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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 40-44

Management of male pattern hair loss (androgenic alopecia) through Ayurveda multimodal approach: A case report


1 Department of Basic Principles, Institute of Teaching and Research in Ayurveda, Jamnagar, Gujarat, India
2 Department of RS and BK, Institute of Teaching and Research in Ayurveda, Jamnagar, Gujarat, India

Date of Submission03-Aug-2021
Date of Acceptance15-Feb-2022
Date of Web Publication20-Apr-2022

Correspondence Address:
Dr. Sunny Patil
Department of Basic Principles, Institute of Teaching and Research in Ayurveda, Jamnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_63_21

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  Abstract 


Male pattern hair loss or Androgenic Alopecia (AGA) is one of the most prevalent forms of hair loss among men. The general symptoms include progressive thinning of the scalp hair and reduction in hair density. Hair loss is typically seen as a receding front hairline or loss of hair on vertex of the scalp or a combination of both. Although considered a relatively minor medical condition, AGA can lead to cosmetic as well as psychosocial distress in a person. Even though many conventional therapies have been evolved, there is no satisfactory cure for this condition. In this study, a case of AGA managed by Ayurveda Shamana (∼pacification) therapy is being presented. The prescribed treatment protocol comprised the drugs having Keshya (∼drug or intervention good for hair), Rakta shuddhikara (∼drug or intervention having potency of purifying blood), and Rasayana (∼rejuvenation) properties. The criterion for assessment was based on the Severity of Alopecia Tool scale. The observations made before and after the treatment showed promising results in the management of AGA without causing any adverse effects.

Keywords: Alopecia, androgenic alopecia, hair fall, Khalitya, male pattern hair loss


How to cite this article:
Patil S, Chaudhari S, Baghel A S. Management of male pattern hair loss (androgenic alopecia) through Ayurveda multimodal approach: A case report. J Ayurveda Case Rep 2022;5:40-4

How to cite this URL:
Patil S, Chaudhari S, Baghel A S. Management of male pattern hair loss (androgenic alopecia) through Ayurveda multimodal approach: A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2022 May 28];5:40-4. Available from: http://www.ayucare.org/text.asp?2022/5/1/40/343507




  Introduction Top


Hair loss is a medical condition that affects people of either gender of all races worldwide. Although hair loss causes no physical discomfort, a wide range of psychological consequences can be seen in it. Androgenic Alopecia (AGA) or Male Pattern Hair Loss (MPHL) is the most prevalent type of hair loss among men. MPHL affects 30%–50% of men by the time they reach 50 years of age.[1] General symptoms of MPHL include progressive thinning of the scalp hair and reduction in hair density. Although considered a relatively minor medical condition, MPHL can result in anxiety and depression in men as the symptoms have a negative impact on self-image.[1]

Clinical management for MPHL is extremely complex. Different systems of medicines offer a number of treatments for this form of hair loss. In spite of this, there is no cure that exists for this condition. In the modern system of medicine, topical application of Minoxidil is often-prescribed treatment for MPHL.[2] Finasteride is also a second choice of drug.[3] A small percentage of sufferers is managed with other treatments such as low-level laser therapy, vitamins, or herbal remedies. Hair restoration surgery is the last choice of treatment and is most likely to achieve good outcomes. Although these treatment modalities are available in conventional science, they have certain side effects and lack of promising results.[2],[4] Considering the wide magnitude of MPHL in the Indian subcontinent and the absence of its promising management with safety, the suffering population is turning toward certain other systems for safe and effective remedies. Ayurveda is a good choice for MPHL patients. This condition is explained in Ayurvedic classics as Khalitya (~gradual loss of hair of the scalp. Different herbal, herbo-mineral formulations along with diet and lifestyle modifications have been in the common treatment regimen, which Ayurveda physicians are prescribing for Khalitya. In the present study, a 30-year-old male patient suffering from MPHL was successfully treated with Ayurveda Shamana (∼pacification) therapy through a multimodal approach along with Nidana parivarjana (∼avoidance of etiological factors).


