A case of Alopecia Areata treated with Capsicum
Dr. Aradhana Chitra (BHMS, CCAH)
A 27-year-old female consulted Dr. Chitra for hairfall and balding in patches on 8th July 2015.
(Following is the case conversation between the Doctor and the patient. The abbreviation D= Doctor, P= Patient. The case is edited for brevity and easy comprehension)
D: Since when have you noticed the hair fall? What is exactly happening?
P: The hair fall started during my Std 12th in 2002. But then it suddenly stopped after 2 years. But now again hairfall has started 3 months back. Hair loss is in patches and since 2 yrs I have been having problems in the skin of my scalp. There are acne, pimples in the scalp. They are red and painful. I have to wash my hair twice a day. But now all of a sudden I have started seeing these patches.
D: All of a sudden means?
P: I did not realise when I started losing hair. One day I asked husband to check my scalp and he found these patches.
D: It started since two years?
P: Yes, Redness of the scalp used to be there, numbness was there, there was pain. Scalp is sensitive to touch.
D: What is the effect of this problem on you?
P: I don’t think much about this. But there is severe itching of scalp. Despite of hair wash , it starts itching badly by the evening. There are red spots, flakes fall out and there is lot of burning sensation. At times, there is bleeding . I am not sure if its psoriasis.
D: What is the impact on you?
P: Obviously I feel bad. I wonder what if it will be seen. It is not good right, if somebody sees and asks what is this!
D: What is this means?
P: They may think it’s some contagious disease and they may give a weird reaction all of a sudden.
D: Weird reaction?
P: They are very hesitant. They move back. One of my friend did that.
D: What is the feeling when others move back?
P: There is a sense of rejection.
D: Rejection means?
P: Somebody doesn’t want your company. That person just walks away seeing you and abruptly ends the conversation.
D: Any incident happened?
P: When I was in college, the patch came up very suddenly and after that I always had this fear at the back of my mind that it will come back. So I always keep checking my scalp. I used to keep torturing my husband to check for the patches in my scalp over and over again. Once I had seen a lady who had lost all her hair. Looking at her I had got this fear that one day if such a thing happens to me, how will I look? Will I be like that ?
D: How is it to feel that way?
P: You get very scared. Lot of fear and you experience pulling sensation in the throat and in the neck (HG). In the chest you feel some choking sensation. Whenever I am scared , I get this kind of pain in the chest. It’s a pulling sensation. When you get scared , you are zapped . and then you need to take deep breath.
D: Tell one incident when you have experienced this the most ?
P: Whenever I watch scary movies or some unexpected things happen. For egs if a cat comes suddenly then I get scared.
D: Unexpected ?
P: Unknown thing, for eg. if something comes and touches me like a cat, then I will be jumping around with the fear of being bitten. The other day, when I went to my neighbors house, her cat was roaming and she went close to my leg, I jumped with fear and at that moment I got the same pulling sensation in my body.
D: What are the things which make you get this kind of fear experience?
P: Insects. I am scared of almost all possible things like cats , dogs etc. If they are stationary, sitting at one place, I am fine but the fear is always there inside me that it should not attack me. I am also scared of darkness, heights.
D: When you say darkness?
P: If I am all alone at home and no one is there , I will keep the lights on. And I will lock the room door and sleep, even bedroom door I will lock. I have to sleep with light on.
D: Describe this fear of darkness?
P: Maybe as a child, my brother would tell me all the horrible stories . I also had interest in all the paranomal stories, horror , scary movies . There are scenes where when you are sleeping , there is someone standing on the door. That’s how I have picked up and so I have the same feeling . but If the light is on then I feel better. The rush feeling in the body due to fear is not there and I feel much relaxed and can sleep comfortably. If room door is open , I wake up and close the door .
D: What is this fear of the dark?
P: It’s about the ghost . somebody is there , staring at you . but when light is on , I am better.
D: Tell more about this.
P: When the thought comes of someone standing at the door, I can’t think beyond and mind gets zapped suddenly. That’s the end. I have to immediately put on the light.
D: Tell one incident of intense fear ?
P: My brother used to tell all kind of stupid stories. He would scare me on purpose.
D: Any particular situation ?
P: Earlier when horror serials were telecast, he would purposely keep those channels on to trouble me and tell me things like the ghost will appear from the window etc.
P: Trouble as in, he would say things like the ghost will enter from the window while I’d be sleeping near it. I used to feel as if there was a shadow in the trees right outside in my garden and that someone was looking at me from there. In this way he trouble me with ghosts stories.
So then onwards I started turning lights on while sleeping. If the lights are on I will be able to see the person coming, in darkness its more scary for me. For eg if I know there is cat, then I am not so scared, but if I don’t know and it comes suddenly then I get very scared. Fear of unknown kind of things.
I am fine with cats from a distance but if its approaching to attack then I get scared. I anticipate the situation even before its going to happen. For eg. If I feel its staring at me , then I know something will happen and then I immediately try to go and escape from the situation even before the situation may happen.
D: Even if its fear of unknown, what is the fear ?
P: Suddenly the heart beats faster, my breathing becomes deep , mind shuts and goes blank and then I can’t think. I feel I should either do something or run away from there , that’s how I react. It’s like when you run, how you become breathless, same kind of breathlessness . it becomes much more when I am very scared when suddenly the light goes off and it becomes very dark.
