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How many acupuncture treatments required for alopecia areata?

Q:  My daughter has had 3 courses of acupunture with 14 sessions for each course.  She has alopecia areata and has had for the last year.   She now has small blond hairs growing on the bald patch which covers the whole of the top of the head.  Her acupuncturist advises that she needs another course of treatment -  14 more sessions.  I am concerned he is treating for the sake of treatment and dare I say payment  although he seems to be a reputable acupuncturist. 
Can you please advise if the course should continue further or has the treatment reached its full potential in your opinion after so many sessions?

A: This is a very difficult question to answer without sight of the patient and the notes. Each practitioner works in their own tried and tested way, and it is not for us to pass comment on practice methods which they have developed over the course of their career. At the same time there are going to be occasions when a question such as yours reveals something which warrants further investigation, and we have to tread carefully so that we do not prejudice the outcome of any more serious investigation.

Alopecia is a difficult condition to treat. We were asked for a view some while ago and our answer was:

Allopecia treated with acupuncture


Q: I´m a family doctor who recently graduated in acupuncture with the masters from our Medical Council in Barcelona. I have a friend who is suffering from a alopecia associated with stress the last 2 years, having also skin problems since his childhood (hipercrhomia and vitiligo). Does anyone has experience or a good literature source about alopecia treated with acupuncture?


 A: There is not a great deal of literature to assist you, we're sorry to say. We tend to undertake the same sorts of literature searches which you might do using the 'ncbi' resource to access most of the Pubmed resource, mainly because we are constrained under UK advertising law to be very clear about the existing evidence for the treatment of specific conditions and extremely clear about what level of certainty this generates. Given that traditional acupuncture and randomised control trials are not a happy mix, the evidence is generally scant. In the case of the acupuncture treatment of alopecia there are only two or three articles in English and these date back to the 1980s and 1990s. There are undoubtedly hundreds in Chinese but we do not have the resources to translate them and assess them carefully for their methodological soundness.
There are a number of articles available in the traditional acupuncture press, such as
but if your training is in medical or western acupuncture, as we suspect it might be, then much of what these articles say will be largely incomprensible.
Certainly from an eastern or traditional acupuncture perspective we would be likely to see what else was happening in the patient's system which might place the symptom of alopecia in a wider and more informative context. Although the problem might be a local one the chances are that there are wider patterns of disharmony and imbalance, and correcting or addressing these patterns might offer the best chance of sustainable improvement. That said, there are a number of treatments which do involve the insertion of a number of needles both within and on the margins of the affected area. From an eastern perspective this is seen as encouraging the local flow of 'qi', and from a western perspective is understood in neurophysiologial and segmental terms, and there is an outside chance that this may help to reduce or reverse the condition. Our experience, however, is that alopecia is not very easy to treat, and we tend to ensure that patient expectations are as realistic as possible.

The fact that your daughter has shown some improvement over the last year is itself very encouraging, although we would be the last people to apply the 'post hoc, propter hoc' argument, that simply because improvement happened while someone has acupuncture does not in and of itself mean that it happened because of the treatment. Alopecia can spontaneously resolve of its own accord.
There are a number of conditions for which treatment can continue for a very long period of time, and we would expect, if this were the case, for there to be underlying patterns in the patient's energetic balance which warranted further treatment and which the practitioner could explain. Otherwise that would reduce what we do to the simple treatment of a symptom in itself, and someone could reasonably challenge the basis on which the treatment was continued if the symptom appeared to be responding well. It would certainly be reasonable to ask for a more in-depth rationale for continuing, even if you do have to end up on the receiving end of a lesson in Chinese medicine.
We are a little concerned about the 'course of fourteen treatments.' We tend to take a much more conservative view in our advice through these pages, and often suggest that four or five sessions constitute a good review period at which one can question whether the treatment is working and with what frequency it should continue. The aim of most practitioners is to reduce the frequency of treatment where the natural healing processes start to kick in, and many of us use the analogy of watering plants to explain this, that where you might need to water frequently to begin with the need decreases as the plant becomes healthy again. We're not suggesting that there is over-watering going on here but we would feel a little uneasy about a straightforward commitment to so many sessions without a good underlying reason. This was one of the most frequent complaints we had to deal with when people came to us for help in dealing with high street shops, where paying for ten sessions up front regardless of prognosis was often the norm.
Our advice to you is to raise this with the practitioner directly, both in terms of the need to book a course of treatments, and the frequency with which treatment needs to take place. If you are not happy with the response there are a number of options. It is always possible to seek treatment from another practitioner with whom you could discuss your concerns. Alternatively you can raise the matter with our Ethics Department if you feel that the practitioner's financial well-being is taking precedence over your daughter's needs.
We can understand your concern, and hope that better communication will resolve the issue. This is the most frequent reason for matters to get adversarial. However, if you are not satisfied with the outcome of any future exchanges we would urge you to let us know and to enable us to follow up. It is always a matter of concern to us if any of our members falls below the standards to which we all aspire. 

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