Alopecia is the term used for loss of hair, either diffuse or patchy, due to a structural or functional defect in the follicle or to a change in the hair itself.
It is of many types. As each one is different in its etiology, pathology and management, it has to be dealt separately.
MALE PATTERN HAIR LOSS/ MALE ANDROGENETIC ALOPECIA
Male balding is a common androgen-dependent trait in which there is a progressive decline in the activity and size of scalp hair follicles. It requires a genetic predisposition, and frequency increases in the population with advancing age.
Clinical features of MALE PATTERN HAIR LOSS/ MALE ANDROGENETIC ALOPECIA
In the majority of men, balding is patterned, the two major components being fronto-temporal recession and loss of hair over the vertex. This process may start at any time following puberty. Hairs become shorter and may, become finer in calibre. Ultimately this may lead to complete hair loss except at the lateral and posterior margins of the scalp where hair is retained.
This can cause significant adverse psychosocial effects in some men. Balding, according to studies, is found to cause increased stress, lowered self-esteem and reduced satisfaction with body image.
Treatment of MALE PATTERN HAIR LOSS/ MALE ANDROGENETIC ALOPECIA
Male balding is a biological normal process. In normal circumstances it has no adverse effects on physical wellbeing. But it has a powerful impact on the human psyche, as studies have shown. For some people, the concern about hair loss reaches the level of a body dysmorphic disorder. In such cases a consultation with a clinical psychologist or a psychiatrist is advised.
Drugs used in male balding – minoxidil and finasteride – stimulates hair growth in some men. Yet neither of them can regrow hair on a completely bald scalp. They are better regarded as preventative treatments.
FEMALE PATTERN HAIR LOSS
Female pattern hair loss (FPHL) is a broad term for the decrease in central scalp hair density that occurs in many females post puberty.
Clinical features of FEMALE PATTERN HAIR LOSS
- Decrease in hair density in the central (vertex, mid and frontal) scalp, bitemporal and parietal regions
- Miniaturization of affected hairs.
- Two ages of onset: early (post-puberty to third decade) and late (age 40+ years).
- Signs of hyperandrogenism (hirsutism, irregular periods) or hyperandrogenemia occur in a subset of women with female pattern hair loss (FPHL) but most women with FPHL have neither.
Treatment of FEMALE PATTERN HAIR LOSS
Many, but not all, affected women respond to antiandrogens or 5α-reductase inhibitors with increased hair growth indicating an androgen etiology in at least some cases of FPHL. Topical minoxidil remains a mainstay of treatment and hair transplants now offer a viable alternative effective treatment for many women with FPHL.
The exact etiology of AA is unknown. It is probable that a myriad of genetic and auto immune factors are responsible for the disease.
CLINICAL FEATURES of ALOPECIA AREATA
- AA typically presents as one of four major patterns:
- Round or oval patches of hair loss
- Loss of all scalp hair (alopecia totalis)
- Loss of all body hair (alopecia universalis)
- Ophiasis pattern alopecia areata – Loss of hair in a wave like pattern at the circumference of the head.
- Nail abnormalities may precede, follow, or occur concurrently with hair-loss activity
- The disease may be associated with allergic rhinitis, asthma, atopic dermatitis or auto immune diseases like thyroiditis and vitiligo.
Treatment of ALOPECIA AREATA
At present there is no universally accepted drug for the treatment of AA. To suppress disease activity, physicians commonly prescribe topical or intralesional corticosteroids and, less commonly, oral steroids. There are also many other treatment approaches and several are currently being evaluated in clinical trials.
Telogen effluvium is another common hair loss condition presenting with a complaint of increased shedding over normal levels and associated diffuse alopecia.
The shedding results in a diffuse loss with a more prominent central and frontal scalp
loss. The patient usually relates loss of body hair and a diminished rate of hair growth, especially of leg hair.
Treatment of TELOGEN EFFLUVIUM
TE is not an ultimate diagnosis, rather a medical sign. So it is important to explore the underlying condition. When a trigger is identified and treated, the patient experiences diminished shedding and later regrowth of hair.
Cicatricial alopecia encompasses a variety of disorders where the hair follicle is irreversibly destroyed along with scar formation, resulting in permanent hair loss.
It is classified into three
- Lymphocytic CA
- Neutrophilic CA
- Mixed CA
MANAGEMENT of Alopecia
Treatment is based on the type of disorder. Combination therapies involving both systemic and topical remedies are used.
