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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 80-83

Ayurvedic management of Urushiol-induced contact dermatitis with Agadayogas: A case report


Department of Agada Tantra, Nandha Ayurveda Medical College and Hospital, Erode, Tamil Nadu, India

Date of Submission13-Aug-2021
Date of Acceptance03-Jun-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Dr. Anjali Nandakumar
Department of Agada Tantra, Nandha Ayurveda Medical College and Hospital, Erode, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_66_21

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  Abstract 


Bhallataka (Semecarpus anacardium Linn.) is a drug mentioned under Upavisha varga belonging to Anacardiaceae family. It is known to produce potential and sometimes life-threatening anaphylaxis. The utility of Agada yogas in cases of hypersensitive allergic responses due to contact, particularly urushiol-induced contact dermatitis, is magnified in this case report. A 23-year-old male patient with clinical presentation of blisters associated with burning sensation and itching over both the hands with a history of contact with marking nut tree is presented here. The case was treated with Ayurvedic approaches and formulations such as Vibhitaki twak (bark of Terminalia bellirica Linn.), Kottamthagaradi agada, Bilwadi agada, Punarnavasava, and Avipattikara churna, which gave a successful and satisfactory result within a short span of time.

Keywords: Agada, Bhallataka, Visha


How to cite this article:
Nandakumar A. Ayurvedic management of Urushiol-induced contact dermatitis with Agadayogas: A case report. J Ayurveda Case Rep 2022;5:80-3

How to cite this URL:
Nandakumar A. Ayurvedic management of Urushiol-induced contact dermatitis with Agadayogas: A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2022 Aug 13];5:80-3. Available from: http://www.ayucare.org/text.asp?2022/5/2/80/348700




  Introduction Top


Agada tantra is the branch of Ayurveda that is least explored in terms of emergency management of various conditions including hypersensitive allergic responses irrespective of the fact that the system has numerous Agada (~antitoxic) formulations that can give best results within a short span of time. Bhallataka (Semecarpus anacardium Linn.) belonging to the Anacardiaceae family is commonly known as the marking nut, which consists of a pigment that has been used since ancient times to mark fabrics and is also known as the varnish tree.[1] It is potent enough to produce allergic manifestations in the form of contact dermatitis.[2] Phytoconstituents of this plant, namely alkyl catechols, phenols, quinols, and resorcinols, are responsible for allergic skin reactions.[3] Bhallataka is subjected to undergo various methods of Shodhana (~preliminary processing) possibly to nullify the toxic effects, that the drug can produce before its therapeutic usage.[4] It is mentioned under Upavisha varga by Rasatarangini and Dhanvantari Nighantu.[5],[6] Sopha hetu, its synonym is attributed due to its blister-causing nature,[7] which indicates that this drug should be handled with utmost care and precautionary methods during collection, processing, etc. The fruit of this plant consists of tarry oil in its pericarp, which causes blisters on contact. The major constituent of tarry oil is anacardic acid and bhilawanol, a mixture of phenolic compounds, including cis and trans isomers of urushiol (3-pentadecenyl-8′catechol).[8],[9] The corrosive properties of the juice are due to these two phenolic acids.[10] Microscopic studies also revealed the presence of large amounts of oils in the pericarp of the plant.[3] Direct contact with the marking nut tree can trigger an allergic response, which is named medically as urushiol-induced contact dermatitis or Toxicodendron dermatitis or Rhus dermatitis.


  Patient Information Top


A 23-year-old male patient came with a clinical presentation of blisters associated with burning sensation, itching over both the hands, and generalized edema of body along with restlessness for 24 h. The Prakriti is found to be Pitta dominance.


  Clinical Findings Top


The patient was apparently asymptomatic before one day. The patient gave a history that immediately after accidentally gripping a tree, a blackish tar-like substance appeared over the areas of the body that came in contact with the tree. Within an hour, the patient developed a severe burning sensation and itching. The patient further developed generalized edema and pain. He visited the nearest allopathic hospital for the same and had been prescribed analgesics as he had developed overall body pain at the time. Meanwhile, the patient was informed by the locals that this tree is known as the marking nut tree (Semecarpus anacardium Linn.) (Cherumaram in Malayalam). The next day morning, the patient woke up and found the appearance of blisters and reddish discoloration over the area of contact with the tree. The patient visited the nearest allopathic hospital for which paracetamol and Avil 25 tablets were prescribed along with an analgesic injection. However, relief was not found in his complaints. Later, on the same day, he approached for Ayurveda treatment.

