Poliosis

Poliosis – a Disorder of Hair Pigmentation

Hair science is one of the most captivating topics of dermatology that goes on evolving over the years. Hair disorders are numerous and the genetic aid has permitted to classify most of the hereditary hair defects. Although hair is not essential for health and survival in humans, changes in hair growth density, pattern or alterations in its color and texture can often lead to distress. In addition, these types of changes can indicate underlying systemic disease, including endocrine, genetic, metabolic and psychiatric disorders.

Hair color comes from cells in the hair follicle called melanocytes, which make pigment. Melanocytes don't live forever, and how well they give color to hair decreases over time. We see grey hair when the amount of pigment becomes less and white hair when all pigment has "run out" and is no longer made by the melanocytes. This usually happens later in life, with the average age between 35 and 50 years.

The greying of hair is also known as canities, which appears in two major categories.

A.    Localized patches of grey hair which may be congenital or also can be seen in cases of Vitiligo, Alopecia areata, Naevus Depigmentosus etc.

B.     Generalized and diffuse greying is seen under following cases:

a.  Senility

b.  Chronic diseases, particularly gastro-intestinal

c.   Sinusitis and nutritional disorders, repeated antibiotic therapy

d.  Nervous strain and stress

e.  Heredo-familial

f.    Endocrine-hypopituitariasm, Simmond’s cachexia and hypothyroidism.

g.  Use of chemicals in the hair in the form of medicated oils

h.  Organic nervous affections, migraines etc.

i.     Congenital Albinism

What is Poliosis?

Poliosis is an inherited or acquired, localized loss of pigment from a group of closely positioned hair follicles resulting in a patch of white / hypo pigmented area of hairs of head, moustache, eyelashes, eyebrows, beard or another place. It may affect persons of all genders and all ages.

Causes:

Poliosis occurs most often along the forehead (so-called white forelock), it can involve hair anywhere on the body and can happen anytime in life. It can occur in otherwise healthy people and may represent no more than an anomaly of hair and skin pigmentation. When healthy people have it, this simply means there is no pigment in the hair and skin of that involved area.

In poliosis, a sharply defined white patch of hair stands out among the normal darker hairs. Most common cause is Vitiligo. Similar changes appear in the re-grown hairs following Alopecia areata, inflammatory processes (such as zoster), Trauma, burns or X-ray radiation. In the latter situation, the hairs may also grow back darker, resulting in a focal hyper pigmentation. . In addition, these types of changes can indicate underlying systemic disease, including endocrine, genetic, metabolic and psychiatric disorders. Other less common causes of circumscribed poliosis include Neurofibromatosis I (often overlying a scalp neurofibroma), Tuberous sclerosis [Pringle syndrome] and some other syndromes. Among autoimmune/auto inflammatory conditions, a T-cell-mediated cyto-toxicity and apoptosis in the development of skin lesions has been suggested in Vogt-Koyanagi-Harada syndrome, in Alezzandrini syndrome, and in a frustrated form of a migratory variety of Alopecia areata.  KIT gene mutations have been described as the major causative mechanisms involved in genetic hair depigmentation in Piebaldism. Topical prostaglandin F2alpha and its analogues , which are useful for primary open angle glaucoma in some patients have been reported to develop eyelash poliosis.

Rare cases of poliosis have been described with Tietz, and Apert syndromes. Reduced eumelanogenesis and melanocyte loss is observed in Prader-Willi and Angelman syndromes, where deletions in the pink-eyed dilution gene have been identified.

Etiology:

Inflammatory or autoimmune: Vitiligo, Halo nevus, Alopecia areata, Post-inflammatory dermatoses, Post-trauma, Vogt-Koyanagi-Harada syndrome, Alezzandrini syndrome, Pernicious anaemia.

Inherited: Marfan’s syndrome, Tuberous sclerosis, Piebaldism, Waardenburg syndrome, Isolated forelock, Isolated occipital (X linked recessive), White forelock with Osteopathia striata (autosomal or X linked dominant), White forelock with multiple malformations (autosomal or X-linked recessive).

Nevoid: with nevus comedonicus secondary to mosaicism, and various kinds of focal skin cancers.

Drug induced: Topical Prostaglandin F2alpha and its analogs (latanoprost and isopropyl unoprostone), Cyclosporine and Chloroquine.

Endocrinal: Hypo / Hyper thyroidism, hypogonadism, hypopituitarism

Idiopathic: Premature growing can appear without any underlying pathology.

            While it may not pose health risks, most people hate it because white hair is mostly viewed as sign of aging by most people. It also makes one look weird and different from the others. Some people especially those with single and small white hair patch term it as normal and they do not see any point of seeking medical care.

            The white hair within black hairs does not look good. The hairs may be concentrated in one spot or in patches. This condition is problematic when it develops later in life. If one is born with this condition, people will get used to seeing the white patches and will view that as natural and normal birth marks. Women are more concerned and worried about Poliosis more than men because they value their beauty and outlook. 

