E-ISSN:2456-3110

Case Report

Alopecia Areata

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

Ayurvedic approach for managing Indralupta (Alopecia Areata): A Case Study

Subodh P1, Hemant P2*, Sajida A3, Anaya P4
DOI:10.21760/jaims.8.11.40

1 Pal Subodh, Post Graduate Scholar, Dept of Kayachikitsa, APM’s Ayurved Mahavidyalaya, Sion Mumbai, Maharashtra, India.

2* Paradkar Hemant, Associate Professor, Dept of Kayachikitsa, Apms Ayurved Mahavidyalaya, Sion Mumbai, Maharashtra, India.

3 Attar Sajida, Assistant Professor, Dept of Kayachikitsa, APM’s Ayurved Mahavidyalaya, Sion Mumbai, Maharashtra, India.

4 Pathrikar Anaya, Professor HOD, Dept of Kayachikitsa, APM’s Ayurved Mahavidyalaya, Sion Mumbai, Maharashtra, India.

Indralupta (Alopecia areata) is a disease characterised by patches of hair loss spread throughout the body and scalp described as Shirogata Roga (diseases of head) & Kapalagata Roga (Scalp disease) by Acharyas. It can be considered alopecia areata according to conventional medicine. Alopecia areata is considered autoimmune, making it difficult to treat with increased chances of recurrence. But Ayurveda is very effective with no side effects and minimal chances of recurrence as it not only treats the disease but also works on the causative factors (Nidan Parivarjana). The present case report is on the effectiveness of Shaman (treatment that pacifies the aggravated Doshas), Keshya (Hair nourishing treatment), and Raktamokshna (blood-letting) in the patient of Indralupta. A 16-year-old boy who had hairless patches on his scalp was diagnosed with Alopecia areata 4 years before by a dermatologist. He already took conventional modern medicines but didn’t get a satisfactory result. It showed recurrence after the stoppage of medicines. So, he came to Kayachikitsa OPD for Ayurvedic treatment. After 4 months of Shamana Chikitsa, Jalaukavcharan (Leech therapy), Nasya (medicine administered through nasal route), and Shirolepa (local application of Ayurveda herbs), complete recovery was seen with no adverse effects during and after treatment. In this case, hair regrowth from hair follicles was evident within 30 days of treatment. The collected data of this study suggest that Shamana treatment, Raktmokshan, and Keshya medicine can provide complete relief in Indralupta.

Keywords: Indralupta, alopecia, Alopecia areata, Hair loss, Case study

Corresponding Author How to Cite this Article To Browse
Paradkar Hemant, Associate Professor, Dept of Kayachikitsa, Apms Ayurved Mahavidyalaya, Sion Mumbai, Maharashtra, India.
Email: 		Subodh P, Hemant P, Sajida A, Anaya P, Ayurvedic approach for managing Indralupta (Alopecia Areata): A Case Study. J Ayu Int Med Sci. 2023;8(11):240-245.
Available From
https://jaims.in/jaims/article/view/2787

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-14 2023-09-25 2023-10-06 2023-10-13 2023-10-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 22.98

© 2023by Subodh P, Hemant P, Sajida A, Anaya Pand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2023;8(11)240
Pal Subodh et al. Ayurvedic approach for managing Indralupta (Alopecia Areata)

Introduction

The very first impression of a person depends on his looks, in which hair plays an important role. Nowadays we can see tremendous ailments related to hair like hair fall, greying of hair, Alopecia, etc. It affects self-esteem, and confidence further leading to depression. Alopecia areata which mainly affects the scalp is an autoimmune disorder in which patchy loss of hair is seen with no signs of inflammation.[1] Due to its location, it affects the beauty of a person which makes him look unpleasant and lowers his confidence. Also, contemporary treatment includes treatment with the use of steroids has many adverse effects with chances of recurrence.[2] Many therapies are available for the treatment of alopecia areata, including topical, systemic, and injectable modalities. However, these treatment methods produce variable clinical outcomes and there are no currently available treatments that induce and sustain remission.[3] Conventional modern therapy consists of intralesional corticosteroids, topical corticosteroids, minoxidil, anthralin, topical immunotherapy, prostaglandin analogs, topical retinoids, bexarotene, capsaicin, sulfasalazine, photochemotherapy, excimer laser, and fractional photothermolysis laser, systemic corticosteroids, methotrexate, cyclosporine, azathioprine, and biologics. None of the agents available currently for treating this condition is curative or preventive completely.[4] In such cases, Ayurveda is found to be promising. Alopecia areata can be correlated with Indralupta explained in Ayurveda. Indralupta is explained under the heading of Kshudrarogas by Acharya Sushruta.[5] Ayurveda emphasizes the involvement of all three Doshas along with Rakta Dhatu in hair fall and Indralupta.[6] According to Ayurveda, vitiated Pitta in association with vitiated Vata causes the falling of hairs from the scalp. After that, vitiated Rakta and Kapha block the orifices of the hair follicles which restricts the growth of new hair. Thus, Vata, Pitta, and Kapha Dosha (three factors responsible for all physiological processes inside the body) and Rakta Dushya (one of the sites in the body where the disease occurs) are the main internal causative factors of Indralupta.[7] So while treating such cases removal of obstruction at hair follicles is important and then start with anti-hairfall treatment. Acharya Sushruta has explained the line of treatment of Indralupta in Chikitsa-sthan.[8]

