Feb 2005 | Volume 2| Issue 2  

 

Anamnesis…on Alopecia
 

Introduction

Alopecia is common illness which had made every system of medicine to trigger their research work. Many pharmaceutical companies irrespective of the system promote their products under this category with more interest since overwhelming response is received in business. Here Dr.R.Gnanasambandam gives a brief study on his clinical experience on Alopecia. He has written articles on different topics and also presented many papers in Scientific seminars, Recently presented a paper on Anamnesis… on Alopecia at White Memorial Homoeopathic Medical College .

Hair is a fashion statement; its style can express a person’s mood attitude or outlook. This could be the reason why many physicians ignore the cases of alopecia having a notion in their mind that the term falls under the division of “Cosmetology”. Indeed, it is a duty of physician to attend cases of alopecia, as we probe into other dermatological conditions. However, the cure is limited to some types.

First a physician should look for the scalp to differentiate the non-scarring and scarring alopecia, in which the scarring types have no scope in the treatment. There are numerous potential etiologic factors in alopecia. Endocrine abnormalities, genetic factors, systemic illness, drugs, psychological abnormalities, diet, trauma, infections, and structural hair defects may all cause hair loss. Here we focus some clinical varieties, which are more practical part to a homoeopathic physician.

Alopecia Areata

Alopecia Areata is an autoimmune disease of the hair. It usually presents with an oval patch or multiple patches of Alopecia. Some cases may proceed to Alopecia Totalis, affecting the entire scalp. Few may go on to Alopecia Universalis, affecting all body hairs, including eyebrows and eyelashes.

White blood cells called T-lymphocytes attacks the hair follicle which causes the hair to stop growing and enter into the telogen phase, then about 3 months later, when the resting phase is over the hair will then fall out. Only when the T-lymphocytes stop attacking the hair follicle, new hair will grow.

Here we need to differentiate from Tinea Capitis and Syphilitic Alopecia. The main symptoms or signs of Tinea Capitis is scaling and redness in a round or uneven area of stubbled hairloss. The fungi Trichophyton Tonsurans and Microsporum Canis can be demonstrated to a hair test and scalp smear. Syphilitic Alopecia is usually a manifestation or secondary syphilis. The hair loss that occurs is patchy and often described as moth eaten. Diagnosis is made by investigations.

Phosphorus patients shed their hair in bunches leaving “Round patches” on the scalp completely deprived of hair. Hair loss is noticed on the occiput, forehead, and on the sides above the hair. A phosphorus patient complains of dandruff with itching. Constitutionally fits with thin, slender, emaciated colourful patients. Vinca Minor patients also present Spotty Baldness in which tiny white hair grows. The short wooly hair mats together and severe itching is also noticed. Selenium patients shed their hair from scalp, eyebrows, beard and genitals.

When an infection is suspected the characteristics most often suits Mezerium, where the pus is collected under leathery crusts. Oleander patients show fetid spot with eruptions behind the ears. Pix Liquida is the drug of choice in scaly eruptions with violent itching; leaving patchy hair loss.

Flouric Acid patients show syphilitic diathesis. It is a good remedy for positive cases and also hair fall in bunches. Fluoric acid patient usually presents their complaints with deep destructive process like Caries of teeth, Mastoiditis etc. The young patient may look very old. The hair is dry, brittle and breaks easily. The hair ends mats together and tangles; Syphilinum is also a drug of choice for those who shed their hairs in circles with positive case history. Aurum met also a drug of choice for Syphilitic Alopecia. A well indicated drug for great depression and suicidal tendencies, which is a remarkable feature in few cases of Alopecia.

Dr. Boericke says” Cochlearia Armoracia locally cures dandruff and Alopecia gives good result in local application.

J.H.Clarke mentions in his Dictionary Materia Medica that” The local use of Arnica produces an extraordinary growth of hair on a limb. This suggested use of an oil mixed with Arnica 1x in a case of Baldness, which was followed with marked success.

