E-ISSN:2456-3110

Case Report

Atopic Dermatitis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Ayurvedic management of Acute Exacerbation of Atopic Dermatitis - A Case Report

Lekshmi P S1*, Marikutty TC2, Navaneeth KN3
DOI:10.21760/jaims.9.7.47

1* Lekshmi P S, Post Graduate Scholar, Department of Kayachikitsa, Vaidyaratnam Ayurveda College Ollur, Thrissur, Kerala, India.

2 Marikutty TC, Professor and HOD, Department of Kayachikitsa, Vaidyaratnam Ayurveda College Ollur, Thrissur, Kerala, India.

3 Krishnan N Navaneeth, Assistant Professor, Department of Kayachikitsa, Vaidyaratnam Ayurveda College Ollur, Thrissur, Kerala, India.

Atopic dermatitis is one of the common skin diseases that affect one’s day to day life. It seriously affects the quality of life of a person. It is the polymorphic inflammatory reaction of skin involving the epidermis and dermis. The term eczema means “to boil over”. Aetiology is unknown. This case study describes a 42-year-old patient who was admitted to Vaidyaratnam Ayurveda college Hospital due to an acute exacerbation of atopic dermatitis. The patient complaints included profuse itching and reddish-brown discoloration over the flexor part of both upper and lower limbs, primarily on the forearm, dorsal part of both palms, and neck region. Patient is a tile worker, always exposed to dust and he is travelling from one state to another as a part of his job. He had a history of allergic rhinitis. On examination, Patient oriented eczema measure (POEM) was 26 which shows very severe eczema, and dermatology life quality index (DLQI) questionnaire score was 24 which shows extremely large effect on patient’s life. Treatment started internally and externally. Internally the treatment protocol was based on Amapachana, Deepana, Srothosodana, Vyadhikshamatwakara, Dosha Dhathu Samyakara. Externally treatment started with Abhyanga, Sarvanga Thakra Dhara, Lepana, Snehapana and Virechana. After the treatment, clinical signs and symptoms were reduced Patient oriented eczema measure was 9 which shows moderate eczema, and Dermatology life quality index questionnaire score was 10 which shows moderate effect on patient’s life.

Keywords: Kshudra Kushta, Vicharchika, Atopic dermatitis, Itching, Oozing, POEM, DLQI

Corresponding Author How to Cite this Article To Browse
Lekshmi P S, Post Graduate Scholar, Department of Kayachikitsa, Vaidyaratnam Ayurveda College Ollur, Thrissur, Kerala, India.
Email: 		Lekshmi P S, Marikutty TC, Navaneeth KN, Ayurvedic management of Acute Exacerbation of Atopic Dermatitis - A Case Report. J Ayu Int Med Sci. 2024;9(7):301-308.
Available From
https://jaims.in/jaims/article/view/3377

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-12 2024-05-24 2024-06-04 2024-06-14 2024-06-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.98

© 2024by Lekshmi P S, Marikutty TC, Navaneeth KNand 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].

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Introduction

The term eczema is defined as the persistent or recurring skin rashes characterized by redness, skin edema, itching and dryness, with possible crusting, flaking, excoriations, oozing and bleeds. The skin discoloration is due to the healed lesions, though scarring is rare. Long- standing eczema is often dry and is characterized by thickened, scaling skin with hyper pigmentation and lichenification.[1]

It is classified into endogenous (due to internal or constitutional factors) and exogenous eczema (due to external agents). Atopic eczema comes under endogenous eczema. It is an acute, subacute, chronic relapsing skin disorder that usually begins within the first 6 months of life, though it can begin at any age. Approximately 70% of patients have family history of Atopy. Etiopathogenesis is, there is a complex interaction between skin barrier, genetic, environmental, pharmacologic and immunologic factors. Eczema is characterized by the infiltration of Th2 cells which play an important role in mast cell activation and eosinophils also stimulates the production of IgE.[2] Triggering factors include inhalants-dust, pollens, microbial antigens autoallergents, foods-eggs, fish, milk, wheat, peanut.[3]

