Featured Case
-
Abstract
A 23-year-old businessman complained of dry and itchy skin with red rashes on the dorsal aspect of the palm in the right hand and the dorsal aspect of both the foot region. The onset of the symptoms was 3 years back, with redness, dryness and itching over the skin. He consulted a general practitioner and got symptomatic relief. Six months back, the symptoms relapsed, and he consulted a dermatologist. The biomedical diagnosis was chronic eczema based on the clinical examination and presentation. He tried topical ointments, steroids, immunosuppressants etc. The patient continued the medicine for 4 months and stopped completely as there was no improvement in the clinical condition. He now consulted Dr Gaurang Joshi. The ayurvedic diagnosis was Vicharcika. The line of treatment adopted are amahara, rakta sodhana, and punah punah sodhana cikitsa along with management of stress and boosting the immunity. He got complete relief from scaly lesions, redness and itching and is in remission when last followed up.
-
Summaries
-
Listen
-
Watch
-
View
-
Read
A 23-year-old businessman complained of dry and itchy skin with red rashes on the dorsal aspect of the palm in the right hand and the dorsal aspect of both the foot region. The onset of the symptoms was 3 years back, with redness, dryness and itching over the skin. He consulted a general practitioner and got symptomatic relief. Six months back, the symptoms relapsed, and he consulted a dermatologist. The biomedical diagnosis was chronic eczema based on the clinical examination and presentation. He tried topical ointments, steroids, immunosuppressants etc. The patient continued the medicine for 4 months and stopped completely as there was no improvement in the clinical condition. He now consulted Dr Gaurang Joshi. The ayurvedic diagnosis was Vicharcika. The line of treatment adopted are amahara, rakta sodhana, and punah punah sodhana cikitsa along with management of stress and boosting the immunity. He got complete relief from scaly lesions, redness and itching and is in remission when last followed up.
-
-
Timeline
-
Tabulated Summary
-
Narrative
TITLE OF CASE
Successful standalone ayurvedic management of chronic eczema - A case report
Dr Gaurang Joshi
ABSTRACT
A 23-year-old businessman complained of dry and itchy skin with red rashes on the dorsal aspect of the palm in the right hand and the dorsal aspect of both the foot region. The onset of the symptoms was 3 years back, with redness, dryness and itching over the skin. He consulted a general practitioner and got symptomatic relief. Six months back, the symptoms relapsed, and he consulted a dermatologist. The biomedical diagnosis was chronic eczema [1] based on the clinical examination and presentation. He tried topical ointments, steroids, immunosuppressants etc. The patient continued the medicine for 4 months and stopped completely as there was no improvement in the clinical condition. He now consulted Dr Gaurang Joshi. The ayurvedic diagnosis was vicharcika [2]. The line of treatment adopted are amahara, rakta sodhana, and punah punah sodhana cikitsa along with management of stress andboosting the immunity. He got complete relief from scaly lesions, redness and itching and is in remission when last followed up.
KEYWORDS
Eczema, Vicarcika, Kushta, Standalone, Ayurveda, Shodhana
INTRODUCTION
Eczema, also known as atopic dermatitis, is the most common form of dermatitis. Genetic as well as environmental factors are thought to play a part in the pathogenesis. Eczema is most commonly seen in children but can be seen in adults. People with the disease tend to have dry, itchy skin that is prone to infection. Eczema is commonly known as the "itch that rashes" due to dry skin that leads to a rash as a result of scratching or rubbing. The most important treatment of eczema is skin hydration followed by topical steroids to address flare-ups.
People with eczema have a dysfunctional barrier which causes various problems. The cells that make up our skin are essential for optimal skin hydration. People with eczema tend to have dry skin due to dysfunction in the skin barrier. Water can easily escape from the skin leading to dehydrated skin. People with eczema are also more susceptible to infection. Harmful substances can more readily penetrate the skin due to dysfunction. People with atopic dermatitis tend to have a skewed inflammatory immune response, and their skin is easily irritated by fragrances and allergens.
