Homeopathic Remedies, oil, medicine, treatment for dandruff or hair fall
Practice of Medicine

Effects Of Homeopathic Remedies In The Management Of Dandruff

AUTHORS: Dr. Mansi Goyal (P.G.SCHOLAR) Under the Guidance of Dr. Prabhakar Wakade(M.D.Hom.)
PROFESSOR & P.G. GUIDE Department of Materia Medica,R.K.D.F. Homoeopathic Medical College & Hospital,Research Centre, Bhopal (M.P.)M.D. (Hom.)‘MATERIA MEDICA’

ABSTRACT

Dandruff is nothing but excessive scaling of dead cells of the skin of the scalp. As you are aware, body undergoes constant but gradual renewal every 24 hours. However, when it is much faster renewal of the skin, it becomes visible in the form of scales, which we call Dandruff. It is a functional disorder of the sebaceous glands in the scalp. In addition to sebum, this Dandruff is linked to Malassezia, immunologic abnormalities, and activation of complement. It is commonly aggravated by changes in humidity, changes in seasons, trauma (e.g., scratching), or emotional stress. It is characterized by scanty, loose, dry, moist or greasy scales, and by crusted, pink or yellow patches of various shapes and sizes; remissions and exacerbations; and no to mild itching. There are two varieties of Dandruff one is dry type and the other one is greasy type. The study is aimed to know the clinical presentation of Dandruff. To Study the group of Homoeopathic Medicines in the management of Dandruff, if any. To study the prophylactic aspect of Homoeopathic remedies in cases of Dandruff.

Thirty out-patients with clinically confirmed as Dandruff were entered trial and treated with homoeopathic remedies on the basis of homoeopathic principles with fixed criterias to know the results of treatment as recovered, improved or not improved. For the present study the patients who visited to R.K.D.F. Homoeopathic Medical College and Hospital, Research Centre, Bhopal and Rural OPDs were selected on inclusion and exclusion criterias.
All the cases of Dandruff was registered between the period of February 2017- June 2019, were taken up & every case was followed up for a period of minimum 2 months. A detailed case history was taken up by interview & clinical examination as per the proforma prepared for the study.
At the end of the study it was observed that, out of 30 patients, 8 patients recovered, 15 improved, and 7 not improved with the help of suitable Homoeopathic remedies.
Conclusion: The homoeopathic medicines proved to have given better results in the management of Dandruff when compared to other types of treatment employed.
Key-Words: Dandruff; Effects; Homoeopathic remedies

INTRODUCTION

Diseases of skin account for a great deal of misery, suffering, incapacity and economic loss. Besides this they are a great handicap in society because they SHOW.

Dandruff is one of the commonly encountered problems of the developed and developing countries. It is one of the most common ailments affecting the scalp. Dandruff is nothing but excessive scaling of dead cells of the skin of the scalp. As you are aware, body undergoes constant but gradual renewal every 24 hours. However, when it is much faster renewal of the skin, it becomes visible in the form of scales, which we call Dandruff. Its worldwide prevalence is estimated to be 15-20% of the population. In India its prevalence is high, and it appears to affect all social groups and occupations.

The main problem that Dandruff poses is a cosmetic one. There is no definitive treatment for the condition in the allopathic school, they depend more on the external ointments and shampoos, which contain chemicals with their own side effects and their efficacy in curing the disease is questionable, as they only check the acute phase of the disease leading to suppression.
The disorder is also a waxing and waning one making it all the more difficult to control. The effects of long term treatment are more and the cost of treatment is high.
Hence Homoeopathy views diseases in a “Holistic Way” and evolved a therapeutic plan for its treatment in the same view point. This is achieved through the similar medicines, which act in the dynamic plane. Similia Similibus Curantur (Let likes be cured by like) is the basic principle of Homoeopathy. This therapeutic law of
homoeopathy derived from Nature’s Law. The treatment is for the diseased individual not for the disease alone. Similimum not only stops the progress of pathology, but even may regresses the pathology and thus bring back the individual to healthy state.
The present study is done therefore for the understanding the nature of dandruff, the miasm behind it and the similimum that envelopes man and his miasm in their entiety and attempts a systematic approach for administration of internal homoeopathic remedy selected based on the totality of symptoms.
Homoeopathy offers a complete solution for the condition, taking into consideration the patient as a whole and not his disease alone. The role of Homoeopathy in such conditions is of a great magnitude as its safe, gentle and requires no external medication.
For the purpose of this study, Dandruff will be considered as a scaling condition of the scalp that ranges from a dry scalp to seborrhoeic condition. In this study, my objective is to study the global problem of Dandruff and the efficacy of Homoeopathy in controlling and the prognosis of this condition. All the results and conclusions will be evidence based.

