The presence or absence of hair is a matter of beauty. Loss of hair is termed as ALOPECIA. Excess of hair is termed as HYPERTRICHOSIS; it is named HIRSUTISM when growth follows patterns of adult male. Another problem with which patients come to us is abnormalities of hair shafts.

ALOPECIA

CAUSES:

• Localised:
  • non scarring:
    • alopecia areata
    • male pattern alopecia
    • traction alopecia
    • ring worm
    • hair shaft abnormalities
  • scarring:
    • congenital
    • inflammatory
    • malignancy
• Generalised:
  • congenital(ectodermal dysplasias)
  • immunological(alopecia universalis)

1. ALOPECIA AREATA :
   • Etiology:
     1. immunological-association of thyroid diseses,vitiligo,atopy.
     2. genetic inheritence
     3. emotional trauma
        
        
   • Clinical features:-
     • Common in both sexes, starts at any age.
     • Lesion-circular patch of alopecia.
     • No scaling, no inflammation.
     • Presence of exclamation mark hair at the edge of the lesion is pathognomonic. (It is the hair which is broken off about 2-3mm from the scalp due to constriction in the shaft. The broken hair is paler and narrower than normal hair.)
     • Site: scalp, beard, sometimes-eye lashes, eye brows.
     • Single lesion-recover within few months, regrowth begins usually at the
     • centre.
     • Some patients lose all the hair from the scalp- ALOPECIA TOTALIS.
     • Few patients lose the hair from whole body- ALOPECIA UNIVERSALIS
       
       
   • Differential diagnosis:
     1. Tinea Capitis:
        • fungal infection
        • scaling present
        • hair can be plucked easily & painlessly from the lesion.
        • no exclamation mark hair.
     2. Cicatricial Alopecia:
        • alopecia preceeded by papules & pustules.
        • pigmentation & scaling.
        • evidence of primary disease like DLE, lichen planus
          
          
2. ANDROGENIC ALOPECIA(MALE PATTERN ALOPECIA:
   Occurs because of progressive transformation of terminal hair follicles of scalp into vellus follicles
   
   • Etiology:
     • Genetic- familial
     • Hormonal-androgen dependent
     • Associations -anxiety
       • monosymptomatic hypochondriasis
       • hyperandrogenism(in women)
       hair loss is relentless with the tendency to follow the pattern in the family.
       
       
   • Diagnosis:
     • MALE - typical presentations
     • FEMALE - androgenic alopecia should be diffrentiated from the other causes of diffuse hair loss like telogen effluvium,& hair loss in endocrine disorders.
       
       
3. TRACTION ALOPECIA :
   • Etiology:
     • any constant traction can lead to alopecia.
     • Hot combing (straightening of hair)
     • Tight hair styles
       
       
   • Clinical features: Incidences-frequent in girls & Sikh males
     
     
   • Presentation:
     • frontal area
     • margin of scalp
     It starts with short broken hair, folliculitis &occasional scarring.
     
     
   • Progress: reversible-in early stages
     
     
   • Diagnosis:
     • Pattern of hair loss
     • tight hair styles
     • absence of exclamation mark hairs &scaling
     • presence of folliculitis.
       
       
4. TELOGEN EFFLUVIUM :
   Diffuse hair loss.
   • Cause:
     • fever
     • prolonged birth
     • surgical trauma
     • haemorrhage
     • emotional stress
       
       
   • Clinical features:
     • Diffuse hair loss occurring 2-3months after the precipitating stimulus
     • varying degree of hair loss
     • regrowth of hair in 2-3months
     • anemia-associated disease.
       
       
5. PATCHY HAIR LOSS DUE TO SKIN DISEASE:
   • BACTERIAL FOLLICULITIS - small area of non-scarring alopecia.
   • FUNGAL INFECTIONS - non-cicatricial alopecia.
   • PSORIASIS(RARE) - reversible
   • LICHEN PLANUS - scarring alopecia
   • DISCOID LUPUS ERYTHEMATOSUS - cicatricial alopecia.

HIRSUTISM

It is the presence of terminal hair in women, exhibiting male pattern.

• Etiology:
  • racial
  • familial
  • hormonal- PCOD, menopause, cushing syndrome, hyperprolactinaemia
  • idiopathic
    
    
• Clinical features:
  • Excess growth of terminal hair in beard, chest, shoulder, periareolar & infraumbilical region.
  • begins at puberty & progresses with age.
  • psychological overtones.
    
    
• Investigation: Gynecological evaluations, sonography, hormonal study.
  
  

HYPERTRICHOSIS

It is an excess growth of terminal hair but one which does not follow an androgen induced pattern.

• Causes:
  • Localised
    • spina bifida
    • melanocytic naevi
    • post inflammatory
      
      
  • Generalised
    • hypertrichosis lanugiosa
    • drugs
    • hepatic porphysis

Homoeopathic medicines for disease of hair

DANDRUFF :

Nat.mur - white dandruff, alternating with cattarh or loss of smell.

Phosphorus - copious dandruff, falling off of hair in bunches. Itching of scalp.

Graphites - dandruff with eczema or other eruptions. Falling of hair. Burning on vertex.

Sepia - dandruff in circles, like ring-worm. Moist scalp. Pimples on forehead near hair. Loosing of hair after chronic headache.

Sanicula - scaly dandruff over the scalp, eye-brows and other hairy parts.

FALLING OF HAIR/ALOPECIA:

Sepia - falling of hair during menopause and pregnancy.

Sulphur - very unruly hair, sandy, harsh, lustreless- growing in every direction.

Ustilago m - baldness due to syphilis. hair will fall and will not grow.

Wiesbaden - by the use of this remedy the hair will grow rapidly and become darker. Give in 200 dilution.

Vinca minor - bald spots with itching of the skin, oozing moisture, matted hair, irresistible desire to scratch.

Graphites - bald spots on the sides of the hair. Important remedy for alopecia areata.

Ars.alb.- bald spots near the forhead. Dry scales on scalp.

Carbo veg - loss of hair from occiput.

Phos - loss of hair from forehead.

Fluoric acid - baldness in spots.

Kali carb - loss of hair from eyebrows.

PREMATURE GREYING OF HAIR:

Natrum mur - Grey hair due to exhausting ailments.

Thyroidin - Given in 30 dilution for one month thrice daily and there after in 200 dilution every week for one month.