Androgenetic Alopecia
Androgenetic Alopecia can affect both men and women although men experience a much greater degree of loss. Genetic predisposition is observed in many cases. However this disorder is inevitable factor of aging, premature cases calls a physician’s attention. It is known specifically that the male hormone dihydrotestosterone (DHT), which is, converted from testosterone by the enzymes 5 alpha reductase. It is interesting to note that individuals with a

deficiency in 5 alpha reductase do not develop Androgenetic Alopecia. This is because the body is unable to convert testosterone into dihydrotestosterone. Uptake, metabolism, and conversion of testosterone affect the hair follicles in specific areas changing less active ones that shrink slightly with each new growth cycle.

Male pattern baldness is most frequently encoun tered. It usually starts with the hair at the temples, which gradually recedes to form an “M” shape. hair is getting thin, short, and less dense and does not grow as long as it once did. You can detect it on your own by feeling thin hair. In some cases the hair on the parietal area begins to thin and gives the horseshoe pattern of hair around the head. It is interesting to note the body hair growth is abundant.

Female pattern Baldness

Female hair loss is usually an overall thinning and moderate loss of hair on the crown or at hairline.

The scope to this types are limited, because most cases show their genetic trait and anti immune disorders as aetiological factor. Endocrine abnormalities also give a complex package in many cases of Androgenetic alopecia. However many physicians had proved their efficacy in treating them constitutionally. Fluoric Acid patients show congestion of the blood with characteristic features. Selenium patients are thin, with great emaciation of face, hands, legs and feet. Great debility is well-marked symptom of a young adult with sexual atony. Natrum mur patients also thin, emaciated and much debilitated with receding hairline in forehead with hair loss in beard and moustache. Hairs come out for least touch much noticeable while combing. Lycopodium may suit with the characteristics of temple and vertex involvement with a tendency to premature greyness.

Anagen Effluvium
Anagen Effluvium is the sudden hair loss, which affects the developmental stage of the hair by Drugs and Radiation. Cosmetic applications and dyes may predispose hair loss. These maintaining causes would be an obstacle to recovery; removal of the cause and application of most similar drug could bring harmony.

Telogen Effluvium
Excessive shedding of normal hairs can be brought about by a number of causes. A sudden or stressful event can cause the hair follicles to prematurely stop growing and enter into a resting phase. The hair1 will then stay in the resting phase for about 3 months after which time a large amount of hair will be shed. Often the person involved will have recovered from the event before the hair loss occurs.

In most cases the hair loss is temporary and the hair soon recovers. However in some cases the hair loss continues until the underlying cause is fixed. Telogen Effluvium appears to affect more women than men because more of the precipitating event such as childbirth are experienced by women.
Telogen Effluvium may be expected in

  • Severe Emotional Stress
  • Child Birth and MTP
  • Anemia
  • All acute and chronic illnesses
  • Endocrine Disorders- Hypo and Hyperthyroidism
  • Crash diets and inadequate protein
  • Drugs and Major Surgery

Under these categories many victims fall, and the recovery is good in many cases. Flouric Acid patients shed their hair after acute illnesses like typhoid, Jaundice or any other ailments. Thallium becomes a well-indicated drug for alopecia that followed after acute Exhausting illnesses. Thallium has very good influence on thyroid; Alopecia with Hypo or Hyperthyroidism may call this remedy. Acid phos patients shed their hair after emotional stress and after acute illnesses. More hair fall is noticed from sides

”Great debility“ is observed from them both mentally and physically. They are debilitated with loss of vital fluids and sexual excess. A leading question for perverted sex often opens the log in many cases of hair complaints particularly in male patients. In severe case, which threatens baldness, internal intake of Mother tincture 5-15 drops three times daily, would prevent it. Mostly the patients fall under psoric or syphilitic tendencies, in this type sycotic tendencies like Poly cystic ovarian Disease or Goitre may give a clue to our prescription and also in depth study of the cases.

