E-ISSN:2456-3110

Case Report

Nummular Eczema

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 11 December
Publisherwww.maharshicharaka.in

Management of Nummular Eczema through Ayurveda: A Case Report

Maneesha K.1*, Chaitra H.2, Rajeswari Y.3
DOI:

1* K Maneesha, Post Graduate Scholar, Department of Agada Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda & Hospital, Hassan, Karnataka, India.

2 H Chaitra, Associate Professor, Department of Agada Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda & Hospital, Hassan, Karnataka, India.

3 Y. Rajeswari, Post Graduate Scholar, Department of Agada Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda & Hospital, Hassan, Karnataka, India.

Nummular Eczema is a type of Eczema characterized by round coin like lesions distributed on the extensor surface of the extremities, posterior aspect of the trunk, buttocks, and lower legs. It shows crusting and weeping. Etiology and pathogenesis is not definitely established; psychogenic stress, focal sepsis, food allergies, alcohol, debility and drugs are usually held responsible. In Ayurveda it is correlated as Vicharchika, as it is having similar feature like Kandu, Srava, Pidaka. The unique treatments in Ayurveda can give a very good result with a very little chance of reoccurrence. In the present case study, A 26 year old male patient diagnosed with Nummular Eczema got admitted in the Agada Tantra inpatient department with chief complaints of reddish circular lesions over the left leg with yellowish discharge, pain and burning sensation. This patient was treated with Snehapana, Virechana and Samana Aushadhis for 10 days and marked changes were observed.

Keywords: Nummular Eczema, Pidaka, Snehapana, Vicharchika, Virechana

Corresponding Author How to Cite this Article To Browse
K Maneesha, Post Graduate Scholar, Department of Agada Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda & Hospital, Hassan, Karnataka, India.
Email: 		K Maneesha, H Chaitra, Y. Rajeswari, Management of Nummular Eczema through Ayurveda: A Case Report. J Ayu Int Med Sci. 2022;7(11):245-249.
Available From
https://jaims.in/jaims/article/view/2104

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-02 2022-11-04 2022-11-11 2022-11-18 2022-11-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by K Maneesha, H Chaitra, Y. Rajeswariand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(11)245
Maneesha K et al: Management of Nummular Eczema through Ayurveda

Introduction

Eczema is an inflammatory skin reaction characterized histologically by spongiosis with varying degrees of acanthosis, and a superficial perivascular lymphohistiocytic infiltrate. The clinical features of eczema include itching, redness, scaling and clustered papulovesicles.

There are two main classifications of eczema - exogenous eczema and endogenous eczema. The nummular eczema also called as discoid eczema comes under endogenous eczema.

Nummular eczema is characterized by scattered, coin-shaped, usually sharply bordered patches, which typically show crusting and weeping2. In the acute phase, the lesions are dull red, oozy, crusted and highly irritable. They progress towards a less vesicular and more scaly stage, often with central clearing and peripheral extension, causing ring-shaped or annular lesions. As they fade, they leave dry scaly patches. After any period between 10 days and several months, secondary lesions occur, often in a mirror-image configuration on the opposite side of the body. A prominent characteristic of this disease is that patches, which have apparently become dormant may become active again, particularly if treatment is discontinued prematurely.[1]

Aetiology: In most cases the cause is unknown. Allergic sensitivity to staphylococci or micrococci maybe responsible at least for secondary dissemination. Local physical or chemical trauma plays a part in some cases and discoid eczema sometimes develop at the site of an old injury or scar. Dry skin caused by low environmental humidity is sometimes associated with discoid eczema. Emotional stress may have a role in some cases, but it is unlikely to be the primary cause.[2]

Vicharchika: In Ayurveda skin diseases comes under Kushta Rogas with types as Maha Kustas and Kshudra Kustas. Vicharchika comes under Kshudra Kusta which has Kapha Pradhana Tridosha and having symptoms like Kandu (Excessive itching), Pidika (Vesicle/Boil/Pustule), Shyavata (Discoloration), Bahu-Srava, (Profuse oozing).[3] Acharya Charaka has described the general Nidana (cause) and Samprapti (pathogenesis) for Kushta Rogas. Nidana`s (causes) like intake of mutually contradictory food, food which is unctuous

and heavy, Chardi Vega Dharana( Suppression of the urge for vomiting) and other natural urges, Performance of physical exercise in excessive heat and after taking very heavy meal, Use of cold water immediately after exposure to the scorching sun, exertion or exposure to frightening situation, Intake of uncooked food and, intake of food before the previous meal is digested are described.[4] Because of the causes the three vitiated Dosas, Vatha, Pitta and Kapha, in turn vitiate the Tvak (skin or Rasa Dhatu), Rakta, (blood), Mamsa (muscle tissue) and Ambu (lymph) and results in skin diseases. Vicharchika is a Kapha Pradhana Kushta and can be treated very well by Ayurvedic treatments like Sodhana(elimination therapy) and Samana (palliative therapy).