Homeopathic medicines are unique in the respect that they can bring back the deranged vital force to normal healthy state thereby in clearing away the irritating factors in Dandruff.

The frame work of this present study, “EFFECTS OF HOMOEOPATHIC REMEDIES IN THE MANAGEMENT OF DANDRUFF” endeavors to evolve a systematic approach.

AIM :

To study a group of remedies, if any, in the management of Dandruff.

OBJECTIVES :

To ascertain role of the prophylactic aspect of Homoeopathic remedies in cases of Dandruff.

To study the clinical presentation of Dandruff.
MATERIALS AND METHODS

Definition of study subject
Subjects are considered on the basis of clinical presentation, a systematic history taking, complete clinical examination.

Sources of data
The subjects for this study have been selected from those patients with Dandruff who attended the outpatient department, Rural outpatient department of R.K.D.F. Homoeopathic Medical College, Hospital & Research centre, Bhopal , during the period of February 2017 to June 2019.

Method of collection of data

Following are inclusion criteria:

1. All age groups
2. Both sexes

Following are exclusion criteria:

1. Diseases who are associated with dandruff

Preliminary Data:

Name
Age
Sex
Occupation
Address

1. All the cases were recorded according to the individualistic and holistic approach of Homoeopathy.
2. Case taking was done according to the scheme of case proforma (Vide Annexure-I), with special emphasis to ascertain the following points.

a) Presenting Complaints:

The complaints were noted in chronological order of appearance with duration

b) History of the presenting complaints:

The details of the presenting complaints were noted with onset, duration, location, sensation, modality and concomitants. With a special consideration to
Scalp affection:

• Duration –

• Nature – Periodical / Intermittent / Persistent

• Location –

• Extension –

• Type of Scaling – White / Grey/yellow Painful / Soreness/burning Greasiness/Dry Hairfall present / absent Itching present / absent

c) Past history:
History of any ailments in the past with their nature, treatment and its results were noted in chronological order.

d) Family history:
A detailed family history was taken to know the incidence of any other acute or Chronic disease prevalent in the family, on both side of the parents or immediate relations.

e) Personal history:
All generalities of the patient, to understand the patient as a whole were noted with special emphasis to Diet, Appetite, Bowels, Thirst, Urination, Desires and aversions. Sleep Dreams, Perspiration, and Relation with heat and cold, Habits and in females the Menstrual and obstetric history was recorded.

f) General physical examination:
Under this the general built of the patient is noted along with nourishment, or any other positive findings in the general appearance of the patient. Next the patient’s vital data is recorded.
g) Systemic examination:
Detail systemic examination of Central nervous system, Respiratory system, Cardiovascular system and Gastrointestinal system is carried out with a special emphasis on local examination of skin and scalp. In case any positive findings are present they are recorded.

h) Diagnosis:
A diagnosis of Dandruff is made on the basis of clinical presentations mentioned above in presenting complaints.

i) General management:
All subjects are advised conservative measures such as open air life. Exposure of the integument to fresh air, mild exercise, bland, well, balanced diet, avoid greasy foods, and alcohol consumption, mental relaxation is very much beneficial and general health of the patient must be improved.

j) Follow up:
Follow up was done till the patient was relieved of her complaints initially once in seven days and later as per the requirement of the patient.

k)Steps of homoeopathic prescription: Analysis of symptoms:
After detailed case taking, the symptoms of the patients were grouped into varies categories like mental generals, physical generals and particulars.

Evaluation:
After analyzing the symptoms into various categories, the symptoms were evaluated and graded according to their importance.