The patient did not have any history of allergic response prior to the present illness and he did not have any surgical history and no family history of allergy. The patient had less appetite with normal bowel habits with symptoms, suggestive of dominancy of Pitta prakriti (~somatic constitution). This might have acted as a triggering factor for the allergic response. Micturition was normal with normal color with a frequency of 5–6 times a day. On Sparsha (~touch) Ushnasparsha (~hot on touch). The patient was moderately built; his sleep was disturbed due to body pain and present illness. The patient was nonvegetarian, nonalcoholic, and had no habit of smoking, consumption of tobacco, or other substance abuse.


  Timeline Top


The detailed timeline is mentioned in [Table 1].
Table 1: Timeline

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  Diagnostic Assessment Top


The diagnosis was based on the clinical history given by the patient along with the local examination of the patient, which revealed the signs and symptoms of urushiol-induced contact dermatitis or Bhallataka sparsha visha as mentioned in Anupanamanjari textbook.[11]


  Therapeutic Intervention Top


Freshly prepared Kashaya of Kottamthagaradi agada[12] was given internally at a dose of 90 ml in the morning at 6:30 am and 90 ml in the evening at 5:30 pm along with 500 mg Bilwadi agada[13] thrice daily before food. Punarnavasava[14] was given at a dose of 30 ml along with 30 ml of lukewarm water after food twice a day. Avipattikara churna[15] was given at a dose of 10 g daily at bedtime along with milk [Table 2]. For external application, Kottamthagaradi agada was advised for Dhara (~pouring medicated decoction), i.e., repeated Dhara every 4th hourly and Vibhitaki twak churna was given for bathing [Table 2]. Coconut water and albumin of coconut were advised for internal use. All the medicines were given for 14 days.
Table 2: Therapeutic intervention

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The patient was advised to avoid non-vegetarian food items and other food items with hot potency such as chilies, tamarind, and spices to avoid the aggravation of Pitta dosha. Ghee and butter were advised to the patient for internal use and external application. External applications were given frequently in a span of every three hours. Ghee and butter were added in the diet along with the food to bring down the symptoms at the earliest. Coconut oil was advised for external application before bathing.


  Follow-Up and Outcome Top


The patient showed marked differences and reduced symptoms within a span of eight days, but still, he was advised to continue the medicines for another six days with an aim of completely eliminating the contents from the body. The patient showed marked relief in symptoms such as blisters and itching within the first five days, and gradually by the last visit on September 22, 2020, almost all the symptoms got reduced [Figure 1] and [Figure 2].
Figure 1: Left hand with blisters (on September 16, 2020)

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Figure 2: Left hand with healing blisters on the first follow-up (on September 22, 2020)

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  Discussion Top


Bhallataka nut shell liquid present in the pericarp of the fruit contains tarry oil consisting of anacardic acid 90% and cardol 10%. Other isolated chemical constituents are bhilawanols (urushiols). These chemical constituents are responsible for the irritation and toxicity.[16],[17] In the present case, accidental exposure to Bhallataka led to an allergic response. Bhallataka possesses Ushna veerya (~hot potency), Tikshna (~potent), and Ushna gunas (~hot in nature).[18],[19] In folk practice, it has been said that application of coconut oil on the affected body parts and drinking tender coconut water is useful in reducing the irritation. Even in Ayurveda, Acharyas have advised to apply coconut oil on the face, hands, and legs during the collection, drying, and Shodhana procedures of Bhallataka.[20] If dermatitis occurs, Pitta shamaka dravyas (~drugs which pacifies Pitta) are advised internally and externally as the Bhallataka is Pittakara in its attribute.[21] Acharya Charaka has quoted the use of Vibhitaki twak (~bark of Terminalia belerica Roxb.) in Granthi (~glandular swellings) and Visarpa (~spreading cellulitis/erysipelas).[22] The active principles in the bark including tannins might catalyze this action and pacify the symptoms.[23]