Case History

Presenting complaint: A 24-year-old male, non-diabetic, normotensive patient was admitted to hospital with chief complaints of reddish round patches on left leg with itching and oozing since two months.

History of presenting complaints

The patient was apparently healthy before 6 months. Gradually he developed reddish circular patches on abdomen with itching and watery discharge. He consulted an allopathic physician and took medicine for the same (details of medication were not available) and the lesions got cured.

Before two months same lesion appeared on left leg, and after 1 month new lesion appeared near to the old one.

Past medical history: Patient had previously consulted a private hospital six months before (details of medications were not available) where he got relief. After 2 months when the new lesions appeared on left leg, he took allopathic medication but got poor relief.

General examination: On physical examination, appearance was moderately built and no major variations.

Systemic examination

Skin examination

Inspection

  • Site - Left leg
  • Colour - Reddish

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Maneesha K et al: Management of Nummular Eczema through Ayurveda
  • Shape - Round
  • Symmetry - Unilateral
  • Border - well demarcated

Palpation

  • Tenderness - Absent
  • Surface texture - Damp
  • Elevation - raised and flat
  • Temperature - Absent
  • Edema - Absent

Diagnostic criteria: Pruritus (Kandu), acute lesion with exudation (Srava), papules (Pidaka), are present so this case is diagnosed as Vicharchika (Nummular eczema)

Table 1: Treatment Given

Day Treatment given Observation
Day 1 Sarvanga Abhaynga with Eladi Taila followed by Triphala Ks Pariseka Chitrakadi Vati (1-0-1) Triphala Churna (E/A) No marked difference
Day 2 Sarvanga Abhyanga with Eladi Taila followed by Triphalaks Pariseka Chitrkadi Vati Triphala Churna (E/A) Lesions began to dry
Day 3 Sarvanga Abhyanga with Eladi Taila followed by Triphala Ks Pariseka Chitrkadi Vati Triphala Churna (E/A) Oozing was not there
Day 4 Snehapana with Mahatikthaka Ghritha 30ml Triphala Churna (E/A) Slight oozing was there
Day 5 Snehapana with Maha Tikthaka Ghrith- 60ML Triphala Churna (E/A) Slight oozing was there
Day 6 Snehapana with Maha Tikthaka Ghrith- 90ML Triphala churna (E/A) Slight oozing was there
Day 7 Sarvanga Abhyanga with Eladi Taila followed by Bashpa Sweda Triphala Churna (E/A) Lesions dried
Day 8 Sarvanga Abhyanga with Eladi Taila followed by Bashpa Sweda Triphala Churna (E/A) Lesions dried
Day 9 Sarvanga Abhyanga with Eladi Taila followed by Bashpa Sweda Triphala Churna (E/A) Virechana with Avipathy Kara Choorna 50g with Triphala Ks 100ml Lesions dried 18 Vegas observed

The patient was discharged with Samsarjana Karma (dietary practice) to restore the digestion and metabolism along with palliative medicine (Shamana Oushadhi). Dietary restrictions included non-vegetarian diet, junk food, fried food items and milk products.

Table 2: Medicines on discharge

SN  Medicine Dose Duration
1.  Haridra Khanda 1tsp-0-1tsp After food 14 days
2. Dooshivishari Gulika 1-0-1 After food 14 days
3. Gandhaka Rasayana 1-0-1 Before food 14 days

1st follow up

Medcine given is Thikthaka Ghritha 1tsp after breakfast.

