Ayurvedic management of vitiligo: An experience

Amit Kataria; Sunaina; Monica Dhiman

doi:10.4103/jacr.jacr_40_22

CASE REPORT

Year : 2023 | Volume : 6 | Issue : 1 | Page : 32-35

Ayurvedic management of vitiligo: An experience

Amit Kataria, Sunaina, Monica Dhiman
Department of Kaumarbhritya, Shri Krishna Government Ayurvedic College and Hospital, Kurukshetra, Haryana, India

Date of Submission	14-May-2022
Date of Acceptance	13-Feb-2023
Date of Web Publication	21-Mar-2023

Correspondence Address:
Dr. Amit Kataria
Department of Kaumarbhritya, Shri Krishna Government Ayurvedic College and Hospital, Kurukshetra, Haryana
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jacr.jacr_40_22

Abstract

Vitiligo is a kind of skin disease characterized by white hypopigmented patches. Although this disorder is not life-threatening, but has a serious cosmetic problem that affects the individual's emotional, psychological, and social well-being. A nine-year-old female child was diagnosed with Shvitra (~vitiligo) two years back who was presented with complaints of increasing area and number of depigmented patches of skin. She has taken PUVA (~Psoralen Plus Ultraviolet A), a type of radiation treatment, and corticosteroids but found no result. Then, an Ayurvedic treatment protocol was designed based on the signs and symptoms. The protocol includes Samshodhana (~eliminative) and Prashamana (~palliative) therapies with a combination of powdered herbal drugs having Raktaprasadaka (~improves the quality of blood), Raktashodhana (~blood purification), and Tridoshahara (~balances three regulatory functional factors of the body) action along with Bakuchi taila (~Psoralea corylifolia L.) for local application. The treatment protocol was found to be effective in the restoration of skin color.

Keywords: Kilasa, Pigmentation, Shvitra, Vitiligo

How to cite this article:
Kataria A, Sunaina, Dhiman M. Ayurvedic management of vitiligo: An experience. J Ayurveda Case Rep 2023;6:32-5

How to cite this URL:
Kataria A, Sunaina, Dhiman M. Ayurvedic management of vitiligo: An experience. J Ayurveda Case Rep [serial online] 2023 [cited 2023 May 30];6:32-5. Available from: http://www.ayucare.org/text.asp?2023/6/1/32/372249

Introduction

The skin diseases in Ayurveda come under the category of Kushtha (~skin diseases). Ayurveda explains Kilasa/Shvitra (~vitiligo) as a type of Kushtha roga.^[1] According to Acharya Charaka, Kilasa is Tridoshaja (~three regulatory functional factors of the body), and Shvitra is one of its types.^[2]

Vitiligo is characterized by developing depigmented skin patches due to dysfunction or destruction of melanocytes, possibly due to an autoimmune mechanism. Its exact cause is still unknown, but various findings instigate that it may be due to autoimmune disorders such as thyroiditis, adrenal insufficiency, polyendocrinopathy, and pernicious anemia.^[3] The prevalence of vitiligo is observed as 0.5%–2.0% of most populations.^[4] The distribution of skin lesions may be generalized and symmetrical or limited to a segment of the trunk or a limb. The lesions are more likely to occur at the sites of repeated trauma.^[3] Various treatment modalities are available in the contemporary system of medicine, such as PUVA (~Psoralen Plus Ultraviolet A) therapy and the use of corticosteroids, but these are time taking, and some even have adverse effects such as skin cancer including melanoma, ultraviolet light burns, nausea, and itching.^[5] It is challenging to provide effective and safe Ayurvedic treatment for vitiligo. An attempt was made in this case to treat Shvitra through Ayurvedic intervention.

Patient Information

A school-going 9-year-old female child of Kapha-pitta prakruti (~physical constitution) visited the Ayurveda hospital outpatient department with complaints of increasing area and number of depigmented patches of skin, which involved most of the back and chest without any discharge and itching from the affected areas [Figure 1]a and [Figure 1]b. Informed consent from the patient was taken. No family history was present related to vitiligo. There was no personal history of allergy and autoimmune disorders (such as atopic dermatitis, psoriasis, and asthma), and none of the substance abuse was noted. The patient skin was normochromic till about two years back, then gradually started with areas of depigmentation over the right lateral aspect of the chest spreading up to the back. The number, size, and area of white patches increased gradually. The patient initially took conservative medication for the same but found no result in the progression of the disease. Then, her parents came for Ayurvedic management.

