Therapeutics for

Alopecia

Dr.Praveen Kumar RaiBHMS.,MD (MM)

Anatomy of Hair

• We have approximately 5 million hairs on our body.

• Of these, about 150,000 are found on our scalp.

• Hair Density;-– @Birth: 1135/cm2

– 1 year: 795/cm2

– 20-30: 615/cm2

– 30-50:485/cm2

– 80-90:435/cm2

• Hair is actually composed of a protein called keratin

• A strand of hair has three layers. – The outermost layer is called the cuticle. – The innermost layer is called the

medulla.– Between these two layers is the cortex.

• The bulk and strength of hair is from this compact area of cells

• Each hair grows from a pocket in the skin called the hair follicle.

• During its growing phase, the follicle has a bulb-shaped bottom, the center of which is called the dermal papilla .

• The papilla is fed by very small blood vessels, which bring it food and oxygen and take wastes away.

• The papilla is highly sensitive to hormones. It is here that hormones and chemicals secreted by your body (or injested as a medicine) work on the hair, making it grow faster, slower, or not at all

Physiology of hair

• The growth phase of scalp hair is approximately 1000 days (range, 2 to 6 years).

• Hair in other areas, such as the eyebrows and eyelashes, has a shorter growth phase (1 to 6 months).

• Scalp hair grows 0.3 to 0.4 mm/day, or approximately 6 inches a year.

• Each hair follicle perpetually goes through three stages in the hair growth cycle: – Catagen (transitional phase), – Telogen (resting phase), and – Anagen (growing phase).

• Approximately 90% to 95% of hairs are in the anagen phase, and

• 5% to 10% are in the telogen phase.

• Up to 100 telogen hairs are lost each day from the head, and about the same number of follicles enter anagen.

• The duration of anagen determines the length of hair, and the volume of the hair bulb determines the diameter.

• Hairs fall off after the visible resting period & new hair cycle starts.

• Upto 100 hairs are shed from the scalp in normal health.

• The duration of anagen which determines the length of hair differs according to hereditary, sex, age, body region & follicular size.

• Hair grows in anagen about 0.35mm/day.

Uses of Hair

• The purpose of hair is to keep the warmth in.

• Warm-blooded mammals require a warm body temperature to survive .

• A tiny hair muscle attached to each hair follicle, called the arrector pili, contracts when in a cold environment (or when fearful).

• This causes the hair to be pulled downwards so it stands up straight (goose-bumps or gooseflesh), and warm air is actually trapped between each hair.

What do you m

ean by

Alopecia……?

• Greek word alopex meaning fox disease.

• It is a non-scarring, inflammatory disease in which there is Visible and excessive loss of hair from the scalp leading to the production of baldness is known as Alopecia.

• Alopecia is grouped into 3 types:-• Diffuse • Localised• Cicatrial alopecia

• About 25% of patients have a family history disorder

• Alopecia may affect men, women and children alike.

• Although this is not a life threatening disease, alopecia often has severe psychological and sociological implications, as at times the condition can result in complete hair loss and cause disfigurement.

Causes for 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.

External/Seasonal Causes:-• Winter excessive use of hair sprays

and gel ,• improper use of hair coloring agent,• excessive used of electric hair

curlers, • dry indoor heating , • infrequent washing of hair ,• inadequate rinsing hair after washing • stress or anxiety.• Truamatic

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.

Types of Alopecia

• DIFFUSE ALOPECIAThere is excess hair loss from all over the scalp.• There are 3 main types:

1) Telogen effluvium2) Anagen effluvium3) Androgenic alopecia

• LOCALISED ALOPECIA• ALOPECIA AREATA:• ALOPECIA TOTALIS• ALOPECIA UNIVERSALIS

• Cicatrical Alopecia

TELOGEN EFFLUVIUM

• This is due to stimuli which induce more hairs to go into Catagen phase and subsequently into Telogen phase and fall off..

