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TITLE OF CASE

Standalone Ayurvedic management of Eczema - A case report.

Dr Soumya 

ABSTRACT

A 60-year-old female patient presented with dry hard skin in the dorsal aspect of both feet with occasional itching that resulted in bleeding followed by the shedding of scales for 2 years. 

The patient had taken steroids and antihistamines, and oral medications past 2 years, but did not get relief. So she consulted Dr Soumya, for better management of her symptoms. Based on the clinical evaluation, Dr Soumya made a biomedical diagnosis as Eczema and an ayurvedic diagnosis as Vicarchika. The line of treatment followed was Vishahara, kanduhara, vrana ropana and initiate rakta shuddhi. After one and half months of treatment, a significant reduction in the symptoms was observed. Itching followed by bleeding was observed rarely. After 5 months of Ayurvedic treatment, the patient is completely free from all the symptoms.

KEYWORDS

Standalone, eczema, case report, ayurveda, vicharcika

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 occur in adults also. 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. They are also more susceptible to infection. Harmful substances can more readily penetrate the skin due to dysfunction. People with this condition tend to have a skewed inflammatory immune response, and their skin is easily affected by irritants 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

A 60 year old female patient presented with dry hard skin in dorsal aspect of both foot with occasional itching, which results in bleeding followed by shedding scaly skin since 2 years. On taking allopathic medicines, she would get temporary relief. But after sometime, the condition would relapse.

Surgical History- Underwent 2 cesarian section in 1984 & 1987.

No significant family/genetic history.

Psychosocial History- She is very stressed.

CLINICAL FINDINGS

A General and systemic examination was done. On examination- Dry skin on  dorsal aspect of both foot, scaling +. Swelling+ on both lower limbs.

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; Though the patient had been consulting and taking allopathic medications, past 2 years on & off, there was no confirmed biomedical diagnosis. 

Ayurvedic Assessment was done based on the presenting complaints and clinical evaluation. The treating physician the confirmed diagnosis, both biomedical and ayurveda.

Differential Diagnosis- The different conditions are as follows

Cutaneous fungal infections

Seborrheic dermatitis

Drug eruptions

Scabies

Psoriasis

The physician clinically diagnosed the condition as eczema. 

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 report, the patient had a long history of eczema which persisted even after taking the standard of care and other alternative treatment for 2 years. With the initiation of standalone Ayurveda treatment, the patient got a complete relief from the symptoms in 5 months.

THERAPEUTIC INTERVENTION

Refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

The first follow up was after one and half months, and there was significant reduction in symptoms. 

The second follow up was after 5 months, where the patient was completely free from all the symptoms. 

Clinician-based assessment; On examination, the skin is normal. There is no scaling and swelling. 

Patient-assessed; Not relevant

Image 2. Baseline Photos dated 1.2.2023 added below.

Video 1. The symptoms being recorded on mobile 

https://youtu.be/riZnitzGzjo?si=k3JKQiq89uDZVr9S

After undergoing one and half months of Ayurvedic treatment, there was a significant reduction in the symptoms- itching followed by bleeding observed rarely. After 5 months, the patient is completely free from all the symptoms. On examination, the skin is normal. There is no scaling or swelling. She is still continuing the Ayurvedic medicines.

Image 3. Images of the lesions taken after treatment dated 23.6.2023

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- Images were taken before and after treatment. 

Adverse and unanticipated events; None reported

DISCUSSION ; 

The patient had been suffering from the skin complaints past 2 years. Inspite of taking steroids and antihistamines, she got only temporary relief. The symptoms would relapse again. The treating physician diagnosed the condition as Vicharcika and the appropriate line of treatment was planned. Being categorised as Kshudra kushta by the classical textbooks of Ayurveda, this is curable. But in a chronic condition, there are challenges. Here, with ayurvedic treatments over a period of 5 months, the patient got complete relief. 

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case report demonstrates the potential effectiveness of Ayurveda as an alternative option for managing eczema when other methods fail. Continuing with the prescribed follow-up medicines is essential to sustain positive results.

INFORMED CONSENT

Written consent obtained from patient. 

ACKNOWLEDGEMENTS

None

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. 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.
2. 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.