Prognosis
Overall, many patients with eczema do improve with time. However, patients may also have allergic rhinitis and asthma, which may not improve. In most cases of childhood-onset eczema, the symptoms can persist for decades. The condition has relapse and remission; relapses often require the use of medications. Individuals who are continuously exposed to smoke, tobacco, pet dander, fumes, pollen, soap, detergent, and wool will have continual symptoms and the overall quality of life is poor.
Persistent and recurrent itching not only is irritating but is costly to manage. A well-known complication is Kaposi varicelliform eruption, which is linked to a primary herpes infection.
Patients are also prone to skin infections with Staphylococcus and streptococcus.
Diagnostic Criteria: History taking, and clinical examination are the basic diagnostic criteria. A patch test can be performed on the skin to help identify allergies.
PATIENT INFORMATION
The patient complained of dry and itchy skin with red rashes on the dorsal aspect of the right palm and the dorsal aspect of both feet. The patient started noticing redness, dryness and itching over the skin 3 years back (2017).
Medical History: At the onset of symptoms consulted a general practitioner and got symptomatic relief. Six months back (March 2020), the symptoms reappeared and he consulted a dermatologist. This was clinically diagnosed as chronic eczema and prescribed topical ointments, steroids, immunosuppressants etc. The patient continued the medicine for 4 months and stopped completely as there was no improvement in the clinical condition. He does not have any co-morbidities other than the presenting complaints.
CLINICAL FINDINGS/PHYSICAL EXAMINATION
Scaly lesions and redness on palm and foot region.
Image 1. Image of the dorsal aspect of the foot before starting the treatment
TIMELINE
Image 2. TIMELINE of events to be added.
DIAGNOSTIC ASSESSMENT
Modern Diagnostic parameter: Based on the clinical presentation and examination, a provisional diagnosis was made as eczema.
Ayurvedic Assessment was done based on the clinical evaluation by the ayurvedic physician.
Differential Diagnosis- The diagnosis was confirmed with a clinical evaluation of the symptoms.
Prognosis- The condition has relapses and remissions; relapses often require the use of medications. Individuals who are continuously exposed to smoke, tobacco, pet dander, fumes, pollen, soap, detergent, and wool will have continual symptoms, and the overall quality of life is poor. In this patient, stress can trigger a relapse in the manifestation of the disease.
THERAPEUTIC INTERVENTION
See the tab ‘Treatment details’
FOLLOW-UP AND OUTCOMES
Clinician-based assessment; With the initiation of standalone Ayurveda treatment, he got relief from the chief complaints in 3 months. The scaly lesions, redness and itching were completely relieved. Regular follow-up was done every month for 1 year. Symptoms and lesions were closely monitored.
Patient-assessed: Not relevant.
Image 3. Image of the dorsal aspect of the foot during treatment
Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well.
Method of assessment- By monitoring the patient.
Adverse and unanticipated events; None reported.
DISCUSSION ;
Line of treatment adopted are amahara, rakta sodhaka, punahpunah sodhana cikitsa along with management of stress and boosting the immunity. Psorotel powder is advised for the preparation of kvatha which is having amahara properties and immuno booster activity. Capsule Asoro advised for amahara and raktasodhana activity. Soro cream and virgin coconut oil are advised for moisturisation and anti-itching activity.
PATIENT’S PERSPECTIVE
Not available.
LEARNING POINTS/TAKE-HOME MESSAGES
The patient had a chronic history of eczema which relapsed after 3 years. He tried topical ointments, steroids, and immunosuppressants, but the symptoms persisted. With the initiation of standalone ayurvedic treatment, the patient got symptomatic relief and remission from the chief complaints in 3 months. This case report demonstrates the successful management of chronic eczema with ayurveda.
INFORMED CONSENT
Written consent was obtained from the patient to publish the case report.
