Alopecia Areata

Alopecia Areata

Introduction

Alopecia Areata (‘baldness in spots’) is a form of hair loss, usually from the scalp, although it can affect other areas of the body. The hair loss mostly remains limited to the scalp but in certain cases it can extend to eyebrows, eyelashes, facial hair (beard, mustache), nasal hair and give rise to bald spots anywhere in the body. Alopecia Areata is a common condition which arises largely due to a mix of immunological and hormonal factors.
Alopecia Areata can affect both men and women and it is not uncommon to see children affected with this disorder. Approximately 2% of the general population worldwide suffers from Alopecia Areata. We come across many children with Alopecia Areata.

Understanding Alopecia Areata:

The hair is made up of a protein called keratin which is also the main constituent of nails. A specialized structure inside the skin called ‘Papilla’ produces the hair as shown in the figure. The papilla is surrounded by a sac-like structure called the ‘Hair follicle’ which also surrounds rest of the hair root within the skin. The part of the hair outside the skin surface is called as shaft.
Alopecia Areata is considered to be an auto-immune condition in which the immune system of the body (which protects the body from bacteria and viruses) mistakenly attacks the hair follicles and destroys them. This leads to hair loss in the affected area.
The commonest presentation of Alopecia Areata is appearance of bald patches on the scalp. In most cases, hair falls out in small, round patches about the size of a small coin. The patient may have single or multiple such patches. In some cases these patches may remain static, whereas in some cases the patches may spread to involve larger areas of the scalp. In some cases, hair loss is more extensive. Although it is not very common, the disease can progress to cause total loss of hair on the head (Alopecia Areata totalis) or complete loss of hair on the head, face, and rest of the body (Alopecia Areata universalis).

Types of Alopecia Areata:
1.Alopecia Areata monolocularis:

In this condition there is a single bald spot on the scalp.

2.Alopecia Areata multilocularis:

In this condition there are multiple bald spot on the scalp.

3.Alopecia Areata totalis:

In this condition, the patient loses all the hair on the scalp.

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4.Alopecia Areata universalis:

In this condition, all body hair, including pubic hair, is lost.

5.Alopecia Areata barbae:

In this condition, the disease is limited only to the beard region.

6.Traction alopecia:

In this condition, alopecia develops along the frontal margins and temporal margins of the scalp due to constant tension on the hair from being tied very tightly.
It is important for all cases of Alopecia Areata to rule out two conditions, which often accompany:
1. Under active Thyroid (Hypothyroidism)
2. Diabetes Mellitus

Causes of Alopecia Areata

The causes of Alopecia Areata are not fully understood. Alopecia Areata is considered to be an auto-immune condition in which the immune system of the body (which protects the body from bacteria, viruses, allergens, etc.) mistakenly attacks the hair follicles and destroys them. This leads to hair loss in the affected area. This abnormal behavior of the immune system is understood to be guided, influenced and triggered by multiple factors.
The exact cause, why hair follicles undergo this kind of destruction, is not known but a genetic component to this is suspected. Family history of Alopecia Areata or any of the other auto-immune diseases (such as hypothyroid, diabetes, cancer, ulcerative colitis, rheumatoid arthritis, etc.) is often seen in many cases, suggesting a role of genetic element. In addition to the genetic predisposition, certain triggering factors may bring on the onset of this condition. Prolonged underlying stress often predisposes some patients to develop auto-immune process leading to Alopecia Areata. However, stress may not be the cause in every case. Alopecia Areata treatment has to take into account the underlying causes.
One or more of the following factors may be found responsible in cases of Alopecia Areata:
1.Hormonal cause: High levels of the male hormones (in men as well as in women) can trigger the onset of Alopecia Areata
2.Thyroid disorders
3.Drugs and medications:
– Commonest is this group are chemotherapy drugs, certain medicines used for gout, arthritis, depression, hypertension, ischemic heart disease, etc
– Large doses of Vitamin A can also trigger Alopecia
– Oral contraceptive pills
4.Chemical treatment of hair, exposure of hair to excessive heat
5.Low levels of iron

6.Poor protein intake
7.Physical stress: After undergoing some major surgery, or due to some chronic illness, rapid weight loss due to dieting
8.SLE (Systemic Lupus Erythematosus)
9.Fungal infection of the scalp
10.Lichen Planus on scalp (with scarring)

Alopecia Areata Symptoms

1. Excessive hair loss in small, round patches, usually in short period of time
2. May affect scalp, eyebrows, eyelashes, beard or moustache
3. Single or multiple bald (hairless) spots
4. Underlying skin usually looks normal
5. Generalized thinning of hair referred as diffused Alopecia Areata over the scalp.
6. Complete loss of hair all over the scalp – Alopecia Totalis
7. Extensive hair loss all over the body – Alopecia Univarsalis.
8. Scarred Alopecia Areata: Any patch of Alopecia which has a scar formation.