AYURVEDIC PERSPECTIVE of Alopecia
KESHA – HAIR
- Human body is made up of doshas, dhathus and malas. Malas are formed during the transformation of one dhathu to the subsequent dhathu. Kesha (hair) is formed when asthi dhathu, with the help of its own dhathwagni, is converted to majja dhathu.
- Kesha is a pithrja bhava (paternal factor)
KHALITHYA AND INDRALUPTHA
In Ayurveda, hairfall is discussed under the headings of Khalithya and Indraluptha. They are two among the shirorogas (diseases of the head). The samprapti progresses as Pitta pradhana tridhoshas along with raktha reaches the root of hair, causing its detachment. In case of khalithya, the hair loss is gradual and generalised, while in indralupta it is sudden loss of hair in patches.
CAUSES of Alopecia as per Ayurveda
Hairfall, according to Ayurveda, may be attributed to the factors that cause pitta and vata vitiation in the body. This may be due to some or all of the following causes:
- Increased use of salt, sour and pungent food items
- Improper sleep patterns
- Skipping meals
- Washing of hair with warm water
- As a swabhavikavyadhi (normal physiology of aging)
- A person with pitta prakrti may experience premature balding and greying compared to others.
Ayurveda Treatment for Alopecia
Ayurveda considers nidanaparivarjana (avoiding the causative factors) as the first line of treatment of any disease. All the causative factors listed above should be avoided.
Sodhana for Alopecia
After assessing the extent of dosha dusti the physician can decide on the administration of purificatory procedures like vamana, virechana, vasti, or raktamoksha.
Rakthamoksha for Alopecia
This is the mainstay of treatment of Indralupta (alopecia areata). Usually lekhana is done with the leaves of Therakam (Ficus exasperate)
Vasti for Alopecia
In case of hairfall due to asthi kshaya, various vasti karmas can be given. Ksheera vasthis and sneha vasthis processed with tikta rasa (bitter taste) drugs will give excellent results
Nasya for Alopecia
After the body is cleansed with the help of the purificatory therapies, nasya can be done. It can be done as marsha nasya or prathimarsha nasya. Marsha nasya is to be done only under the supervision of a qualified physician. Pratimarsha nasya is done in small doses for longer periods of time.
Eg: Ksheerabala taila, Anu taila
After the body is cleared of doshas, external therapies may be tried.
Siro-abhyanga (Oil massage on head)
Some yogas for siro abhyanga :
- Bhrangaraja taila
- Nilibhrngadi keram
- Chemparathyadi keram
- Malathyadi keram
Siro lepa with paste of triphala or amalaki churna is beneficial.
Internal medications for Alopecia
Rasayanas like Chyavanaprasha rasayana, Narasimha rasayana, Agastya rasayana
In case of asthi kshaya – Tiktaka ghrta, Mahathiktaka ghrta
Commonly used properitory medicines for Alopecia
- Indraluptha Lepam
- Hairzone Solution
- Capsule Step
- Tablet Septilin
- Tablet Guggulupanchapalam
- Tablet Varanadi
- Tablet Gugguluthiktakam
- Tablet Gandhak Rasayan
- Tablet Arogyavardhini Vati
Ayurvedic Hairoils Used for the Treatment of Alopecia
- Dhurdhurapatradi Kera Tailam
- Malatyadi Kera Tailam
- Chemparathyadi Kera Tailam
- Neelibhringadi Kera Tailam
- Bruhat Dantapala Tailam
- Parantyadi Kera Tailam
DO’S for Alopecia
- Timely intake of nutritious food in the right quantity
- Food prepared with barley, wheat, njavara rice, green gram etc may be consumed
- Include gooseberries, pomegranate and dark raisins in diet
- Have a time table for going to bed and waking up
- Regular exercise
Hairfall is a common disorder which troubles people of all ages irrespective of race and ethnicity. More often than not, it can be corrected with minor modifications in lifestyle and dietary habits. But sometimes it may also be due to an underlying condition which has to be found out and remedied. Either way, Ayurveda has a lot to offer in the management of this disease, through the modification of lifestyle, purification therapies and internal or external medications.
Evaluation of Therapeutic Efficacy of Ayurvedic Formulations in Patients with Alopecia areata
A case study on Ayurvedic management of Alopecia areata (Khālitya)
Alopecia Areata (Indralupta): A case successfully treated with Ayurvedic Management