Repertorisation :
All the cases were repertorized using various repertories likeKent’s repertory, Complete repertory and R.P.Patel’s Repertory of Miasms were used for miasmatic diagnosis. The most similar remedy was selected.

Selection of remedy:
The most indicated drugs was selected from the reportorial result with the help of Materia Medica.

l) Constitutional remedy:
Constitutional remedies were used after analyzing the patient according to mental and physical general, and particular.

m) Intercurrent remedy:
Intercurrent remedy was given when a suspected miasmatic block was found, indicated by partial or no relief of complaints in various potencies, and repetitions.

n) Result of treatment:
The result of treatment was interpreted of those cases, whose follow up was obtained until the end of the study.
The following criteria’s were fixed to know the results of treatment, depending upon the type of response from different subjects.

1. Recovered:
Feeling of mental and physical well being and no recurrence of the complaints for a period of 6 months.

2. Improved:
Feeling of mental and physical well being along with disappearance of the complaints and recurrence of symptoms with in 6 months.

3. Not improved: No response or just improved but not reduction in the frequency of attacks of complaints, after treating for a considerable period of time.
DISCUSSION

Dandruff can be defined as an abnormality of the desquamative process confined to scalp. It is a near physiological scaling condition of the scalp. It is commonly aggravated by changes in humidity, changes in seasons, trauma (e.g., scratching), or emotional stress. The prevalence rate of Dandruff is 3-5%, with a worldwide distribution. Dandruff, the mildest form of this Seborrhoeic Dermatitis, is probably far more common and is present in an estimated 15-20% of the population. The usual onset occurs with puberty. It peaks at age 18-40 years and is less severe, but present, among older people. Overwhelming majority of individuals with Dandruff have no underlying disorder. White or grey scaling, itchiness or greasiness of scalp, hairfall and mild pruritis are the main clinical presentation.
Thirty clinically diagnosed cases of Dandruff were taken into consideration for the study. The patients were between the age group of 15 – 45 years. Patients of both sexes were treated. A detailed case history with the proper clinical examination was done in all the patients

1.Age incidence:
In the study of 30 patients of Dandruff, the highest incidence was from the age group21-25 yrs with the total of 12 patients i.e 40.0%.the next higher incidence found in the group 26-30 yrs with 6 patients i.e 20.0%. This shows that the incidence is more in the age group of 21-30 because sebaceous glands undergo marked hypertrophy indicating hormonal control of these glands.

2. Sex distribution:
In the above study 17 patients i.e 58.8% were females and 13 patients i.e 43.4% were the males. This shows the highest incidence was found in females according to the distribution my study samples. But the sebaceous gland is an androgen target organ, and the sebaceous secretion being androgen dependent, males have higher incidence than females. Hair lotions and shampoos were used more by the females and made the case more complicated.

3.Occupation
In the study of 30 patients of Dandruff, 17 patients i.e. 58.8% were students followed by 3 patients i.e. 10.0%were employe and teachers. The highest incidence in students indicates that it has some hormonal influence, improper nutrition and consumption of excessive junk foods including food rich in sugar and fat and also mental stress was the additional factor.

4.Presenting symptoms:
“Every symptoms [subjective and objective] is indicative of a deviation from the normal state”-Dr .J.T. Kent

Dr. H.A. Roberts says “Symptoms are the only representative expression of the diseased state”

Signs and symptoms represent the only perceptible form of evidence which signifies to us the reaction that takes place within the organism.

Dandruff presents itself as itching of the scalp, falling of flakes greasiness of scalp, hair fall, burning of scalp and brittling of hair. In the study conducted in 30 patients all the 30 patients i.e. 100% had presence of flakes in the scalp. Itching [mild to moderate] of the scalp in 27 patients i.e. 90.90%, hairfall in 12 patients i.e. 40.00%, greasiness of scalp in 9 patients i.e. 30.30%, burning of scalp in 7 patients i.e. 23.8% and brittling of hair in 4 patients i.e. 13.33%. from the above observation the classical symptoms of Dandruff was observed in the study patients along with other complaints.

