A Case Study of Shwitra (Vitiligo) in Pediatrics with Ayurvedic Management

Abstract

The word Shwitra is derived from Sanskrit word Shweta, which means white patch. Shwitra is mentioned in Kushta Roga Chikitsa in classics, Shwitra (Vitiligo) and affect a large portion of the population in the pediatric age group as a result of poor lifestyle and eating habits. Shwitra According to Kashyapa Samhita ‘Shweta Bhava Michanti Shwitram’. It is also called as Kilasa, Daruna, Aruna and Shweta Kushta. Vitiligo is the problem described in modern medicine as auto immune disease as white spot on the skin. Vitiligo is such a common chronic and progressive skin disease characterized by the lack of melanin pigments producing skin patches with sharp and often hyper pigmented edges. This disease affects approximately 1% of the world-wide population. Ayurveda has incorporated this condition into the broad heading of Shwitra. All Acharyas have similar view the Shwitra or Kushtha should be initially treated by Samshodhan Karma followed by Samshaman Karma are two main line of treatment described in the classics also Various permutations and combinations have been described for internal and external use along with sun exposure by Acharyas in their respective Samhitas regarding Shaman Chikitsa in the Shwitra Roga. A detailed description of various single and compund drugs are mentioned in Samhitas, Shwitrahar Kashaya and lepa are one of them is selected and was found effective for the study.

Introduction

I. INTRODUCTION

Ayurvedic science considers Shwitra as a group of skin disorders, Partial or complete loss of skin pigmentation giving rise to white patch on any part of the body is called as vitiligo and in Ayurveda it is called as Shwitra. Due to Atisevan of Asamyak Aahar Vihar, vitiation of Tridoshas occur in association with Twakchagat Pitta Dosha and Rasa-Rakta-mamasa –Udaka Dhatu . When the vitiation is significantly at the level of Ras and Rakta it results into Shwitra-Kushtha. Vata Pradhan Shwitra is difficult to cure, Pitta Pradhan Shwitra is more difficult to treat and Kapha Pradhan Shwitra is incurable. Also, the lesions at palm, sole, genitalia, lips are incurable.

But the lesions which are occurred due to burn, non-matted, newly originated, thin, with black hair are curable. Ayurveda states that basically it is due to the aggravation of Pitta Dosha which leads to cause of accumulation of Aam in deep layers of skin. Main part of treatment depends upon whether the disease is spreading or it is stable. If it is spreading, first step should be to stop the spread and then re-pigmentation can be done. Treatment again depends upon Dussham-Desham-Balm-Kaalam-Prakriti-Analam-Vayah etc.1,2,3

Though it is not very common disease but as explained in Ayurveda it is difficult to cure (kashtasadhya vyadhi). The exact cause is unknown, but it may be due to autoimmune disorder. Faulty dietary habits Kulaj Itihas, excessive mental stress, general low immunity are the precipitating factors of vitiligo.

In modern science Haemoglobin, carotenoids and melanin pigment are the responsible factors for the normal skin colour. It is an autoimmune disease in which hypo-pigmentation occurs due to the insufficiency or complete absence of melanin in skin. It is progressive type of disease with gradual destruction of melanocytes in epidermis resulting in de-pigmented, a-pigmented or hypo-pigmented areas on the skin. In this, the autoimmune destruction of melanocytes oocurs. Though the exact cause is unknown, stress like conditions triggers the disease and the stress triggered vitiligo include the increased levels of catecholamines and neuropeptides is seen.4

II. AYURVEDIC MANAGEMENT-

A. Internal Medication5

To relieve the Aam, the best Shodhan Karma as per Dosha-Dushya is Virechana. Virechan with herbal decoction of Psoralia Corylifolia (Bakuchi) and Euphobia Neriifolia (Snuhi). For Shaman treatment Bakuchyadi Churna, Khadirasaradi Churna, Panchnimbadi Churna can be used. Asavas like Kanakabindvarista, Madhwasava and Ghrita like Neeli Ghrita, Mahatikta Ghrita and Neelika Ghrita can be used. Other Ayurvedic praparations such as dried ginger, black pepper, Pippali and Leadwort root fermented in Gomutra also are in use which gives positive results.

B. External Medication 6,7,8

1. Stimulation of Pigmentation: The best combination for the external application on lesion is of Cassia fistula, Psoralia Cordifolia (active principle is Psoralen) and Piper Longum. This combination stimulate the pigment cells for re-pigmentation.
2. To Provide Favourable Conditions in the skin for Better Pigmentation: Pigment cells multiply very slowly like nerve cells. So herbs like vitix can be given to provide better environment for pigment cells to grow quickly.
3. To Preserve the Pigmentation: Pigmentation which has been formed, this can be achieved by using different herbal combinations in adequate dosage.
4. Suitable Oil Application: Oil application followed by exposure of lesion to the sun rays as long as according to the tolerance of patient. After exposure to the sun rays the affected part gets dark colour as well as form a bullae. If bullae is formed, it should be punctured with sterile needle.
5. Lepa Application: Applicaton of Ankollakandi Lepa, Avalgujadi Lepa, Balyadi Lepa, Bhallakadi Lepa, Bhringarajadi Lepa, Manashiladi Lepa, Panchnimbadi Lepa etc also has fruitful effect.

