Prasanth Thangavelan was a little over 30 when he first noticed a bald patch on his scalp but ignored it.
Within a month the coin-sized hairless area had spread into a much bigger patch. Truly concerned now, he visited a dermatologist who diagnosed it as alopecia areata, a non-scarring inflammatory hair loss where the hair falls out in patches.
“Losing my hair became a constant source of anxiety. Initially, I had a patchy skin issue on my scalp. But I neglected it and went on with my day-to-day activities without giving it much thought,” says the information technology professional from Bengaluru, now aged 32.
With his hairy issue, Thangavelan is in sizeable company: according to the National Alopecia Areata Foundation, 147 million people worldwide are affected by alopecia areata with a lifetime risk of 2.1 per cent.
The condition can appear in different ways. It can be a complete hair loss from the scalp, called alopecia universalis; a total loss from the entire body which is called alopecia totalis; or alopecia areata, with bald patches on the scalp and beard.
According to experts, hair follicles are not destroyed permanently and there is a high chance of hair regrowth.
Thangavelan recalls his early attempts to treat the condition. “[Initially,] I was given cortisone shots and several prescriptions after which my hair did grow back, but there was a sudden relapse. My insecurities increased, and since the prescriptions were not helping me, I decided to find an answer in something more natural,” he says.
Why it happens
In this condition, which cuts across age groups, one’s immune system views normal body cells as foreign invaders and starts attacking them. It is still unclear what causes the immune system to attack healthy hair follicles in affected people, says the Foundation.
Alopecia may be directly related to psoriasis and can affect both the scalp and other parts of the body, according to a review article on Psoriatic Alopecia by the Department of Dermatology, Eastbourne District General Hospital, Eastbourne, UK.
Imbalance of elements
As per Ayurveda, Indralupta – as it calls the condition – is caused due to an imbalance of the three doshas or bodily energies, namely vata (air element), pitta (fire energy) and kapha (water energy). Starting with pitta, all three doshas should be normalised during the therapy.
Panchakarma expert Dr Anakha Venugopal, who is chief physician at Indeevaram Ayurveda, Kochi, Kerala, shares with Happiest Health the Ayurvedic view of alopecia.
“Due to unhealthy food habits, improper metabolism, and other environmental factors, the imbalance of bodily energies affects hair roots or romakoopa, causing hair fall. Later, the hair follicle channel gets obstructed, thereby blocking the hair root and not allowing new hair to grow,” says Dr Venugopal, at whose clinic Thangavelan was treated.
According to Dr Venugopal, first, a procedure called Rakta shodhana or blood cleansing is used to normalise the tridoshas. In the case of alopecia areata, the body is first treated for clearing excess pitta followed by cleansing for the other two doshas.
Then follows the pracchana or scraping technique, by which the pores blocked by the doshas are opened to allow the hair to regrow.
Superficial incisions or scrapings are made on the scalp using the thick leaves of calotropis (locally known as arka or yucca) to unblock the root hair. This stimulates the hair follicles and in turn natural hair growth through mild capillary bleeding.
“This therapy can be done for a week, and later it is advised to apply the medicinal paste,” says Dr Venugopal. “Prashanth was first treated with calotropis leaves and later given an application of aloe vera gel.”
Thangavelan, whose treatment lasted for about 40 days, says, “Though the treatment was mildly painful, my hair grew naturally.”
In many cases, regrowth is complete in 5-6 months. In others, it may require a year.
In a pharmacological investigation of calotropis leaves, it was found that the leaves have antioxidant and anti-bacterial properties and are used to treat vertigo, baldness, hair loss, and rheumatoid arthritis. During the bloodletting, the woolly hairy surface of the leaves helps capillary bleeding.
Even though Ayurveda says it can treat alopecia areata, there are no large-scale clinical trials or systematic reviews of the safety and efficacy of its line of treatment.
In 2021, an open labelled single-arm clinical trial titled Management of Indralupta (Alopecia Areata) with Prachchhana karma chose 32 people as participants. It found that patients who followed pathya or a wholesome, mild prescribed diet responded better than others who did not follow the diet.
In a 2017 study conducted at the All-India Institute of Ayurveda in New Delhi, a single case of alopecia was managed with blood-letting therapy and ayurvedic medicines. Virechana – purgation controlled medically with herbs – was adopted first, and pracchana was done with internal and external medications. The hair regrew after 73 days.
Healthy food and lifestyle
“This alone is not a complete cure; you need a regular follow-up,” cautions Dr Venugopal. “Alopecia areata can be managed well through an Ayurvedic diet, nutrition and rasayanas (rejuvenation). Once the hair has regrown, you must change how you eat and manage your anxiety. This way, you can maintain your regrown hair.”
An expert’s tips on saving the crowning glory
Dr Venugopal suggests a few changes in habits and nutrition to improve hair health, especially in the case of spot baldness.
- Stay hydrated
- At least twice a week, give yourself a head massage and bath with warm coconut oil, castor oil or any natural oil.
- Avoid fried foods, excessively salty or spicy diet, red meat, canned foods, white rice, bread, sugar, and simple carbohydrates.
- Include seasonal and home-cooked food, legumes, pulses, whole grains, beans, fruits, vegetables, seeds, and nuts.
Vegetables: snake gourd, bitter melon, bitter gourd, and eggplant (brinjal).
Spices: fenugreek, turmeric, ginger, and cumin.
- Replace curd with buttermilk.
- Ensure adequate levels of Vitamin D and Vitamin B.
- Practise daily meditation or yoga for at least 10-15 minutes.
“Also, use a natural shampoo made from the flowers and leaves of hibiscus. Boil the flowers and leaves of hibiscus in water for three to four minutes. Use the cooled extract as shampoo,” she says.
Post-treatment, Thangavelan seems to know what he needs to do next. “I fully understand that this (the hair regrowth) is not a permanent cure,” he says. “I cannot abuse my body now by having junk food, carrying unnecessary stress, and not taking preventive measures for health. I need to maintain this as an everyday investment and for that, I know that I need to make some lifestyle changes.”
Disclaimer: Not everyone with alopecia areata requires the same treatment. This article focusses on the Ayurvedic bloodletting procedure to manage alopecia. Please note that the treatment requires the guidance of a highly trained ayurvedic practitioner. Consult your physician for complete information on diagnosis and treatment options.