» Child birth» Abortions» Cessation of oral contraceptives» Surgical operations» mental stress» Nutritional deficiencies» Hypo/ hyperthyroidism» Drugs- anti hypertensives

• Usually it takes 2-3 months for alopecia to become evident after its induction.

• Prognosis usually good.• Identification of the cause & its

removal.

ANAGEN EFFLUVIUM

• Here growth in anagen phase is interrupted & this leads to weakness and brittleness of hair.

• Usual causes are, – cancer chemotherapy, – exposure of scalp to radiation etc.

• Hair re-grows when toxic drug is withdrawn.

ANDROGENic ALOPECIA• It is the male pattern alopecia

caused by the increased sensitivity of hair follicles to androgens.

• This is genetically predisposed & transmitted as autosomal dominant.

• Thining of hair usually begins between 12 & 40 years.

•

• The successive duration of anagen shortens & and the follicles become smaller & the hairs become shorter & thinner & subsequently alopecia results.

• Baldness is limited to the frontal, temporal & vertical areas of scalp

LOCALISED ALOPECIA.

ALOPECIA AREATA:• It is a non cicatrical type of patchy

loss of hair without any other change in skin.

• Occurs in young adults and children. • Lesions frequently occur in scalp,

beard, moustache, and eyebrows.

ALOPECIA TOTALIS

• Complete loss of scalp hair.

ALOPECIA UNIVERSALIS

• When alopecia involves whole body.

FUNGUS INFECTION• Tinea capitis may cause patchy loss

of hair in which the broken hair stumps appear as black dots.

• Hair can be easily pulled out from follicles.

TRICHOTILLOMANIA• A compulsive disorder in which hairs

are pulled out & hairs are broken at different levels, resulting in patchy hair loss.

• Traction Alopecia :-– Traction alopecia is usually due to

excessive pulling or tension on hair shafts as a result of certain hair styles.

– It is seen more often in women .– Prolonged traction alopecia can stop

new hair follicles developing and lead to permanent hair loss.

Diagnostic Techniques

• Hair pull,(grasping a group of 50 to 100 scalp hairs).

• Applying gentle traction from the base to the terminal ends and repeating this in various areas of the scalp

• Normally only three to five hairs total are dislodged on six to eight such hair pulls.

• more than three to five hairs per hair pull is pathologic

Why to Treat…….?

• Lead to,,,,,– Less Attractive.– Low self Esteem.– Looks older.– Weaker– Less productive

General Management

• Don’t comb hair when its wet.• Wipe hair with soft cloth.• Don’t take Head bath daily.• Use Shampoo,which is mild(Less pH).

– Dilute it with water before applying.• Apply Hair oil,but don’t keep for day

along,instead wash it off within half an hour.

• Massage gently.

• Better avoid applying hair gels.• Avoid consumption of Fatty foods,oily

foods.• Avoid hard water drinking & taking

Bath.• Dietery;-

– Have plenty of fruits,green vegetables.– Protein rich food– Iron rich food

• Last but not the least Don’t take more tension about Hair loss

Is it

Boring…

…?

Don’t sc

ratc

h

Head,,,Bco

z

Hair Fa

lls……

Homoeopathic

Therapeutics

Phosphorus• Round patches on scalp completely

deprived of hair;• The roots of the hair seem to be dry;

the denuded scalp looks clear, white and smooth;

• Dandruff copious, falls out in clouds.• Bald spots on the head, which are

dry and scaly, are characteristic of Phosphorus.

• Dandruff, roots of hair get gray and the hair comes out in bunches.

• The head sweats easily.• The most important remedy in

alopecia areata. • Falling off of the hair in large

bundles on the forehead and on the sides above the ears;

Flouric Acid

• Alopecia. (syphilitic)• Caries of skin. Especially adapted to

chronic diseases with syphilitic and mercurial history.

• Glabella region bloated. Complaints of old age, or the prematurely aged, with weak, distended blood vessels.

