Hair Loss Disorders and Homoeopathy

Abstract: Evaluating and treating hair loss (alopecia) is an important part of primary care, yet many physicians find it complex and confusing. Hair loss affects men and women of all ages and frequently has significant social and psychologic consequences. This article reviews the physiology of normal hair growth, common causes of hair loss, and homoeopathic treatment currently available for alopecia.

Hair loss (alopecia) affects men and women of all ages and often significantly affects social and psychologic well-being. Although alopecia has several causes, a careful history, close attention to the appearance of the hair loss, and a few simple studies can quickly narrow the potential diagnoses. Androgenetic alopecia, one of the most common forms of hair loss, usually has a specific pattern of temporal-frontal loss in men and central thinning in women. Telogen effluvium is characterized by the loss of “handfuls” of hair, often following emotional or physical stressors. Alopecia areata, trichotillomania, traction alopecia, and tinea capitis have unique features on examination that aid in diagnosis. Treatment for these disorders and telogen effluvium focuses on resolution of the underlying cause.

Normal Hair Growth: Each day the scalp hair grows approximately 0.35 mm (6 inches per year), while the scalp sheds approximately 100 hairs per day, and more with shampooing. Because each follicle passes independently through the three stages of growth, the normal process of hair loss usually is unnoticeable. At any one time, approximately 85 to 90 percent of scalp follicles are in the anagen phase of hair growth. Follicles remain in this phase for an average of three years (range, two to six years). The transitional, or catagen, phase of follicular regression follows, usually affecting 2 to 3 percent of hair follicles. Finally, the telogen phase occurs, during which 10 to 15 percent of hair follicles undergo a rest period for about three months. At the conclusion of this phase, the inactive or dead hair is ejected from the skin, leaving a solid, hard, white nodule at its proximal shaft. The cycle is then repeated.

Evaluation of Hair Loss: A directed history and physical examination usually uncover the etiology of hair loss. The history should focus on when the hair loss started; whether it was gradual or involved “handfuls” of hair; and if any physical, mental, or emotional stressors occurred within the previous three to six months (Table 1). Determining whether the patient is complaining of hair thinning (i.e., gradually more scalp appears) or hair shedding (i.e., large quantities of hair falling out) may clarify the etiology of the hair loss.

TABLE 1

Historical Clues and Possible Hair Loss Etiologies

The pattern of hair loss, especially whether it is focal or diffuse, also may be helpful (Figure 1). The hair-pull test gives a rough estimate of how much hair is being lost. It is done by grasping a small portion of hair and gently applying traction while sliding the fingers along the hair shafts. Usually one to two hairs are removed with this technique. The hairs are then examined under a microscope. In the hair-pluck test, approximately 50 hairs are grasped with a hemostat and removed with one motion.  This test produces a trichogram to assess the telogen:anagen ratio but is rarely needed for clinical diagnosis of hair loss.

Appearance of Hair Loss and Possible Etiologies

FIGURE 1: Algorithm for the physical appearance of hair loss and possible etiologies.

Androgenetic Alopecia: Androgenetic alopecia (AGA), or male-pattern baldness, is hair thinning in an “M”-shaped pattern; hair loss occurs on the temples and crown of the head with sparing of the sides and back⁵. This pattern reflects the distribution of androgen-sensitive follicles in most people.⁶ Starting at puberty, androgens shorten the anagen phase and promote follicular miniaturization, leading to vellus-like hair formation and gradual hair thinning. Women also may experience AGA, often with thinning in the central and frontal scalp area but usually without frontal–temporal recession. A history and physical examination aimed at detecting conditions of hyperandrogenism, such as hirsutism, ovarian abnormalities, menstrual irregularities, acne, and infertility are indicated.

Telogen Effluvium: Telogen effluvium occurs when the normal balance of hairs in growth and rest phases is disrupted, and the telogen phase predominates. The disproportionate shedding leads to a decrease in the total number of hairs. Axillary and pubic areas often are involved, as well as the scalp. The hair-pluck test usually shows that up to 50 percent of hairs are in the telogen phase (in contrast to the normal 10 to 15 percent), although these results can vary in persons with advanced disease.  The patient often is found to have had inciting events in the three to four months before the hair loss. If 70 to 80 percent of hairs are in the telogen phase, the physician should look for causes of severe metabolic derangements, toxic exposures, or chemotherapy. No specific treatment for hair loss is required because normal hair regrowth usually occurs with time and resolution of underlying causes. Lack of significant historical events and a delay in regrowth should raise suspicion for syphilitic alopecia.

Possible Causes of Telogen Effluvium

Alopecia Areata: Alopecia areata is characterized by a localized area of complete hair loss. This may extend to the entire scalp (alopecia totalis) or the entire body (alopecia universalis). Alopecia areata is probably secondary to an autoimmune reaction involving antibody, T-cell, and cytokine-mediated losses. The trait appears to be polygenic, affecting 0.1 to 0.2 percent of the population, with men and women equally affected.On microscopic evaluation, “exclamation-point” hairs are found, in which the proximal hair shaft has thinned but the distal portion remains of normal caliber. Spontaneous recovery usually occurs within six to 12 months, with hair in areas of re-growth often being pigmented differently. Prognosis is not as good if the condition persists longer than one year, worsens, or begins before puberty. Persons with a family history of the disorder, atopy, or Down syndrome also have a poorer prognosis. The recurrence rate is 30 percent, and recurrence usually affects the initial area of involvement.Thyroid abnormalities, vitiligo, and pernicious anemia frequently accompany alopecia areata.