Thuja takes highest choice in many cases of proliferative pathology. Thuja patient presents white scaly dandruff. Their hair is lusterless with split ends. A great remedy for hormonal imbalance very often the symptom similarity corresponds with hypothyroid patients who shed their hair on slight touch of comb. Hair is very dry with white scabs on the scalp. Great sensitiveness of the scalp with coldness is a remarkable feature.

Scarring Alopecia

When inflammation of the hair follicles occurs due to infection it can lead to Scarring Alopecia. It is easy to identify a case of severe Scarring Alopecia because there will berough patches on the surface of the scalp made up of small blood vessels and connective tissue.Discoid Lupus Erythematosus Lichen Planus, Pseudopelade ,Aplasia Cutis Congenita are some diseases which cause scarring alopecia. Any severe fungal, viral or bacterial infection may result in scarring.

However the scope is little limited, Homoeopathy has shown its efficacy of healing even deep proliferative disorders like Keloid, Lipoma, etc. Remedies like Graphites, Causticum, Nitric Acid may call for these conditions. There are other conditions like trichotillmania and traction alopecia, which needs suitable similarity. The public, even in other systems of medicine, believe

that local application is the remedy irrespective of the types with out considering dynamic derangement of health. Homoeopathy, steps forward in treating them dynamically with similar applications.

Try to apply the highest similarity to a particular case with knowledge of Materia Medica considering the time factors and quickness to your prescription. If you fail, do reperterise or search for key symptom as our Dr Hahnemann said in Aphorism no 153 and 154.
References
1. Dr.Farokh Jamshed Master “ Hair Loss explained and analysed “
2. Dr.William Boericke, New Manual of Materia Medica and Repertory
3. H.C.Allen’s “Key Notes with Nosodes”
4. E.B.Nash “Leaders in Homoeopathic Therapeutics “
5. Dr.Rajan Sankaran “Homoeopathy the science of Healing”
6. J.K.Sharma - http://www.nu-life.co.uk
7. Dr. Mukesh Batra - http://www.positivehealthclinic.com
8. Dr.Rajesh sha - http://www.hairfalling.com


Hair Facts

Hair Structure
Hair is composed of strong structural protein called keratin. This is the same kind of protein that makes up the nails and the outer layer of skin. Each strand of hair consists of three layers.

  • An innermost layer or medulla, which is only present in large thick hairs.
  • The middle layer known as the cortex. The cortex provides strength and both the color and the texture of hair.
  • The outermost layer is known as the cuticle. The cuticle is thin and colorless and serves as a protector of the cortex.

Structure of the hair root

Below the surface of the skin is the hair root, which is enclosed within a hair follicle. At the base of the hair follicle is the dermal papilla. The dermal papilla is fed by the bloodstream which carries nourishment to produce new hair. The dermal papilla is a structure very important to hairgrowth because it contains receptors for male hormones and androgens. Androgens regulate hairgrowth and in scalp hair Androgens may cause the hair follicle to get progressively smaller and the hairs to become finer in individuals who are genetically predisposed to this type of hair loss.

The Hair Growth Cycle
Hair follicles grow in repeated cycles. One cycle can be broken down into three phases.
1) Anagen - Growth Phase
2) Catagen - Transitional phase
3) Telogen - Resting Phase
Each hair passes through the phases independent of the neighboring hairs.

Anagen Phase - Growth Phase
Approximately 85% of all hairs are in the growing phase at any one time. The Anagen phase or growth phase can vary from two to six years. Hair grows approximately 10cm per year and any individual hair is unlikely to grow more than one meter long.
Catagen Phase - transitional phase
At the end of the Anagen phase the hairs enters into a Catagen phase which lasts about one or two weeks, during the Catagen phase the hair follicle shrinks to about 1/6 of the normal length. The lower part is destroyed and the dermal papilla breaks away to rest below.

Telogen Phase - resting phase
The resting phase follows the catagen phase and normally lasts about 5-6 weeks. During this time the hair does not grow but stays attached to the follicle while the dermal papilla stays in a resting phase below. Approximately 10-15 percent of all hairs are in this phase at an one time.