CONFLICT OF INTEREST
None declared.
FUNDING
None
REFERENCE
- Sohn A, Frankel A, Patel RV, Goldenberg G. Eczema. Mt Sinai J Med. 2011 Sep-Oct;78(5):730-9. doi: 10.1002/msj.20289. PMID: 21913202.
- Savalagimath MP, Rani J, Patil SF. Ayurvedic management of Vicarcika with special reference to eczema: A case report. Indian J Health Sci Biomed Res 2018: 11:92-6.
Image 1. Image of the dorsal aspect of the foot before starting the treatment
Image 2. Timeline of events added below
Image 3. Image of the dorsal aspect of the foot during treatment
-
Immersive Learning
-
Modern Diagnosis
MODERN DIAGNOSIS: CHRONIC ECZEMA
ABOUT THE DISEASE:
Eczema, also known as atopic dermatitis, is the most common form of dermatitis. Genetic as well as environmental factors are thought to play a part in the pathogenesis. Eczema is most commonly seen in children but can be seen in adults. People with the disease tend to have dry, itchy skin that is prone to infection. Eczema is commonly known as the "itch that rashes" due to dry skin that leads to a rash as a result of scratching or rubbing. The most important treatment of eczema is skin hydration followed by topical steroids to address flare-ups.
People with eczema have a dysfunctional barrier which causes various problems. The cells that make up our skin are essential for optimal skin hydration. People with eczema tend to have dry skin due to dysfunction in the skin barrier. Water can more easily escape from the skin leading to dehydrated skin. People with eczema are also more susceptible to infection. Harmful substances can more readily penetrate the skin due to dysfunction. People with atopic dermatitis tend to have a skewed inflammatory immune response, and their skin is easily irritated by fragrances and allergens.
In the case report, the 23-year-old male complained of dry and itchy skin with red rashes on the dorsal aspect of the right palm and the dorsal aspect of both feet in 2017. He took conventional treatment and got relief. But the symptoms relapsed after 3 years. During this episode, he tried topical ointments, steroids and immunosuppressants, but the symptoms persisted.
Prognosis
Overall, many patients with eczema do improve with time. However, patients may also have allergic rhinitis and asthma, which may not improve. In most cases of childhood-onset eczema, the symptoms can persist for decades. The condition has relapse and remission; relapses often require the use of medications. Individuals who are continuously exposed to smoke, tobacco, pet dander, fumes, pollen, soap, detergent, and wool will have continual symptoms and the overall quality of life is poor.
Persistent and recurrent itching not only is irritating but is costly to manage. A well-known complication is Kaposi varicelliform eruption, which is linked to a primary herpes infection.
Patients are also prone to skin infections with Staphylococcus and streptococcus.
In this case, the patient is having stress, which can trigger a relapse in the manifestation of the disease.
Diagnostic Criteria: History taking, and clinical examination are the basic diagnostic criteria. A patch test can be performed on the skin to help identify allergies.
Baseline Evaluation
Image 1. Images of the affected area in the feet before treatment
I
-
Ayurveda Diagnosis
AYURVEDA DIAGNOSIS; Vicharcika
About the disease
Acc to Sushruta Samhita
राज्योऽतिकण्ड्वर्तिरुजः सरूक्षा भवन्ति गात्रेषु विचर्चिकायाम् |
कण्डूमती दाहरुजोपपन्ना विपादिका पादगतेयमेव ....(SS.Ni.5.13)
It is a condition in which the skin has linear rough lesions with intense itching and pain. When the symptoms appear only in the feet, it is termed as “vipadika”.
Vicarchika is a type of kshudra kushtha characterised by symptoms namely kandu, srava, pitika and shyava varna. Vicarchika is often correlated to eczema based on clinical presentations. No satisfactory treatment is available in contemporary medical practice. The main line of treatment for vicarchika ia Ayurveda is Shodhana and Shamana. In the Ayurvedic text, all skin diseases are included under Kushtha roga. Kushtha is classified as Mahakushta and Kshudrakushta. Vicarchika is described under Kshudrakushta- the management of this condition is not as difficult as mahakushtha, as they are a group of minor ailments.
