Featured Case

BIOMEDICAL DIAGNOSIS: Acne vulgaris

ABOUT THE DISEASE: 

Acne, or acne vulgaris, is a common skin condition that develops when dead skin cells, sebum (skin oil), and bacteria plug the pores, leading to skin lesions commonly known as pimples or zits. Acne outbreaks can develop on the face, back, shoulders, and chest. A range of acne treatments—from over-the-counter products to prescription medications to specialist procedures—can help clear the skin and prevent scarring. The specific treatment depends on the type and severity of acne. 

Types of Acne Vulgaris; There are several types of acne. They have similar causes but vary in appearance and severity. The different types of acne include White heads, Black heads, Pustules and Papules, Nodules and cysts.

Symptoms- 

• Small, red bumps 
• Small, red bumps containing yellow or white pus
• Whiteheads
• Blackheads
• Crusting over the bumps 
• Redness and swelling on the skin surrounding the blemishes
• Pain or tenderness, especially with cysts and nodules

Risk Factors: Age, hormonal changes, diet, skin type, family history, personal care products, medication and smoking can cause acne. 

Diagnostic criteria: Medical history, clinical evaluation are the basic diagnostic criteria. Tests may be suggested if the doctor suspects any underlying medical condition. 

Treatment options & prognosis; There are many treatment options for acne. Treatment can help control acne breakouts and may prevent long-term scarring. Your healthcare provider can recommend specific treatments based on the severity of your acne. This may include topical treatments applied to the skin, oral prescription medications, or procedures performed as an out patient. Dermatological procedures can address stubborn or severe acne. This might include laser therapy and corticosteroid injections. Laser therapy and light devices, when combined with other acne treatments, can reduce inflammation, clear acne, and help prevent scarring. Corticosteroid injections work quickly to reduce pain and inflammation. The injections help treat severe acne breakouts that are causing painful cysts and nodules. However, if acne are not managed well, it can cause complications like scarring, hyper pigmentation, infections and emotional distress. 

In this case report, a 28-year-old female patient, presented with a three-month history of papules, pustules, redness, black spots, and overall dull skin on her forehead. She had tried Ayurvedic medicines for 15 days followed by Allopathic treatment for 10 days. But the symptoms persisted and so she opted for a second ayurvedic consultation. She consulted Dr Sushma, who made the biomedical diagnosis as Acne vulgaris and the Ayurvedic diagnosis as Mukhadooshika. 

Image 1. Baseline image taken of the symptoms

Reference

1. https://www.health.com/acne-vulgaris-7973570

AYURVEDIC DIAGNOSIS: Mukhadooshika

ABOUT THE DISEASE:

The Biomedical diagnosis in this case report is Acne vulgaris and the ayurvedic correlation given by the treating physician is Mukhadooshika. 

In Ayurvedic texts the disease, Mukhadooshika has not been mentioned independently. It has been described with some minor diseases. This group of minor diseases is known as ‘Kshudra roga.’ According to Sushruta, 44 diseases have been described under this group; Mukhadooshika is one of the kshudra roga. 

शाल्मलीकण्टकप्रख्याः कफमारुतशोणितैः। जायन्ते पिडका यूनां वक्त्रे या मुखदूषिकाः॥३९॥(SS.Ni.13)

The Shalmali thorn like eruptions on the face of adults due to vitiation of Kapha, Vata and Rakta are known as “Yuvanapidaka” or “Mukhadooshika.” Acharya Vagbhata has mentioned the role of Meda in the pathology of Mukhadooshika which resembles the modern theory of sebum involvement in the pathogenesis of acne. 

Causes: The causative factors of acne are mainly divided into 4 types

• Kalaja- Vasanta Ritu, Grishma Ritu, Sharad Ritu, Tarunya
• Aharaja; Excess intake of Katu, Tikta, Amla, Lavana Rasa, Snigdha, Guru, Picchila, Abhishyandi Aharasevana, Ushna Tikshna Ahara.
• Viharaja; Divaswapa, Excess Atapasevana, Ratri jagarana, Vegavarodha.
• Manasika; Atichinta, Atikrodha, Atibhaya, Udvega, Svabhava.

