Treatment of alopecia areata with individualised homoeopathic medicines: An evidence-based case series

INTRODUCTION

Alopecia areata (AA) is an autoimmune disorder characterised by patches of non-scarring hair loss affecting the skin. The disease may be limited to one or more discrete, well-circumscribed, round, or oval patches of hair loss on the scalp or body; it may also affect the entire scalp (alopecia totalis) or the entire body (alopecia universalis). The incidence of AA is approximately 2% worldwide.^[1] It affects people of all ages and sexes. Hair loss in AA is an autoimmune process, leading to chronic inflammation due to the presence of organ-specific CD8+ T-cell-dependent response affecting the hair follicles. Infections, trauma, hormones and stress are known to trigger the condition. Genetic factors play an important role, with a likelihood of severe symptoms seen in first-degree relatives. AA is associated with other autoimmune diseases such as vitiligo, lupus erythematosus, psoriasis, atopic dermatitis, thyroid disease, allergic rhinitis, pernicious anaemia, diabetes mellitus and rheumatoid arthritis.^[2]

At present, there is no specific treatment for AA. However, topical immunotherapy, intralesional and topical or systemic corticosteroids are used in patients. Other treatment options include immunosuppressants and biologics; however, these require constant patient monitoring for potential adverse effects.^[3] An important element in managing AA cases is offering psychological support and education about the disease, which helps achieve long-term improvements.^[4] The diagnosis is clinical and generally simple in common cases. In diffuse chronic forms, trichogram and biopsy are advised.^[5]

Sharquie and Al-Obaidi^[6] investigated the effectiveness of topical crude onion juice for treating patchy AA in comparison with tap water. An Iranian research group investigated the effectiveness of topical garlic gel for treating AA.^[7] Shaoqiong^[8] described a case report of a girl with AA treated with a traditional Chinese remedy. Hay et al.^[9] treated AA with aromatherapy with significant improvement. However, despite all the positive results, unfortunately, no study was of sufficient internal validity to provide robust evidence of the benefit of complementary and alternative medicine in AA.

Limited published studies are available about the treatment of AA with homoeopathic medicines. There are four individual case reports, wherein AA was treated with individualised homoeopathic medicine. The patients varied considerably: an 11-year-old boy, two cases of women in their early 40s, a 19-year-old girl and a 15-year-old boy.^[10-13] All the cases reported excellent results over the long term, without any recurrence of the complaints. As AA is a chronic autoimmune condition with a possible genetic basis, homoeopathic treatment must take into consideration the patient’s miasmatic background along with the symptoms.

In this case series, we explore the efficacy of homoeopathic medications in the treatment of AA; we present three cases wherein the similimum was prescribed based on a thorough case taking and analysis of the symptoms as well as of the miasmatic background.

CASE SERIES

• Study design: Experimental study.

• Study setting: Out-patient department of Mahesh Bhattacharyya homoeopathic medical college and hospital.

• Consent: Consent was obtained from all patients for the publication of their data.

Case Report 1

A 27-year-old male working as a clerk in a private bank, reported the complaint of hair loss from the vertex area of the head for 8 months. He was not undergoing any other treatment and desired homoeopathic treatment for his complaints.

Patient information

The patient was very hurried in nature. He was very hurried in stating his symptoms and kept on saying that there is much hair loss from 8 months . He was depressed about this because it was not normal for his age. He felt embarrassed to attend the office. He had an extreme craving for sweet things and cold food. His thermal reaction was chilly. He prefers meat in his daily meals. His bowel movements were regular, but he often had loose stools. He was often very anxious about his daily routine and work in office and would get headaches due to mental exertion. His perspiration was profuse, especially when narrating his symptoms. His sleep was disturbed by thinking about his ailments. He had no particular dreams.

His medical history was diarrhoea at the age of 16. His father had a history of pulmonary tuberculosis. His mother had osteoarthritis.

On detailed case taking and analysis, the symptoms were evaluated to construct the totality and repertorisation was done. The following characteristic mental general symptoms, as well as physical general and particular symptoms, were considered for repertorisation [Figure 1].

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Figure 1:

Repertory sheet for case 1.

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Remedy selection

After thorough case taking, totality formation, converting symptoms into rubrics, repertorisation and studying Materia medica, Lycopodium 200C was prescribed on 7^th October 2020 [Table 1].

Table 1: Prescription and follow-up data for case 1.

Date	Symptoms	Prescription
7 September, 2020	Loss of hair in vertex area for 8 months, with headache from mental exertion and thinking about his ailments [Figure 2]. Regular loose stool. Great desire for sweet, chilly patient, very apprehensive about daily work, nervous patient.	Lycopodium 200C 2 doses. Followed by placebo for 28 days
4 October, 2020	No improvement at all in the vertex area. No new hair growth. Bowel habits are now normal. Other complaints persisted.	Placebo for 28 days.
2 December, 2020	Slight growth in the vertex area [Figure 3]. The patient was happy with this improvement. Headache reduced, bowel habits normal.	Placebo for 28 days.
6 January, 2021	Hair growth was better, more of the affected area showed hair growth [Figure 4]. All physical symptoms were better. No new symptoms.	Placebo for 28 days.
3 February, 2021	The vertex area is now full of hair [Figures 5 and 6]. Patient was very happy. His hurriedness is much reduced since the reduction in his ailments. Regular bowel habits, no new complaints, no headache. He regularly attends his office without any hesitation.	Placebo for 28 days.

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Figure 2:

Case 1 visit 1.

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Figure 3:

Case 1 visit 2.

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Figure 4:

Case 1 visit 3.

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Figure 5:

Case 1 visit 4.

