E-ISSN:2456-3110

Case Report

Alopecia Areata

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

Management of Indralupta (Alopecia Areata) - A Case Study

Sufiyan S1*, Hiremath V2, Shashikala K3, Gururaj N4, Raju SN5
DOI:10.21760/jaims.8.11.29

1* Syed Rasool Sufiyan, Post Graduate Scholar, Dept Of Shalakya Tantra, Shri Jagadguru Gavisiddheshwar Ayurvedic Medical College Hospital, Koppal, Karnataka, India.

2 Veerayya R Hiremath, HOD Professor, Dept of Shalakya Tantra, Shri Jagadguru Gavisiddheshwar Ayurvedic Medical College Hospital, Koppal, Karnataka, India.

3 Shashikala K, Associate Professor, Dept of Shalakya Tantra, Shri Jagadguru Gavisiddheshwar Ayurvedic Medical College Hospital, Koppal, Karnataka, India.

4 Gururaj N, Associate Professor, Dept of Shalakya Tantra, Shri Jagadguru Gavisiddheshwar Ayurvedic Medical College Hospital, Koppal, Karnataka, India.

5 Raju SN, Assistant Professor, Dept of Shalakya Tantra, Shri Jagadguru Gavisiddheshwar Ayurvedic Medical College Hospital, Koppal, Karnataka, India.

Indralupta is one of the Urdhwajatrugata Vyadhi characterized by the patchy hair loss over hair-bearing skin that includes scalp and beard. According to Sushruta Acharya, Indralupta is due to the vitiated pitta in association with vitiated Vata causing the falling of hairs from the scalp and vitiated Rakta and Kapha block the orifices of the hair follicles which restricts the growth of new hair. Alopecia areata is autoimmune disease presented as nonscarring, circumscribed, smooth patch of hair loss, management is by the intralesional and topical corticosteroids. Shodhana (Raktamokshana) and Shamana Chikitsa is advised for the Indralupta in ayurveda classics. In this present case study 17 years old male patient is treated with Pracchanna Karma (Raktamokshana) followed by Maricha Lepa along with internal medicine. The therapy has shown a remarkable improvement in the signs of Indralupta. The patient obtained considerable relief from the symptoms through the therapy. The treatment proved to be easy, economical, highly effective with in short duration.

Keywords: Indralupta, Prachanna, Maricha, Alopecia areata

Corresponding Author How to Cite this Article To Browse
Syed Rasool Sufiyan, Post Graduate Scholar, Dept Of Shalakya Tantra, Shri Jagadguru Gavisiddheshwar Ayurvedic Medical College Hospital, Koppal, Karnataka, India.
Email: 		Sufiyan S, Hiremath V, Shashikala K, Gururaj N, Raju SN, Management of Indralupta (Alopecia Areata) - A Case Study. J Ayu Int Med Sci. 2023;8(11):182-186.
Available From
https://jaims.in/jaims/article/view/2889

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-16 2023-09-21 2023-09-26 2023-10-02 2023-10-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 19.78%

© 2023by Sufiyan S, Hiremath V, Shashikala K, Gururaj N, Raju SNand 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].

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Syed Rasool Sufiyan et al. Management of Indralupta (Alopecia Areata) - A Case Study

Introduction

Indralupta is prevalent from pre-vedic to medieval period, as we get the description form the Vedas.[1] In Ayurveda classics, Acharyas have briefed about the explanation of Indralupta. It is one of the hair loss over hair-bearing skin that includes scalp and beard. According to Acharya Sushruta, Indralupta is due to the vitiated Pitta in association with vitiated Vata causing the falling of hairs from the scalp, vitiated which restricts the growth of new hair. Thus, Vata, Pitta, and Kapha Dosha and Rakta Dushya (one of the sites in the body where the disease occurs) are the main internal causative factors of Indralupta.[2] Alopecia areata, also known as patchy hair loss, is a prevalent autoimmune disease in modern science. It affects individuals of all age groups and is characterized by the presence of nonscarring, circumscribed, smooth patches of hair loss. The pathogenesis of the alopecia areata is not clearly yet known.[3] The alopecia areata is managed by the intralesional and topical corticosteroids and are often the first-line therapy for most cases of patchy alopecia areata.[4] Based on the symptoms the Indralupta is corelated with alopecia areata. The Shodhana (Raktamokshana) Chikitsa has been described as the first line of treatment followed by Shamana Chikitsa in this type of disorder.[5]

Case Report

A 17 years old male patient, who is student by occupation was presented with history of patchy hair loss on scalp, for 1 month. There was no history of recurrent patchy skin lesion on other body parts, psychological disorder, hair plucking habit, local recurrent friction or trauma or surgery. There was patchy hair loss measuring about 1×2cm over the left occipital region. There was mild sliminess over patch. The area was demarcated with “Exclamation hair”.

