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A case study on Ayurvedic management of Alopecia areata (Khālitya)
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Case Report
Anveshana Ayurveda Medical Journal
A case study on Ayurvedic management of Alopecia areata (Khālitya)
Jitender Kumar 1
Prasanth Dharmarajan 2
Abstract
Alopecia areata is also known as spot baldness. It is a common autoimmune skin disease
causing hair loss on the scalp, face and sometimes on other areas of the body[i]. Alopecia
can be the cause of psychological stress, individuals with it may experience social phobia,
anxiety and depression[ii]. In modern medicine topical or injected corticosteroids are used
to treat this condition. In Ayurveda it can be correlated to Khālitya one of the kṣudra roga[iii].
Vāta, Pitta, Kapha and Rakta are involved in Khālitya as mentioned in the texts [iv]. In the
present case study, a case of Alopecia areata was managed with Ayurvedic medicines and
bloodletting therapy (Pracchāna). Patient presented with patches of baldness on head and
chin with redness and itching since 2 years. Virechana was adopted first, then Pracchāna
was done along with some internal and external medications. Regrowth of hairs was
achieved completely. Patient felt relieved of itching and redness of scalp also. This case
study reveals the potential of Ayurvedic management of Alopecia areata and may form a
basis for further detailed study of the subject.
PG Scholar, 2 Assistant Professor, Department of Panchakarma, All India Institute of Ayurveda,
New Delhi.
1
CORRESPONDING AUTHOR
Dr. Jitender Kumar
PG Scholar,
Department of Panchakarma,
All India Institute of Ayurveda,
New Delhi, (India).
Email: jitenderk331@gmail.com
AAMJ / Vol. 3 / Issue 2 / March – April 2017
http://aamj.in/wpcontent/uploads/Volume3/Is
sue1/AAMJ_1196_1199.pdf
Jitender & Prasanth : A case study on Ayurvedic management of Alopecia areata (Khalitya)
INTRODUCTION
A
lopecia areata is the commonest cause of patchy
hair loss. It may be regarded as an immune-mediated type of hair loss [v]. The condition affects
0.1% to 0.2% 0f the population and occurs in both males
and females [vi]. A single round or oval patch of complete
baldness develops rapidly usually over the vertex or in
the occipital region. There are no subjective symptoms
and the denuded area of scalp is of normal color and
texture. Patches in the beard may occur alone or in association with the scalp. Ridging or pitting of the nails accompanies in severe cases. The cause is still disputed. A
history of acute emotional stress or anxiety preceding the
onset is common, Focal sepsis and unidentified agent
have been also suggested [vii]. Histopathology shows perifollicular and intrafollicular inflammatory cell infiltrate
composed mainly of lymphocytes described as swarm of
bees’ appearance [viii]. In Ayurveda it can be correlated
to Khālitya one of the kṣudra roga. The prognosis is always uncertain. In many cases regrowth is complete in
6-7 months but in others may require a year. About one
third never recover completely from initial attack and recurrences are common. In modern medicine treatment is
unsatisfactory has no effect on long term progression. Potent topical or injected steroids may be of limited use[ix]
because hair is lost again when the treatment is discontinued and they should not be prescribed. These drugs
can cause serious side effects.
Case Report
A male patient of age 25 years with O.P.D no.145825
dated 09.01.2017 admitted in I.P.D of AIIA with complaint of multiple patches of hair loss of scalp and beard
since 1 year.
History of present illness: - A 25 year’s old male patient
experienced dandruff and itching of scalp 2 year back.
After few months, he suffered from hair fall. Gradually he
developed patchy hair loss of scalp and beard. He also
had redness of scalp. He was under mental stress due to
hair loss. He had undergone allopathic treatment but that
provided him only temporary relief. With these complaints, patient approached the AIIA New Delhi.
History of past illness: - There was no relevant past history.
Family history: - No member of the family had history of
such illness.