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Figure 6:

Case 1 visit 5.

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Case Report 2

A 22-year-old male student of poor socioeconomic status reported with a complaint of loss of hair from the vertex area of the head for 3 months. He was not undergoing any treatment.

Patient information

The patient was very mild in nature, always smiling. He appeared very artistic and stated that he loved painting and writing. He had a history of long-lasting grief, since the death of his mother from cancer in his childhood. He loves animals and is very sympathetic. He had an extreme craving for meat and cold foods. His thermal reaction was chilly. Bowel movements were regular but unsatisfactory. He was fastidious about cleanliness. His perspiration was normal, with no odour, sleeps well and had no significant dreams.

He had no significant medical history. His father had a history of pulmonary tuberculosis. His mother died from breast cancer. Uncle had a history of ampullary cancer.

On detailed case taking and analysis, the symptoms were evaluated to construct the totality and repertorisation was done. The following characteristic mental general symptoms, as well as physical general and particular symptoms, were considered for repertorisation [Figure 7].

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Figure 7:

Repertory sheet for case 2.

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Remedy selection

After studying the Materia Medica, Carcinosinum 200C was prescribed on 2 December 2020 [Table 2].

Table 2: Prescription and follow-up data for case 2.

Date	Symptoms	Prescription
2 December, 2020	Loss of hair from lateral side of head [Figure 8]. No other symptoms. Desire cold drinks cold food. Craving for meat.	Carcinosinum 200C 2 doses Followed by placebo for 28 days.
6 January, 2021	No improvement. No other new symptoms. Patient generally doing well.	Placebo for 28 days.
3 February, 2021	There was some hair on the affected area [Figure 9]. No other new symptoms. The patient was generally doing well.	Placebo for 28 days.
3 March, 2021	There was a considerable improvement. The affected area showed new hair growth of a good density [Figure 10]. No new symptoms. Patient doing well	Placebo for 28 days.

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Figure 8:

Case 2 visit 1.

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Figure 9:

Case 2 visit 2.

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Figure 10:

Case 2 visit 3.

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Case Report 3

A 30-year-old male who was working as the manager of a private bank reported with a complaint of loss of hair from patches on the right side of the head for the past 2 years.

He was not undergoing any other treatment.

Patient information

The patient had a considerable affinity for catching cold from the slightest change in the weather. His tonsils got inflamed every time he caught a cold. The patient was very anxious about his hair loss and constantly kept on asking if his complaint was curable or not. He had a great fear of dogs. His appetite was good and could not tolerate hunger. His thirst was moderate. He had a great desire for bitter and sweet things. He had an intolerance to meat. His bowel movements were regular and satisfactory, but he had to pass stool as soon as he woke up in the morning. His perspiration was more on his palms and soles. He had dreams of daily activities. He was very chilly.

His medical history revealed nothing significant. His grandfather and father had pulmonary tuberculosis. His mother had type 2 diabetes mellitus.

On detailed case taking and analysis, the symptoms were evaluated to construct the totality and repertorisation was done. The following characteristic mental general symptoms, as well as physical general and particular symptoms, were considered for repertorisation [Figure 11].

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Figure 11:

Repertory sheet for case no 3.

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Remedy selection

After studying the Materia Medica, Tuberculinum 200C was prescribed on 18 November 2020 [Table 3].

Table 3: Prescription and follow-up data for case 3.

Date	Symptoms	Prescription
18 October, 2020	Loss of hair from a particular area for 2 years [Figure 12]. Easily catches cold, very chilly patient, dread of dogs.	Tuberculinum 200C 2 doses. Followed by placebo for 28 days.
16 December, 2020	After the first visit, there was sign of improvement [Figure 13]. New hair growth was seen in the affected area. No new symptoms. Patient doing well.	Placebo for 28 days.
13 January, 2021	After the second visit, the hair growth was slightly increased [Figure 14]. No new symptoms. Patient was doing well.	Placebo for 28 days.
10 February, 2021	New hair growth was seen [Figure 15]. Patient was very cheerful about that. No other new symptoms. Patient was doing very well and felt the best since beginning treatment.	Placebo for 28 days.

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Figure 12:

Case 3 visit 1.

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Figure 13:

Case 3 visit 2.

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Figure 14:

Case 3 visit 3.

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Figure 15:

Case 3 visit 4.

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DISCUSSION

All three patients presented with bald patches on the head. There was no family history of AA in any of the cases. However, in the first case, a history of pulmonary tuberculosis in the father and osteoarthritis in the mother were seen. In the second case, there was a history of pulmonary tuberculosis and ampullary cancer from the paternal side and a history of breast cancer from the maternal side. In the third case, there was a history of pulmonary tuberculosis from the paternal side and type 2 diabetes mellitus from the maternal side. All three patients have a complex miasmatic background, with a definite influence of the tubercular miasm in the family history with a complex syphilitic component. We strongly considered the miasmatic background when analysing the symptoms of each case and prescribing the remedies.^[15,16]

All three patients showed considerable improvement right from the beginning of treatment [Figures 2-6, 8-10, 12-15], which confirms the correct selection of medicine on the basis of homoeopathic law and principle. Data regarding cases of AA that has been treated successfully with homoeopathic medicine will encourage homoeopathic physicians to treat such cases with confidence. However, a limitation of this study is that it is a limited case series. In future, well-designed experimental studies are necessary to allow more conclusive demonstration of efficacy of homoeopathy in cases of AA.

CONCLUSION

AA is a chronic and complex condition that has no gold standard of treatment. The case series in the present study showed good results with homoeopathic treatment, in symptom relief as well as improvement in the patient’s general condition.