Alopecia Areata Treatment

Duration of treatment:

The total length of treatment varies form case to case, depending of the following factors:
1. Duration of Alopecia
2. Areas affected (scalp, beard, mustache, limbs, other body areas)
3. Extent of spread (Small or large; one or multiple spots)
4. Previous medication (Extensive use of oral or local cortisone)
5. Associated diseases like Under active thyroid, diabetes, other diseases,
One may expect a definite change in about three to five months, depending on the extent. The total length of medication may be anything between six months to two years or longer.
Cases of Alopecia Totalis (universalis) do not respond to homeopathy.

Why homeopathy for Alopecia Areata?

Major benefits of homeopathy could be summarized as under:
1. It addresses altered immune system, treating the roots of this autoimmune disease.
2. It is not superficial but deep acting; gives lasting to almost permanent results in most cases.
3. It is absolutely harmless, safe and non-toxic.

The Limitations of homeopathy:

1. It is relatively slow acting as compared to the steroids.
2. It gives no results in cases of Alopecia Totalis (full body hair loss).
3. The success rate is not 100%.

Alopecia Areata Masked with Immunosuppressive Medicines

Is your Disease Masked with Immunosuppressive Medicines? (Guide to Patients who have taken immunosuppressive medicines) By Dr Rajesh Shah, MD(Hom)

Many patients with one or more of the following diseases, approach us for the treatment, when their disease may have been ‘masked’ by some immunosuppressive medicines, as described in this article.
Common diseases, which could be ‘masked’ with other medicines:
1. Psoriasis
2. Urticaria
3. Nephrotic Syndrome
4. Alopecia Areata
5. Lichen Planus
6. Psoriatic arthritis
7. Rheumatoid Arthritis
8. Vitiligo
9. Ulcerative colitis
10. Eczema (atopic dermatitis)
Immunosuppressive medicines are those conventional (allopathic) drugs, which help, in allergic, inflammatory and auto-immune diseases by suppressing the immune response of the body. It may be noted that the immunosuppressive medicines may prove to be effective in treating the diseases, but with following riders attached:
1. Temporary relief
2. Significant adverse effects
3. Relapse of diseases, which are at times hard to manage.
4. Drug dependency.
The purpose of this article is neither to criticize the efficacy of immunosuppressive medicines, nor to discuss their adverse effects; but to review the difficulty they pose when we initiate their homeopathic treatment.
Some of the commonly used conventional (immunosuppressive) medicines which may mask the diseases (without necessarily curing them), can be listed as under:
1. Cortisone (steroids) (oral, topical application, injections, mouth wash)
(In all of the above stated diseases)
2. Tacrolimus (Vitiligo)
3. Methotrexate (In Psoriasis, Rheumatoid Arthritis, Psoriatic Arthritis, etc.)
4. Cyclosporine (In Psoriasis, Psoriatic Arthritis, etc.)
5. Cyclophosphamide (In Nephrotic Syndrome)
6. Propysalic (In Psoriasis)
The patients who approach us for homeopathic treatment, who may have been eithercurrently taking one of the above mentioned immunosuppressive medicines; or may have taken it in the recent six months time, must note that:
a. As soon as the effect of immunosuppressive medicine gets over, the disease is likely to return, in some of the patients, if not all. In case of skin diseases (Lichen planus, vitiligo, alopecia areata), the disease may appear on different part of the body, not necessarily at the same old place.
b. In any case, the immunosuppressive medicines are never supposed to be taken life long. On stopping them some day, the relapses are likely to happen. For better management, it would be wiser to introduce homeopathic medicines in such cases.
c. The return of disease on stopping immunosuppressive medicine is likely to coincide with the starting of homeopathic medicines. This situation might give a feeling that the return of disease or an increase of disease is caused by homeopathic medicine! It must be noted that homeopathic medicines do not cause increase of the disease in such conditions, as some people believe it.
d. The disease that returns on stopping immunosuppressive medicines is likely to be more severe than before.
e. The resurfaced disease is likely to be more resistant than before. It may be noted that even after starting homeopathic treatment, such cases are likely to show relapse; which may require use of those immunosuppressive medicines for some time. Some patients believe that once homeopathic treatment started, there should be no need to take any conventional medicines! Need to take the immunosuppressive medicines in cases of relapse after stopping them, is not an indication of failure of homeopathic medicines; it must be noted.
f. One is likely to need it again, as no milder medicine might work.
g. Patients body is likely to get dependent or addicted to immunosuppressive medicines on using it frequently. Such cases are often called ‘drug dependent diseases’. Examples: Cortisone dependent Ulcerative colitis or Nephrotic Syndrome.
h. In case of eczema or psoriasis or urticaria, the resurfaced skin eruptions after stopping immunosuppressive medicines may pose difficulty on first or second instances of relapse. Such cases require to be managed strategically for better success rate in overcoming the crisis.
h. Patients who have immunosuppressive medicine dependent diseases, they can still be managed with homeopathy; but it may take time. Some to the cortisone dependent or cortisone resistant cases (especially UC or NS) may be really very difficult to treat. Homeopathy cannot be a short cut for such difficult diseases.
Patients must know that homeopathy is an effective medical system. However, some disease situations can be really difficult. The diseases treated and masked using immunosuppressive medicines fall in the category of difficult diseases.
Careful evaluation, thorough medical knowledge, strategic planning, sound homeopathic experience on the side of the treating homeopathic doctor; combined with patient’s compliance can help success in long term management of such diseases.