  Patient Information Top


A 30-year-old male patient approached to the outpatient department (OPD) of Institute Hospital with a chief complaint of hair loss on scalp. The patient was asymptomatic four years ago and gradually developed hair loss on scalp predominantly on vertex with mild itching over affected area. Hair loss on temporal, parietal, and occipital regions was also present but was in lesser extent as compared to the vertex region. No similar family history in first-degree relatives. No history of autoimmune disorders such as psoriasis, vitiligo, atopic dermatitis, urticaria, rheumatoid arthritis was found. No history of any major physical or psychological disorders for which patient had to take any prolonged treatment was noticed. Neither exaggerative nor relieving factors for the present disease condition were observed by the patient. The patient had taken allopathic treatment for one and half years in the form of lotions and internal medication but did not find any relief in his condition. The patient then presented to OPD of Basic Principles Department, to seek Ayurvedic management for the illness.


  Clinical Findings Top


On examination, it was found that the severity of hair loss was more on vertex region of the scalp. Hair loss on the right, and posterior scalp was comparatively less as compared to vertex. Hair loss was assessed using the Severity of Alopecia Tool (SALT) scale which is a standard scale used for determining the percentage of scalp hair loss.[5] No scarring or any other skin lesion was observed over scalp area. Mild scaling was observed on the scalp, which was indicative of dandruff. On physical examination, the general condition of the patient appeared to be healthy with body mass index – 21.6 (weight – 58 kg and height – 164 cm). Blood pressure was 128/82 mmHg and pulse was 74/min. The patient had Vata pradhana pitta prakriti (∼physical constitution). No loss of sensation or any discharge was observed over the scalp. Routine hematological, biochemical, and urine investigations were within the limits except total red blood cell count was (4.29 mill./cu. mm) and serum triglyceride level was 241 mg/dL.


  Timeline Top


The patient was treated with the prescribed treatment regimen for 90 days. The detailed timeline of the treatment is given in [Table 1].
Table 1: Prescribed treatment protocol

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  Diagnostic Assessment Top


Based on the clinical manifestations, the condition was diagnosed as Khalitya (alopecia-MPHL) and advised for Shamana therapy through a multimodal approach. In the modern system of medicine, depending on the etiological factors, hair loss is categorized into focal and diffuse types of hair loss. Focal hair loss occurs due to underlying disorders that may cause scarring or nonscarring alopecia. Scarring alopecia is manifested as a secondary condition usually due to discoid lupus erythematosus, while nonscarring alopecia is caused mainly due to tinea capitis. Diffuse hair loss is a condition in which, shedding of hair along with decrease in hair growth is observed. This type is seen predominantly in male or female pattern hair loss.


  Therapeutic Interventions Top


The medicines were prescribed to the patient as per the treatment protocol shown in [Table 1]. Amapachana vati[6] and Manjishthadi kwatha[7] were given for the first 14 and 28 days, respectively. Rasayana churna[8] and Anu taila[9] Nasya (∼errhine therapy) were continued for three months. The applications of powders of Amalaki[10] (Emblica officinalis Gaertn.) and Yashtimadhu[11] (Glycyrrhiza glabra Linn.) and Coconut oil[12] along with hair wash with decoction made up of Triphala[13] was also advised for three months. All possible etiological factors were identified through detailed case history and the patient was advised to avoid those factors (∼Nidana parivarjana) [Table 2].
Table 2: Possible etiological factors and corrective measures adopted (Nidanaparivarjana)

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  Follow-up and Outcome Top


Observations on consecutive visits of patients to the OPD were noted. There was no improvement in hair fall for the first 14 days, but the occurrence of dandruff was reduced. In the next 14 days, dandruff was decreased further but still no significant improvement in hair fall was observed. Subsequent 14 days showed decrease in hair fall and scattered regrowth of hair was seen on vertex. This improvement continued to happen for the next one and half months. The 90 days visit of the patient showed marked reduction in hair fall and dense regrowth of hair on the vertex as well as the left, right, and posterior regions of the scalp [Table 3]. Significant improvement in SALT was noticed as the overall percentage of scalp hair loss was reduced from 64.8% to 12.4% [Graph 1] and [Graph 2]. The parameters such as quality, thickness, and density of the scalp hair were also improved which were evident visually [Figure 1], [Figure 2], [Figure 3].
Table 3: Observations

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Figure 1: Hair growth before treatment