Aim and Objective

To find out the efficacy of Pracchanna Karma followed by Maricha Lepa.

Materials and Methods

Case Findings

Patient was said to be asymptomatic before 1

months. Then he routinely done the haircut and found the bald spot-on scalp lasts 1 months back. He didn’t take any medicines and approached OPD of Dept of Shalakya tantra SJG Ayurveda Medical College & Hospital, Koppal, Karnataka, for the treatment.

Past History

Patient did not have any relevant past history.

Family History

There is no any disease related family history found in this case.

Personal History

Aahar: Amisha and Niramisha Ahara (veg-nonveg food), spicy, fermented food and also took excessive Amla and Lavana Rasa Sevana.
Appetite: Normal
Sleep: Normal

Systemic Examination

General condition of patient was normal.
Pulse rate: 82/min
BP: 126/76 mm of hg
Weight: 71kg

Treatment

1. Prachchanna Karma

Poorva Karma (Pre-treatment)

  • Collection of materials includes needle 22G, pair of gloves, sterile cotton balls,
  • Vitals were checked and found to be stable.
  • Sthanika Abhyanga with Tila Taila [Fig no. 1] and Swedana with Ushnajala Patta Sweda was done [Fig. no. 2]

Jaims_2889_01.jpg
Fig. 1: Sthanika Abhyanga


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Syed Rasool Sufiyan et al. Management of Indralupta (Alopecia Areata) - A Case Study

Jaims_2889_02.jpg
Fig. 2: Sthanika Ushnajala Patta Sweda

Pradhana Karma (Main treatment)

  • In the presence of bright light, the patient was made to sit on a chair in comfortable position.
  • The patchy area was cleaned with surgical spirit.
  • Pracchanna was done with a needle 22G starting from one end of the boundary of affected area in an equally spaced manner.
  • It was allowed to bleed for 5 min. After observing the bleeding intensity, blood was wiped by sterile cotton balls. [Fig no 3]

Jaims_2889_03.jpg
Fig. 3: Pracchanna Karma

Paschat Karma (post-treatment)

  • After wiping the blood, scalp area was wiped by sterile cotton balls.

2. Lepa Karma

Jaims_2889_4.jpg
Fig. 4: Maricha Lepa

Maricha Lepa was applied [Fig no 4] after the Paschat Karma and Bandhana was done.

Table 1: Showing overall treatment given during the study

TreatmentMedicinesDurationDate
AnulomanaTab. Anuloma DS (od night after food)3 days12/11/2023 to 14/11/2023
Prachanna Karmawith needle 22G5 sittings (5 days apart)15/11/2023 to 05/12/2023
Lepa KarmaMaricha Churna Lepa (Mishrana Dravya Tila Taila)
Samshamana ChikitsaVidangarishta (1tsp bid)Krimikuthara Rasa (1 od night after food)25 days15/11/2023 to 10/12/2023

Total Duration of Treatment - 1 month

The patient was advised to follow the Pathya, and refrain from the Apathya’s.

Pathya

Ahara: Dugdha, Ghrita, Shashtikashali Sevana.
Vihara: Chhatradharana (covering of the head).

Apathya

Ahara: Atilavana, Atikatu Rasa Sevana

Vihara: Head bath, Ratrijagarana, Exposure to sunlight and dust.

Observation and Results

Jaims_2889_5.jpg
Fig. 5: Before Treatment

Jaims_2889_6.jpg
Fig. 6: At 25 days


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Syed Rasool Sufiyan et al. Management of Indralupta (Alopecia Areata) - A Case Study

Jaims_2889_7.jpg
Fig. 7: After Treatment (30 Days)

Discussion

Indralupta is one of the Urdhwajatrugata Vyadhi characterized by the patchy hair loss over hair-bearing skin that includes scalp and beard. The Shodhana (Raktamokshana) Chikitsa. has been described as the first line of treatment. In this case study among the type of Raktamokshana, Pracchanna Karma with 22G needle had been selected. Pracchanna is indicated in Uttana Rakta, Ek Desha, Pindit Rakta and Twakgata Dosha.[6] The pathogenesis of alopecia areata is in the dermis layer of the skin of scalp where the hair follicle is present.[7] Hence, Pracchanna type of Raktamokshana is more appropriate for the Raktamokshana in Indralupta. Due to hard surface of scalp and for convenient use here 22G needle was selected for Pracchanna Karma.