A characteristic defect in AD that contribute to the pathophysiology is an impaired epidermal barrier. There will be a mutation of gene encoding filaggrin, a structural protein in the stratum corneum, is responsible.[4] Clinical features include pruritis leads to scratch, rash, itch; interfere with sleep, skin becomes dry. In Ayurveda, it can be correlated to Vicharchika. Nidanas of Kushta includes Virudha, Adhyasana, Asathmyasana, Vegavidarana, Papakarma, Ayoga Snehadhi Krama.[5]

The Lakshana of Vicharchika involves presence of striations (Raji), severe itching (Kandu), pain (Arthi), dryness (Rookshatha).[6] Nidana Parivarjana, both Bahya and Abhyanthara Kriyas will be helpful in managing Vicharchika.

In modern science the management is by avoiding the predisposing factors like dust, infection, food, dry skin management. Oral and topical antibiotics to avoid the staphylococcus aureus infection. Antihistamines like hydroxyzine are one of the drugs of choice. Steroids mometasone is another anti-inflammatory drug.[7]

Case History

42-year-old patient complaints of itching and reddish-brown discoloration over the flexor part of bilateral forearm, dorsal part of both hands, flexor part of both calf region and on lateral sides of the lower back, neck region for 3 months.

Patient is a tile worker, always exposed to dust and he is travelling from one state to another as a part of his job. In the year 2002, he is diagnosed with allergic rhinitis with symptoms of sneezing in the morning and evening time and also after bath sneezing also associated with sore throat, eye itching.

He took allopathic medicines for 3 months. There after relieved. Four months back (September 2023), skin manifestations first started on dorsal part of the both palms mainly on fingers. It starts with a papule leads to itching more at the night time, which tempt him to scratch, and then it will burst and oozes, bleeds, there after it turns into blackish discoloration which becomes dry.

The same symptoms started over the dorsal side of foot, flexor part of calf on bilateral side and on popliteal region. At last, the lesions occurred over the neck (just below the jaw), sides of lower back and ears.

He also complains that itching is more severe after taking bath. His body is extremely dry in nature. He took allopathic treatment, there was only symptomatic relief, also took Ayurvedic medications internally, but again reappeared.

Personal History

The patient of age 42 belonging to lower middle-class family who is anxious in nature font of non veg, especially beef, pork, fish, mutton, fried snacks, hot and sour food items. He takes alcohol occasionally.

His appetite is good, bowel is constipated and unsatisfied, Micturition is 4-5/day, Sleep is disturbed due to itching. Allergy towards Dust, Cold. His mother is diabetic regarding the family history.

Treatment History

In the year 2002, he took 3 months of medication for the allergic rhinitis.1 ½ month before he took allopathic medicines-Teczine, Tenovate, Bioline, T air 180 for the atopic dermatitis.


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General and Systemic Examination

General appearance of the patient was neat and tidy. He is cooperative in nature, Built is medium and state of nutrition is moderate with Height is 165 cm, weight is 68 kg, BMI is 25kg/msq, orientation to time place and person intact also his intelligence is intact.

On examination of integumentary system, Primary lesion was erythematous papule and the Secondary lesion was erotic due to continuous scratching of the lesion which became flat topped reddish black discoloration, oozing, bleeds some areas as lichenified areas.

Configuration of the lesion is Linear. Distribution of the lesion is Localized bilaterally symmetrical over the flexor part of both fore arm, dorsal part of both Palms, flexor part of both calf, sides of lower back, below the jaw, small lesion over ears. Hair and nails didn’t show any abnormalities. Patient oriented eczema measure was 26 which shows very severe eczema, and dermatology life quality index questionnaire score was 24 which shows extremely large effect on patient’s life.

