Evidence Based Clinical Study on Alopecia

About the Author:

DR.NISHANT KUMAR SRIVASTAVA , 

Dr. Nishanth Kumar Srivastava

Dr. Nishanth Kumar Srivastava

RECIPIENT –

  • Dr. Hemant Kumar Banerjee National Award 2015
  • Homoeo Friends Hahnemann Award 2013
  • Personality Award 2004 at Bharati Vidyapeeth Homoeopathic Medical College Pune.

ADVISOR-

HOMOEO FRIENDS SWASTHA PATRIKA

CONSULTANT–

  • National Institute of Public Cooperation & Child Development, Ministry of Women and Child Development, Govt of India, Lucknow,U.P.
  • State Bank of India, Lucknow,  U.P
  • HONORARY GUEST LECTURER –Solan Homoeopathic Medical College, Solan (H.P).
  • TATA MOTORS, Lucknow (U.P)
  • Ex- Consultant- Gaurang Clinic & Center for Homoeopathic Research

 

ABSTRACT

A total of 100 well-diagnosed cases of ALOPECIA AERATA & TOTALIS were registered for treatment at Geetanjali Homoeopathic Clinic & Research Center Lucknow from October 2008 to November 2015. Clinical diagnosis followed by constitutional treatment with homoeopathic medicines showed encouraging results in majority of cases. Out of 100 cases 21 cases showed complete re-growth of all the lost patches of hair in both alopecia totalis and aerata both taken together. While   42 cases showed improvement in few patches and rest 25 cases did not show any response to the treatment. Whereas 12 cases worsened after treatment in which increase in size and number of bald patches was observed. Duration of treatment varied from case to case depending on the size and number of the bald patches and response of the patient. In depth case taking was done in each and every case on holistic principle giving more emphasis on causation and mental symptoms. The outcome of this study is very encouraging, which gives new dimensions and confidence to young Homoeopaths in treatment of alopecia aerata/totalis strictly abiding by Hahnemaanian principles of minimum dose and minimum repetition.

Evidence Based Study on Alopecia

Evidence Bases Study on Alopecia

INTRODUCTION

Alopecia areata is a prevalent autoimmune skin disease resulting in the loss of hair on the scalp and elsewhere on the body. It usually starts with one or more small, round, smooth patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis). The scalp is the most commonly affected area, but the beard or any hair-bearing site can be affected alone or together with the scalp. It is an autoimmune disease in which  cells of body fail to recognize its own body cells and destroys its own tissue as if it were an invader. Often it causes bald spots on the scalp, especially in the first stages. In 1–2% of cases, the condition can spread to the entire scalp (alopecia totalis) or to the entire epidermis (alopecia universalis). Hair can grow back in or fall out again at any time, and the disease course differs from person to person. No matter how widespread the hair loss, most hair follicles remain alive and are ready to resume normal hair if treated properly.

TYPES OF ALOPECIA

  • Diffuse alopecia areata. Hair may also be lost more diffusely over the whole scalp, in which case the condition is called Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.
  • Alopecia areata multilocularis refers to multiple areas of hair loss.
  • Ophiasis refers to hair loss in the shape of a wave at the circumference of the head.
  • Alopecia areata barbae – The disease may be limited only to the beard.
  • Alopecia totalis If the patient loses all the hair on the scalp, the disease is then called.
  • Alopecia universalis. If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia areata totalis and universalis are rare.[5]

PRECIPITATING FACTORS

Alopecia areata results when the body’s immune system attacks healthy hair follicles by mistake. Alopecia areata is often likened to a “swarm of bees” in the form of specific T cells that attack the hair follicle. Normal hair follicles are hidden from immune recognition and a state of immune privilege or protection from autoimmune attack. The collapse of this immune privilege is what allows the swarm of T cells to attack in alopecia areata. We do not know what activates the autoimmune reaction in alopecia areata but research suggests it is a combination of genetic susceptibility and environmental triggers outside the body, such as bacteria or viruses, which may signal changes that confuse the immune system. It occurs more frequently in people who have affected family members, suggesting heredity may be a factor. Strong evidence of genetic association with increased risk for Alopecia Areata was found by families with two or more affected members.

