Featured Case

MODERN DIAGNOSIS: Xeroderma

ABOUT THE DISEASE:

Xeroderma, xerosis or xerosis cutis, or simply dry skin, is a skin condition characterised by excessively dry skin.

The medical term xeroderma, meaning 'dry skin', derives from Greek (xeros) 'dry' (derma) ‘skin'.

Causes: Xeroderma is a very common condition. It happens more often in the winter when the cold air outside and the hot air inside create a low relative humidity. This causes the skin to lose moisture and it may crack and peel. Bathing or hand washing too frequently, especially if one is using harsh soaps, can contribute to xeroderma. Xeroderma can be caused by a deficiency of vitamin A, vitamin D, zinc, systemic illness, severe sunburn, or some medication. Xeroderma can be caused by choline inhibitors. Detergents such as washing powder and dishwashing liquid can cause xeroderma.

Prevention: Many creams and lotions, commonly based on vegetable oils/butters, petroleum oils/jellies, and lanolin are widely available. As a preventive measure, such products may be rubbed onto the affected area as needed (often every other day) to prevent dry skin. The skin is then patted dry to prevent the removal of natural lipids from the skin. Taking a shower or washing hands with special moisturising soaps or body washes can protect the skin from drying out further.

Diagnostic criteria: Diagnosis of xeroderma is based on clinical evaluation. Xeroderma can usually be differentiated by inflammatory disorders such as atopic dermatitis and psoriasis by the absence of erythema in xeroderma. Unlike the fine white scales of xeroderma, ichthyosis is characterised by fish-like scales.

Prognosis: Xeroderma is generally benign and may persist for years. The prognosis is favorable with avoidance of triggers and incorporating a skincare regimen focused on gentle cleansing and adequate moisturising. Many people with the condition have a shortened lifespan from developing skin cancer at a very young age. Taking steps to prevent sun damage early in life can increase the chances of living longer.

In this case report, the patient is a 19 year old male who complained of itching and dandruff in scalp since 4 years associated with scaling, dry skin lesions, and itching over the entire body for 2 years. There were no prior consultation or treatment. Based on the clinical evaluation, the ayurvedic physician made the biomedical diagnosis as Xeroderma and ayurvedic diagnosis as Darunaka. This was a chronic condition, with no prior medical intervention. 

Treatment: Repeated application (typically over a few days) of emollients or skin lotions/creams to the affected area will likely result in quick alleviation of xeroderma. In particular, the application of highly occlusive barriers to moisture, such as petrolatum, vegetable oils/butters, and mineral oil have been shown to provide excellent results. Many individuals find specific commercial skin creams and lotions (often comprising oils, butters, and or waxes emulsified in water) quite effective (although individual preferences and results vary among the wide array of commercially available creams).

Lanolin, a natural mixture of lipids derived from sheep's wool, helps replace natural lipids in human skin and has been used since ancient times (and in modern medicine) as among the most powerful treatments for xeroderma. Some people may, however, have allergies to lanolin, producing the opposite of the desired effect.[5] Also, pure lanolin is a thick waxy substance which, for many individuals, proves difficult and inconvenient for general use on dry skin (especially over large areas of the body).

Reference

1. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.[page needed]
2. "Medical Definition of Xeroderma". MedTerms. 29 March 2021. Retrieved 17 May 2022.
3. "Dry Skin (Xeroderma)". Merck Manuals. May 2021. Retrieved 17 May 2022.
4. "Managing Dry Skin". US Pharmacist. 30 (3). 2005. Retrieved 17 May 2022.
5. R. Wolf (1996). "The Lanolin Paradox". Dermatology. 192 (3): 198–202.
6. Zirwas MJ; Stechschulte SA (2008). "Moisturizer allergy: diagnosis and management". J Clin Aesthet Dermatol. 1 (4): 38–44.
7. my.clevelandclinic.org › health › diseases

AYURVEDA DIAGNOSIS: Darunaka

ABOUT THE DISEASE:

The ayurvedic physician has correlated Xeroderma to darunaka. Darunaka means difficult to bear or tolerate. This is commonly referred to as dandruff, a disorder that affects the scalp. It has been reported that Darunaka (Seborrhoeic Dermatitis) affect about 4% of the population, and dandruff (which is mild seborrhoeic dermatitis of the scalp) can affect almost half of all adults. It can start at any time after puberty and is slightly commoner in men. It can result in social or self-esteem problems.

The primary symptoms in this patient, were itching and dandruff in the scalp for 4 years. Though the symptoms also affected the entire body, the treating physician connects it to darunaka. Dandruff causes white, dry flakes of dead skin cells to shed from the scalp. Although dandruff rarely causes baldness and hair loss, the itchiness of this condition may most certainly be a cause of concern. If white flakes persist for a long time, the person may experience symptoms of seborrhea, psoriasis, or eczema. 

Darunaka is a Kapalagataroga but Acharya Sushruta has described this disease as a Kshudraroga due to the vitiation of Vata and Kapha Doshas with symptoms like Kandu (itching on scalp), Keshachyuti (falling of hair), Swapa(abnormalities of touch sensation on scalp), Rookshata (roughness or dryness of the scalp) and Twaksphutana (breaking or cracking of the scalp skin). Seborrhoeic Dermatitis, an irritative disease of the scalp in which shedding of dead tissue from the scalp with itching sensation is the cardinal feature which can be correlated with Darunaka. 

In this case report, the patient is a 19 year old male who complained of itching and dandruff in scalp since 4 years associated with scaling, dry skin lesions, and itching over the entire body for 2 years. There were no prior consultation or treatment. Based on the clinical evaluation, the ayurvedic physician made the biomedical diagnosis as Xeroderma and ayurvedic diagnosis as Darunaka. This was a chronic condition, with no prior medical intervention.

Causative factors: Madhava Nidana in Kshudra roga adhyaya explains that non-application of Kesha Taila (oiling of head), improper cleaning, sleeping during day time, night vigil, exposure to dust, hot weather etc. are causative factors for Darunaka. 

Prognosis: This being categorised as Kshudra roga, the management can be done easily. Vaghbhata specifically mentions that it is sadhya in nature.

Rationale of Treatment: The general line of treatment for Tvak roga was followed. The symptoms like itching, scaling and dry skin lesions were also addressed. 

Table 1. The medicines and the specific rationale for choosing them are being tabulated as explained by the treating physician

Reference

1. Kumari Archana et.al. An ayurvedic approach in the management of darunaka (seborrhoeic dermatitis): a case study. Vol.10; Issue: 4; April 2020

OUTCOME MEASURES

The patient is a 19 year old male who complained of itching and dandruff in scalp since 4 years associated with scaling, dry skin lesions, and itching over the entire body for 2 years. There were no prior consultation or treatment. Based on the clinical evaluation, the ayurvedic physician made the biomedical diagnosis as Xeroderma and ayurvedic diagnosis as Darunaka. This was a chronic condition, with no prior medical intervention.

Assessment: Subjective parameters were assessed to analyse the outcome of the treatment.

Subjective parameters: The symptoms as proceeding through the treatment were tabulated. Itching, Scaling, Dryness and Constipation were recorded. 

Table 1. Symptoms assessed and documented date wise

After 2 months of treatment, there was a significant reduction in symptoms. After 4 months, itching completely relieved. Mild dryness and scaling persists. After 5 months, only constipation persists. He got complete relief from itching, scaling and dryness. After 6 months, complete relief from all the symptoms. 

Objective parameters: None