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Figure 2: Hair growth after treatment

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Figure 3: Hair growth during follow-up

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  Discussion Top


Describing the pathogenesis of Khalitya, it has been stated that Dehoshma (∼body warmth) along with Vatadi doshas affects the scalp region (∼Keshabhumi) and causes the loss of hair.[14] Further two stages in the pathogenesis of Khalitya have been proposed. Firstly, there is vitiation of Pitta and Vata inside the hair roots (∼Romakupa) which causes hair fall, and thereafter Kapha accompanied by Rakta that obstructs the channels of Romakupa leading to inhibition of regeneration of hair.[15] Hence, it can be understood that Vata, Pitta and Kapha dosha, along with Rakta dushya are the key contributing factors in the manifestation of Khalitya. Considering the pathological factors involved and chronicity of the disease, Shamana chikitsa consists of drugs having Tridoshahara (∼pacification of three Doshas), Rakta shuddhikara (∼drug or intervention having potency of purifying blood), and Keshya (∼drug or intervention good for hair) properties was administered.

In the first phase of treatment, Amapachana vati and Manjishthadi kwatha were administered to pacify the Aamdosha. Both these medicines have significant effects on Dhatvagnis (∼metabolic factors located in Dhatu),[6],[7] thus will contribute to the nourishment of Dhatus (∼major structural components of the body) and Updhatus (∼minor structural components of the body). As Kesha (∼hair) is considered a Updhatu of Majjadhatu (∼bone marrow), this augmentation in nourishment will accelerate the regrowth of hair.[16] Manjishthadi kwatha also acts as Rakta shuddhikara by mitigating all the three Doshas responsible for vitiation of Rakta. Rasayana churna internally and Anu tailam in the form of nasal drops were also started simultaneously. The loss of hair is also a sign associated with the aging process and Rasayana is cardinal therapeutic approach in aging disorders. Rasayana churna owing to its immune-modulatory and rejuvenation properties helps in regeneration of new hair and also in continuous nourishment of hair.[17] Practice of Anu tailam as nasal drops is said to prevent hair fall and also stimulate the process of hair growth.[9] Amalaki with its Tridoshaghna and Rasayana properties and Yashtimadhu with its Keshya property also contribute to the management of Khalitya.[10],[11]

As per the Ayurveda classics, the application of hair oil (Moordhna-taila) prevents premature hair fall, early graying of hair, and it also leads to long, black, and firm rooted hair.[18] Thus, the patient was advised to apply coconut oil on the scalp thrice in a week at bedtime. Coconut oil with its Vata-pitta-shamaka and Keshya properties pacifies Vata-pitta and helps in nourishment of hair. Hair wash with Triphala yavakuta kwatha was advised as it helps in external cleansing of the skin of scalp that eliminates dead cells and dandruff. The patient was advised to avoid incompatible food (khichadi + milk) and excessive salt consumption. Over-indulgence in Viruddha ahara (∼incompatible diet) and Ati-lavana sevana (∼excessive salt intake) leads to the early appearance of Valita (∼wrinkles), Palitya (∼greying of hair), and Khalitya.[19]

This dual approach therapy, i.e., Shamana chikitsa along with Nidana parivarjana was found effective in the present case of Khalitya. Significant improvement was observed in clinical parameters as well as on the standard SALT score scale adopted for the study.


  Conclusion Top


Ayurveda advocates the fact that medicines, i.e., Chikitsa and Nidana parivarjana are the two important aspects for the management of any type of disease. Ayurveda with its unique principles of treatment has tremendous potential in disorders such as AGA or MPHL, where other systems of medicine have limited scope. Significant improvement in clinical signs and symptoms as well as on standard scoring scale was observed in patients of MPHL through Ayurveda multimodal approach. The patient showed high compliance to the treatment prescribed as there were no adverse effects, eventually yielding good clinical results.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hasanzadeh H, Nasrollahi SA, Halavati N, Saberi M, Firooz A. Efficacy and safety of 5% minoxidil topical foam in male pattern hair loss treatment and patient satisfaction. Acta Dermatovenerol Alp Pannonica Adriat 2016;25:41-4.  Back to cited text no. 1
    