Probable Mode of action of Pracchanna

  • Raktamokshana of Dushita Rakta was done by the Pracchanna with 22G needle.
  • Pracchanna had caused the elimination of impure blood, and it reduces the Ushna, Tikshna property of Pitta and Rakta.
  • Following the elimination of impure blood, blocked hair follicles were released, paving the way for potential hair regrowth.[8]

Probable Mode of action of Maricha Lepa

  • Maricha lepa applied after Pracchanna Karma is Ushna, Tikshna and Kapha Vatagna, thus reduces the accumulation of the Kapha in the Romakoopa causing Samprapti Vighatana.
  • Piperene present in the Maricha acts like catalyst for the absorption of the nutrients in potential regrowing hairs.[9]


Probable Mode of action of Shamana Chikitsa

  • Vidanga Arishta and Krimikuthara Rasa acts as Krimihara. Since Krimi is one of the Nidana for Shiroroga, hence these were given to address the Krimi and also to prevent any secondary infections arising from open wounds caused post Pracchanna Karma.

Conclusion

From the above case discussion, it can be concluded that the patient suffering from Indralupta underwent a successful treatment using Pracchanna (Raktamokshan) and Shamana therapy. It is important to note that Nidanaparivarjana was an integral part of the treatment process. The therapy has shown a remarkable improvement in the sign of Indralupta. The patient obtained considerable relief from the symptoms through the therapy. The treatment Pracchanna Karma and Maricha Lepa along with internal medicine can be given to Indralupta patients. In order to confirm the efficacy of this treatment protocol statistically, it is essential to conduct a thorough clinical evaluation involving a large population of patients.

References

1. Ath.Veda. Kanda, 6: 21-23, 136, 137 https://sacred-texts.com/hin/av.htm,

2. Sushruta, Sushruta Samhita, Dalhanacharya’s Nibandha Sangraha and Gayadas’s Nyaya Chandrika Panjika Commentary, edited by Vaidya Yadavji Trikamji Acharya,
Published by Chaukambha Surabharti Prakshana, Varanasi, Reprint Edition - 2014 Nidana sthana 13/33-34, page no, 322.

3. B S Chandrashekar, Madura C. IADVL textbook of trichology. Editorial: New Delhi: Jaypee the Health Science Publishers; 2018, chapter no- 20, page no, 171.

4. Lepe K, Syed HA, Zito PM. Alopecia Areata. [Updated 2023 Oct 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537000/

5. Sushruta, Sushruta Samhita, Dalhanacharya’s Nibandha Sangraha and Gayadas’s Nyaya Chandrika Panjika Commentary, edited by


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Vaidya Yadavji Trikamji Acharya, Published by Chaukambha Surabharti Prakshana, Varanasi, Reprint Edition - 2014 chikitsa sthana 20/24, page no, 479

6. Sushruta, Sushruta Samhita, Dalhanacharya’s Nibandha Sangraha and Gayadas’s Nyaya Chandrika Panjika Commentary, edited by Vaidya Yadavji Trikamji Acharya, Published by Chaukambha Surabharti Prakshana, Varanasi, Reprint Edition - 2014 sutrasthana 14/34, page no, 65.

7. B S Chandrashekar, Madura C. IADVL textbook of trichology. Editorial: New Delhi: Jaypee the Health Science Publishers; 2018, chapter no- 20, page no, 170.

8. Patil SB, Patil GS, Patil V. Effective management Alopecia totalis by Ayurveda - A case report. J Ayurveda Integr Med. 2023 Dec 2;14(6):100805. doi:
10.1016/j.jaim.2023.100805. Epub ahead of print. PMID: 38043433; PMCID: PMC10711465.

9. Dudhatra GB, Mody SK, Awale MM, Patel HB, Modi CM, Kumar A, Kamani DR, Chauhan BN. A comprehensive review on pharmacotherapeutics of herbal bioenhancers. Scientific World Journal. 2012;2012:637953. doi: 10.1100/2012/637953. Epub 2012 Sep 17. PMID: 23028251; PMCID: PMC3458266.


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