Here a case of 16 years old boy describes the usefulness of Ayurvedic management with Shamana medicines, Jalaukavcharan, Nasya, and Shirolepa Chikitsa in the treatment of alopecia areata.

Patient Information

On 10th November 2022, a 16-year-old boy came to OPD of the Kayachikitsa department with complaints of patchy loss of hairs on the scalp gradually increasing for 4 years. He had no history of any major illness. Also no family history of such diseases. There were multiple patches of hair loss all over the scalp of variable sizes as seen in [Fig. 1]. The patient identified a small patch of hair loss on the scalp before 4 years. The patient visited a dermatologist where he was diagnosed with alopecia areata and treated for the same. Eventually, he recovered from it. After 1 year, again similar patches of hair loss started appearing on the scalp not relieving with the same line of treatment he was taking. He had stopped the treatment after 6 months due to unsatisfactory results. Then he took various other treatments with local physicians and General practitioners, whose details were not available [Table 1]. The patient was referred to our hospital by one of his friends. After examining the patient diagnosis was made as Indralupta. The patient was explained about the disease and was advised of internal Ayurvedic medicines along with procedures like Jalaukavcharan, Nasya, and Lepan Chikitsa. Internal medicines are listed in [Table 2]. Treatment principles included Krumighna Chikitsa considering his age, Srotovishodhan Chikitsa to improve nourishment to Rasa, Rakta, and Asthi Dhatu, Keshya Chikitsa to initiate regrowth of hair. Details of procedures are mentioned in [Table 3]. The line of treatment showed successful results in this case of Indralupta within 4 months. The patient was followed up on every 15th day for 1st two months and then monthly. Follow-up details are mentioned in [Table 4].

Clinical findings

The patient had hairless patches on the scalp for the past 4 years, no itching on the scalp, the general condition was good, all the vitals were normal, and no systemic illness.

Ashtavidha Pariksha

1. Nadi: 72/min, Vata kapha


J Ayu Int Med Sci 2023;8(11)241
Pal Subodh et al. Ayurvedic approach for managing Indralupta (Alopecia Areata)

2. Mutra: Samyak (Normal output)
3. Mala: Asamadhankarak (Non satisfactory)
4. Jivha: Saam (coated)
5. Shabda: Spashta (Clear)
6. Sparsha: Anushna (Warm)
7. Druk: Samyak (Normal)
8. Akruti: Madhyam, but many patches of hair loss are seen on the scalp

Other examinations

Prakriti: Vata Kaphaj; Vikruti: Tridosha; Saar: Mansa; Samhanana: Madhyam; Satva: Madhyam; Satmya: Madhyam; Aahar Shakti: Samyak; Vyayam Shakti: Madhyam; Vaya: 16years; Desha: Aanup; Kaal: Aadan

Timeline

Table no. 1 represents the timeline of the occurrence of events in the present case study. It represents all the symptoms along with the previous treatment taken by the patient and the results obtained.

Table 1: Timeline

Dec 2018A small patch of hair loss on the scalp was diagnosed as Alopecia areata and treated by Dermatologist. Complete recovery with treatment.
Feb 2020Recurrence of patches of hair loss on the scalp. Started the same line of allopathic treatment taken before. Treatment continued for 6 months but no complete remission.
Sept 2020Stopped the treatment due to unsatisfactory results.
Jan 2021 - Apr 2022Patients have taken intermittent treatment from local physicians and general practitioners but no sustainable result achieved.
10th Nov 2022The patient was advised to visit the OPD of Kayachikitsa by one of his friends. The patient came with complaints of many patchy hair loss patches on the scalp.

Diagnostic findings

Several patches of hair loss are seen on the scalp. The patient was already pre-diagnosed with alopecia areata by a dermatologist.

Treatment schedule

The patient was treated as shown in Table no. 2,3.

