Alopecia

##Alopecia

Definition
Alopecia means loss of hair from the scalp or any part of the body. It may be partial or total and can appear suddenly or gradually.

Causes / Etiology

• Genetic predisposition (family history)
• Hormonal factors – especially excess dihydrotestosterone (DHT) in males and post‑menopausal women
• Auto‑immune attack on hair follicles (as in alopecia areata)
• Nutritional deficiencies – iron, zinc, biotin, vitamin D
• Physical or chemical trauma – tight hairstyles, burns, drugs (e.g., chemotherapy, retinoids)
• Systemic illnesses – thyroid disease, lupus, anemia, infections

Types or Classification
Androgenetic alopecia – male or female pattern baldness; thinning of hair in characteristic patterns.
Alopecia areata – patchy, round bald spots caused by an autoimmune reaction.
Alopecia totalis – complete loss of all scalp hair.
Alopecia universalis – total loss of hair over the entire body.
Traction alopecia – hair loss due to chronic pulling or tension from hairstyles.
Cicatricial (scarring) alopecia – permanent loss where the follicle is destroyed and replaced by scar tissue.

Pathology (step‑wise)

Androgenetic alopecia
step 1 → Increased circulating androgens (testosterone)
step 2 → 5‑α‑reductase converts testosterone to DHT
step 3 → DHT binds to androgen receptors in susceptible follicles (mainly on the vertex and frontal scalp)
step 4 → Follicular mini‑miniaturisation – the growth phase (anagen) shortens, hairs become finer and shorter
step 5 → Progressive thinning and eventual baldness

Alopecia areata
step 1 → Loss of immune tolerance to hair‑follicle antigens
step 2 → Cytotoxic T‑cells infiltrate the peribulbar region (the “swarm of bees” appearance)
step 3 → Inflammation disrupts the hair‑growth cycle, pushing follicles into catagen → telogen
step 4 → Sudden shedding of hair in well‑defined patches

Traction alopecia
step 1 → Continuous mechanical tension on hair shafts
step 2 → Follicular irritation and perifollicular inflammation
step 3 → Follicular damage and eventual mini‑miniaturisation if tension persists

Clinical Features

General – visible loss of hair, may be diffuse or patchy; scalp may feel normal or tender.

Specific –
• Androgenetic: thinning at the temples (M‑shaped) in men; diffuse thinning over the crown in women.
• Alopecia areata: one or more smooth, round bald patches; exclamation‑mark hairs at the margin.
• Totalis / Universalis: complete baldness of scalp or whole body, respectively.
• Traction: hair loss along the hairline or at sites of tight braids, often with perifollicular erythema.

Complications

Acute – emotional distress, anxiety, reduced self‑esteem, social avoidance.

Chronic – permanent follicular scarring in cicatricial types, irreversible baldness if treatment is delayed, possible secondary skin infections from scratching.

Diagnosis / Investigations

Routine – detailed history (onset, pattern, family history, drug intake), thorough scalp examination, hair‑pull test.

Special –

• Dermoscopy (trichoscopy) to see follicular patterns and exclamation hairs.
• Scalp biopsy (punch) when scarring alopecia is suspected.
• Blood tests: CBC, serum ferritin, thyroid profile, ANA if autoimmune disease is considered.
• Hormonal assay (testosterone, DHT) in suspected androgenetic cases.

Management

General – counseling, stress‑reduction techniques, avoidance of tight hairstyles, gentle hair care.

Modern treatment –
• Minoxidil 2–5 % topical solution or foam (stimulates anagen phase).
• Finasteride 1 mg oral (inhibits 5‑α‑reductase; for men only).
• Oral corticosteroids or intralesional triamcinolone for active alopecia areata.
• Anthralin or topical immunotherapy (diphenylcyclopropenone) for resistant patches.
• Low‑level laser therapy (LLLT) as adjunct.

Dietary advice – balanced diet rich in protein, iron, zinc, biotin and vitamin D; consider supplementation if labs show deficiency; adequate hydration and omega‑3 fatty acids may support hair health.

Homeopathic Therapeutics

Phosphorus

• Hair loss with marked anxiety or fear of cold.
• Bald patches on the vertex, especially after emotional shock.
• Burning or tingling sensation on the scalp.
• Hair loss worsens in damp, chilly weather.
• Patient feels weak, prefers warm drinks.
• Often indicated when hair loss follows grief or sudden fright.

Lycopodium

• Thinning of hair on the crown with itching and redness.
• Worse in the evening and from cold exposure.
• Patient is nervous about public speaking, has digestive complaints.
• Hair loss appears after prolonged mental strain.
• Scalp feels tight, hair is brittle.
• Beneficial when the patient is left‑handed and has a habit of biting nails.

Thuja

• Patchy alopecia areata after a bout of infection or after taking a drug.
• Bald spots on the scalp, especially on the crown, with a feeling of coldness.
• Hair loss aggravated by cold, damp weather.
• Patient may have a history of warts or skin eruptions.
• Scalp may show a dry, scaly surface.
• Useful when there is a tendency to develop moles or skin growths.

Natrum Muriaticum

• Hair loss on the frontal scalp with itching and a sensation of “dryness”.
• Patient is emotionally reserved, often grieving past sorrows.
• Bald patches appear after a stressful event, especially loss of a loved one.
• Scalp may be oily at the base, dry on the top.
• Better after taking cold drinks, worse after salty foods.
• Often indicated when the patient is introverted and keeps feelings inside.

Graphites

• Diffuse thinning especially on the vertex, hair feels rough and brittle.
• Itching and burning of the scalp, worse in warm rooms.
• Patient has a tendency to develop skin cracks and fissures.
• Hair loss may follow prolonged use of harsh chemicals or dyes.
• Scalp may be dry, with a “cracked” appearance.
• Beneficial when the patient is slow‑moving, thoughtful and has a tendency to gain weight.