2.
Tripathi KD, editor. Essentials of Medical Pharmacology. 7th ed., Ch. 40. New Delhi: Jaypee Brothers Medical Publishers Pvt. Ltd.; 2013. p. 567.  Back to cited text no. 2
    
3.
Tripathi KD, editor. Essentials of Medical Pharmacology. 7th ed., Ch. 21. New Delhi: Jaypee Brothers Medical Publishers Pvt. Ltd.; 2013. p. 302.  Back to cited text no. 3
    
4.
Tripathi KD, editor. Essentials of Medical Pharmacology. 7th ed., Ch. 21. New Delhi: Jaypee Brothers Medical Publishers Pvt. Ltd.; 2013. p. 303.  Back to cited text no. 4
    
5.
Olsen EA, Hordinsky MK, Price VH, Roberts JL, Shapiro J, Canfield D, et al. Alopecia areata investigational assessment guidelines – Part II. National alopecia areata foundation. J Am Acad Dermatol 2004;51:440-7.  Back to cited text no. 5
    
6.
Gokhale BV, editor. Chikitsa Pradipa. Agnimandya-Ajirna Prakarana. 4th ed. Pune: Vaidyamitra Publications; 2001. p. 108.  Back to cited text no. 6
    
7.
Shastri RD, editor. Bhaishajya Ratnavali of Sri Govind Das Sen, Kushtha Chikitsa. Ch. 54., Ver. 71. Varanasi: Chaukhamba Publications; 2011. p. 891.  Back to cited text no. 7
    
8.
Paradkar HS, editor. Ashtangahridaya of Vagbhata, Uttara Sthana. Ch. 39., Ver. 159. Varanasi: Chaukhamba Surbharti Prakashana; 2010. p. 937.  Back to cited text no. 8
    
9.
Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 5., Ver. 59. Varanasi: Chaukhamba Orientalia; 2008. p. 41.  Back to cited text no. 9
    
10.
Chunekar KC, Pandey GS, editors. Bhavaprakasha Nighantu of Sri Bhavamishra, Haritakyadi Varga. Ver. 38-41. Varanasi: Chaukhamba Bharati Academy; 2010. p. 10.  Back to cited text no. 10
    
11.
Chunekar KC, Pandey GS, editors. Bhavaprakasha Nighantu of Sri Bhavamishra, Haritakyadi Varga. Ver. 145-6. Varanasi: Chaukhamba Bharati Academy; 2010. p. 62.  Back to cited text no. 11
    
12.
Sharma PV, Sharma GP, editors. Kaiyadeva Nighantu of Sri Kaiyadeva Pandit, Aushadhi Varga. 2nd ed., Ver. 274. Varanasi: Chaukhamba Orientali; 2006. p. 53.  Back to cited text no. 12
    
13.
Chunekar KC, Pandey GS, editors. Bhavaprakasha Nighantu of Sri Bhavamishra, Haritakyadi Varga. Ver. 42-3. Varanasi: Chaukhamba Bharati Academy; 2010. p. 12.  Back to cited text no. 13
    
14.
Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana. Ch. 26., Ver. 132. Varanasi: Chaukhamba Orientalia; 2008. p. 606.  Back to cited text no. 14
    
15.
Shastri AD, editor. Sushruta Samhita of Sushruta, Nidana Sthana. Ch. 13., Ver. 33. Varanasi: Chaukhamba Sanskrit Sansthana; 2008. p. 284.  Back to cited text no. 15
    
16.
Murthy SK, editor. Sharangadhara Samhita of Sharangadhara, Prathama Khanda. Ch. 5., Ver. 15. Varanasi: Chaukhamba Orientalia; 2001. p. 21.  Back to cited text no. 16
    
17.
Hardik S, Surendra B, Biswajyoti P. Standardization of rasayana churna – A classical ayurvedic formulation. Int J Res Pharm Sci 2013;4:283-9.  Back to cited text no. 17
    
18.
Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 5., Ver. 82. Varanasi: Chaukhamba Orientalia; 2008. p. 42.  Back to cited text no. 18
    
19.
Acharya YT, editor. Charaka Samhita of Agnivesha, Vimana Sthana. Ch. 1., Ver. 18. Varanasi: Chaukhamba Orientalia; 2008. p. 234.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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