Abstract
Alopecia areata (AA) is a prevalent autoimmune condition characterised by non-scarring areas of body and scalp hair loss. 0.15 percent of people with alopecia areata, an organ-specific autoimmune disease. The severity of alopecia areata is evaluated using the Severity of Alopecia Tool (SALT) score. Homoeopathy offers effective medications for treating AA based on individualisation, notwithstanding the unpredictability of AA’s course.
Key Words : Alopecia areata, paediatrics, homoeopathy
Introduction
Alopecia areata (AA) is a common autoimmune disease that causes non-scarring hair loss on the body and scalp. The third most common skin condition in kids, AA is linked to a lower quality of life in terms of health for both kids and their parents.
Patients with alopecia may experience profound psychological and emotional changes, including low self-esteem, feelings of vulnerability, and a changed perception of themselves.
Embrology And Normal Hair Development
The entire set of hair follicles is present at birth, and no additional hair follicles develop. Three types of hair can be produced by each follicle: terminal, vellus, and lanugo. Vellus hairs are short, fine, lightly pigmented hairs found throughout the adult body; terminal hairs are long, thick, strongly pigmented hairs found on the scalp and brows of adults and children, as well as the axillary and pubic areas of adults and the chest and facial areas of adult males; and lanugo hairs are soft, fine, nonpigmented hairs found in neonates without a central medulla.
The growth of human hair is cyclical. Over the course of a lifetime, a scalp follicle goes through ten to thirty cycles. Every anagen growth phase results in the production of a new, unique hair. During catagen, the lower transitory part of the follicle involutions beneath the arrector pili muscle’s insertion. In telogen, the follicle seems to be dormant. Exogen, or dead hair from the follicle, is shed either early in anagen or late in telogen.
Alopecia Areata
An organ-specific autoimmune condition, alopecia areata affects 0.15% of people.It affects both men and women equally.Alopecia areata affects 40–50% of people before the age of 21 and 20% beyond the age of 40. Although it has been suggested that alopecia areata is an autosomal dominant trait with varying penetrance, it is more likely to be a multifactorial trait in 10–50% of patients with a positive family history.Autoimmune illnesses and atopic problems can be linked to alopecia areata. Additionally, those with Down syndrome are more likely to get alopecia areata.
Pathophysiology
Alopecia areata is known to be caused by two factors: a hereditary predisposition and a second triggering event or cofactor. Usually undiagnosed, this secondary event could be a severe life crisis, pregnancy, or a generic feverish sickness. Anagen hair follicles are immunological privileged because they typically do not express human leukocyte antigen (HLA) class I antigens. T cells may be able to recognise hair antigens due to aberrant expression of HLA class I antigens on the transitory part of early anagen hair follicles. The anagen hair bulbs express HLA class II and intercellular adhesion molecule (ICAM)-1 in response to cytokines generated by T lymphocytes, intensifying the immune assault on the hair. The hairs prematurely transition into telogen after the anagen follicular injury. An region of alopecia develops quickly as the weaker hairs break off at the scalp’s surface. Patchy or confluent hair loss on the scalp or any other part of the body that bears hair is the hallmark of alopecia areata.
The History And Physical Examination
Every part of the scalp should be systematically assessed during a physical examination. It is important to assess whether there is scattered or localised hair loss on the scalp. It is important to record the location of the loss. Periphery, occiput, vertex, temples, and parietal scalp are among the locations. Scale and redness of the scalp are indicators of inflammation and should be evaluated.
Because it doesn’t require any specialised equipment, a hair pull test is an easy tool that all paediatricians can utilise. In the hair pull test, 20 to 60 hairs are gently pulled from various parts of the scalp between the thumb and forefinger. While hairs in the telogen phase should emerge readily, anagen or developing hairs should stay rooted in situ. Telogen is roughly 10% if two hairs emerge from a hair pull of about 20 hairs. 10% to 20% is the normal telogen. Asking patients when they last washed their hair is crucial. It should ideally be the day before the test. You should anticipate less hair loss if it happened on the same day.When feasible, the pull test hairs can be mounted and examined under a microscope for anomalies in the hair shaft and the phase of the hair cycle.