Figure 1: (a) Showing lateroanterior view- before treatment. (b) Showing lateroposterior view- before treatment

Click here to view

Clinical Findings

The patient looked well with no distress, patches were found on the right lateral aspect of the back and chest in an asymmetric scattered pattern with well-demarked borders, and bright whitish color. Some of the patches have white hair. The biggest patch has about 10–15 small brown spots within. On palpation, the surface of the skin was nontender, smooth, and hairy, without scaling.

Ashtavidha pariksha (~Eight-fold examination)

Mala (~excreta) was Niraama (~unassociated with Ama) with semisolid consistency. Jiwha (~tongue) was uncoated, Sparsha (~touch) was Ruksha (~dry), and Akruti (~body stature) was Samanya (~normal).

Dashavidha pariksha (~Ten-fold examination)

Satva (~psyche) was Pravara (~superior); Aahara shakti (~power of intake and digestion of food) was Madhyama (~moderate); Vyayama shakti (~power of performing exercise) was Avara (~inferior), and Vayah (~age) was Balyavastha (~childhood). She preferred consuming a diet predominantly with Madhura (~sweet) and Lavana rasa (~salt).

Diagnostic Assessment

Hematological parameters such as thyroid profile and serum calcium were carried out, and all parameters were found within normal limits. The patient was observed under woods lamp and diagnosed with a case of Shvitra. Avoiding fast food, oily food, pickles, etc., was advised. The patient had the habit of Divasvapna (~day sleeping) for the last three years.

Timeline and Therapeutic Intervention

The treatment was started with Avipattikara churna (3 gm) with lukewarm water once a day in the morning hours before meal^[6] and Arogyavardhni vati (250 mg) two times a day. Manjishthadi kwatha (10 ml) twice a day before meal was also prescribed. Local application of Bakuchi taila every morning followed by sun exposure for 15-30 mins. For last three years, the patient was taking an incompatible diet in the form of milk- and salt-containing food in night regularly. This habit was advised to discontinue. Diva svapna (~day sleeping) and Ratri jagarana (~night awakening) were avoided. Psychological counseling was given to the patient and her parents so that she could be free from any type of Vata-vardhana causes. On the 7^th day of the treatment, the parent complained that the patient is unwilling to consume Manjishthadi kwatha regularly due to its bitter taste. Thus, Khadirarishta (10 ml) was replaced with Manjishthadi kwatha on the 14^th day. During the assessment, slight redness was observed over few lesions. On the 21^st day, the mixture of Hartala, Gandhaka, and Manashila yoga with Gomutra (~cow urine) was prescribed, in place of Bakuchi Taila for local application for 10–15 min, followed by the early morning sun exposure [Table 1]. After one and half month, brownish spots appeared between the white patches of the back area [Figure 2]a. Avipattikara churna was stopped, and Shashilekha churna (125 mg) with honey was started in the afternoon after meal for one month.^[7] No new patches were observed during this period, and pink color was persisting in the spots and patches. After six months of management, maximum recovery was noticed [Figure 2]b and [Figure 2]c.

Figure 2: (a) After six weeks. (b) After 8 weeks. (c) After treatment

Click here to view

Table 1: Therapeutic intervention

Click here to view

Follow-up and Outcomes

During the treatment, white patches gradually started to become brownish. After one and half month of sun exposure, a brownish patch started spreading to surrounding areas. After 6–8 weeks, normal pigmented skin color appeared in maximum patches [Figure 2]a and [Figure 2]b. After six months of the treatment, repigmentation continued, and changes in patches were very significant [Figure 2]c. Due to continuous sun exposure, the skin of the nonaffected area becomes dark-pigmented. There were no side effects during the whole treatment, and no new patch has been noticed during the follow-up of four months.

