Her head was bare;
But for her native ornament of hair,
Which in a simple knot was tied above,
Sweet negligence, unheeded bait of love!
~ Ovid (Publius Ovidius Naso), Metamorphoses--Meleager and Atalanta (l. 68), (Dryden's translation)
You collect your straggling hairs on each side, Marinus, endeavoring to conceal the vast expanse of your shining bald pate by the locks which still grow on your temples. But the hairs disperse and return to their own place with every gust of wind; flanking your bare poll on either side with crude tufts….Why not confess yourself an old man? Be content to seem what you really are, and let the barber shave off the rest of your hair. There is nothing more contemptible than a bald man who pretends to have hair.
Martial (Marcus Valerius Martialis), Epigrams (bk. X, ep. 83)
As the above quotes remind us, hair has since ancient times been considered an object of beauty and baldness a sign of old age and unattractiveness. The ‘comb-over’ was being ridiculed even in ancient Rome. In this article we will consider the physiology, diagnosis and management of abnormal hair loss.
Human head hair has rather different physiological characteristics than the fur or hair of other mammalian species. Specifically, unlike your cat or dog, we do not undergo seasonal moulting. Head hair passes through three phases. The anagen or growth phase lasts from two to eight years, during which time the hair is in active growth. At any given time, approximately 80% of hair is in the anagen phase. Next comes the transitional catagen or involution phase, during which the growth activity ceases. This phase lasts 10-14 days. Finally comes the telogen or resting phase
The telogen phase is the point at which the hairs move into resting state. This phase lasts for 90-100 days, culminating in shedding of the hair (1). It is normal to shed 100-200 hairs a day; while loss in a greater amount is consistent with a diagnosis of alopecia or abnormal hair loss (2).
A complaint of hair loss call for a specific type of clinical examination focused on the hair. First look at the overall appearance of the hair noting length, colour and thickness. Are there any bald patches? Is the hairline receding (men) or is there thinning along the parting (women)? Note the presence of acne or abnormal hair growth elsewhere, indicative, in women, of virilization. Now, moving to the hair itself, look at the hair tips against a contrasting card (black for light hair, white for dark hair). Are the ends split? Do hair tips show a normal tapering or are they blunt? Blunt tips indicate damaged or cur hair. Is the hair abnormally fine? Examine the scalp for abnormalities such as inflammation, exudate, erythema or scaling. Next, conduct a pull test by grasping a tuft of hair (about fifty hairs) between thumb, forefinger and middle finger. Gently and firmly pull the hairs away from the scalp. In a normal situation, two to five telogen hairs will be pulled out, whereas in excessive shedding, six or more hairs will easily be obtained.
Ayurvedic texts describe the pathology of hair loss as follows. “Pitta present at the root of the hairs, getting increased in association with vata, makes for falling of the hairs. Then kapha and rakta together block the follicles of the hairs not allowing fresh ones to grow.” Madhava mentions two kinds of hair loss, indralupta (alopecia areata) and khalitya (male pattern baldness) (4,5).
Within Western pathology there are three types of hair loss conditions. Hair cycle disorders arise secondary to systemic conditions which cause a large number of hairs to enter the telogen phase at the same time. Conditions which may produce hair cycle disorder include childbirth, thyroidconditions and severe depleting situations such as high fevers, infections, chronic illness, major surgery, protein deficiency, anorexia nervosa, crash diets and certain medications. (6)
Hair Shaft Damage arises as a result of inappropriate hair care and can easily be remedied by alterations in the hair care regimen.
Hair follicle disorders include those meticulously described by Madhava. Khalitya is now described as androgenetic alopecia, a benign if cosmetically displeasing genetic condition in which head hair is gradually replaced by vellum hair as on the rest of the body. This condition is more noticeable in men because male pattern baldness leads to receding hairline and evident bald areas, whereas in the female pattern it leads to thinning along the central parting and the hairline does not recede noticeably. It is quite normal for this condition to begin in the teens or twenties, a fact that often distresses young male patients. A much more severe hair follicle disorder is indralupta or alopecia areata, an autoimmune condition. In this case, as Madhava describes, inflammation (pitta) affects the hair follicles, preventing normal hair growth. This can lead to patchy or occasionally, complete hair loss which may affect not only head hair but also eyebrows, eyelashes and body hair.