Diagnosis:

The main emphasis should be laid on a complete physical examination, a nutritional and endocrinal survey, a study of the organic nervous causes and also a study of the local bleaching factors.

Prognosis:

            It is usually unfavorable, though elimination of the causes and nutritional “building up” may help to check further progress.

Treatment:

It consists in the following:

1.     Reassurance

2.     Elimination of causes. Avoid excessive use of antibiotics.

3.     Improvement of general health; the administration of iron, liver extract, vitamins, synthetic or predigested proteins, amino acids, copper, zinc, Orabolin (P) or Placental extract injection, calcium pantothenate 200 mg daily.

4.     Ammi majus lotion or ointment, and U.V.R exposures (similar to the treatment for vitiligo) may be beneficial.

5.     Dyeing is often the only effective method of changing the color of grey hair.

6.     Surgical Intervention: An epidermal graft on depigmented skin is seen to be helpful in repigmentation of poliosis.

Homoeopathy can do much more than all of the above mentioned methods to a case of Poliosis. A remedy selected according to basic principles of Homoeopathy and Materia Medica may at times make miracles which I perceived myself from the case reported me few months back. 

Case Report:

Name: Mr. A.L.

Age: 35 years

Sex: M

Marital Status: Unmarried

Date of case taking: 05/01/2011

Presenting complaint: Patient came with the complaints of patches of white hair in the scalp and beard area since 4 months.

History presenting complaints:

            Patient was apparently well a year back. One day he noticed falling of hair from scalp in bunches, slowly the problem increased and he noticed a patchy area of baldness in the forehead.  Within a period of time he noticed some 4-5 such patches in the scalp and even a bald spot on the chin. Within a span of two months, the hair started re growing but it was grey in color. Slowly the condition progressed and the maximum hairs have turned grey. No history of itching, scaling or any other health problems associated with the chief complaint.

Past History - No history of similar complaints / any other diseases in the past. History of fever due to weather changes in the past.

Treatment History – Not taken treatment for the above complaints, not on any regular medication, Takes Homoeopathic medicines for any acute illness.

History of allergy – No significant history

Family History - No history similar complaints in the family. Mother expired due to Tuberculosis, elder brother died due to psychiatric illness.

Personal History:

Diet: Mixed

Addictions: Nil

Environment: Lives in orphanage

Physical generals:

Thermal reaction: chilly pt.

Appetite: Increased

Thirst: Moderate, craving for tea

Desires: sweets, fried food, oily food, meat, warm food

Aversion: Nothing specific.

Bladder habits: 6-8 times per day

Bowel habits: Hard stools, once in 2-3 days

Sleep: Good

Dreams: anxious; of robbers.

Perspiration: increased generally, increased on head, face and offensive.

Mental generals:

Angered very easily

Anxious, fear of darkness

Restlessness

Hysterical – outbursts of crying and anger

Changeable temperament.

Observation by the physician:

            Patient looks unclean & untidy. Does not take bath and wash cloths on his own, offensive, wears a cap always.

Physical findings:

Pallor – present

Icterus - Ab

Cynosis – Ab

Clubbing - Ab

Oedema – Ab

Lymphadenopathy - Ab

Skin - dry

Pulse rate -  80\min

Respiratory rate - 20/min

Temperature - Afebrile,

BP – 130/90 mmhg.

Examination of the skin and hair:

Inspection:

Skin looks dry and unhealthy, no area of hypo/hyperpigmentation observed

Hair - overgrown and not trimmed recently.

About 70 to 80% of the scalp hair grey in colour.

A big patch of grey hairs present on chin.

Size & Shape: Not able to clearly identify the dimension of the patches of white hairs on scalp

A patch of 0.5cm x 4cm size present on the chin

Distribution: Forehead, vertex, temples and chin.

Palpation: No scaling, no signs of inflammation, no hypopigmentation of scalp

Systemic Examination: Respiratory, cardiovascular and central nervous Systems - no abnormalities detected.

Prescriptions:

05/01/2011

Rx:      1. Psorinum 1M      1 dose HS

            2. Tab 3 gr 1- 0 - 1 x 1 month

Patient was asked to come after one month and was advised to regularly trim the hair to maintain the hygiene.

12/02/2011

Complaints much better (about 40 – 50% better),

Patient looks more fresher than earlier; hair trimmed, appears clean and tidy.

Localized patches of white hairs - clearly distinguishable with reduction in grey hairs.

5 – 8 patches present on the scalp

A Big patch on the chin, which is same as before.

            

Rx:      1. Psorinum 1M      1 dose HS

            2. Tab 3 gr 1- 0 - 1 x 1 month

Advise: to report after one month

01/07/2011

No complaints, No grey hairs

Conclusion:

            Unrevealing the mysteries of hair pigmentation disorders in human beings continues still. Though Poliosis is not a life threatening condition, most people seek medical help due to the undesirable look it gives.

In the above case, Psorinum suits well for the miasmatic, constitutional and acute totalities. The holistic approach, single remedy and minimum dose are able to permanently restore the health in a most gentle way by Homoeopathy.