The condition is thought to be a systemic autoimmune disorder in which the body attacks its own anagen hair follicles and suppresses or stops hair growth. For example, T cell lymphocytes cluster around affected follicles, causing inflammation and subsequent hair loss.

Endogenous retinoids metabolic defect is a key part of the pathogenesis of the Alopecia Aerata , a genome-wide association study was completed that identified 129 SNPs (single nucleotide polymorphisms) that were associated with alopecia areata. The genes that were identified include regulatory T cells, cytotoxic T lymphocyte-associated antigen 4, interleukin-2, interleukin-2 receptor A, Eos, cytomegalovirus UL16-binding protein, and the human leukocyte antigen region.

hair_folicile_cycle

PREVALENCE & INCIDENCE

The condition affects 0.1%–0.2% of humans, occurring in both males and females. Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen with people of all ages. Patients also tend to have a slightly higher incidence of conditions related to the immune system asthma, allergies, atopic dermal ailments, and hypothyroidism. Epidemiology of the disease also depends on various factors enlisted below-

  • Family history
  • Distribution by sex
  • Distribution by age 
  • Distribution by body site
  • Burden of diseases & Quality of life-
  • Psychiatric co-morbidity

DIFFERENTIAL DIAGNOSIS

The causes of hair loss can be broadly divided into focal or diffuse hair loss (Table 1). Focal hair loss is secondary to an underlying disorder that may cause non-scarring or scarring alopecia. Non-scarring focal alopecia is usually caused by tinea capitis or alopecia areata, although patchy hair loss may also be caused by traction alopecia or trichotillomania. Scarring alopecia is rare and has a number of causes, usually discoid lupus erythematosus. Diffuse hair loss can be further categorized into conditions that cause hair shedding, of which the most common is telogen effluvium, and predominant hair thinning caused by male or female pattern hair loss (previously called androgenetic alopecia).

MODEL CASE: 1

Name: Mrs. Meena Mishra

Registration No: M-451

Age: 42 yrs.

Gender: Female

Occupation: House wife

Date of First Consultation: 23.09.2013

CHIEF COMPLAINT:

  • 41 year old lady came to me in September 20012 for large patches of hair loss on the scalp. It was only when she removed her wig that I realized the extent of her hair loss. Three fourth of her head was hair less. She had seen many dermatologists and several renowned Homoeopaths of the city without any improvement.

alopecia_study

 

LIFE SPACE:

She had very strained relation with her husband. Her husband was a government servant in a transferable job. She use to stay alone while her husband was away for his job. While staying alone for year she developed certain fears and anxieties. She was always worried and tense about well being her husband and childrens. She was very timid in nature with yielding disposition. Forsaken, feels of not being loved by her husband and family. Lack of self confidence.

MENTALS:

Frequent transfers of her husband  made her feel very lonely, unsettled, forsaken and unloved. It was important for her to have few close people around. She was scared of being alone or abandoned. She developed extreme fears especially of Rats,

Darkness alone while and heights.
Aversion to crowds, and unknown people and noises.
She desired company of few close people (3+). Averse pity (3+) but wants people to supportive. She gets irritated if people become obstinate. Usually suppresses her anger. Does not like confrontation. Ready to talk about her problems. Very friendly with mother. She is very scared (3+) of her father who is disciplined and matter of fact and would shout at her when he was angry. She hated being yelled at.

As a child she was very intelligent yet coward. Rude  behavior of  her father would get upset and occasionally she was beaten. She was terrified of this. She cried if angry but avoided crying in front of others.

As a child she was thin with a big head. Friendly and fond of travelling and walking. She was good in studies, use to solve puzzles etc. Very shy. She was nervous going to any new place.

Tremendous stage fright(3+). She gets petrified with cold & sweaty palms and feet. She was afraid that people could see she was nervous. She could deal with one or two people, but would not perform in front of a large crowd. Anticipatory anxiety and diarrhoea before exams.