At the end of the Telogen phase the hair follicle re-enters the Anagen phase. The dermal papilla and the base of the follicle join together again and a new hair begins to form. If the old hair has not already been shed the new hair pushes the old one out and the growth cycle starts all over again.


Hair ... Loss Repertory
 

FALLING

Alum, Ambr, Amm-C, Amm-m, Ant-c, Ant-t, Apis, Arn, Ars, Ars-iod, Arund, Asc-t, Aur, Aur-m, Aur-m-n, Aur-s, Bar-c, Bell, Bor, Boc, Boy, Bry, Bufo, Calc-c, Calc-p, Calc-S,Canth, Carb-an,Carb-s,Carb-veg, Carl, Caust, Chel, Chlol, Chin, Colch, Con, Cop, Dulc, Elaps, Ferr, Ferr-ars, Ferr-m,. Ferr-p, Flu-ac, Form, Glon, Graph, Hell, Hepar, Ign, Iod, Kali-ars, Kali-bi, Kali-c, Kali-iod, Kali-nit, Kali-p, Kali-S, Kreos, Lach, Lyco, Mag-c, Manc, Merc, Merc-cor, Mez, Naja, Nat-c, Nat-m, Nat-p, Nit-ac, Nuph, Oena, Op, Osm, Par, Petr, Phosp-ac, Phosp, Plb, Psor, Rhust, Rhus-v, Sab, San, Sars, Sec, Sel, Sepia, Silicea, Staph, Sulph, Sulph-ac, Syph, Tab, Tep, Thuj, Thyr, Tub, Ust, Vesp, Zinc.