The patient was treated with Arogyavardhini 125mg twice daily along with Krumikuthar Rasa 125 mg at night with Guda till 21 and 15 days respectively. It was followed by Rasapachak Tab 125 mg, Asthimajjapachak Tab 125 mg, and Mahamanjishthadi Kwath 20 ml with an equal amount of water twice daily for 3 weeks, Bhringaraja Ghana 250 mg and Bibhitak Ghana

250 mg for 13 weeks. After completion of 4 months and complete recovery, Amalaki Ghan 250 mg with lukewarm water was started for 2 months for hair nourishment. Jalaukavcharan was done on the scalp 4 times every 15 days. Anu Tail Nasya 3 drops in each nostril were given, daily from the 21st day onwards till the 120th day. Tagar + Daruharidra Lepa were done on an alternate day from the 61st to the 120th day.

Table 2: Shamana treatment.

SNMedicinesDoseAnupaanDuration
1.         Arogyavardhini Rasa125mg (1-0-1)lukewarm waterFirst 21 days
2.         Krumikithar Rasa125mg (0-0-1)Guda (Jaggery)First 15 days
3.         Rasapachak125mg (1-0-1)lukewarm waterFrom 22nd day to 42nd day
4.         Asthimajjapachaka125mg (1-0-1)lukewarm waterFrom 22nd day to 42nd day
5.         Mahamanjisthadi Kwath20ml. (1-0-1)an equal amount of lukewarm waterFrom 22nd day to 42nd day
6.         Bhringaraja Ghana250mg. (1-0-1)lukewarm waterFrom 22nd day to 120th day
7.         Bibhitaki Ghana250 mg (1-0-1)lukewarm waterFrom 22nd day to 120th day
8.         Amalaki Ghana250mg. (1-0-1)lukewarm waterFrom 121st day to 180th day as Keshya

Table 3: Procedures

SNProceduresDuration
1.Jalaukavcharan4 Times 15th, 30th, 45th and 60th day
2.Nasya – Anu Tail3 drops in each nostril daily from the 21st day onwards till the 120th day.
3.ShirolepaTagar + Daruharidra Lepa was done on an alternate day from the 61st to the 120th day.

Outcome and follow-up:

Follow-up changes are given in Table no. 4. As per the [Figs. 1-4], there was no visible hair or hair roots at various places on the scalp before treatment. After 30 days of treatment, there was visible hair eruption at many places on the scalp. The images were taken after treatment of 4 months [Figs, 5-8] and the regrowth of hair was clearly visible. The patient was instructed to continue the Amalaki Ghan 250 mg with lukewarm water with Pathya (wholesome diet regimen). Thereafter, the patient regularly came to the hospital for follow-up and continued the treatment.


J Ayu Int Med Sci 2023;8(11)242
Pal Subodh et al. Ayurvedic approach for managing Indralupta (Alopecia Areata)

Table 4: Follow-up

SNFollow-up Changes seen
1.         1st dayArogyavardhini and Krimikuthar started.
2.         15th dayThe patient’s bowel habits were improved, Samyak Malapravrutti with Niram Jivha. No hair growth was seen. Krimikuthar stopped. Leech therapy was done.
3.         21st dayArogyavardhini Stopped. Bhringaraja Ghana 250 mg, Rasapachak Tab 125 mg, Asthimajjapachak Tab 125 mg, Mahamanjishthadi Kwath 20 ml, and Bibhitak Ghana 250 mg started. Anu Tail Nasya Started. Not much hair growth was seen.
4.         28th dayA few tiny brownish hair growths were seen on some patches. Treatment continued. Leech therapy was done.
5.         35th dayTiny hair growth was seen on all patches. Treatment continued.
6.         42nd dayRasapachak Tab, Asthimajjapachak Tab, Mahamanjishthadi Kwath stopped. Bhringaraja Ghana and Bibhitak Ghana continued. Nasya continued. Leech therapy was done. Hair growth was seen.
7.         60th dayLeech therapy was done. Asked to start Tagar + Daruharidra lepa alternate day.
8.         90th dayBhringaraja Ghana and Bibhitak Ghana continued. Nasya continued. Tagar + Daruharidra Lepa continued. More black hairs are seen.
9.         120th dayComplete recovery was seen. Bhringaraja Ghana, Bibhitak Ghana and Nasya stopped. Lepa therapy stopped. Amalaki Ghan 250 mg twice daily started for the next 2 months.
10.      180th dayNormal hair growth was seen. No recurrence of alopesia. Amalaki Ghan stopped.
11.      250th dayNo recurrence of alopesia. Patient was happy with the results.