Trichotillomania: Trichotillomania is a psychiatric impulse-control disorder. The mean age of onset is eight years in boys and 12 years in girls, and it is the most common cause of childhood alopecia. Although any part of the body can be involved, the scalp is the most common. Patients also may eat the plucked hairs (trichophagy), causing internal complications such as bowel obstruction. The hair loss often follows a bizarre pattern with incomplete areas of clearing. The scalp may appear normal or have areas of erythema and pustule formation. A scalp biopsy may be necessary to rule out other etiologies, because patients may not acknowledge the habit. Because of its psychologic nature, the mainstays of treatment are counseling, behavior modification techniques, and hypnosis.

Traction Alopecia: In contrast to trichotillomania, traction alopecia involves unintentional hair loss secondary to grooming styles. It often occurs in persons who wear tight braids (especially “cornrows”) that lead to high tension and breakage in the outermost hairs. Traction alopecia also occurs commonly in female athletes who pull their hair tightly in ponytails. The hair loss usually occurs in the frontal and temporal areas but depends on the hairstyle used. Treatment involves a change in styling techniques.

Tinea Capitis: Tinea capitis is a fungal infection of the scalp, usually caused by Microsporum or Trichophyton species of dermatophytes. It usually occurs in prepubertal patients. The most severe form of tinea capitis is a kerion, a fluctuant, boggy lesion with overlying hair loss. Tinea capitis can result in widespread hair loss with increased fragility of the hairs and frequent breakage.

Cicatricial Alopecia: Cicatricial alopecias tend to cause permanent hair loss. These disorders destroy hair follicles without regrowth and follow an irreversible course. It is likely that they involve stem-cell failure at the base of the follicles, which inhibits follicular recovery from the telogen phase.Inflammatory processes, including repetitive trauma as in trichotillomania, also may lead to stem-cell failure. Other processes may be caused by autoimmune, neoplastic, developmental, and hereditary disorders.

Homoeopathic Management:

Patients seeking homeopathy for hair loss disorders are increasing. Homoeopathy has a positive role in these cases. Proper case history is vital in the selection of remedy and management. In case of side effects of toxic drugs, similar tautopathic drugs can be selected. Further detoxification drugs like Azadiractha Indica, Echinacea and Hydrastis may also be supportive. Alopecia due to nutritional deficiencies and impaired nutrition is to be managed with medicines like Alfalfa, Avena Sativa, tissue salts etc. There are individualistic drugs for many causes of hair loss disorder like from grief, menopause, pregnancy, parturition etc.

A thorough repertorisation would be helpful for effective selection of remedy. Intercurrent, constitutional, miasmatic, past illness targeted nosode would check the respective malady and also enhance the action of specific remedy. If alopecia is due to skin conditions like eczema, dermatitis and fungal infection, remedy is selected based on these. Along with indicated remedy mother tinctures enhancing hair growth, controlling dandruff, promoting blood supply through peripheral vessels, acting as hair tonic, etc. are usually recommended to use externally mixed with some oil for consistency.

Homoeopathic Therapeutics

Following remedies are given with indications. It may help the physicians to remind for a remedy considering the symptoms. Selection of potency and dosages depend on the sensitivity, individual’s response to the remedy and chronicity of the condition.

Acid Fluoricum: Alopecia with great dryness if hairs and sot nails. Falling out of hairs after fever. Children with a tendency to patchy bald areas, without a definite skin disease. But it is patchy areas of thinning of the heir rather than actual baldness.

Acid Nitricum: Alopecia from congestion of blood to the scalp. Falling of the hairs from the genitals.

Acid Phosphoricum: Hair turns grey and falls out early in life. Hair fall from grief, general debility.

Apis Mellifica: Hair falls out in spots with burning and stinging pain in the scalp.

Arsenic Album: Falling of hair with convalescence. Sometimes from skin conditions like eczema, urticaria, herpes zoster, etc.

Alumina: Hair falling with excessive dryness, itching and numbness of scalp.

Arundo Mauritanica: Falling of hair with painful root. Itching of scalp. Entire hair falls out in children.

Aurum Metallicum: Shedding of the hair copiously. Falling of hair from eye lashes. Hair falling due to syphilis and mercury intoxication.

Baryta Carb: Hair falling begins from the vertex. Hair falls from the moustache.

Borax: Hairs fall mainly from the eye brows. Hair fall associated with plica polonica (tangled hairs).

Calcarea Carb: Hair dry, falling out from sides and temples down to beard, with yellowish-white dandruff and a cold scalp. Hair falling from tinea capitis. Dryness of hair and sensitiveness of the scalp.