SPOTS: - ALOPECIA AREATA

Alum, Apis, Ars, Calc-c, Calc-p, Canth, Carb-an, Flu-ac, Hep, Iod, Lyco, Nat-m, Petr, Phosp, Psor
BEARD:
Agar, Ambr, Anan, Aur-m, Calc-c, Carb-an, Graph, Kali-c, Nat-c, Nat-m, Nit-ac, Phosp-ac, Plb, Sanic, Sel, Sil.
BREGMA: (FOREHEAD)
Ars, Bell, Hep-s, Merc, Nat-m, Phosp,Sil.
EARS : above and behind:-Phosp.
EYE BROWS:
Agar, Nil,Alum, Anan, Aur-m, Bell, Caust, Hell, Kali-c, Mill, Par, Plb, Sele, Sil, Sulph.
EYE LASHES:
Alum, Apis, Ars, Aur, Bor, Bufo, Calc-s, Chel, Chlol, Euph, Graph, Med, Merc, Nat-m, Phosp-ac, Psor, Rhus-t, Sele, Sep, Sil, Staph, Sulph.
MOUSTACHE:
Bar-c,Kali-c,Nat-m,Plb,Sel.
NOSTRILS: Calc-c,Caust,Graph,Iod,Sil.
OCCIPUT:
Calc-c, Carb-veg, Chel, Hep, Merc, Petr, Phosp, Sep., Sil, Staph, Sulph.
SIDES:
Ars, Bov., Calc-C, Graph, Kali-c, Merc, Phosp, Phosp-ac, Staph, Zinc.
TEMPLES:
Calc-c, Kali-c, Lyco, Merc, Nat-m, Par, Sab.
VERTEX(CROWN)
Alum,Anac,Apis,Aurum,Bar-C,Calc-c,Carb-an,Flu-ac,Graph,Hep,Lyco,Nit-ac,Phosp, Plb,Sel,Sil,Syph,Thuja,Zinc.
ROOTS:
Destroyed by auption (tinea) –Ars
Turn dry and hair gray – Phosz
Painful – Arund, Calc, Coloc
Painful on combing – Nat-s
Painful when combed as from
ulceration – Chel
Pain when hair is moved – CINCH
Painful after scratching – Caps
Painful esp to touch – Cinnab, Sulph
Abdominal diseases after – LYCO
Bunches in – PHOSP
Children in – Arund
CLIMAXIS AT:
Sep.
FEVERS AFTER
Flu-ac.
typhoid fever – FLU-AC
GRIEF FROM: (Sorrow from)
Phosp-ac
Handfuls in when combing- –Sulph
HEADACHE AFTER:
Ant-c, Hep-s, Nit-ac, Sepia, Sil, Thuja.
HYSTERIA WITH:
Lyco
ILLNESS SEVERE AFTER
Carb-v, Manc, Thal.
INJURY FROM:
Hyper
LACTATION DURING:
Nat-m.
PARTURITION AFTER:
Calc-c, Canth, Carb-veg, Hep, LYCO. Nat-m, Nit-ac, Sep, Sil, Sulph.
PREGNANCY DURING:
LACH
TYPE OF HAIR:
Bristling:
Acet-ac, Acon, Amm-c, Arn., Bar-c, Calc-c, Canth, Carl, Carb-veg, Cham, Chel, Cina, Cocc-a, Dulc, Lachn, Haur, Lyco, Mag-m, Mang, Meny,Merc.,Mur-ac,Nit-ac,Nux-v,Puls,Seneg,Sil,Spong,Sulph-iod, Tarent, Verat.Zinc.
Brittle:
Ars, Bell, Flu-ac, Graph, Kali-c, Psor.
Bunching of(Sticking, Tangles, Matted)
Ant-t, Borax, Flu-ac, Graph, Lyco, Mez, Nat-m, psor, Sars, Verat, Vinc.
Cold:
Sabad.
Constant attempt to tear
In children – Bell
With unconsciousness – Tub
Uterine dementia-Lil-tig
In peureral convulsions-Ign
Dry:
Aloe,Alum,Ambr,Bad,Calc-c,Chel,Flu-ac,Graph,Hipp,Kali-c,Med,Phosp,Phosp-ac,Plb,Psor,Sec.,Sulph, Thuj.
Fluffy:
Med,Phosp-ac.
Frowsy:
Bor
Gray:
Ars,Graph,Hipp,Kali-iod,Kali-nit,Kreos,Lyc,Op.Phosp-ac,Sec,Sil,Staph, Sulph,Sulph-ac, Thuj.
Greasy:(Oily)
Bry, Lac-c, Lyss, Phosp-ac, Plb, Thuja,
Growth, slow, short – Thuja
Lustreless:
Flu-ac, Hippo, Kali-nit, Med, Psor, Thuja, Tub.
in seborrhea sicca – Hydras
Offensive:
Bufo,Lyco,Staph,Sulph,Vinca, Vio-t.
Pulled as if – Aethusa, Caps
Headache with – Alum
Hemicrania – Phosp
As if drawn upward with vertigo – Mur-ac
Stiff:
Ars., Canth, Iod.
Thin – Thuja
In eczema of scalp – Kali.bi
With uterine neuralgia – Nux-v
Withered look:
Phop-ac.
Dandruff:
All-s,Alum,Amm-m,Ars,Bad,Bry, Calc-c, Calc-s, Canth, Carb-s, Dulc, Graph, Kali-c, Kali-chl, Kali-p, Mali-s, Lac-c, Lyco, Mag-c, Med,Mez,Nat-m,Olnd, Phosp, Psor,Sanic,Sep, Stann, Staph,Sulph,Thuja.
Itching:
Med.
Scaly, (Profuse)
Sanic
White:
Ars,Kali-chl,Kali-m,Mez, Nat-m, Phosp, Thuja.
Yellow: Calc-c, Kali-s.

 
Dr.R. Gnanasambandam, MD (hom)
# 6, Lloyds II nd Lane,
Royapettah, Chennai – 600 014
Phone : 044-28113300
Tamil Nadu –INDIA.
EML: gnanas@vsnl.com
URL: www.drgnanas.com