Constitutional Pulsatilla Nigricans in Acute-Onset Alopecia Areata: A Case Report Demonstrating Early Disease Stabilization and Hair Regrowth

Abstract

Background: Alopecia areata (AA) is an organ-specific autoimmune disease characterized by sudden non-scarring hair loss. The disease affects approximately 2% of the population during their lifetime and often causes considerable psychological distress due to its unpredictable course and cosmetic impact. Although corticosteroids, topical immunotherapy, and Janus kinase inhibitors are available, recurrence remains common and long-term management continues to be challenging. Individualized homoeopathy aims to restore health by treating the patient constitutionally rather than focusing solely on the local pathology.

Case Summary: A 25-year-old female accountant presented with sudden onset of a single patch of alopecia over the vertex of the scalp of one week's duration. Hair loss was active, exceeding 50 hairs per day, with a positive Hair Pull Test. Detailed constitutional evaluation revealed marked emotional sensitivity, tendency to weep easily, fear of loneliness, preference for solitude, mood swings, low confidence, desire for spicy food, chilly constitution, and characteristic dreams of ghosts and her own death. Repertorization based on the totality of symptoms indicated Pulsatilla nigricans as the constitutional remedy. Fluoric acid was prescribed during the acute phase for active hair fall, while Thuja occidentalis was kept as an intercurrent remedy based on the underlying miasmatic background.

Outcome: Within two months, active hair fall ceased, Hair Pull Test became negative, no new patches developed, and progressive terminal hair regrowth was observed throughout the lesion.

Conclusion: This case demonstrates successful clinical improvement in alopecia areata following individualized homoeopathic treatment, emphasizing the importance of constitutional prescribing based on the totality of symptoms.