Appearance In Clinics
AA can show up as a number of different clinical patterns. The most typical pattern is the abrupt onset of round, smooth, bald patches on the scalp that are asymptomatic and, very rarely, somewhat itchy. Exclamation point hairs are visible through dermoscopy or the unaided eye within the patches. These hairs are indicative of disease activity because they are short and have black, enlarged tips. Black dot hairs are hairs that break just at the scalp’s surface. A more widespread form of AA known as the ophiasis pattern causes hair loss along the parietal scalp and the occiput.
The prognosis for this pattern is not as good. Alopecia can occasionally be widespread and resemble telogen effluvium. Alopecia totalis, or complete loss of scalp hair, affects some people, whereas alopecia universalis, or complete loss of scalp and body hair, affects others. Alopecia totalis or universalis develops in only approximately 5% of people with typical AA. Hairs often become lighter in colour and smaller in size as they develop. With time, hair diameter and colour return. Nails may be affected, and many patients exhibit longitudinal or vertical striations or pitting in their nails.
Dermoscopic Findingof Alopecia
| Finding | Associated condition |
| Absence of follicular ostia | Destruction of follicle opening due to scarring alopecia |
| Fibrotic white dots | Fibrosis associated with scarring alopecia |
| Black dots | Broken hairs at the scalp surface – alopecia areata, tinea capitis |
| Yellow dots | Accumulation of sebum and keratin – alopecia areata |
| Exclamation points | Associated with alopecia areata and trichotillomania |
| Common hairs | Associated with tinea capitis |
| Medical and family history | Questions about past medical history and family history of alopecia (often undiagnosed) may assist diagnosis.In adolescent females, enquire about menarche.A diagnosis of telogen effluvium is often made when an inciting factor is identified (eg medical illnesses, stress, poor diet, medications) |
SALT Severity of Alopecia Tool
An instrument used in the evaluation of the Severity of Alopecia Tool (SALT) score for alopecia areata that calculates the degree of hair loss based on the proportion of SSA affected on the top, back, and each side of the scalp
Prognosis
AA’s trajectory is uncertain. Cycles of hair loss and regrowth can last for years or even a lifetime. If the onset occurs before puberty, there is a positive family history, substantial hair loss, a history of atopic dermatitis, a history of prolonged disease duration without regrowth, severe nail alterations, and/or patients with Down syndrome, the prognosis is worse.
Homoeopathic Management
Arsenic Album –.A suggested homoeopathic remedy for alopecia areata, which manifests as circular bald patches on the scalp along with burning and itching, is arsenic album. At night, these feelings get worse. The scalp can also be sensitive under certain situations.
Vinca Minor – Another effective homoeopathic remedy for alopecia areata is vinca minor. It is effective when there is a propensity for hair to break out in patches and be replaced by white hair. In addition, there may be severe scratching and itching on the scalp.
Fluoric Acid– One of the best homoeopathic treatments for alopecia areata is fluoric acid. In bald areas, fluoric acid promotes hair growth. Another excellent homoeopathic remedy for hair loss with a fever is fluoric acid.
Phosphorus –Phosphorus is another homoeopathic remedy that has demonstrated efficacy in cases of alopecia areata. When someone has patchy hair loss, phosphorus works well. There is dandruff on the scalp in addition to hair loss. In certain instances, hair loss is accompanied with scalp itching. Additionally, traction alopecia sufferers appear to benefit from phosphorus. There is a receding hairline in certain circumstances. There is noticeable hair loss from the forehead. A person in need of phosphorus could have a craving for ice cream and cool beverages.
Natrum muriaticum– used frequently, especially in youngsters, to treat patchy hair loss.
Lycopodium Clavatum– Appropriate for strengthening follicles and patchy hair loss; occasionally used at higher potencies to demonstrate noticeable improvement.
Tuberculinum– used occasionally when certain symptoms are present, such as severe cold sensitivity or persistent hair loss.
Thuja Occidentalis– used to treat thinning hair, particularly if dandruff or an oily scalp are present.
Co-Author- Dr.Prasoon Choudhary
HOD,Dept of Paediatrics,
Dr. MPK Homeopathy Medical College And Reseaech Center Jaipur Rajasthan