Homeopathy Remedies for Alopecia Areata

Important note:

Every case calls for detailed study of the patient individually. There are no disease specific medicines in homeopathy. The exact treatment is determined only on “in-depth” evaluation of the individual case. The medicines described below are commonly indicated in Lichen Planus, only for the purpose of information. The readers are advised not to indulge in any kind of self-medication.

Natrum Muriaticum:

Natrum Muriaticum is an interesting example of homeopathic medicine prepared from a common food substance, the common salt, sodium chloride. As a rule, the common salt undergoes a special procedure called potentization, whereby its inner healing power is activated to make it available for healing.
Constitutionally, this medicine has a broad spectrum of action, and is useful for a wide range of disease processes affecting the skin, gastrointestinal organs, nose, lungs, kidney, metabolism, muscles, head, hormonal system, etc. It is one of the commonly used remedies for Alopecia Areata, hair loss, fissures, Urticaria, Migraine, Eczema, Lichen Planus, Vitiligo, Asthma, etc.
Natrum muriaticum is frequently prescribed in cases of hair loss especially in anemic females.

Silicea (Silica):

It is one of the splendid acts of homeopathy that substances labeled as inert can also be used efficiently to treat a large variety of disorders. Silica is the example of one such substance, which is chemically inert in its natural form, but after undergoing the process of potentization it gets transformed into a wonderful, deep acting remedy. Silica is in true sense called as polycrest remedy as it has a broad spectrum of action, useful for a wide range of disease processes. In fact this remedy has helped Homeopaths world over to treat so-called surgical conditions gently without requiring knife.
Silica positively influences bones and joints, mucous membranes, skin, cellular tissue, nerves, glands, lungs, digestive system, etc. Silica is one of the frequently used medicines for complaints of hair loss, vitiligo, eczema, lichen planus, herpes, urticaria, asthmatic bronchitis, pneumonia, tuberculosis, styes and chalazion, trigeminal neuralgia, complaints of nails, tonsillitis, etc. It is frequently prescribed for the complaints of hair loss.
Patients requiring silica usually have tendency of easy suppuration of skin injuries. Silica positively influences nutrition as well and hence its one of the prominent remedies used for rickets in children.

Phosphorus:

This is a wonderful remedy prepared by the potentization of inorganic phosphorus. After undergoing the process of potentization, the latent healing powers of this drug are brought to surface and it proves to be a wonderful remedy capable of curing a wide range of diseases.
Phosphorus predominantly acts on the gastrointestinal tract, hepato-biliary system, blood, kidneys, bones, lungs, nervous tissue, etc.
It is frequently used in the homeopathic treatment of hair loss, nephrotic syndrome, hepatitis, cirrhosis, hemorrhagic tendencies, respiratory infections, osteomyelitis, paralytic symptoms, etc. Some of the common indications of this drug are:
Falling of hair in large bunches; in spots. Dandruff with intense itching of the scalp. Highly sensitive to external impressions such as light, sound, odors, touch, thunderstorms, etc. Restless, excitable, nervous individuals. Affects the kidneys causing albuminuria and haematuria; patient has profuse, pale, watery urine with intense weakness. There is increased susceptibility to colds amongst children.

Lycopodium:

Lycopodium is one of the wonderful remedies in Homeopathy and it is prepared from the club moss (fungus). After undergoing the process of potentization the hidden curative powers of this fungus are brought to the surface and it is transformed to a deep acting homeopathic remedy.
This drug is frequently prescribed for complaints of hair loss, premature baldness, premature graying of hair. Lycopodium is also one of the commonly prescribed remedies for complaints of the gastro-intestinal organs, reproductive organs, urinary complaints, skin and respiratory disorders. Its frequently prescribed for chronic eczemas where the skin becomes excessively dry and raw from itching. Thick and indurated skin due to eczema. Offensive secretions, fissured eruptions and violent itching are a few of its common indications. The complaints are worse from warmth and better by cold applications.