5.Associating symptoms:
Dr. R.P. Patel quotes about associating symptoms as, “They do not have any definite relationship to the case. These symptoms cannot be explained according to theories of pathology and hence they are sometimes more striking and peculiar symptoms. These symptoms many a times help to individualize the patient and the remedy”
In the present study of 30 patients 10 patients i.e. 33.33% had acne and eruptions,4 patients i.e. 13.3% had cough and cold, haemorrhoids, constipation, warts, grey hair and menstrual problems as associating symptoms in 2 patients each i.e. 6.6% and other associating symptoms were found in 6 patients i.e. 20.0%.
These associating symptoms do not have much diagnostic value but they helps in individualizing the patients.

6.Past history:
Khan L.M. quotes “past is not a dead history. It is the living and essential material out of which the patient as a person makes him/her a whole self and by which the homoeopath prescribes according to the anamnesis of the case for eradication of most obstinate disease”.
It helps in finding out the striking, singular, uncommon peculiar in the patient whose diagnosis of the disease is same as of many other patients, It distinguishes the uncommon features of the patient from the common features of the disease.
In this study, Past history shows that 5 subjects i.e. 16.6%% had Typhoid. Chicken pox was observed in 5 subjects i.e. 16.60%. Malaria, Hemorrhoids, RTA, and DM found in 2 subjects i.e. 6.6%, each.
Majority of the patients with the past history have been treated allopathically which has lead to suppression and responsible for present set of symptoms.

7. Family history:
The study shows the highest incidence of HTN in 7 members of the
patients families i.e. 23.8%, followed by DM in 5 members i.e. 16.6%, OA,
Bronchial asthma, fibroid uterus, MI and TB etc.
It shows that family history of multiple diseases were responsible for the amount of predisposition to get disease as shown in this study. This forms of genetic inheritance is termed by Hahnemann as miasms [fundamental cause of disease].

8.Dandruff varieties:
Above study of 30 patients shows that 23 patients i.e. 76.9% were noticed as dry type and 9 patients i.e. 30.30 % were noticed as greasy types. Classification of Dandruff is made by the clinical presentation of the patients, but each patient can be individualized by holistic approach which helps in Homoeopathic prescription.

9.Areas involved:
In the above study the highest number of patients i.e. 21[71.4%] have
scalp affections only followed by scalp and post auricular area 6 patients i.e.
20.0 %, scalp and beard in 2 patients i.e. 6.6 % and scalp and eye brows in 1
patient i.e. 3.3%. almost in 100% cases scalp affection is noticed. This shows
that Dandruff is a desquamative process confined to hairy and sebum rich area
i.e. scalp.

10. Miasmatic diagnosis:
In the study of 30 patients of Dandruff, presenting
Symptomatology , past history of the patient, mental and physical generals
were considered for repertorisation with R.P. Patel’s Repertory of miasms.
It was found after repertorisation Psoro-syco-syphilitic background was found in 20 patients i.e. 66.66%, Psoro-sycotic in 4 patients i.e. 13.3%, Psoro-syphilitic in 3 patients i.e. 10.0% and psora in 3 patients i.e. 10.0%.

This shows that most cases had multimiasmatic inheritance. The presenting symptomatology is because of the intermingled miasms.

11. Constitutional remedies:
Homoeopathic treatment is thus and essentially constitutional. His reactions to external influences such as heat or cold, weather and infection unmistakably point to his constitution and as modalities and concomitants; they are, besides mental symptoms, of highest importance. The modalities reveal the patient and in the least the disease.
Kent is always at pains to insist that the similarity between the patient and the disease must be constitutional. In other words, the symptoms which are characteristic of and mark out the patients individuality must agree similarly with the individualizing characteristic symptom of the remedy. The constitution of the patient must agree with the constitution of the remedy.
In the present study the constitutional remedies were selected on the basis of totality of symptoms and reportorial result after repertorisation with Kent’s Repertory, Synthesis and DR.R.P Patel’s repertory of miasms. The constitutional remedies were not only similar but also anti-miasmatic.
Natrum mur was used as a constitutional remedy in majority of 6 patients
i.e 20.0%. The other remedies used were Calcarea carb in 6 patients, phosphorus in 5 patients, Ars alb in, Graphites, Thuja in 3 patients each, Lycopodium and Sulphur in 2 patients each and sepia in 1 patient. It appears from above study that all drugs were polycrests and multimiasmatic which cover the entire expression of the patient.

