A A M J Anveshana Ayurveda Medical Journal

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1 A A M J Anveshana Ayurveda Medical Journal ISSN: Case Report A case study on Ayurvedic management of Alopecia areata (Khālitya) Jitender Kumar 1 Prasanth Dharmarajan 2 A b s t r a c t 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. 1 PG Scholar, 2 Assistant Professor, Department of Panchakarma, All India Institute of Ayurveda, New Delhi. CORRESPONDING AUTHOR Dr. Jitender Kumar PG Scholar, Department of Panchakarma, All India Institute of Ayurveda, New Delhi, (India). jitenderk331@gmail.com sue1/aamj_1196_1199.pdf AAMJ / Vol. 3 / Issue 2 / March April 2017

2 INTRODUCTION Alopecia 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 dated 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 Micturition Appetite Sleep Bowel habit Addiction Aṣṭhavidha Parīkṣa: Nādī (pulse) Mala (stool) Mūtra (urine) Jihvā (tongue) Śabda (speech) Sparśa (touch) Drika (eyes) Akruti (built) vegetarian 4-5 times/day, 0-1/night good adequate, rarely disturbed Irregular nil 82/min, regular, normal in character often constipation frequency - normal coated clear Normal Normal 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 Table 1: Ayurvedic treatment plan Panchakarma Treatment Drugs Days Deepana-Pachana Guduchi Choorna 3gm TDS, Nagarmotha Choorna 3gm TDS 03 days Snehapana Tiktaka ghritam 06 days Abhyanga Chinchadi taila 04 days Swedana Dashmoola kwatha 04 days Virechana trivruta avaleha, eranda taila 01 days Bloodletting (Pracchāna) 3 times every fortnight AAMJ / Vol. 3 / Issue 2 / March April

3 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. Dose Intake time Onset of hunger am 12pm Passing of flatus Table 2: Snehapana am 12:30pm Passing of flatus, Symptoms am 2 pm Passing of flatus, increase in appetite, hard stool am 3 pm Passing of flatus, increase in appetite, soft stool, lightness of body parts 6.30 am 6 pm Passing of flatus, increase in appetite, soft and unctuous stool, softness of body parts, lightness of body parts 6.30 am 8 pm Passing of flatus, increase in appetite, soft and unctuous stool, softness of body parts, lightness of body parts Table 3: Virechana Virechana drug Dose Anupana No. of Vega Symptoms Complications if any Trivruta avaleha, 120 gm Triphalakwatha 60 Followed by ushnodakapana at every 15 to 20 minutes 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 Dose Days Trichup cap. 1 cap. TDS 45 days Brihatmanjishthadi kwatha 15 TDS with 15 water 15 days Kaishore Guggulu 2 Tab TDS 15 days Sarivadhyasava 15 TDS 15 days Triphla Choorna 5 gm HS 15 days Table 5: Rasāyana Drugs Medicine name Dose Days Saptamrita lauha 500 mg TDS 1month Narsinha Rasāyana 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 Right profile of scalp- 18%(0.18)of scalp surface Left profile of scalp- 18%(0.18) of scalp surface Posterior aspect of scalp- 24%(0.24) of scalp surface Percentage of hair loss in any of these areas is percentage hair loss multiplied by percent surface area of scalp AAMJ / Vol. 3 / Issue 2 / March April

4 in that area. SALT score is sum of percentage of hair loss in all above mentioned areas. Table 6: SALT scale 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. Area SALT (Before treatment) SALT (After treatment) Vertex 4 1 Right scalp Occiput Total Score 6.o 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 CONCLUSION 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. ΛΛΛΛ Before Treatment After Treatment AAMJ / Vol. 3 / Issue 2 / March April

5 REFERENCES i. National Alopecia Areata Foundation Available from ii. Alopecia areata Wikipedia Available from -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 vi. Alopecia areata Wikipedia Available from -areata vii. Savill s System of Clinical Medicine, edited by E.C.Warner, 14 th edition, Alopecia areata, page no viii. API Text Book of Medicine Volume 1, edited by Surender K Sharma, A K Agarwal et al, 10 th 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 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 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: ΛΛΛΛ AAMJ / Vol. 3 / Issue 2 / March April