In cases of Bhallataka sparsha visha, we cannot confide only on single drug or external application alone. Considering the toxic nature of Bhallathaka, the most suitable Agada yoga 'Kottamthagaradi agada' is selected. This Yoga is exclusively indicated in Visha (~poisoning) as well as in the Sopha (~inflammation). The external and internal use of this formulation was beneficial in reducing the redness, blisters, and itching. This Yoga consists of ingredients that pacify Pitta dosha due to its Sheeta virya (~cold potency) and the external Dhara was carried out with the Kashayam prepared out of the ingredients as told in Prayoga samuchayam. Dhara was done for 30 min every fourth hourly as the symptoms were irritating the patient. Along with Kashayam, Punarnavasava was given internally as the edema was generalized. The ingredients of Punarnavasava have anti-inflammatory property, which helps reduce edema and swelling.[24] The patient was advised to take Bilwadi agada as it is a Vishahara yoga, and generally, in clinical practice, Bilwadhi agada is given under conditions of Visha to assure the complete elimination of toxic effects, which may further manifest as Dushivisha (~artificial poison).[25] Avipattikara churna was also advised to the patient to pacify Pitta and Raktha dushti and to reduce the overall body heat.[15] The specific antidote for the toxicity of Bhallataka is Vibhitaki.

In folklore, the decoction or powder preparations with fruit rind and bark of Vibhitaki are effective in sudden allergic reactions manifesting with systemic symptoms.[26] Drugs that mitigate Pitta like milk and clarified butter and other drugs with Sheeta virya have also been advocated internally in cases, where there is an aggravation of Pitta dosha as in urushiol-induced contact dermatitis.[26] All the medicines were given for 14 days and the patient showed marked differences and reduced symptoms within a span of eight days, but still, he was advised to continue the medicines for another six days with an aim of eradicating all the symptoms completely from the body.


  Conclusion Top


The case report infers that Ayurveda treatment modalities can be satisfactorily applied in conditions such as urushiol-induced contact dermatitis. Such customized approaches are proven in this case to successfully prevent further complications associated with dermatitis. In addition, individuals of Pitta prakriti may be more susceptible in developing such manifestations; thus, specific precautions are to be taken when handling Bhallataka-related activities.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
Botanical Dermatology Database – Anacardiaceae; 26 August, 2003. Available from: http://bodd.ct.ac.uk/Bot.Derm.Folder/Bot.Derm.A/ANAC.html. [Last accessed on 2021 Aug 13].  Back to cited text no. 2
    
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Chunekar KC, editor. Bhavaprakasha Nighantu of Shri Bhavamisra, Dhatwadidivarga. Ver. 205. Varanasi: Chaukhambha Bharati Academy; 2010. p. 622.  Back to cited text no. 4
    
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[PUBMED]  [Full text]  
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Nagabhushanaa KS, Umamaheshwari S, Tocolic FE, Prabhu SK, Green IR, Ramadoss CS. Inhibition of soybean and potato Lipoxygenases by Bhilawanols from Bhilawan (Semecarpus anacardium) nut shell liquid and some synthetic Salicylic acid analogues. J Enzyme Inhib Med Chem 2002;17:255-9.  Back to cited text no. 9
    
10.
Naidu DS. Constituents of the marking-nut: Semecarpus anacardium Linn. J Indian Inst Sci 1925;8:129-42.  Back to cited text no. 10
    
11.
Premchand DY, editor. Ayodhya Prasad Achal's Agada Tantra Textbook of Toxicology. 1st ed., Ch. 9. Varanasi: Chaukamba Surabharati Prakashan; 2019. p. 91.  Back to cited text no. 11
    
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Agnives CR, Unnikrishnan P, George MJ, editors. Toxicology – Ayurvedic Perspective. 1st ed. Kottakkal: Vaidyarathnam P.S Varier Ayurveda College; 2002. p. 201-2.  Back to cited text no. 17
    
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22.
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    Figures

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    Tables

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