Throughout the days of treatment patient should follow Pathyakar Aahar-Vihaar.

C. Pathyakar Aahar-Vihar

Aachar Rasayana and diet containing aged rice, Godhum,Mudga, Laghu Aahar, Patola, Khadiridaka etc should be practice of daily routine. At the same time Viruddh Aahar, Guru Aahar, Vidahi Aahar, Vishthanbi Aahar, Anup Mamsa, Kanda Moola, Masha etc should be avoided.

D. Yoga practice

Yoga practice for 20 minutes in the morning will act as good stress reliever. As stress triggers the disease, that’s why this treatment part is as must to do level.

III. OBJECTIVES

To evaluate the efficacy of Shwitrahar kashay and lepa with ayurvedic management in vitiligo in children’s.

A. DRUG-9

Shwitrahara kashaya (decoction):10,11

Bakuchi (Psoralia corylifolia), Haridra (Curcuma longa), Khadira (Acacia catechu), Sariva (Hemidesmus indicus), Kakoudambar (Ficus hispida),Chakramarda (Cassia tora), and Chakshushya (Cassia absuss) were taken in equal quantity (1 kg each) and mixed thoroughly and ground to a coarse powder and stored in a dry container. The 50 g of the coarse powder was soaked in 500 ml of water and boiled to reduce it to 100 ml and administered in two divided doses of 50 ml each.

Shwitrahara lepa (ointment):12

A little modification in the method of preparation was done as per the advice of The Head of the Department of RasaSastra, IMS, BHU, Varanasi.

IV. CASE REPORT

A 12-year-old female child with Diagnosed case of vitiligo visited the OPD of our ayurved medical college. She had complaints of white patch over left and right leg since childhood. She has consulted many different doctors for same complaints and took homeopathy medicines for about three years. She had sense of embarrassment due to vitiligo.

A. Birth History

The patient’s parents reported that the pregnancy and child’s hospital delivery was normal and not reported any gross congenital anomalies at the time of birth.

1. Past History: No history of Any major illness.
2. Family History: Nothing significant, all the family members are said to be healthy.
3. Personal History

Table 1- Personal history of patient

Table 2- Nidana

Table 3-Clinical observations

Table 4-Systemic Examination

B. Local Physical Examination

Site of lesion-White patches over both the legs.

Character of lesion- Macules

Colour- White

Itching- Mild present

Discharge- Absent

Diagnosis: Shwitra (Vitiligo).

V. TREATMENT

A. On Consultation

Shwitrahara kashaya -3.5 ml

(2 times after food) for 1 month

Shwitrahara lepa for local application

(2 times a day) for 1 month

B. On 1st follow up

Table 5- Treatment given on !st follow up

C. On 2nd follow up

Table 6-Treatment given on 2nd follow up

D. On 3rd follow up

Table 7-Treatment given on 3rd follow up

Figure 1- Effect of Ayurvedic treatment on shwitra

Figure 2- Effect of Ayurvedic treatment on shwitra

VI. MATERIALS AND METHODS

The literary sources for the Present study was collected by ayurvedic samhitas like Rasa Ratna Samucchaya, Charaka Samhita, Sushruta Samhita, Sharangdhar Samhita, etc. It will be correlated with the contemporary available books, literature, journals, websites, and research paper as per the need of the study.

VII. DISCUSSION

Shwitrahara Kashaya and lepa contains psoralens, which on exposure to the sun bring out melanin in the depigmented lesions13. Haridra, whose synonyms are named after its beneficial effects on the skin, is a potent drug with adaptogenic, hypoglycemic, antimicrobial, antiallergic, hepatoprotective and antioxidant properties. Here, its role is to protect the skin from the irritating effects of Bakuchi and as an emollient.Chakramarda and Chakshusya are best owed with similar properties and are popular for skin disorders and have potent antimicrobial and antiallergic properties. Purified Haratala, an arsenic compound, was used in the ointment. This was selected on the basis of its reference in Rasa Ratna Samucchaya. Purified Haratala is bestowed with immune modulating properties.

The combined effect of all Shaman-Shodhan and Bahya Chikitsa may be due to increased hepatic function, immunostimulation and photoreaction.

The main Dushya in Shwitra is Rakta Dhatu and Dosha is Pitta Dosha the expression of disease is at skin level. Among the main ingredients of Shwitrahara kashaya and lepa, Bakuchi is a renowned herb with many therapeutic properties. It has been extensively used by all the Ayurvedic scholars in hypopigmentation with great success14

Conclusion

Though the Shwitra is explained as Kashtasadhya Vyadhi and takes long period to cure, can be managed with better improvement with practice of Shodhan, Shaman and external application of oils and Lepas taking the consideration of Rugna, Bala, Vyadhi Bala, Dosha, Dushya, Desh, Prakriti, Kaal. A clinical trial with Shwitrahara kashaya containing Bakuchi, Haridra (powerful antioxidant), etc. in the decoction form, and the same drugs along with Haratala (immunomodulating) on topical use in vitiligo showed that the formulation is a safe remedy with significant pigment regenerating capacity.

References

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Copyright

Copyright © 2024 Dr. Mikhil Trambakrao Patil, Dr. Deepak Khawale. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.