • Hair grey ,offensive ,dry ,cold and hard. 

20.Syphilinum :-

  • Hair fall out after syphilis,in circles from heard and scalp. 

21. Thuja :-

  • White scaly dandruff ;hair dry and falling out .
  • Hair fall after headache, from vertex.
  • Dry or greasy hair , lusterless and split .
  • Gray hair. 

22. Thyroidinum :-

  • Premature graying of hair. 

23. Vinca minor :-

  • Hair fall out in single spots and white hair grows there ;spot on head oozing moisture , the hair matted togather.
  • Bald patches covered.
  • Itching of scalp. 

24. Wiesbaden:-

  • Hair falls and grows rapidly.
  • Hard ,brittle and lustreless hair

Dr. Shivaji Gaur (M.D)Hom
8/402 Indira Nager,Lucknow -226016, Utter Pradesh
Email : drshivajigaur@yahoo.com

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