Lakshana of Mukhadooshika: 

………..सरुजो घनाः।

मेदोगर्भा मुखे यूनां ताभ्यां च मुखदूषिकाः॥५॥(AH.Utt.31)

• Pidika – means eruption. The disease is in the form of eruptions.
• Saruja – The eruptions are painful. The pain may be mild or acute in nature.
• Ghana – means thick, hard or indurate. So, the eruptions of the disease are hard and thick.
• Medogarbha – The eruptions are impregnated with Meda. Meda is known as comedone.
• Yuna Mukha – This disease occurs on the face of adults.

Samprapti of Mukhadushika 

 According to Sushruta, the disease Mukhadooshika is due to vitiated Kapha, and Vata dosa and Rakta Dhatu. The exact description about the disease process is not available and the involvement of Pitta Dosa is also not explained in any of the Ayurvedic text. But when Rakta is involved, Pitta will automatically be vitiated, because the aggravating factors for both Rakta and Pitta are similar. According to Acharya Charaka Pitta plays a significant role in the formation of Pidaka. Though Vyaktisthana of the Pidaka is on the skin, involvement of Rasa Dhatu can also be considered here. 

Samprapti Ghataka 

• Dosha – Kapha, Vata, Rakta
• Dushya – Rasa, Rakta, Meda, Shukra
• Srotas – Svedavaha, Rasavaha, Raktavaha • Mala – Sweda, Tvaka Sneha
• Srotodusti – Sanga, Atipravritti
• Agni – Jatharangimandya
• Udbhavasthana – Amashayasamuttha
• Roga Marga – Bahya 

Cikitsa: Chikitsa of Mukhadushika 

Line of treatment prescribed by different Acharya can be summarised as follows.
Sushruta – Vamana, Lepana
Ashtanga Hridaya – Lepana, Vamana, Nasya, Shiravyadha

Bhavaprakash - Lepa, Vamana, Abhyanga
Yoga Ratnakara - Siravedha, Pralepa, Abhyanga
Sharangadhara Samhita - Lepa
Bhaishajjya Ratnavali - Siravedha, Pralepa, Abhyanga 

In this case report, a 28-year-old female patient, presented with a three-month history of papules, pustules, redness, black spots, and overall dull skin on her forehead. She had tried Ayurvedic medicines for 15 days followed by Allopathic treatment for 10 days. But the symptoms persisted and so she opted for a second ayurvedic consultation. She consulted Dr Sushma, who made the biomedical diagnosis as Acne vulgaris and the Ayurvedic diagnosis as Mukhadooshika. 

Rationale of treatment explained by the Physician: The logic of using medicines and their targets as explained is tabulated below. 

Table 1. The medicines, therapies and the rationale for choosing them 

Reference 

1. Vidhya’Bharti, Sharma et al. A SHORT REVIEW ON MUKHADUSHIKA WITH SPECIAL REFERENCE TO ACNE VULGARIS. Int.J.Res.Ayurveda Pharm.11(3). 2020

OUTCOME MEASURES

In this case report, a 28-year-old female patient, presented with a three-month history of papules, pustules, redness, black spots, and overall dull skin on her forehead. She had tried Ayurvedic medicines for 15 days followed by Allopathic treatment for 10 days. But the symptoms persisted and so she opted for a second ayurvedic consultation. She consulted Dr Sushma, who made the biomedical diagnosis as Acne vulgaris and the Ayurvedic diagnosis as Mukhadooshika. 

Assessment: Both objective and subjective parameters were assessed to analyse the outcome of the ayurvedic treatment. 

Subjective parameters: The symptoms were tabulated date wise to assess the outcome.

Table 1. Date wise assessment of symptoms

Objective parameters: Images were taken through out the treatment, and documented to assess the changes. 

Image 1. Jalaukavacaranam dated 6.7.2023

Image 2. Image dated 7.8.2023

Image 3. Image dated 10.9.2023

Image 4. Image at endpoint dated 6.10.2023