12. Intercurrent remedies:
Dr M.L Dhawale describes the intercurrent remedies and their utility as, “sometimes in the chronic cases we find that the action of a well indicated constitutional remedy gets blocked and the patient refuses to make further progress. Under such circumstances, we should make a detailed study of symptomatology and the circumstances of its occurrence. Analyses from the miasmatic point might indicate the type of miasm responsible for this block and a suitable antimiasmatic remedy will help to remove it and restore the sensitivity to be constitutional remedy. At times with a family history of tuberculosis, a few doses of Tuberculinum might prove helpful.” 70
Out of 30 patients, 4 patients i.e. 13.33% were administered Psorinum as intercurrent remedy, Medorrhinum in 3 patients i.e. 10.0% and Tuberculinum in 2 patients i.e. 6.6%. intercurrent remedies were used to overcome a state where there was no progress or the symptom did not recede or to bring out the real symptomatic picture of patient.

13. Recurrence and non recurrence:
In the study of 30 patients, 20 patients i.e. 66.66% shows recurrence and 10 patients i.e. 33.33% shows no recurrence. This shows that Dandruff is a waxing and waning disorder and relapses is more common.

14. Types of treatment taken:
Out of 30 patients, 21 patients i.e. 71.4% had taken allopathic treatment previously for Dandruff followed by homoeopathy and native treatment in 2 patients i.e. 6.6% and no treatment taken by 5 patients i.e. 16.6%.
The generally received external treatment of the disease of the skin, whatever, with lotions or ointments or whatsoever else is demonstrably shallow in conception, wrong in theory, harmful in practice and therefore inadvisable.
This shows the dominance of allopathic treatment [antifungal lotions] made our case complicated by the mode of suppression and masking the true picture of the disease.

15. Results of treatment:
In the study conducted on 30 patients of Dandruff, it was found that 8 patients i.e. 26.6% recovered, 15 patients i.e. 50.0% improved, 7 patients were not improved. The totality of symptoms was removed in 8 patients without recurrence of symptoms for at least 6 months and 15 patients shows disappearance of symptoms for less than 6 months with general well being.
Homoeopathy which has a holistic approach to the patient also considers psychological and stress factors of the individual and hence, is more beneficial in the treatment of Dandruff.
In my study, Homoeopathic constitutional remedies has given some improvement in the patients, but as per the literature review the recurrence rate is higher and relapses becomes common and unavoidable. So this study concludes that Homoeopathy can give some good hope in the management of Dandruff when given according to strict homoeopathic principles compared to the other existing therapeutic procedure.

CONCLUSION

After understanding the clinical presentation of dandruff I have taken up 30 confirmed and clinically verified cases of dandruff for the present study.
All the cases were studied in detail to draw the conclusion.

• In the study conducted the highest incidence falls between the age group of 21- 25 yrs [40.0%] and 26-30 yrs[20%].
• In the above study 17 patients i.e. 58.8% were females and 13 patients i.e.
• 43.4% were the males. This shows the highest incidence was found in females according to the distribution my study samples.
• In the study of 30 patients of dandruff, 17 patients i.e. 50.0% were students followed by 3 patients i.e. 10.0%were employe and teachers.
• In the study conducted in 30 patients all the 30 patients i.e. 100% had presence of flakes in the scalp. Itching[mild to moderate] of the scalp in 27 patients i.e. 90.90%.
• In the present study of 30 patients 10 patients i.e. 33.33% had acne and eruptions,4 patients i.e. 13.3% had cough and cold, haemorrhoids, constipation, warts, grey hair and menstrual problems as associating symptoms in 2 patients each.
• Past history shows that 5 subjects i.e. 16.6% had Typhoid. Chicken pox was observed in 5 subjects i.e. 16.60%.

• The study shows the highest incidence of HTN in 7 members of the patients families i.e. 23.8% , followed by DM in 5 members i.e. 16.6%.
• Above study of 30 patients shows that 23 patients i.e. 76.9% were noticed as dry type and 9 patients i.e. 30.30 % were noticed as greasy types.
• In the above study the highest number of patients i.e. 21[71.4%] have scalp affections only followed by scalp and post auricular area 6 patients
i.e. 20.0 %.