Discussion

Acharya Charaka explains the pathophysiology of Khalitya and Palitya in Trimarmiya Chikitsa where he says that when Teja along with Vatadi Doshas reaches the scalp leads to Indralupta.[9] Acharya Sushruta explains about Indralupta in Kshudraroga where he says that Kapha and Rakta block the Romkupa, while Vata & Pitta Dosha leads to hair fall.[5] So the involvement of Vata, Pitta, Kapha, and Rakta can be seen in this disease.

Arogyavardhini is said to be Kusthaghna (can alleviate all types of skin disorders). Also, the drug has properties like-Pachani (digestive), Dipani (appetizer), Pathya (wholesome for channel), Hridya (cardioprotective), Medonashaka (help in fat reduction), Malashuddhikari (cleaning of waste materials from the body), increase Kshudha (appetizer), Sarvaroga prashamani

(can alleviate all types of disorders from the body). So, it was used for Srotoshuddhi (clearing of channel).[10] Aarogyavadhini Vati is used in all types of Kushtha, especially in Vata and Vata-Kaphajkushtha. It helps to remove Ama (toxins) from the body. It has an antipruritic nature that relieves the itching sensation. Contains Kutaki as the main content, which works as Shodhan and Bhendan of Dosha.[11]

Acharya Sushruta explains the involvement of Krimi in all types of skin diseases. So considering his age and consumption of Viruddhahar, Krumikuthar rasa was used. It is a herbo-mineral combination containing Karpura, Hingul, Vatsanabh, Pasash Beej, etc. mainly works on Krumi. It is considered that many Twak Vikar involve Krumi in their pathophysiology and Krumikuthar Rasa is a time-tested formulation in Skin diseases.[11] Bhringaraja is a well-known herb used in hair ailments. It is Ushna Veerya, which breaks the Srotoavrodh and leads to hair growth.[12] According to the Principles of Ayurveda, it is said that when Rasa Dhatu is of good quality the succeeding Dhatus will also be good.[13] So Rasapachak was used to improve the quality of Rasa Dhatu. Kesha [Hairs] is Mala of Asthi Dhatu, so the quality of hair depends on the quality of Asthi Dhatu. Hence Asthimajjapachaka Yog was used.[14]

Bibhitaki is also Keshya with Kashaya Rasa, Madhur Viapaka, Ushna Virya, and Ruksha Guna which acts as Srotorovishodhak and shows Keshya properties.[15] Amalaki is a Rasayana i.e., good for all the Dhatus. Amalaki (Emblica) has been ubiquitously used in Ayurvedic medicine for nourishing hair since ancient times. Experiments showed that Amalaki extract solution promoted hair strength (tensile strength and extensibility).[16] Mahamanjishthadi Kwath is a blood purifier. It pacifies the vitiation of Kapha and Pitta and acts as a Rakta Shodhaka. It detoxifies blood and helps to eliminate accumulated toxins from the body.[17] Jalaukavcharan- Acharya Sushruta tells to do Raktamokshana in Indralupta. It helps to eliminate the Srotasavrodh and vitiated Rakta Dhatu.[8] Shirolepa- Acharya Sushruta has mentioned the Lepa of Tagar + Daruharidra in Indralupta.[8] Nasya is indicated in all Urdhvajatrugata Vyadhis of which Indralupta is one. Anu Tel is very effective for hair growth as well as it prevents hair fall.[18] There are many clinical studies published on Indralupta


J Ayu Int Med Sci 2023;8(11)243
Pal Subodh et al. Ayurvedic approach for managing Indralupta (Alopecia Areata)

. These studies highlighted the results of Shamana or Shamana along with some external applications or the use of only local procedures like Pracchhanna Karma and Jalaukavacharana. In this case, we have used the Shaman Chikitsa along with Keshya Chikitsa, Nasya, Jalaukavacharana, and Lepa. Recurrence is a major issue in alopecia areata. In this case, no recurrence was observed till the 8th month. The patient regularly visits the OPD for follow-up and following the diet and medications.

Conclusion

In this case of Alopecia areata Ayurvedic principles of diagnosing the disease, finding out the Samprapti (Pathophysiology), and then starting the treatment which do Sampraptibhanga (Treating the root cause of Pathophysiology) gave complete recovery with no side effects during or after the treatment. We conclude that the Ayurveda protocol of Shamana, along with Jaloukavacharan, Nasya, and Keshya treatment used for this patient for four months was beneficial and the regrowth of hair started considerably in 30 days. The results obtained from this treatment show that further research can be undertaken based on this treatment plan for the Ayurvedic management of alopecia areata (Indralupta).