But now I am brave enough as I have a daughter, so in front of her I have to portray myself brave but when I am alone, I cannot manage. I can’t face it . I can’t think what will happen after that. I get scared just like my brother. I just want to save myself . I immediately put on the light and open all the doors. This is how I used to do in school days. I would go outside and look for matchstick. But now I will keep talking to my daughter to divert my attention.
D: Tell about your dreams .
P: Very stupid dreams. I laugh when I get up but when I am going through it, I am very nervous. I see dead people in the dream and I get very scared .
Recently got my mother in laws dream who has passed away. I see myself in a outhouse. This was a house in my childhood where I used to get very scared as it was always dark there. In the dream I see that I am speaking with my mother in law something without realizing that she is dead. Then I see something like a satan walking down the stairs behind her with its face covered. It was wearing a kind of a saree and neck was bent and I suddenly woke up with fear.
D: What was the fear ?
P: It was like as if something evil is walking behind towards my mother in law. So I wake up to break the dream. If I don’t wake up then I feel it will do some damage like it may attack, a soul torture kind of a thing.
D: What is attack and soul torture mean?
P: It may physically attack you. It has that weird face like seen in horror movies. It will try to kill you, choke the neck and then remove the soul out of you and squeeze it (HG of squeeze). Then it will torture you.
As kids we were told that if you do bad things, god will punish you and send in hell and in there is this kind of torture where your soul is squeezed and put in hot oil. I feel it will do those kind of things with me.
D: What is torture?
P: It’s like when they stab you , that kind of pain. It’s like when you get hurt, you get so much pain.
D: How was the face of the ghost ?
P: In evil dead, eyes colour change, teeth coming out, blood dripping everywhere and looking at that I get very scared. Looking at the dreadful face, I get terrified. And then I try to protect myself and go and sleep besides my husband.
D: How were you as a child?
P: I was very scared earlier. My brother used to keep troubling me. He would keep pulling me leg. He was 8 yrs older than me. So I used to easily fall into his trap. I would keep believing him. I never felt he is lying. He used to scare me again & again and thus this fear got instilled in me.
I also have fear of heights. If I stand in the balcony, I get a PULLING sensation in the abdomen. I feel I am going to fall.
D: What are your hobbies and interests?
P: Busy with the babies. Cooking.
D: Food & drinks?
P: Nothing in particular.
D: Anything that worsens your physical problem?
P: Drinking less water. I feel better with water. Using antidandruff shampoo worsens it.
D: What happens in your scalp?
P: Itching and burning sensation in the scalp. It’s like when you get burnt , you get marks and it keep burning.
D: How is the burning and what gives relief?
P: Not much relief. If I wash its causes more problem. There is a red patch in the thighs too with boils. In the past 2 yrs, there are reddish eruptions that get worse after hair spa and its painful especially area of redness.
I also get body ache and cramps during periods and pain in the heels. Besides, I have running nose, sore throat and cough .
Remedy given on 08/07/2015
Potency 1M/ bd for 3 days and followed by 0/7 LM.
In the case we see that the her problem of alopecia recurred twice in her life and every time it came ALL of a SUDDEN and she always had an anticipatory anxiety that it will come back again. So she always lived with the fear that it would come back and she mentioned that she tortured her husband to keep checking her scalp every now and then for alopecia . This anticipatory anxiety and then occurrence of the incident all of a sudden with fear, gives us pointers to the malarial miasm.
Her diagnosis was alopecia areata (name level) and her symptoms were hairfall with redness , flakiness of scalp with intense burning (fact level)
Regarding her problem, she felt rejected by others (feeling level) and she has a fear of losing all the hair, like a lady whom she saw had lost all her hair (delusion level) and then her experience of that situation was expressed as extreme fear with sensation of palpitation in heart, breathlessness, choking of neck and throat, pulling sensation in the head and neck (sensation level) and she connected the occurrence of the same sensation when she gets very scared in situation when light goes off suddenly, with darkness, with ghost , evil , with cats with fear of unknown , with perception of someone standing near her door and wants LIGHT immediately to feel better.
So we see the common sensation in the physical as well as emotional level of suddenness, darkness, evil, ghosts, cats which brings tremulous reactions of choking in neck and throat , breathlessness, palpitations when extreme fear and her reaction of fright or flight (either do something or run away) . This is the sensation of Solanaceae family. Her dream too depicted the spirit which came to harm her mother in law and its intention was Soul torture of squeezing the soul and putting in hot oil. She felt troubled by her brother who as a child made her scared every now and then. So the tortured and troubled experience again brings us back to malarial miasm .
Hence the remedy selected was Capsicum as it also covered the burning sensation of the scalp .
As seen in the above repertorization chart, Capsicum covers mainly all the peculiar physical and mind symptoms of the patient. Hence, she received Capsicum 1M bd for 3 days followed by LM 0/7. The potency 1M is apt her as we see she is at a higher level of experience.
Follow up after 2 months :-
There is improvement in the hair fall. Redness and burning sensation has reduced. Now there is no need to wash my hair twice. Reduced the hair wash to alternate days .on observation – the hair patches have slight filled.
Follow up after 4 mnths:-
Hair patches greatly reduced. Hair thickness has improved.