Alopecia Areata is loss of hair from roots in different parts of the body which are known to have hairs. It can be in scalp, beard area, eye brows,and any particular part of skin. It is a non-scaring condition and appears as sharply defined as non-inflamed bald patches, usually on the scalp. During the active stage of hair loss pathognomonic hairare seen (broken off hair of 3-4 mm long which taper off towards the scalp). An uncommon diffuse pattern on the scalp is recognized.
It is an autoimmune disease,which means that the body’s immune system attacks the body.
Alopecia can be observed in association with inflammatory disorders that cause scarring (lichen planus, discoid lupus) and others that do not cause scarring (tinea capitis, psoriasis, seborrhoeic eczema). Alopecia areata has an autoimmune basis and there is a strong genetic component, with a family history in approximately 20% of cases. In addition to atopy, it is associated with other autoimmune diseases, particularly thyroid disease, and with Down’s syndrome. The cause of androgenetic alopecia is unclear but likely to be multifactorial, with genetic, hormonal and end-organ receptor sensitivity to the factors implicated.1
Alopecia Areata usually presents with well-defined, localized, non-inflammatory, non-scarring patches of hair loss usually seen on the scalp. Broken hairs, tapering towards the scalp are seen during active hair loss. A diffuse pattern can uncommonly occur on the scalp. In many cases also seen is the affection of eyebrows, eyelashes, beard and body hair. 1
Alopecia totalis describes complete loss of scalp hair, and alopecia universalis is complete loss of all hair. Spontaneous regrowth is usual for small patches of alopecia but the prognosis is less good for larger patches, more extensive involvement, early onset and an association with atopy.1
Male-pattern baldness is physiological in men over 20 years old, although it can also occur in teenagers. It is also found in women, particularly post-menopausal ones. Characteristically, this involves bitemporal recession initially and subsequent involvement of the crown (‘male pattern’), although it is often diffuse in women.1
Important investigations include full blood count, kidney and liver function tests, iron studies, thyroid function, autoantibody screen and syphilis serology to find the cause of the condition in each case. Hair pull tests may help to establish the ratio of anagen to telogen hairs but require expertise for interpretation. Scrapings and plucking should be sent for mycology analysis if there is localized inflammation. Scalp biopsy and direct immunofluorescence ofscarring alopecia may confirm a diagnosis of lichen planus or discoid lupus erythematosus but expert interpretation is needed.1
Any underlying condition, such as iron deficiency, should be treated and may result in clinical improvement. Alopecia can have a major impact on quality of life and psychological support is usually required. It is particularly important to establish realisticexpectations. Hair may spontaneously regrow in alopecia areata and it may be appropriate to offer no active intervention as, while some treatments may induce some hair regrowth, there is noevidence that any treatment fundamentally alters the course of the disease. There may be some response to topical or intralesional glucocorticoids. PUVA or immunotherapy with diphencyprone may be effective, with evidence of hair regrowth, but there is a risk of relapse on discontinuation of treatment. Short courses ofsystemicglucocorticoids are occasionally used in an attempt to limit acutely progressive extensive alopecia areata but should not be used in the long term; the risk of relapse on discontinuation is high. Ongoing trials of Janus kinase (JAK) inhibitors may provide future hope for patients with this difficult disease. Some males with androgenetic alopecia may be helped by systemic finasteride. Topical minoxidil can be used in males and females with androgenetic alopecia but, if an effect is obtained, treatment must be continued and is expensive. In females, anti-androgen therapy, such as cyproterone acetate, can be used. Wigs are often appropriate for extensive alopecia. Scalp surgery and autologous hair transplants are expensive but can be used for androgenetic alopecia.1
- Sometimes can be associated with the administration of some drugs, particularly doxorubicion and cyclophosphamide. If such drugs are prescribed,it is important to warn the patient in advance and if appropriate, to arrange for a wig to be fitted.
- Otherwise definite cause is unknown and can be stress related.
- Alopecia is almost always reversible on cessation of therapy.
Scope of Homeopathy
Homeopathy does play a role in treatment of Alopecia Areata. Constitutional homeopathic remedy given can treat Alopecia and bring back hair growth. Few common drugs useful for Alopecia are following but medication for this concern shall be taken only under guidance of a registered homeopathic practitioner. But it’s a time taking process and usually takes few weeks to few months for completely to be reversed or treated.
Alopecia Areata Medicines2
Large patches entirely denuded of hair; new hair dry and breaks off; must comb the hair often, it mats so at the end; baldness.
Hair becomes gray early; hair falls off after abdominal diseases; after parturition; with burning, scalding, itching of the scalp, especially on getting warm from exercise during the day.
Hair falls out if touched; mostly on forepart of head, temples and beard; scalp very sensitive; face shining as if greasy.
Round patches on scalp completely deprived of hair; falling off of the hair in large bundles on the forehead and on the sides above the ears; the roots of the hair seem to be dry; the denuded scalp looks clear, white and smooth; dandruff copious, falls out in clouds.
Hair falls off when combing; also of eyebrows, whiskers and genitals; tingling itching on scalp, which feels tense and contracted.
Hair falls out, mostly from occiput and around the ears, with humid, foetid eruption or dandruff on the scalp. Hair pulls out without pain after the slightest effort.
Hair falls out in single spots and white hair grows there; spots on head oozing moisture, the hair matting together.
- Ralston S.H., Penman I.D., Strachan M.W.J., Hobson R.P. Davidson’s, Principles and Practice of Medicine. 17th rev.ed. Edinburgh; New York: Churchill Livingstone; 1995. 1203p.
- Boericke W. Pocket Manual of Homoeopathic Materia Medica. New Delhi: B. Jain Publishers (P) Ltd.; 2011