Ayurvedic Management of Indralupta (Mild Alopecia Areata) with Combined Therapies including Jalaukavacharana (Leech Therapy) and Bhringraj Ghanvati: A Case Report

Indralupta in Ayurveda refers to sudden, patchy hair loss caused by aggravated Pitta and Vata Dosha. Raktadushti caused by kapha obstructs hair follicles in long-term situations, preventing regeneration. It correlates with Alopecia Areata, an autoimmune disorder causing localised, non-scarring hair loss. Conventional treatment includes topical or intralesional corticosteroids and immunosuppressants, which often show variable response and recurrence. Ayurveda offers a holistic approach focusing on Dosha balance and hair restoration. A 33-year-old female with a seven-month history of patchy hair loss (≈4×7cm) over the vertex, along with irregular and scanty menstruation, acid reflux, and chest burning. Her diet included processed and bakery foods. Following clinical and ayurvedic examination, the patient was diagnosed with Indralupta. Management included Jaypala Pratisarana (external herbal applications) and Jalaukavacharana (leech therapy) along with internal medications for the correction of Dosha and Rakta imbalance. After 45 days of treatment, near-complete clinical hair regrowth was observed within the affected patch, with residual scalp involvement <1% on Severity of Alopecia Tool (SALT) assessment along with resolution of hair fall, Gastrointestinal (GI) symptoms and improvement in menstrual regularity. The early improvement may be related to the mild and localised nature of the disease (baseline SALT score ≈2%) and should be interpreted cautiously. At the three-month telephonic follow-up, no recurrence was reported. However, as a single case, spontaneous remission and confounding factors cannot be excluded and controlled studies are required to validate safety and efficacy.