Discussion

Nidana: Excessive use of tea, daily intake of curd at night, intake of spicy foods, alternate exposure to hot and cold

Samprapti: Due to the above said Nidanas (causes), Pitha and Kapha Dosha Dushti happens. This along with Agni Mandya and Srotho Dushti leads to Srothorodha and Sthana Samsraya of Doshas on Rasa, Raktha Dhatu. This results in Vicharchika

The treatment planned for this patient was Snehapana (oleation) and Virechna (purgation), as the condition was of Pitha- Kapha predominance, the patient constitution was of Pitha Prakruthi and lesion was on below Nabhi (umbilical region), hence Virechana was the apt choice for treatment.

Deepana and Pachana: For preparing the patient for Snehapana (oleation), the patient should be in a Nirama state. For this Pachana of Ama and Deepana of (digestive fire) is needed, for which Chitrakadi Vati was advised to be taken twice daily before food. Chitrkadi Agni Vati is a potent medicine for Amapachana and Deepana. Along with this light diet such as Mudga Yusha (green gram soup) and Kichadi was advised for 3 days.

Snehapana: As the Purvakarma (preparatory) for Virechana Acchasnehapana was given with Mahathikthaka Ghritha.

The Tikta Rasa (bitter tase) helped in Kelda Shoshanam, and caused Kapha and Pitha Harana thereby relieving the symptoms of itching, oozing etc. Snehapana also helped in bringing the Leena Dosha into Aleena Dosha Avastha. After obtaining the Samyak Snigdha Lakshanas (symptoms of proper administration), Sarvanga Abhyanga (full body massage) with Eladi Thaila and Bashpa Sweda (steam fomentation) was given. Eladi Gana being Vatakapha Hara, Varnya (enhance complexion) and Kandu Nirharana (removes itching), it was selected for Abhyanga (massage).

Virechana: After Snehapana and Swedana the Doshas were in Uthklishta state. As the patient was of Pith Prakruti and the lesions were presented below Nabhi (navel region), Sodhana procedure selected was Virechana (Purgation). 50g Avipathikara Choorna was given for Virechana with 100ml Triphala Kashaya, Avipathikara Choorna is


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Maneesha K et al: Management of Nummular Eczema through Ayurveda

Pitha Hara and Triphala helps to alleviate Kapha Dosha.

Palliative measures: After Sodhana medicine given were Haridra Khanda, Dooshi Vishari and Gandhaka Rasayana. Haridra and other ingredients works efficiently for skin as they are Pitta-Kaphahara in nature, hence useful in the condition of this patient.

Dooshivishari Gulika was administered for Shesha Dosha Harana. Gandhaka Rasayana is good for skin as it balances Tridosha and is nourishing also.

Thikthaka Ghritha was given in order to balance Pitha in his body as he was having a Pitha Pradhana constitution.

Result

At time of admission the patient was suffering with reddish coloured lesions associated with itching and oozing. After Snehapana and Sodhana, Samana treatment along with light diet was given, as a result of which oozing and itching become absent and lesions dried upto a marked extend.

jaims_2104_01.JPGFigure 1 & 2: On the day of admission
jaims_2104_02.JPGFigure 3 & 4: On the day of discharge

jaims_2104_03.JPGFigure 5 & 6: 1st Follow Up

Conclusion

Nummular eczema is a non-contagious skin disease characterized by coin shaped patches with crusting and weeping. In Ayurveda it can be correlated with Vicharchika which has symptoms like Kandu (itching), Srava (oozing) caused as a result of improper diet and habits. Kushta is a Dushchikithsya Vyadhi but with the help of Shodhana procedures we can remove the Dosha from the route and can manage Kushta effectively. According to the Dosha predominance, Dosha Avastha, and patient strength appropriate Sodhana should be selected. In this case the patient was of Pitha Prakruthi and the disease was of Kapha Pitha predominance so the Shodhana procedure planned was Virechana. With proper external and internal treatment, a very good result was obtained.

Reference

1. Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D. In: Rook's Textbook of Dermatology. John Wiley & Sons Inc.; 2016. p.17,18.

2. Braun-Falco O, Plewig G, Wolff HH. In: Dermatology. Berlin: Springer; 2000. p.491.

3. Charaka Samhita, Chikitsasthana Hindi commentary by Pandit Kashinath Shastri, Chaukhambha Publication, Varanasi, reprint 2011:7/26 page252.

4. Charaka Samhita, Chikitsasthana Hindi commentary by Pandit Kashinath Shastri, Chaukhambha Publication, Varanasi, reprint 2011:7/4 8 page248


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