Alopecia

1. Definition

Alopecia refers to the absence or loss of hair, especially from the head (NIH Reference). In Ayurveda, this condition manifests when the Pitta dosha (associated with heat and fire), combined with Vata (air/wind), burns the hair roots. Subsequently, Kapha (phlegm/earth) blocks the hair follicles, preventing new growth.

2. Etymology & Conceptual Meaning

• Khalitya: Derived from Khalata, meaning baldness or falling of hair.

• Indralupta: Often translated as "Alopecia Areata," referring to the sudden, patchy disappearance of hair.

• Ruhya: Another synonym used in classical texts like Madhava Nidana.

Conceptual Interpretation: Ayurveda views hair (Kesha) as a byproduct or waste product (Mala) of the bone tissue (Asthi Dhatu). Therefore, hair health is intrinsically linked to the health of the bones and the nutritive fluids (Rasa Dhatu).

3. Causes (Nidana)

The primary causes are rooted in dietary habits and physiological imbalances that aggravate the Pitta and Vata doshas.

Dietary Causes

• Excessive Salt Intake: The Charaka Samhita explicitly states that excessive consumption of salt (Lavana) vitiates the blood and Pitta, leading to untimely baldness (Indralupta/Khalitya) and graying of hair (Palita).

• Alkali (Kshara): Excessive use of alkaline substances can damage hair.

Lifestyle Causes

• Provocation of Vata and Pitta

• Suppression of Natural Urges (Vegadharana) — impacts Vata and systemic balance.

4. Journey of the Disease (Samprapti)

• Dosha:

  • Pitta (Tejas) – Primary aggressor

  • Vata – Weakens hair roots

  • Kapha (Shleshma) – Causes obstruction

• Dushya (Tissues): Rakta (Blood) and Romakoopa (Hair follicles)

• Adhisthana (Site): Scalp and hair roots

The aggravated Bhrajaka Pitta (cutaneous metabolic fire) penetrates hair roots, scorching them. Following hair fall, Kapha blocks the follicles, preventing regrowth.

5. Symptoms (Lakshana)

• Hair Loss

• Smooth Shiny Scalp

• Skin Discoloration

Clinical correlation:

• Alopecia Areata

• Androgenic Alopecia

6. Classification (Bheda)

• Indralupta → Patchy loss (Alopecia Areata)

• Khalitya → Pattern baldness

• Ruhya → Severe hair loss

7. Diagnosis

• Darshana (Inspection)

• Differential diagnosis from:

  • Tinea Capitis

  • Fungal scalp infections

8. Disease Management

Diet (Ahara)

• Reduce Lavana (Salt)

• Follow Pitta-pacifying diet

Medicines

• Gunja (Abrus precatorius) – Phytochemical Study

• Karanja (Pongamia pinnata) – Dermatological Research

• Tiktadighrita – Used in skin disorders

Panchakarma Therapies

• Nasya – AYUSH Reference

• Raktamokshana – Bloodletting therapy

• Shirodhara – Stress reduction & scalp cooling

• Shirolepana – Herbal head application

• Prachhana – Superficial scraping technique

9. Prognosis

• Fresh Indralupta → Curable

• Chronic Khalitya → Difficult to reverse

10. Modern Correlations

• Alopecia Areata – Autoimmune origin (PubMed Review)

• Androgenic Alopecia – Linked to DHT (NIH)

Modern medicine attributes causes to:

• Genetics

• Dihydrotestosterone (DHT)

• Autoimmune mechanisms

Ayurveda attributes causes to:

• Pitta aggravation

• Excess salt intake

• Systemic heat imbalance

11. References

1. WHO – ICD-11 Classification

   • Alopecia areata – ICD-11 Code: EA80

   • Other specified alopecia – ICD-11 Code: EA8Y
     ICD-11 Browser:
     https://icd.who.int/browse11

2. Global Burden of Disease Study – Hair Disorders

   • GBD 2019 Diseases and Injuries Collaborators.
     Global prevalence and burden of skin diseases.
     The Lancet, 2020.
     https://doi.org/10.1016/S0140-6736(20)30925-

     Pratt CH, King LE Jr, Messenger AG, Christiano AM, Sundberg JP.
     Alopecia Areata.
     Nature Reviews Disease Primers. 2017.
     https://doi.org/10.1038/nrdp.2017.11

3. Cranwell WC, Lai VW, Photiou L, et al.
   Treatment of Alopecia Areata: A Systematic Review.
   JAMA Dermatology. 2019.
   https://doi.org/10.1001/jamadermatol.2018.4663

4. Islam N, Leung PS, Huntley AC, Gershwin ME.
   The Autoimmune Basis of Alopecia Areata.
   Autoimmunity Reviews. 2015.
   https://doi.org/10.1016/j.autrev.2015.01.006

• Lolli F, Pallotti F, Rossi A, et al.
  Androgenetic Alopecia: A Review.
  Endocrine. 2017.
  https://doi.org/10.1007/s12020-016-1030-5

  Gilhar A, Etzioni A, Paus R.
  Alopecia Areata.
  New England Journal of Medicine (NEJM). 2012.
  https://doi.org/10.1056/NEJMra1103442

• Petukhova L, Duvic M, Hordinsky M, et al.
  Genome-Wide Association Study in Alopecia Areata.
  Nature. 2010.
  https://doi.org/10.1038/nature09114

12. FAQ Section

Q: Can eating too much salt cause baldness?

A: Yes. According to Charaka Samhita, excessive intake of salt (Lavana) vitiates the blood and Pitta, directly leading to Khalitya (baldness) and Palita (graying of hair).

Q: What is the Ayurvedic explanation for why hair doesn't grow back in alopecia patches?

A: Ayurveda states that after the hair falls out due to the heat of Pitta and Vata, the Kapha dosha (phlegm) blocks the pores (Romakoopa). This obstruction prevents new hair from sprouting.

Q: Is Nasya (nasal drops) good for hair loss?

A: Yes. Nasya is a primary treatment for all diseases of the head. Regular use of prescribed nasal drops prevents hair fall, graying, and strengthens the hair roots.

Q: What is Indralupta?

A: Indralupta is the Ayurvedic term for patchy hair loss, commonly known as Alopecia Areata. It is considered a minor disease (Kshudra Roga) involving the blockage of hair follicles.