Personal history:
Diet
vegetarian
Micturition
4 - 5 times/day, 0 - 1/night
Appetite
good
Sleep
adequate, rarely disturbed
Bowel habit
Irregular
Addiction
nil
Aṣṭhavidha Parīkṣa:
Nādī (pulse)
Mala (stool)
82/min, regular, normal in character
often constipation
Mūtra (urine)
frequency - normal
Jihvā (tongue)
coated
Śabda (speech)
clear
Sparśa (touch)
Normal
Drika (eyes)
Normal
Akruti (built)
madhyam
Systemic Examination: - On examination, patient was
found to be conscious and well oriented to time, place
and person. Assessment of Central nervous system, cardiovascular system, respiratory system and musculoskeletal system of patient was found within normal limits clinically. No clinical abnormality was detected on per abdomen examination.
Blood investigation: - Blood investigations of the patient
reveals Hb-9.6g/dl. TLC, DLC values were within normal
limits.
Treatment Planned
Panchakarma Treatment
Deepana-Pachana
Snehapana
Abhyanga
Swedana
Virechana
Table 1: Ayurvedic treatment plan
Drugs
Guduchi Choorna 3gm TDS,
Nagarmotha Choorna 3gm TDS
Tiktaka ghritam
Chinchadi taila
Dashmoola kwatha
trivruta avaleha, eranda taila
Bloodletting (Pracchāna)
AAMJ / Vol. 3 / Issue 2 / March – April 2017
1294
Days
03 days
06 days
04 days
04 days
01 days
3 times every
fortnight
Jitender & Prasanth : A case study on Ayurvedic management of Alopecia areata (Khalitya)
After Virechana karma, Samsarjana karma was advised
for 5 days. After Samsarjana karma some internal medications [Table-4] were prescribed for 15 days. Rasāyana
drugs [Table-5] were advised for next one month. Bloodletting (Pracchāna) was done after (Pracchāna) during
that period every fortnight for three times on OPD basis
with follow up of 2 months. The duration of treatment was
63 days and follow up was done on every 15 days for
2 months. The study was conducted at All India Institute
of Ayurveda New Delhi. The patient was informed about
the treatment and the study was carried out ethically in
accordance with International Conference on Harmonization-Good Clinical Practices guidelines.
Table 2: Snehapana
Dose
30 ml
50 ml
80 ml
110
ml
140
ml
160
ml
Intake
time
6.30 am
6.45 am
6.30 am
6.40 am
12pm
12:30pm
2 pm
3 pm
Passing
Passing
Passing
Passing
6.30 am
6 pm
6.30 am
8 pm
Passing of flatus, increase in
body parts, lightness of body
Passing of flatus, increase in
body parts, lightness of body
Onset of hunger
Symptoms
of
of
of
of
flatus
flatus,
flatus, increase in appetite, hard stool
flatus, increase in appetite, soft stool, lightness of body parts
appetite, soft and unctuous stool, softness of
parts
appetite, soft and unctuous stool, softness of
parts
Table 3: Virechana
Virechana
drug
Dose
Anupana
Trivruta avaleha,
120
gm
Triphalakwatha 60 ml
Followed by ushnodakapana at every 15 to
20 minutes
No. of
Vega
Symptoms
Complications if
any
19
Clarity of channels, lightness , increase in
appetite, weakness, decrease in disease
symptoms and feeling of well-being
None
Blood Letting (Pracchāna)
Poorvakarama- Shiro-prakshalan(head wash) with lukewarm triphla kwath.
Pradhana karma- bloodletting (pracchāna) is done on
diseased area using lancet needle.
Paschata karma- Shiro-prakshalan(head wash) with lukeworm triphla kwath. Local application of paste of
Madhuyashti choorna mixed with Shatdhouta ghruta on
diseased area.
Table 4: Internal medicines
Medicine name
Trichup cap.
Brihatmanjishthadi kwatha
Kaishore Guggulu
Sarivadhyasava
Triphla Choorna
Dose
1 cap. TDS
15 ml TDS with 15 ml
water
2 Tab TDS
15 ml TDS
5 gm HS
AAMJ / Vol. 3 / Issue 2 / March – April 2017
Days
45 days
15 days
15 days
15 days
15 days
1295
Table 5: Rasāyana Drugs
Medicine name
Saptamrita lauha
Narsinha
Rasāyana
Dose
500 mg TDS
Days
1month
1 tsf TDS
1 month
Assessment of Result
Assessment is done on the basis of improvement in clinical symptom and SALT score
Scalp is divided into 4 areas namely,
 Vertex- 40%(0.4) of scalp surface area;
 Right profile of scalp- 18%(0.18)of scalp surface
area;
 Left profile of scalp- 18%(0.18) of scalp surface
area;
 Posterior aspect of scalp- 24%(0.24) of scalp surface
area;
Percentage of hair loss in any of these areas is percentage hair loss multiplied by percent surface area of scalp
Jitender & Prasanth : A case study on Ayurvedic management of Alopecia areata (Khalitya)
in that area. SALT score is sum of percentage of hair loss
in all above mentioned areas.