Patient perspectives

The patient was pleased after getting complete hair growth.

Declaration of patient consent

The authors certify that they have obtained the patient's consent, for reporting his case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

References

1. Thomas EA, Kadyan RS. Alopecia areata and autoimmunity: a clinical study. Indian J Dermatol. 2008;53(2):70-4. DOI: 10.4103/0019-5154.41650. PMID: 19881991; PMCID: PMC2763714.

2. Waljee AK, Rogers MAM, Lin P, Singal AG, Stein JD, Marks RM, et al. Short term use of oral corticosteroids and related harms among

adults in the United States: population-based cohort study. BMJ. 2017;357:j1415. DOI: 10.1136/bmj.j1415.

3. Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, Shapiro J. Alopecia areata: An appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018 Jan;78(1):15-24. DOI: 10.1016/j.jaad.2017.04.1142. PMID: 29241773.

4. Alsantali A. Alopecia areata: a new treatment plan. Clin Cosmet Invest Dermatol. 2011;4:107-15. DOI: 10.2147/CCID.S22767.

5. Sushruta. Susruta Samhita with the Nibandhasangraha commentary of Sri Dalhanacharya. Nidansthan Adhyaya 13/3; 2023 edition, Chaukhamba Surbharati Prakashan, Varanasi. 2023;318.

6. Astangahrdaya of Vagbhata with the commentaries sarvangasundara of Arundatta & Ayurvedrasayana of Hemadri, uttarsthana, Adhyaya 23/24; 2020 edition; Chaukhamba Surbharati Prakashan, Varanasi; 2020;859.

7. Singhal P, Vyas V, Chhayani P, Patel M, Gupta SN. Ayurvedic management of alopecia areata: A case report. J Ayurveda Integr Med. 2022 Jul-Sep;13(3):100604. DOI: 10.1016/j.jaim.2022.100604. Epub 2022 Jul 19. PMID: 35868136; PMCID: PMC9307686.

8. Susrutasamhita of Susruta with the Nibandhasangraha commentary of Sri Dalhanacharya. Chikitsasthan Adhyaya 20/24-26; 2023 edition, Chaukhamba Surbharati Prakashan, Varanasi. 2023;479.

9. Chakrapanidatta, commentator Charaka samhita, Chikitsa sthana, Adhyaya 26/132-133, 3rd ed. Varanasi: Chaukambha Krushnadas Academy; 2020.p.606

10. Mahajon B, Pal S, Aku R. Arogyavardhini Vati: A theoretical analysis. J Sci Innov Res. 2016;5. DOI: 10.31254/jsir.2016.5605.

11. Gawas CP, Pathrikar A, Paradkar H, Kamat N. Management of Charakokta stravi vicharchika (Contact dermatitis) through Ayurveda Medicines: A Case Study. Int J AYUSH CaRe. 2023;7(3):244-248.

12. Shrigod AR et al. Ayurvedic management for Indralupta: A case report. Int J Emerging


J Ayu Int Med Sci 2023;8(11)244
Pal Subodh et al. Ayurvedic approach for managing Indralupta (Alopecia Areata)

Technol Innov Res. 2022;9(7):ppe386-e391. Available at: http://www.jetir.org/papers/JETIR2207450.pdf.

13. Susruta Samhita of Susruta with the Nibandhasangraha commentary of Sri Dalhanacharya. Sutrasthan Adhyaya 15/18; 2023 edition, Chaukhamba Surbharati Prakashan, Varanasi. 2023;71.

14. Sarngadhara Samhita of Dr. Brahmanand Tripathi; Purvakhanda, Adhyay 5; 2017 Edition; Chaukhamba Surbharati Prakashan, Varanasi. 2017;41-42.

15. Khemraj Shrikrishnadass Prakashan. Bhavprakash Samhita of Shree Lalashaligram Vaishya krut hindi tika sahit evam Pandit Kantinarayan Mishra; Prakaran 5 Haritakyadi varga; 2010;163.

16. Tiampasook P, Chaiyasut C, Sundaram Sivamaruthi B, Timudom T, Nacapunchai D. Effect of Phyllanthus emblica Linn. on Tensile Strength of Virgin and Bleached Hairs. Appl Sci. 2020;10(18):6305. DOI: 10.3390/app10186305.

17. The Ayurvedic Formulary of India. Ministry of Health and Family Welfare, Govt. of India. 2000; I (20:4):664-5.

18. Charaka samhita, Sutrasthana, Adhyaya 5/59; 3rd ed. Varanasi: Chaukambha Krushnadas Academy; 2020;51.


J Ayu Int Med Sci 2023;8(11)245