Discussion

Shvitra is a common skin problem that a dermatologist encounters very frequently. Having hypopigmented skin is psychologically a disturbing situation for kids and adults as well. In the present scenario, there is no such effective treatment, which gives us a minimal rate of relapse. As with present treatment modalities, improvement cases are fewer and relapsing cases are more. An attempt was made with Ayurvedic formulation here in this case. Pitta pacification, Ama pachana (~removal of undigested toxins), Rakta shodhana (~blood purification), proper diet plan, and Nidana parivarjana (~avoidance of etiological factors) were planned in the patient where significant outcomes were observed. Drugs used in this treatment are potent antisecretory, anti-ulcerogenic, antioxidant, Rakta-shodhaka, and increase blood supply in that area.^[8],[9],[10]

Mode of action of different formulations

Samsodhana was not possible in this patient due to Krisha (~emaciated). Thus, Mridu koshtha shuddhi (~mild laxative) was planned with Avipattikara churna. Bakuchi which stimulates melanocytes and forms an exuded pigment that gradually diffuses into the decolorized area is one of the drugs used in this case.^[11] In practice, it was observed that oil application followed by sun exposure helps in inducing the normal color of skin. During treatment, it was observed that the areas, which have hair follicles recovered faster than the areas without hair follicles assuming that the roots of hairs provide an easy pathway to the melanocyte movement.

Patches over the area where the amount of fat is more were recovered slowly assuming that excess fat causes difficulty in melanocyte cells to move from deep to the upper layer of skin. Shashilekha churna which contains Bakuchi and Tamra (~copper) was given orally to enhance the process of pigmentation and local rubbing of Bakuchi taila. According to Acharya Charaka, Vata gets aggravated by Chinta (~worry).^[12] Thus, psychological counseling plays an important role as it decreases Vata of the patient which aids in the treatment.

Conclusion

Oral administration of Arogyavardhini vati, Shashilekha churna, and the local application of Gandhaka yoga with Gomutra and Bakuchi taila after Anulomana (~smooth evacuation) with Avipattikara churna is effective in the management of Shvitra. No adverse effect was observed during or after treatment. As the results are satisfying, a similar treatment can be followed in other cases of Shvitra judiciously.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Sharma P, editor. Sushruta Samhita, Nidana Sthana; Kushtha Nidana. 7^th ed., Ch. 5, Ver. 17. Varanasi: Chaukhambha Oriental; 2002. p. 286-7.
2.	Sharma P, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana; Kushtha Chikitsa. 5^th ed., Ch. 7, Ver. 174. Varanasi: Chaukhambha Oriental; 2000. p. 142.
3.	Singh M. The skin and its appendages. In: Pediatric Clinical Methods. 6^th ed. New Delhi: CBS Publisher and Distributors; 2020. p. 162.
4.	Kliegman R. Nelson Text Book of Pediatrics. 21^st ed., Vol. 2. Philadelphia, PA: Elesevier; 2020.
5.	Available from: https://www.medicinenet.com/puva_therapy_photochemotherapy/article.htm#what_are_puva_light_therapy_side_effects/. [Last accessed on 2023 Jan 11].
6.	Paradkar H, editor. Astangahrdaya: A Compendium of the Ayurvedic System: Virechana Kalpa Adhayaya. 6^th ed., Ver. 21-23. Mumbai: Nirnaya Sagar Press; 1939. p. 743.
7.	Shastri SB, editor. Yogratnakar, Uttrardh; Kushtha Chikitsa. 8^th ed. Varanasi: Chaukhambha Oriental; 2004. p. 234.
8.	Gyawali S, Khan GM, Lamichane S, Gautam J, Ghimire S, Adhikari R, et al. Evaluation of anti-secretory and anti-ulcerogenic activities of avipattikar churna on the peptic ulcers in experimental rats. J Clin Diagn Res 2013;7:1135-9.
9.	Wang TX, Yin ZH, Zhang W, Peng T, Kang WY. Chemical constituents from Psoralea corylifolia and their antioxidant alpha-glucosidase inhibitory and antimicrobial activities. Zhongguo Zhong Yao Za Zhi 2013;38:2328-33.
10.	Hussain I, Hussain N, Manan A, Rashid A, Khan B, Bakhsh S. Fabrication of anti-vitiligo ointment containing Psoralea corylifolia: In vitro and in vivo characterization. Drug Des Devel Ther 2016;10:3805-16.
11.	Nadkarni KM. Indian Materia Medica. Vol. 2. Mumbai: Popular Parkashan Private Limited; 1976. p. 1021.
12.	Sharma RK, Dash B, editors. Charaka Samhita, Chikitsa Sthana; Vatavyadhi Chikitsa. Vol. 5, Ch. 28, Ver. 16. Varanasi: Chaukhambha Oriental; 2000. p. 25.