At the time of Admission

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On 14/12/2023
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18/12/23
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Ayurvedic parameters examination details

  • Prakriti: Vatha Pitta; calculated using TNMC Questionnaire.
  • Doshas: Kapha Pitta, Pradhana Tridosha (Apana Vayu, Samana Vayu, Brajaka Pitta).
  • Dushyas: Rasa, Rakta
  • Mala: Sweda
  • Upadhatu: Twak
  • Saram : Madhyama
  • Samhananam : Madhyama
  • Sathwam : Pravara
  • Sathmyam : Ushna, Katu, Amla, Lavana, Suska
  • Pramanam : Madhyama
  • Aharasakthi: Madhyama
  • Abyavaharana Sakthi : Madhyamam
  • Jarana Sakthi : Pravaram
  • Vyayamasakthi : Madhyamam
  • Vaya : Madhyamam
  • Kalam – Kshanadi : Sarath
  • Vyadhyavastha : Navam

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  • Desham - Bhoomi : Sadharanam, Deham : Pani Pada Kati
  • Rogamargam : Bahyam
  • Srotas affected : Raktha, Swedavaha

Nidanam

  • Aharaja Nidanas include Katu, Amla, Lavana, Suska, Snigdha, Seetha Aharas like fried snacks which are hot and sour, Lassi, Madhya, Red meat, Pork, Chicken,
  • Viharaja Nidanas - Kshuth Vegarodha, Anila, Atapa Seva.
  • Manasika Nidanas - Bhaya Soka Krodha

Poorvaroopam

  • Kandu, Vivarnatha, Koto Unnathi, Roodanam Api Rookshatwam Nimithe Alpe Api Kopanam, Asrija Karsnyam.

Roopam

  • Sa Kandu Pidaka Syava Lasikadya Vicharchika.

Samprapthi

Due to Mithya Ahara and Vihara, Manasika Dosas, Tridosha Dushti occurs and Sthana Samsraya in Twak Raktha Lasika Mamsa leads to manifestation of Kushta.

Upasayam: Snigdha Ushna

Anupasayam:Rooksha Seetha

Diagnostic and Assessment Criteria: Diagnosis was made by clinical examination and it is diagnosed as Acute Exacerbation of Atopic Dermatitis. Ayurvedic correlation is Vicharchika. On assessment, Patient oriented eczema measure was 26 which shows very severe eczema, and dermatology life quality index questionnaire score was 24 which shows extremely large effect on patient’s life.

Therapeutic Intervention: Patient admitted in Vaidyaratnam Ayurveda College Hospital on 11/12/2023. Treatment protocol was Amapachana, Deepana, Srothosodana, Vyadhikshamtvakara and Dosa Dhathu Samyakara. (Table 1). Externally treatment started from Abhyanga, Lepana, Sarvanga Thakra Dhara, Sneha Pana, Virechana(Table 2).

Table 1: Internal administration

DateInternal medicinesDosageTime
11/12/20231. Patoladi Kasayam15ml bd with 45 ml lukewarm water6am, 6pm Before food
2. Kaisora Guggulu1 bd with Kasayam
3. Avipathy Choornam1 tsp with lukewarm waterBed time
4. Dooshivishar Tab1-0-1After food
5. Nimbarajanyadi Tab0-1-1After food
6. Shathadhoutha GrithamSOSE/A

Table 2: External administration.

DateProcedureMedicineRemarks
12/12/2023 to
18/12/2023		1.  Lepana
2.  Sarvanga Thakra Dhara - 7 days after body Abhyanga with Paranthyadi Keram		1.  Lepanam  with Nimbadhi Choornam + Thakram (2 hrs)
2.  Paranthyadhi Keram for Abhyanga		Itching reduced and lesion normalized on 18/12/2023
19/12/2023SnehapanaAragwadha Maha Thikthakam Gritham - 30ml, 6amAppetite - 8:30am
Food intake - 10:30am
20/12/2023Snehapana70 mlAppetite - 8:15am
Food intake - 10:00am
21/12/2023Snehapana110mlAppetite-8:15am Food intake-10:00am
22/12/2023Snehapana150mlAppetite - 10.00am Food intake - 10:30am
23/12/2023Snehapana190 mlAppetite - 11:00am Food intake - 11:00am
24/12/2023Snehapana220mlAppetite -10:30am Food intake -10:30am
25/12/2023Snehapana250mlAppetite - 10:30am Food intake - 10:30am
Loose stools with slimy appearance, fatigue, aversion towards Sneha as Samyak Snigdha Lakshana
26/12/2023 to
27/12/2023		Abhyangam, hot water bathAbhyanga with Paranthyadhi Keram + Doorvadhi Keram