• Caries of ossicles and mastoid, with copious discharge; worse warmth. [Silica; worse cold.]

• New hair dry and break off .• Often hair matts at the end .

Lycopodium

• 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.

• PREMATURELY OLD LOOKING PEOPLE.

Arnica

• Improve the blood circulation to the hair root.

• Reduces 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.

• Used as Hair oil.

Staphysagria

• 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.

Vinca Minor

• Hair falls out in single spots and white hair grows there.

• spots on head oozing moisture, the hair matting together.

• Falling of the hair with great itching of the scalp

Phosporic Acid

• Gnawing grief changes hair of the young to gray.

• Falling of hair from general debility, ESP AFTER TYPHOID.

Borax

• Hair rough and horny.• Tangles at tips, sticks together.

(Tubercular)• If these bunches are cut off,they

form again, cannot combed smooth (fluor.ac.,Lyco.,Psorinum.,Tub.).

• Hair can’t be combed smooth-especially occiput, sides and ,vertex. temples., beared,

Carbo veg• Disintegration and imperfect

oxidation is the keynote of this remedy.

• Sluggish, fat and lazy and has a tendency to chronicity in his complaints. Patient seems to be too weak to hold out.

• Persons who have never fully recovered from the effects of some previous illness.

• falling of the hair after parturition or severe illness

• Aches from any over-indulgence. • Hair feels sore, falls off easily; scalp

itches when getting warm in bed.

Arsenic Alb

• Periodical burning pains, with restlessness; with cold skin.

• Scalp itches intolerably; circular patches of bare spots; rough, dirty, sensitive, and covered with dry scales; extending sometimes even to forehead, face and ears.

• Bald spots neat the forehead nightly burning and itching; dandruff.

• Scalp very sensitive; cannot brush hair.

Natrum Mur

• Has the symptoms of easy falling out of the hair; it falls out when touched or combed.

• This is quite frequently seen in nursing women.

• Hair falls out if touched; mostly on forepart of head, temples and beard;

• scalp very sensitive; face shining as if greasy.

• Especially anemic ladies.

Jaborandi

• Good indicated remedy in the treatment of Alopecia.

• hypodermic use of it, in many cases of baldness, will completely restore the hair, from its wonderful action upon the skin.

Baryta Carb

• Baldness, especially of the crown, in young people.

• Scalp very sensitive to touch, aggr. from scratching

Calc Carb

• Hair falls out, especially when combing; dryness of hair.

• Great sensitiveness of scalp, with yellowish or white scales on scalp.

• sensation of coldness of outer head

• Hair fall out especially when combing especially during confinement.

Tuberculinum

• It is Antitubercular medicine. • Plica polonica (Swelling and

bleeding of hair follicle ,so that knit together); [vinca.minor,psorinum] ,several bad cases permanantly cured after borex &Psorinum fail.

• Chronic eczema; itching intense ; worse at night in tubercular children.

Sepia

• Hair fall after chronic head aches.

• Especially suited to middle aged women.

• Great fall of hair after; chronic headaches or at climacteric and menopause .

• Especially from vertex and occiput,worse when combing .

• Itching of root of hair.• Hair fall out when touched,in

nursing women ( Nat .mur).

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.

Thuja

• White scaly dandruff.• Hair dry & falling out.

Graphitis

• 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.

Selenium

• Hair fall off on head ;when combing, also of eyebrows, whisker,vertex eyelashes and genital.(Syphilis)

• Tingling itching on scalp.• Which feel tense and contracted.• Does not want hair touch.

Mancinella

• LOSING HAIR AFTER SEVERE ACUTE DISEASES.

WIESBADEN

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

References

• Fitzpatricks Dermatology in General Medicine.

• API Textbook of Medicine.• Homoeopathic therapeutics, samuel

lilienthal• Homoeopathic materia medica &

repertory, w. boericke• Allens Key notes & characteristic

symptoms• www.hpathy.com• www.similima.com• www.remedyfinder.com