Samprapti
- Acc to Charak nidana 5:6, samprapti of kushtha is as follows. By various causative factors as mentioned in kushtha nidana, all the three doshas are simultaneously provoked, the four dushyas (twak, mamsa, rakta and lasika) thin out or lose their natural properties. The tridosa along with the dushya manifests as kushtha.
Prognosis
Regarding prognosis, Acarya have stated that kushtha appearing in a person, who has full control over his sense organs, kiushtha is confined only to tvak, rakta and mamsa dhatu of the body, involving vata and kapha doshas should be regarded as curable and can be eradicated completely. In the case of one, whose infection has penetrated the medas is yapya.
In a case when infection has reached the bone, the bone marrow or semen or ovum or which is caused by the three doshas together or kushtha presenting with complications are incurable.
As twak, rakta, and mamsa dhatus are generally vitiated in the disease vicarcika, and it is placed under kshudra kushtha, it may be considered as sadhya. In this case report, a 23-year-old male complained of dry and itchy skin with red rashes on the dorsal aspect of the right palm and the dorsal aspect of both feet in 2017. He took conventional treatment and got relief. But the symptoms relapsed after 3 years. During this episode, he tried topical ointments, steroids and immunosuppressants, but the symptoms persisted. Hence, he opted for ayurveda.
Treatment
Besides the classical references the treatment of kushtha can broadly be classified into main methods of management. They are as follows:
Shodhana
Antaha parimarjana
Bahi parimarjana
Shastra pranidha
Shamana
Nidana parivarjana
External Therapies – Vamana, virecana, rakta mokshana, lepa, pariseka, avagaha, dhuma are recommended taking into consideration the dosa and the dushya.
Internal medicines – In clinical practice, snehapanam is the most recommended by physicians in kushtha roga.
Rationale of treatment: Line of treatment adopted are amahara, rakta sodhaka, punahpunah sodhana cikitsa along with management of stress and of boosting immunity.
-
Treatment
Name of Medicine Dosage Form Dosage Mode of Administrtation From - To (Date) Medicine Reference Psorotel powder kadha Kashaya 5ml, twice daily Oral, with 20 ml of water 2020-09-15 - 2021-10-15 Ayurvedic proprietary medicine Capsule Asoro Capsule 1 cap Oral 2020-09-15 - 2021-10-15 Ayurvedic proprietary medicine Soro cream Oinment As required External application on the lesions 2020-09-15 - 2021-10-15 Ayurvedic proprietary medicine Virgin coconut oil Oil As required External application on the lesions 2020-09-15 - 2021-10-15 Ayurvedic proprietary medicine -
Outcome Measures
CLINICAL OUTCOMES
A 23-year-old businessman complained of dry and itchy skin with red rashes on the dorsal aspect of the right palm and the dorsal aspect of both feet for 3 years (2017). He consulted a general practitioner and got symptomatic relief. Six months back (2020), the symptoms relapsed and he consulted a dermatologist. The dermatologist clinically diagnosed the condition as chronic eczema and prescribed topical ointments, steroids, immunosuppressants etc. The patient continued the medicine for 4 months and stopped completely as there was no improvement.
With the initiation of standalone ayurveda treatment, he got relief from the chief complaints in 3 months. The scaly lesions, redness and itching were completely relieved.
Assessment: Subjective assessment was done pre and post-ayurvedic treatments.
Image 1. Images of the foot taken before treatment dated 15.9.2020
Image 2. Images of the foot taken after treatment dated 15.12.2020 added below
Disease Modifying effect: The patient is in remission and there has been no relapse to date.
Image 1. Images of the foot taken before treatment
Image 2. Images of the foot taken after treatment
-