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28/12/2023VirechanamManibadra Gulam - 25gm, 6am.Up till 9:00 no Virechana, 9:15am Vegas occurred - 4 Vegas
Discharge medicines1.  Aragwada Mahatiktha Gritham - 1tsp morning b/f
2.  Manjishtadhi Kasayam -0-0-15 ml with lukewarm water at 7pm
3.  Nimbarajanyadhi tab-1-0-1 bd a/f
4.  Manibadragulam 1tsp a/f bed time
5.  Paranthyadhi Keram e/a
Review after 3 weeks		Discharged

Results

After treatment, the clinical signs and symptoms like itching, discoloration reduced and appeared to be normal skin texture. POEM score showed moderate eczema of 9 and DLQI showed moderate effect on patients’ life of 10. (Table 3)

Table 3: Before and After treatment score

AssessmentBefore treatmentAfter treatment
POEM ScoreVery severe eczema - 26Moderate eczema - 9
DLQI ScoreExtremely large effect on patients’ life - 24Moderate effect on patients’ life - 10

After treatment skin changes

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Discussion

Atopic dermatitis also known as Eczema is a disorder in which dry rough itchy sometimes bleeding and oozing as the presentations. This 42-year-old patient diagnosed case of Acute Exacerbation of Atopic Dermatitis managed with the Kushta Chikitsa. The treatment protocol includes Amapachana Deepana Srothosodana, Raktha Prasadhana, Dhathu and Dosha Samyakara, Vyadhikshamatwakara Chikitsa. Internal medicines include Patoladhi Kasayam, Kaisora Guggulu, Avipathy Choornam, Dooshivishari tab. Patient’s Koshta is Krura and the condition of the patient needs a Sodana, so Padoladhi Kasaya is advised. Padolathi Kasayam is Kapha Pithahara, Vishagna, Kushtahara, Anulomana, Srothosodana.[8] The medicine Kaisora Guggulu is having Agni Deepana, Amapachana, Vranagna, Kushtagna property. Avipathy Choorna is Pithahara and Srothosodana.[9] Dooshivishari tab. is having Ama Pachana and Deepana, Vishagna property.[10] Though the patient is having less immunity, Nimbarajanyadi tab will be a good option. Nimbarajanyadi tab is Peenasa-Kandugna, Rakthaprasadaka, Vyadhikshamtwakara. Externally, Lepana with Nimbadi Choornam in Thakra is advised on the affected area. Sarvanga Thakra Dhara also advised after Abhyanga with Paranthyadhi Kera Thailam. Lepana and Thakra Dhara following helps in relieving the acute exacerbation. Nimbadhi Choorna is helpful in Vicharchika due to its Thiktha Rasa, it is Kapha and Pittahara.[11]


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Thakra is Laghu Kasayam Amlam. It is Sheetha Sparsha due to Amla Rasa in turn reduces Pitha, Kasayarasa helpful in reducing Kapha, Amla Rasa reduces Vatha, soothens body, relaxes the body, reduces the stress related aggravating factor of skin diseases.[12] So Sarvanga Thakradhara acts in the level of mind and body. Paranthyadhi Keram used for Abhyanga is having Varnya, Kandugna, Kushtagna, Pithahara property.[13] For the Sodanartha Snehapana, Aragwada Mahathiktham Gritham is administered. It is beneficial in Kushta, Kapha Pittahara, Kandugna Vrana Shodana.[14] Classical Virechana done. For that Manibhadra Gulam is recommended. It is the Lehya with Trivrith as main ingredient and all other drugs having Krimigna, Kushtagna property and it wash out the toxins of the body.[15] On the day of discharge, Manjishtadi Kasaya also added with the previously prescribed internal medicines.

