Indralupta (Alopecia Areata) Kshudraroga management in sushruta samhita and allopathy
Pratibha M. Gayakwad*1 , Seema V. Giri2 , Gauri P. Patange3
1. P. G. Scholar, (Shalyatantra)
2. Guide and Professor, Contact No.8308351973
3. P. G. Scholar, (Shalyatantra), Contact no. 9503889158
Department of Shalyatantra, Govt. Ayurvedic College, Osmanabad, Maharashtra, India
*Corresponding Author: Mob.: 9158099814; Email: pratibhagayakwad11@gmail.com

Abstract:
The history of cosmetics extents at least 6000 years and is present in almost every society all over the world. In today’s era people are suffering from stress and strain due to the hustle and bustle of urban lifestyle. This has succumbed them to various lifestyle disorder.. Due to which it’s effects are seen on the body and out of which hair is affected the most. Sushruta has mentioned about Khalitya. It is caused by vitiation of vata and pitta doshas. In Indralupta there will be vitiation of rakta with kapha which obstruct the hair follicle. sushruta had said that the drushti and the lomkupaa never grow throughout lifetime but hairs and nail do. In chikitsasthana the treatment for Indralupta. The bald paer or seat should be anointed and fomented, and then bleeding (by venesection) should be resorted to, after which a plaster composed of Manahsila, Kasisa, Tuttha and Maricha, or of Kutannata and Devadaru pasted tighter, should be applied to it. Alopecia areata also known as spot baldness, is a state in which hair is lost from some or all areas of the body. Typical symptoms of alopecia areata are small bald patches, underlying skin is unscarred and looks superficially normal. Patients also tend to have a slightly higher incidence of condition related to the immune system, such as asthama, allergies atopic dermatitis, and hypothyroidism. It occurs at any age. Hair loss area may tingle or painful. Due to autoimmunity, colic disease, endogenous retinoids metabolic defect alopecia areata occur..
Keywords: Indralupta, Khalitya, Rakta Kapha, Pitta, Alopecia.
Introduction
The beauty of the person i.e. the hair. Hair not only gives “Some of the worst mistakes in my life were haircuts”... In some monks or South Korean soldiers in the army purposefully cuts off all their hair off. Baldness also known as alopecia. Baldness is most often caused by a medical condition known as androgenic alopecia. When it occurs, it will mean that those affected will permanently lose some of hair. Since some of the factors are linked to the genes on the chromosomes[1], the condition can be seen more often with men, than with women. Alopecia total is the loss of all head hair. It is autoimmune, but many with the disorder lead relatively low stress lives. Alopecia areata is a condition in which hair is lost from some or all areas of the body, usually from the scalp[2] Because it cause bald spots on the scalp, especially in the first stages, it is sometimes called spot baldness. In sushrut samhita under Kshudraroga Indralupta is narrated. Kshudra roga is ‘Minor disease’ or disease of niglisible manifestation. Kshudra is made up of two words i.e. Kshudra means alpa; or short/small/minor and roga means disease. Sushrutacharya enlisted it is a disease of vitiated Rakta (Blood) dosha. Approximately o.2% - 2% of the population are affected from alopecia[3]
Ayurvedic Review
The term indralupta is Alopecia areata is an acquired skin ailment that can affect all hair – erring skin including scalp, beared, which can be charecterized by localized areas of non-scaring disorder. The sushruta in his sushrutasamhita in nidansthan thirteenth chaptor kshudraroga the Indralupta narrated as fallows

रोमकुपानुगं पित्तं वातेन सह मुर्चितम् |
प्रच्यावयति रोमाणि तत: श्लेष्मा सशोणित:||
रुणद्धि रोमकूपास्तु ततोડन्येषामसम्भव:꠰
तदिन्द्रलुप्तं खालित्यं रुज्येति च् विभाव्यते ||
सु. नि. १३/३२,३३[5]