She tends to do badly in exams as she is very slow and cannot finish the exam paper though fond of studies. Obstinate (3+) about certain things. Mostly yielding disposition and always soft spoken.

PAST HISTORY –

Catches cold easily  dust (+2), dampness, change of seasons

Desired undigestible things (chalk) during infancy

Milestones normal.

FAMILY HISTORY –

Diabetes& Hypertension

 PHYSICAL GENERALS:

  • Craves-Sweets3+
  • Aversion-spicy food
  • Thirst- increased (3+).
  • Thermal – Chilly (3+)
  • Perspiration – Sweats (3+) especially the underarms, back, face, head, palms and soles.
  • Skin – Dandruff (3+), flaky eyelashes. Allergic to metallic jewellery like ear rings which cause inflammation and pus formation. Worse silver or artificial jewellery.
  • Menses – Started at 12 years. Irregular for 3-4 years. Often got menses before exams and preceded by cough and cold, weight gain, heavy breasts and a sore and patchy tongue.

PHYSICAL EXAMINATION:

Large bald patches on scalp. Warts on neck & axilla.

RUBRICS:

1– Ailment from anticipation

2- Shy/ Timid appearing in public

3 – Egotism

4- Delusion everything will fail

5—Fear failure

6- Anxiety from noise

7- Obstinate

6 – Fixed Ideas

8- coldness-  hand palm s

9- cold- soles- foot

10- hair – affection- of baldness; young people

REPERTORY  USED:

·         Synthesis Repertory

·         Murphy’s Repertory

alopecia

Selection of Drug:

Silicea

Selection of Potency:

Following are the reasons of selecting a high potency like 1M in this particular case.

  • Marked  ailments symptom present in the case
  • Presence of characteristic mental symptoms
  • Characteristic Delusion present in this case
  • Recurrent dream and fears
  • Syphilitic miasm is predominant in this case
  • Characteristic physical general symptoms

TREATMENT & FOLLOW-UP:

1st prescription11- 6 – 2013 SILICEA 1M – single  doses, Sac Lac 2 weeks.

2nd follow up 29-6-13 – not much changes in hair follicles but patients general symptoms are improving i.e thirst, hunger etc. Moreover mentally patient seems to be much calm and composed anxieties have reduced considerably thus  Sac lac was  given.
3rd follow up 15 -7-13 – Hair follicles starts appearing this  Sac lac was repeated .

alopecia_study_images
4th follow up 8-8-2013 – Hair follicles are appearing in almost all places and thick starnds of hair are clearly visible. As response of the medicine is good so again sac lac was repeated.

5th follow up 3-9-2013 – months she improved greatly but since last follow up the speed of recovery has slowed considerably thus it is the  appropriate time for single dose repletion thus Silicia 1M  was repeated.

studyonalopecia

6th follow up 10-10-2013 – almost all patches have been covered by tender follicles of the hair. Mentally patient seems to be very confident and sure of herself. On cross checking all her fears have reduced considerably.

alopecia_final_result

 

CONCLUSION-

  • The overall impact of this evidence based scientific study is encouraging. It reveals that homoeopathic drugs have definite action on hair follicles which rejuvenates and thus produces   thin hairs which later gets converted to thick hair strand.
  • The period of treatment varies according to the chronicity of the disease & individual response of the patient.
  • Alopecia either aerata or totalis can be reduced and cured permanently with suitable Homoeopathic drugs.
  • Homoeopathic drugs are cost effective and easy to take having no side effects.
  • The recurrence rate after homoeopathic treatment in alopecia is nil or very less.

References:

  • Harrison – principles of internal medicines
  • Khanna- illustrated synopsis of  Dermatology and STD
  • Wikipedia
  • Rox burgh –common skin diseases
  • Soul of remedies Dr Rajan Sankaran
  • Elements of Homoeopathy vol 1 & 2.
  • Perceiving rubrics – Dr F.J. Master  etc.