• In the study of 30 patients worked out in R.P. Patel’s Repertory of miasms. Psoro-syco-syphilitic background was found in 20 patients i.e. 66.66%, Psoro-sycotic in 4 patients i.e. 13.3%, Psoro-syphilitic in 3 patients i.e. 10.0% and psora in 3 patients i.e. 10.0%.

• Natrum mur was used as a constitutional remedy in majority of 6 patients
i.e 20.0 %. The other remedies used were Calcarea carb in 6 patients, Phosphorus in 5 patients, Ars alb in, Graphites, Thuja in 3 patients each, Lycopodium and Sulphur in 2 patients each and Sepia in 1 patient.
Out of 30 patients, 4 patients i.e. 13.3% were administered Psorinum as intercurrent remedy, Medorrhinum in 3 patients i.e. 10.0% and Tuberculinum in 2 patients i.e. 6.6%.
• In the study of 30 patients, 20 patients i.e. 66.66% shows recurrence and 10 patients i.e 33.33% shows recurrence.
• Out of 30 patients, 21 patients i.e. 71.4% had taken allopathic treatment previously for dandruff followed by homoeopathy and native treatment in 2 patients i.e. 6.6%

• In the study conducted on 30 patients of dandruff, it was found that 8 patients i.e. 26.66% recovered, 15 patients i.e. 50.0% improved, 7 patients were not improved.
• Dandruff being a recurrent disease, in 10 of the patients no recurrence was seen for 6 months after the treatment. So our constitutional medicines acted prophylactically in preventing the disease.
• In my study, Homoeopathic constitutional remedies has given some improvement in the patients, but as per the literature review and by the present study the recurrence rate is higher and relapses becomes common and unavoidable. So this study concludes that Homoeopathy can give some good hopes in the management of Dandruff as the disease was suppressed previously by various therapeutic measures.

SUMMARY

Dandruff can be defined as an abnormality of the desquamative process confined to scalp. It is a near physiological scaling condition of the scalp .Dandruff is linked to Malassezia, immunologic abnormalities, and activation of complement. It is commonly aggravated by changes in humidity, changes in seasons, trauma (e.g., scratching), or emotional stress. It is characterized by scanty, loose, dry, moist or greasy scales, and by crusted, white or yellow patches of various shapes and sizes; remissions and exacerbations; and no to mild itching.
Thirty two clinically diagnosed cases of Dandruff were taken into consideration for the study. The patients were between the age group of 15 – 45 years. Patients of both sexes were treated. A detailed case history with the proper clinical examination was done in all the patients.
In my study I have made a moderate attempt to study the effects of Homoeopathic remedies in the management of Dandruff in a systematic and scientific manner. Out of all 30 patients the highest age incidence was between 21-25 yrs [40.0%] and 26- 30 yrs [20.0%]. It is evident that sebaceous gland undergo marked hypertrophy indicating hormonal control of these glands. And also improper nutrition and consumption of excessive junk foods including food rich in sugar and fat and also mental stress was the additional factor in the evolution of symptoms of Dandruff.
The study shows that the prevalence of dry scalp in 23 patients and greasy scalp in 9 patients.Among the constitutional remedies, Natrum mur and Calcarea carb were found to be the most frequently indicated remedies in Dandruff, followed by Phosphorus, Ars alb, Graphites, Thuja, Lycopodium, Sulphur and Sepia. Scalp [71.4%] was the most common area to be affected followed by post auricular area [20.0%] and beard [6.6%]. About 66.66 % patients had recurrence confirming the fact that Dandruff was a waxing and waning disorder. Recovery in all symptoms was found in 8 patients [26.66%], improvement was seen in 15 cases [50.0%] and no improvement was seen in 8 cases [23.80%].
This study was successful one in terms of fulfilling the objectives set for the study. This was the modest effort on my part to find the role of Homoeopathic medicines in the management of Dandruff.

RECOMMENDATIONS
I. A similar study on Dandruff can be conducted with a large sample.
II. An experimental study can be conducted by using control group and experimental group.
III. A study with more clinical evidence in an extended time line can be conducted.
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Dr.Mansi Goyal
Author: Dr.Mansi Goyal

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