Chikitsa:
इन्द्रलुप्ते स्निग्ध-स्विन्नस्य मुर्ध्नि सिरां मोक्षयेत् ꠰
शिलाकासीसतुत्थकै: समरिचै: कल्कैर्लेप: कार्य:, अथवा कुटन्नटदारुकल्कैर्लेपनं शस्तम्, अवगाढं प्रच्छ् यित्वा गुन्जाकल्कैर्मुहुर्मुहुर्लेप्येत् |
(सु. चि. २/२४,२५)[7]
In sushruta chikitsastahna twenty second chaptor kshudraroga ckikitsa idralupta chikitsa given. In case of Indra-lupta (baldness or Alopesia), the bald paer or seat should be anointed and fomented, and then bleeding Siravedhan (by venesection) should be resorted to, after which a plaster composed of Manahsila, Kasisa, Tuttha and Maricha, or of Kutannata and Devadaru pasted tighter, should be applied to it. As an alternative, Rasayana medicine should be administered for its cure.[8]
तथैव इन्द्रलुप्तपहम् अभ्यन्जने शस्तं मालत्यादि तैलम् ꠰ (सु. चि. २/२४,२५)[8]
An oil cooked with Malati (Combretum indicum), Karavira (Nerium oleander), Chitraka (Plumbago zeylanica) and Naktamala is highly efficacious in curing a case of Alopecia, if used as an unguent.[9]
Modern view:
Alopecia areata
Synonyms: Alopecia Celsi, vitiligo capitis, Jonston's alopecia[10])
Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often it results in a few bald spots on the scalp, each about the size of a coin. Psychological stress may result. People are generally otherwise healthy. In a few, all the hair on the scalp or all body hair is lost and loss can be permanent. Alopecia areata is believed to be an autoimmune disease. Risk factors include a family history of the condition. There is no cure for the condition. Efforts may be used to try to speed hair re-growth such as cortisone injections. Sunscreen, head coverings to protect from cold and sun, and glasses if the eyelashes are missing is recommended. Onset is usually in childhood. Males and females have the condition in equal numbers. The condition does not affect a person's life expectancy.[11][12]
Signs and symptoms
• Alopecia areata
• Typical first symptoms of alopecia areata are small bald patches.
• The underlying skin is unscarred and looks superficially normal.
• Although these patches can take many shapes, they are usually round or oval[13].
• Alopecia areata most often affects the scalp and beard, but may occur on any part of the body with hair.[14]
• Different areas of the skin may exhibit hair loss and re-growth at the same time.
• The disease may also go into remission for a time, or may be permanent. It is common in children.
• Patients also tend to have a slightly higher incidence of conditions related to the immune system, such as asthma, allergies, atopic dermatitis, and hypothyroidism.
• The area of hair loss may tingle or be painful.[15]
• Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen at any ages.[16]
• The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.[17]
• When healthy hair is pulled out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp.
• In cases of alopecia areata, hair will tend to pull out more easily along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy.[18]
The condition affects 0.1%–0.2% of the population,[19] and occurs equally in both males and females. Alopecia areata occurs in people who are otherwise healthy and have no other skin disorders.[20]
Causes:
1. Autoimmunity
2. Colic disease.
3. Endogenous retinoids metabolic defect is a key part of the pathogenesis of the alopecia areata.
Diagnosis
1. Alopecia areata is usually diagnosed based on clinical features.
2. Trichoscopy.
3. A biopsy.
Classification[16][21][22]
Sr. no. Name of type Description
1 alopecia areata Hair loss in one or more round spots on the scalp.
2 Diffuse Alopecia Areata Hair may also be lost more diffusely over the whole scalp.
3 Alopecia areata monolocularis Baldness in only one spot, anywhere on the head
4 Alopecia areata multilocularis Multiple areas of hair loss.
5 Ophiasis Hair loss in the shape of a wave at the circumference of the head
6 Alopecia Areata Barbae The disease may be limited only to the beard
7 Alopecia Areate Totalis All the hair on the scalp lost.
8 Alopecia Areata Universalis If all body hair, including pubic hair
9 Alopecia areata totalis and universalis are rare