The drugs of Manjishtadi Kasaya possess Kapha Pithahara properties, also alleviate diseases affecting Raktha and Vata.[16] Along with the Bahya and Abhyanthara Prayoga, Patient is directed to follow the Pathya Ahara and Vihara at the time of discharge. He is guided to avoid the Curd, Milk, Oil, Horsegram, Black gram, Sour taste, Acrid taste, day time sleep. Pathya Ahara involve Sali rice, Shashtika rice, Greengram, Mustard oil.[5]

Conclusion

Atopic dermatitis is skin conditions that mainly

affecting the dermis and epidermis. It can be managed by both internal and external therapy. Medicines were selected based on the Dosha predominance. The skin manifestations showed a significant change after treatment. Pathya Ahara and Vihara, Rasayana Prayoga also plays a detrimental role in avoiding the reoccurrence of the conditions.

References

1. Gupta Sneha Satpute Kalpana. Ayurvedic management of vicharchika (Eczema)-A case study. JAIMS. 2020 Aug;5(4).

2. Ibbotson SH. Dermatology, Atopic eczema. In: Davidson’s Principles and Practice of Medicine. 24th ed. Elsevier; p. 1097.

3. Vaidyanatha Usha. Dermatology, Section 18, Eczema, chapter 209. In: K V Krishnadas Textbook of medicine, 5th ed. Jaypee Brothers Medical Publishers (P)LTD; 2008. p. 1368–73.

4. Lawley P Leslie cheeley TJ Swerlick A Robert. Eczema, Psoriasis, Cutaneus infections, Acne, and other skin disorders. In: Harrison’s Principle of Internal Medicine. 21st ed. Mc Graw hill; p. 1519–23.

5. K R Sreekanda Murthy. Susrutha samhitha, Nidana sthana, chapter 5,. Reprint 2016. Vol. 1. Chaukamba Orientalia; 496 p.

6. K R Sreekanda Murthy. Susrutha samhitha, Nidana sthana, chapter 5. Reprint 2016. Vol. 1. Chaukamba Orientalia; 496 p.

7. Vaidyanatha Usha. Dermatology, section 18, Eczema, chapter 209. In: K V Krishnadas Textbook of Medicine. 5th ed. Jaypee Brothers Medical Publishers (P)LTD; 2008. p. 1370.

8. Sreekandamurthy K R. Vaghbata’s Ashtanga hridaya, sutrasthana, chapter 15, Sodanadigana Samgraha. 9th ed. Vol. volume 1. Choukambha Orientalia; 2013. 202 p.

9. Sreekandamurthy K R. Vagbhata’s Ashtangahridaya, Kalpasthana, Virechana Kalpa. reprint 2013. Vol. volume 2. Chaukamba Orientalia; 542 p.

10. Sreekandamurthy K R. Vaghbata’s Ashtanga Hridaya, Uttarasthana, chapter 35, vishaprathisheda. Reprint 2008. Vol. volume 3. 334 p.

11. Sreekanda Murthy K R. vagbhata’s Ashtanga hridaya, chapter 19, kushtachikitsa. Reprint 2014. Chaukamba Krishnadas academy; 483 p.

12. Achuthan Deepa Nellicode Shabeer. Efficacy of shodhana and sarvangtakradhara therapy in the management of psoriasis: A case study. Int J Preclin Clin Reasearch. 2024;15–20.

13. Prayogasamuchayam, Thrithiyaparichedam, Mandalisamanya chikitsa. 1999th ed. Sulabha books; 87 p.

14. K R Sreekanda Murthy. vagbhata’s Ashtanga Hridaya,shodanadi gana samgraha. 9th ed. Vol. 1. Chaukamba Orientalia; 2013. 381 p.


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15. K R Sreekanda Murthy. Vagbhata’s Ashtangahridayam chikitsa sthana chapter 19, Kushta chikitsa. Reprint 2014. Vol. 2. Chaukamba Krishnadas academy; 472 p.

16. P K Reshmi. A single case study of Ayurvedic Management of Vicharchika w.s.r to weeping eczema. JAIMS. 2022 Aug;7(7):181–4.


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