Although the most common cause of hair loss, khalitya, is a genetic condition that cannot be cured, a good hair care regime can help support the life, growth and health of the hair.(4) A number of Ayurvedic herbs are keshyam or hair growth promoting. Most famous among these is bhringarj (eclipta alba), also known as kesharaja. “Bhringaraj is pungent in taste, penetrating, drying, hot in potency, and diminishes excess pitta and vata. It acts as a hair and skin tonic.” (7). Bhringaraj has remarkable hair growth promoting properties. (8), Active compounds for hair growth are sitosterol and wedelolactone, which are effective in promoting hair growth in androgenic alopecia (9). Another excellent herb traditionally used in Ayurveda for hair growth is hibiscus. (10). Aloe Vera has demonstated effectiveness for hair growth and so makes a good anupan for keshyam herbs. Amlaki is such an excellent hair growth promoter that it could serve as a herbal alternative to minoxidil (Rogaine) the allopathic treatment of choice (11). Other herbs with significant keshyam properties include brahmi, bibitaki and Haritaki (4). Coconut oil (12) has proved particularly effective preventing damage to hair and healing damaged hair while sesame oil provides antioxidants directly to the hair. “Anointing the head with oil cures diseases of the head, makes the hair soft, lengthy, abundant, unctuous smooth and black.”
In approaching hair loss, first determine by history and hair examination whether this is a hair cycle, hair shaft or hair follicle disorder. Also consider iron deficiency as a possible cause of hair loss. In hair cycle disorders, if there is a current underlying condition such as hypothyroidism, it must be addressed. Hair thickness can then be restored using good hair care and a keshyam formula such as Healthy Hair. In hair shaft disorders, emphasize Ayurvedic hair care and give keshyam herbs to speed the recovery process. This condition is completely reversible. In khalitya, the situation is unfortunately quite normal for this individual but, as mentioned above, can be best managed with optimal hair care and herbs such a Bhringaraj. Khalitya may also be a normal and essentially benign condition for women, unless there is evidence of virilisation, such as amenorrhoea or oligomenorrhoea, acne and hirsutism. In the event that these features are present, referral to an endocrinologist is indicated. For allopecia areata, systemic treatments for inflammation and auto-immunity, such as kaishore Guggulu, should be used along with keshyam herbs.
Ralf, P.& George, C., The biology of hair follicles, New Engl, J. Med., 341, 1999; 491-497.
Bertolino, A. P., Klein, L. M.& Fredberge, L. M., Biology of hair follicles, In Dermatology in General Medicine, TB Fitzpatrick, AZ Eisen, K Wolf, IM Fredberg, KF Austen editors; 1993; Mc Graw Hill Inc, New York, 289-293
Srikantha Murthy tr. Madhava Nidhanam, Chaukhambha Orientalia, Varanasi 2007 Ch 55, v .28
V.M. Jadhav, R. M.Thorat, Kesharaja: Hair Vitalizing Herbs International Journal Of Pharmtech Research CODEN( USA): IJPRIF ISSN : 0974-4304Vol.1, No.3, Pp 454-467, July-Sept 2009
Dr Bharat Vaidya, personal communication
Paradi Mirmirani, MD How to Approach Hair Loss in Women http://www.medscape.com/viewarticle/569800
Sitaram, Bulusu , tr. Bhavprakasha of Bhava Mishra, Chaukhambha Orientalia, Varanasi 2006 p 293
Adhirajan, N., T. Ravi Kumar, N. Shanmugasundaram and Mary Babu In vivo and in vitro evaluation of hair growth potential of Hibiscus rosa-sinensis Linn in: J. Ethnopharmacol 88 235-239 2003
Inaoka, Y., Fukushima, M.& Kuroda, H., Hair tonics containing aloenin, Jpn. Kokai, Tokkyo koho, 1988, 3: J P 63198615
Lipi, P., Suryaprakash, B. N., & Pande, M. S., Development and evaluation of herbal formulations for hair growth, E-Journal of Chemistry, Vol-5, No-1, Jan 2008; 34-38
G. H. Hajini, K. C. Kandhari, L. N. Mohapatra, L. K. Bhutani, Effect of hair oils and fatty acids on the growth of dermatophytes and their in vitro penetration of human scalp hair. Sabouraudia. 1970 Nov;8(3):174-6.
Srikantha Murthy tr. Sushruta Samhita, Chaukhambha Orientalia, Varanasi 2005 vol 2 pg 225
Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda community both nationally and internationally.
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