Nitricum acidum:

As the name suggests, this drug is prepared from nitric acid. It must be remembered that the remedy does not contain the original drug substance in its material form but it contains only the dynamic powers of the drug which are released after it undergoes the process of potentization.
Nitricum acidum is a deep acting, constitutional remedy which positively influences the gastrointestinal tract, nerves, glands, skin, bones, etc.
Its one of the commonly used drugs for hair loss, vitiligo, warts, ulcers, fissures, gastritis, hemorrhoids, bony and rheumatic affections, malignancy, cachexia, etc.
Loss of hair from the vertex. Sensitiveness of the scalp.

Sepia:

It is the beauty of homeopathy that it can use wide range of natural sources ranging from plants and their products, minerals and compounds, and even animal products for its medicines. Sepia is one such example of medicine prepared from inky juice of Cuttle fish. The latent medicinal power of this juice is aroused by means of homeopathic potentization.
Sepia, in true sense, is called as polycrest remedy as it has a broad spectrum of action and is useful for a wide range of disease processes. It positively influences the skin, digestive system, female genital organs, liver, glands, lungs, and nerves. It is one of the most commonly used medicines for hair loss, irritable bowel syndrome, herpes, eczema, urticaria, lichen planus, ring worm, vitiligo, styes and chalazion, asthma, urinary tract infection. It is one of the best medicines for many gynecological and pregnancy related complaints.
It’s an especially good drug for hair loss during the climacteric period, during and after parturition. It’s also a very good remedy for alopecia areata where the hair falls out from the scalp leaving bald patches behind. Good drug for matting of the hair.

Graphites:

Graphites is a wonderful deep acting constitutional remedy prepared from black lead (mineral carbon). It’s truly a good example of one of the splendid acts of homeopathy that an inert substance like this can be transformed into a remedy having such a wide sphere of action. Graphites positively influences the skin, nutrition, circulation, gastrointestinal organs, reproductive system, glandular tissues, mind, etc.
Its one of the commonly indicated remedies for hair loss, eczema, callosities, fissures, ulcerations, dyspepsia, chronic constipation, obesity, menstrual complaints, etc.
Graphites is a great remedy for menopausal complaints and it’s frequently indicated for various symptoms that develop during the menopausal period. A few of its common indications are:
One of the very good remedies for falling out of hair from the entire scalp; also for alopecia patches on the occiput due to moist eruptions on the scalp. Falling of hair at temples. Alopecia in infants.

Phosphoric acid:

Phosphoric acid is a wonderful deep acting constitutional remedy prepared from potentization of Glacial Phosphoric Acid. It is one of the very good remedies for mental debility followed by physical debility, which leads to a host of complaints. Frequently used for complaints of hair loss, diabetes, hemorrhages, debility, depression, gastro-intestinal affections, sexual complaints, etc. Complaints arising due to loss of vital fluids from the body and after acute illnesses. Early hair falling and graying of hair. Hair tends to fall out from the scalp, eyebrows, genitals, etc. When complaints of hair loss come on after acute illnesses like fevers, etc. Phosphoric acid turns out to be a very good remedy. Often the complaints come on after some sorrowful experience and the patient tends to be chronically sad and depressed.

Fluoric acid:

This is a remedy that is prepared from potentization of hydrofluoric acid. Its one of the excellent remedies for hair loss and few of its common indications are as follows: Very good remedy for cases of alopecia areata. Patient has loss of hair especially after fevers. Brittle hair. After fever, patient loses hair in spots from the scalp. Hair loss due to syphilis. Sticking of hair; they are matted together and tangle easily. Hair loss and Alopecia Areata after typhoid or any long term febrile ailment.

Types and sites of Alopecia

Scalp, beard, moustache, eyebrows, eyelashes, any hairy skin part, arm-pits, pubic, total skin…
Alopecia areata may present in the form of several types. Simply, they affect different areas of the skin.
The most common being the scalp, where one may present with a very small hairless patch or many patches, small or as large as 15 cm diameter; or complete loss of hair on the scalp.

Face:

In addition or independently, one may has patchy hair loss on the beard area, in males; single or multiple, mostly multiple.
Lack of growth of or facial hair in males is a related but a different condition due to deficient testosterone hormone.
Some male patients may present with patches on the moustache.
Loss of eyebrows and eyelashes may be observed in severe cases, which are relatively more difficult to treat.

Arm-pits (axillae) and pubic area:

Patchy or complete hair loss in armpits or in pubic areas could be seen in males and females, equally.

Other skin parts:

Alopecia may affect any hair skin areas. One my has single or multiple or extensive hair loss on different body areas.

Alopecia Totalis:

IN this variety, the patients may progressively lose hair on most body parts.

Alopecia universalis:

Complete hair loss on all the parts of the body, from head to toes, including eye-brows, arm-pits eyelashes, pubic hair, all over the skin; is called Alopecia universalis.

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