Treatment
1. Corticosteroid medications cloberasol or fluocinonide, corticosteroid injections.
2. Application of corticosteroid creams to the affected skin is less effective and takes longer to produce results.
3. Some other medications that have been used are minoxidil, Elocon (mometasone) ointment (steroid cream), irritants (anthralin or topical coal tar), and topical immunotherapy ciclosporin, sometimes in different combinations.
4. The objective assessment of treatment efficacy is very difficult and spontaneous remission is unpredictable, but if the affected area is patched, the hair may re-grow spontaneously in many cases.
5. Oral corticosteroids may decrease the hair loss, but only for the period during which they are taken, and these medications can cause serious side effects.[14]
6. celiac disease, treat with a gluten-free diet allows for complete and permanent re-growth of scalp and other body hair in many people, but in others there are remissions and recurrences. This improvement is probably due to the normalization of the immune response as a result of gluten withdrawal from the diet.[23]
Discussion:
According to Sushruta vitiated Pitta in association with Vata causes falling of hair from scalp. After Snehan and Swedan Siravedha (blood letting) is the treatment. Easy and economical way of treatment. According to ayurved vitiated Rakta and Kapha blocks orifices of hair follicles, restricts growth of new hair, this is called as Indralupta disease.[24] so in the pathogenesis of Indralupta, according to Sushrutacharya four doshas of the body are involved. Looking towards pathogenesis, selection of treatment has to remove obstruction of Kapha and Rakta at hair follicle first. After Snehan and Swedan Viddhakarm is the treatment. Viddhakarm means to take pricks on the area of Indralupta with the disposable needle [25]. Here small quantity of blood oozes out. Due to this pricking, obstruction of Rakta and Kapha gets released which is the main pathology of Indralupta. This release of obstruction also leads to Vatanuloma (pacification of vata). In this way this Viddha treatment acts on Rakta, Kapha and Vata Dosha and improves the condition of Indralupta.[26] Manahsila, Kasisa, Tuttha and Maricha (Piper longum) possesses pramathi property, or of Kutannata and Devadaru(Cidrous devdara) is possesses sweadjanan property pasted tighter. An oil prepard with Malati (Combretum indicum), Karavira(Nerium oleander), Chitraka (Plumbago zeylanica) and Naktamala is highly efficacious in curing Alopecia. The conteint of this oil is most of the having ushna tikshna gunas and ushna virya katu vipaka so this combination of dravya has property of release of obstruction of capha and due to ushna gunas sweadjanana tikshna gunas having penetrating property of that bald area and improve the condition of alopecia areata.
References:
1. ↑ “Hair Loss and Causes” Hairloss DHT.
2. https://simple.m.wikipedia.org˒wiki˒B.
3. NHANES-1 (first National Health and Nutrition Examination Survey) report .., Study do Nutrition by Safavi K. Prevalence of alopecia areata in the first Natinal Health and Examination Survey. Arch Dermatol. 1992;128(5):702.
4. Healing earth
5. Sushruta, Sushruta Samhita, Ayurveda- tattwa-sandipika commented by Ambikadutta Shastri,Nidansthan 13:32,33 pg.284. Chaukhmba Sanskrit sansthan, Varanacy
6. Sushruta, Sushruta Samhita, Kaviraj kunjalal Bhishagratna, Nidansthana13:33, pg. 89 Chakhamba Sanskrit Series office Varanasi-221001 1999.
7. Sushruta, Sushruta Samhita, Ayurveda- tattwa-sandipika commented by Ambikadutta Shastri, Nidansthan 13:32,33 pg.284. Chaukhmba Sanskrit sansthan, Varanacy
8. Sushruta, Sushruta Samhita, Kaviraj kunjalal Bhishagratna, Nidansthana13:33, pg. 89 Chakhamba Sanskrit Series office Varanasi-221001 1999.
9. Sushruta, Sushruta Samhita, Ayurveda- tattwa-sandipika commented by Ambikadutta Shastri, Nidansthan 13:32,33 pg.284. Chaukhmba Sanskrit sansthan, Varanacy.
10. ^ Jump up to:a b c d e f g h i “ Alopecia Areata – NORD (National Orgnization For Rare Disorders)”.2004.
11. 12. ^ Jump up to:a b c d e f g h i “Alopecia Areata – NORD (National Orgnization For Rare Disorders)”.2004. Archived from the original on 21 february 2017. Retrieved 10 July 2017.
12. ^ Jump up to:a b c Beigi, Pooya khan Mohhammad (2018). Alopecia Areata: A Clinician Guide. Springer .p.14. ISBN 9783319721347
13. Jump up ^ Freedberg IM , Fitzpatric TB (2003). Fitzpatrick’s dermatology in medicine. New York: Mc Graw-HILL, Medical pub. Division. ISBN 978-0-07- 138076-8.
14. ^ Jump up to:a b c d e f Alopecia Areata at Merck Manual of Diagnosis and Therapy professional Edition
15. ^ Jump up to:a b c American Osteopathic College of Dermatology. Alopecia Areata Archived 2007 -12-13 at the Wayback Machine. Dermatologic Disease Database. Aocd.org. Retrieved on December 3, 2007.
16. ^ Jump up to:a b c d e f g h i Zoe Diana Draelos(August 30,2007), Alopecia Areata Archived 2007 – 12 -08 at the wayback Machine. Medicine Net. Com. Retrieved on December2, 2007.
17. Jump up ^ Donovan, Dr.Jeff. “Exclamation mark hairs in alopecia Areata are located at periphery”. Donovan Hair Clinic. Retrived 2018-06-21.
18. Jump up ^ Hunt N, Mc Hale S (October 2005). “The physicochemical impact of alopecia”. BMJ (Review). 331 (7522): 951-3.doi:10.1136/bmj.331.7522951.PMC 1261195 PMID 16239692.
19. Jump up ^freeberg IM, Fitzpatrick TB (2003). Fitzptrick dermatology in medicine new York : Mc Graw- Hill, medical pub. Division. ISBN 978-0-07 -138076-8.
20. ^ Jump up to :abc American Osteopathic college of Dermatology. Alopecia Areata Archived 2007 -12-13 at the wayback Machine Dermatologic Disease Database Aocd .org. Retrived on December 3,2007.
21. Jump up ^ Donovan ,Dr. Jeff. ““Exclamation mark hairs in alopecia Areata are located at the periphery”. Donovan Hair Clinic. Retrived 2018-06-21.
22. ^ Jump up to:a b c Beigi, Pooya khan Mohhammad (2018). Alopecia Areata: A Clinician Guide. Springer .p.14. ISBN 9783319721347.
23. Acharya Madhavakar, Madhavanidana with Vidyotini hindi commentary by Shri Sudarshana shastri revised and edited by prof. Yadunandana Upadhyaya, Varanasi, Choukhamba Sanskrit Sansthan, Twenty seventh edition, 1997, Uttarardh 55/28,29 Pg.203.
24. Dr. Gogate RB; Vidhha ani agnikarma chikitsa, pune, 1st edition 2006, Vaidyamitra prakashana, Chaptor 3,pg.25.

Cite article:
Indralupta (alopecia areata) Kshudraroga management in sushruta samhita and allopathy
Dr. Pratibha M. GayakwadSeema V. Giri, Gauri P. Patange
Ayurlog: National Journal of Research in Ayurved Science- 2018; (6)(5): 1-7