Table 6: SALT scale
Area
Vertex
Right scalp
Occiput
Total Score
SALT (Before
treatment)
4
2.4
3.2
6.o
CONCLUSION
SALT (After treatment)
1
1.4
1
3.4
DISCUSSION
Alopecia areata (Khālitya) is described as one of the Kṣudra roga in Samhitas. Vāta, Pitta, Kapha and Rakta are
involved in Khālitya as mentioned in the texts. There was
redness of scalp in diseased region which indicates towards involvement of Pitta. Virechana is the best treatment for Pittaja and Raktaja Vikara. That’s why
Virechana was done. Pracchāna is indicated when there
Before Treatment
AAMJ / Vol. 3 / Issue 2 / March – April 2017
is localized Rakta Dushti as in this case[x]. Internal Medications are chose on the basis of their Raktashodhaka
property. Rasāyana drugs which were given also had
Kesya property.
This case study shows the successful management of a
case of Alopecia areata (Khālitya). Whilst there is enormous scope for further research but still it proves that with
proper diagnosis and proper treatment protocol Ayurveda can be extremely beneficial in the management of
Alopecia areata (Khālitya). By Panchakarma therapy
along with internal medicines relief can be obtained on
SALT scale. The recovery in the present case was promising and worth documenting.
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After Treatment
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Jitender & Prasanth : A case study on Ayurvedic management of Alopecia areata (Khalitya)
REFERENCES
i. National Alopecia Areata Foundation Available from
http://www.naaf.org/alopecia-areata
ii. Alopecia areata – Wikipedia Available from
http://en.m.wikipedia.org/wiki/Alopecia-areata
iii. Sushruta
Samhitha
with
Nibandhasangraha
of
Dalhanacharya & Nyayachandrika panjika of Gayadasacharya edited by Vaidya Yadavji Trikamji
Acharya,published by Chaukamba surbharati prakashan,Varanasi, reprint 2017, Nidana sthana,Chapter
13/34, page no.322.
iv. Sushruta
Samhitha
with
Nibandhasangraha
of
Dalhanacharya & Nyayachandrika panjika of Gayadasacharya edited by Vaidya Yadavji Trikamji
Acharya,published by Chaukamba surbharati prakashan,Varanasi, reprint 2017, Nidana sthana,Chapter
13/34, page no.322.
v. Kumar & Clarke’s Clinical Medicine, edited by Prof,
Praveen Kumar & Dr. Michel Clerk, 5th edition, 2002,
Alopecia areata, page. no.1316.
vi. Alopecia areata – Wikipedia Available from
http://en.m.wikipedia.org/wiki/Alopecia-areata
vii. Savill’s System of Clinical Medicine, edited by
E.C.Warner, 14th edition, Alopecia areata, page no.
1022.
viii. API Text Book of Medicine Volume 1, edited by Surender
K Sharma, A K Agarwal et al, 10th edition, 2015, Alopecia areata, page. no.734.
ix. Kumar & Clarke’s Clinical Medicine, edited by Prof,
Praveen Kumar & Dr. Michel Clerk, 5th edition, 2002,
Alopecia areata, page. no.1316.
x. Astanga Hrudaya with Sarvanga Sundara teeka of Aruna
dutta & Ayurveda Rasāyana of Hemadri edited by Pt. Hari
Sadashiva Shastri Paradkara, published by Chaukamba
surbharati prakashan,Varanasi, reprint 2017, Sutra
sthana, Chapter 26/53, page no. 325.
Source of Support: Nil.
Conflict of Interest: None declared
How to cite this article: Jitender & Prasanth : A case study
on Ayurvedic management of Alopecia areata (Khalitya).
AAMJ 2017; 2:1293 – 1297.
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