Carbo Vegetabilis: Hair falls after illness after pregnancy (Lachesis and Sepia). Alopecia from general weakened condition.

Graphitis: Hair of vertex, sides and beard turns grey early and falls out, with matted and brittle hair. Bald patches at the beard and chin.

Kali Sulph: Falling out of the hair, of bald spots. Yellowish or white scales on the scalp with hair falling, with dry and scaly lips. Hair falls out easily when combing.

Lycopodium: Hair falls out, first on the vertex, later on the temples, especially after diseases of the abdominal viscera and parturition, with hair turning grey early. Alopecia with violent burning, scalding, itching of the scalp.

Mercurius Solubilis: Profuse hair-fall, perhaps from suppressed anger. Hair becomes dry and falls. Hair falling mostly from temples.

Mezerium: Hair falls in handfuls with white dandruff and dry scalp.

Natrum Muriaticum: The hair falls out when touched, especially in nursing women. Falling of hair from lack of nutrition. Hair falls out when merely grasped, most on bregma and temples but also on beard and genitals.

Petroleum: Rapid falling of hair. Suited well to the people whose skin is cracked, rough, bleed easily and unhealthy.

Phosphorus: 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. Alopecia areata in the frontal region, especially above ears.

Selenium: Hair falling on combing. Hair falls off from the head, eyebrows, whiskers and genitals.

Sepia: Hair falls after pregnancy, chronic headache and climacteric. More suitable to weak women with yellow complexion, bearing down sensation and tendency to abortion.

Sulphur: Hair falling with dry, cold and hard scalp, worse washing. Scalp sore to touch, itching violently, worse in the evening, when getting warm in bed. Alopecia with dandruff.

Syphilinum: More suited to the people of syphilitic nature; usually prescribed based on miasmatic presentation of the patient. Profuse hair fall, in spots, with white scaly dandruff and dry scalp.

Thuja Occ: Thin hairs, grows slowly, splits and falls off. White scaly dandruff.

Vinca Minor: Hairs falls out and is replaced by grey hair. Falling of the hair with great itching of the scalp. Eczema of scalp and face, matted hair and offensive odour. A crust is formed, the discharge is retained underneath and causes the hair to fall out to mat together, forming the plica polonica.

Drugs for External Application:

Homoeopathic mother tinctures are often prescribed by physicians to apply locally. Application of these drugs is aimed at enhancing the growth of hair, controlling dandruff, promoting blood supply to the cutaneous region, acting as hair tonic etc. it is usually advised to mix the mother tincture with some oil like olive, coconut, sesame, etc. in different ration (prevailing practice is from the ratio of equal amount of total quantity of mother tinctures and drugs to 1 part of mother tincture to 2/3 part of oil) depending upon the case. This mixture is applied on the head regularly preferably everyday 20-30 minutes before washing. Gentle rubbing on the scalp after application would facilitate more permeability.

Berberis Aquafolium QExternally useful in cases of hair fall due to fungal and bacterial infection.Cantharis QHair falls out in bunches, spots when combing especially during pregnancy and lactation. Scales on scalp, enormous dandruff with stiff hair. 10% solution is used.Cardiospermum QAlopecia due to eczema and psoriasis.Ceaonanthus Americana QIt is used locally as hair tonic.Cochlearia Armoracia QA useful remedy in dandruff when applied locally.Jaborandi QIt is claimed to have a favourable influence in cases of alopecia. If continued over a prolonged period it restores the original colour of grey hair.Salvia Officinalis QExternally used for premature graying

Repertorial Rubrics:

Apart from the above drugs, there could be specific drugs for specific indication related to alopecia. These are given as rubrics in different repertories. Such rubrics related to alopecia are extracted from Synthesis repertory. If any of the below rubrics matches with the patient’s indication, one can refer to the corresponding medicines.

Drugs of Indian System of Medicines

Incidentally many drugs used for alopecia in Indian system of medicine are also in homoeopathy for variety of problems. For example Abrus precatorius, which is commonly called in homoeopathy as Jequirity, is used in Indian medicine for hair loss. Aloe barbadensis is also used in Indian medicine for alopecia. It is noteworthy that the active ingredient aloin and barbaloin are common in both Aloe barbadensis and homoeopathic medicine Aloe socotrina. Indian drug Hibiscus abelmoschus is used as Abel moschus in homoeopathy, an anti itching drug. Myrica is used in homoeopathy as antiseptic and anti-inflammatory. Myrtus communis ia an antiseptic but not widely known in homoeopathy for hair-loss. Plumbum and its salts are also prescribed in Indian system of medicine for alopecia but are not used frequently in Homoeopathy. So, there is a need to verify their uses in homoeopathy for alopecia and allied problems.

References:

• Journal of the American Academy of Family Physicians, July 2003
• Dictionary of Practical Materia Medica, Clarke J.H.
• Pocket manual of Homoeopathic Materia Medica, Boericke W
• Practical Homoeopathic Therapeutics, Dewey
• Synthesis Repertory
• Schwabe India’s CME on Alopecia