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ALTERNATIVE MEDICINE
Year : 2015  |  Volume : 1  |  Issue : 1  |  Page : 41-43

Management of vitiligo: An ayurvedic perspective


1 Department of Ayurveda, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
2 Department of Ayurved Samhita, Podar Ayurved Mahavidyalaya, Mumbai, Maharashtra, India
3 Department of Kayachikitsa, Government Ayurved College and Hospital, Nagpur, Maharashtra, India

Date of Web Publication1-Dec-2015

Correspondence Address:
Anuradha Khandekar
Department of Ayurveda, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/WKMP-0110.170752

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  Abstract 

Shwitra or Shwet-Kushtha can be co-related with skin disease "vitiligo" in biomedicine. According to Ayurveda, the skin is one of the essential sense organs. Vata and bhrajaka pitta reside in the skin (called twak in Sanskrit). As the skin covers the whole body, bhrajaka pitta should be maintained in a proper state, and it needs continuous care. An imbalance in Vata and bhrajaka pitta may cause skin diseases. The first step (Step 1) in Ayurvedic management of vitiligo is purification therapies (shodhana karma) using herbal decoction of Psoralea corylifolia (bakuchi kwatha) and Euphorbia neriifolia (snuhi) aimed to induce multiple bouts of purgation. In the next step (Step 2), oil massage using oil selected on the basis of patient examination (rogi pariksa) and disease (roga). Step 3 is the exposure of lesions to the sun rays as long as the patient can tolerate (Soorya pada santhapam in Ayurveda). Herbomineral preparations include topical application of herbal Lepa, powders made up of medicinal plants (Curna), herbalized ghee preparations similar to paste (Ghrita, semi-solid preparations taken orally, by licking (Avaleha), herbalized oil preparations (Thaila), fermented solutions (Asava-Arista), and tablets (Vati/Gutika). Various minerals and metallic salts (Rasousadha) are also used. Bakuchi oil is Ayurvedic medicinal oil prepared from the dried fruits of P. corylifolia, and sesame oil is a popular therapy for vitiligo in Ayurveda that contain psoralen to stimulate melanocytes when exposed to ultraviolet light exposure. Details of above-mentioned therapy are discussed. Scientific rationale behind the use of these medications needs to be further explored with modern methods and research.

Keywords: Ayurveda, herbal, kushtha, psoralen, shwitra, treatment


How to cite this article:
Khandekar A, Jadhav JH, Danga SK. Management of vitiligo: An ayurvedic perspective. Indian J Drugs Dermatol 2015;1:41-3

How to cite this URL:
Khandekar A, Jadhav JH, Danga SK. Management of vitiligo: An ayurvedic perspective. Indian J Drugs Dermatol [serial online] 2015 [cited 2019 Sep 22];1:41-3. Available from: http://www.ijdd.in/text.asp?2015/1/1/41/170752




  Introduction Top


Vitiligo is known in Ayurveda as "shwitra."[1] It is of two types, that is, Kilas and Varuna.[2] However, some authors consider these are synonymous.[3] Modern science explains it as a condition caused due to improper distribution of the melanin (impaired melanocyte production), beneath the skin surface. This may be hereditary, medicine originated (caused due to toxicity), side effects of radiation or chemotherapy, etc., However, in significant percentage of people, it is found without any above said specific reasons and are grouped under the heading of idiopathic leukoderma. In Ayurveda, the disease shwitra is grouped under skin disorders.[4]


  Etiology (Nidana) Top


The causative factors for skin diseases (kusta) and vitiligo (Shwitra) are the same [5] and affect the same basic body tissue (dhatu) levels. Shwitra differs from other skin disorders by the normal functioning of all but the "skin tissue" (twak)[6] resulting in discoloration of the skin (twak vaivarnyata), without discharge (aparisravi).[7],[8]

Ayurvedic texts explain following factors as the direct or indirect reasons for vilitigo (shwitra): Viruddhahara (incompatible food), chardivegadharana (suppression of vomiting), atibhojana (excess food intake), Atyamla, Lavana, Madhura, Katu Rasa Sevana (intake of sour, sweet, salt, and pungent food excessively), navanna, dadhi, matsyabhakshana (heavy intake of fresh grains, curd, and fish), vipra-guru gharshana (teasing and disrespecting the elders), papakarma (sinful acts), etc.[9]


  Ayurvedic Pathophysiology (Samprapti) Top


Due to one or all of the above said reasons, three doshas – Vata, pitta, and Kapha are aggravated in association with skin, blood (Rakta), muscles (Mamsa), and watery element (Udaka). These altogether involved invariably in different grades, and hence varieties of skin diseases are caused. If lymph (Rasa) and blood (Raktha) are significantly involved, it results in vitiligo that is, shwitra-kushta.[3] Among these, Vata variety is difficult to cure. Pitta variety is still more difficult for treatment, and Kaphaja kind is impossible to treat. Based on the clinical features, the condition where the lesions appear with black hair, thin, nonmatted, newly originated, caused due to other than burn reasons are curable. The lesions which are very white in color and chronic in nature are incurable. The lesions of vitiligo appearing in palm, sole, genitalia, and lips are incurable.


  Treatment (Chikitsa) Top


Vitiligo (Shwitra) is chronic (Deergha Roga) and should be treated immediately. Classical textbooks of Ayurveda recommend four steps of treatment. The first step (Step 1) is purification therapies (shodhana karma) using an herbal decoction of Psoralia corylifolia (Bakuci Kwatha) and Euphorbia neriifolia (snuhi). This medicine is expected to induce multiple bouts of purgation. In the next step (Step 2) oil massage using oil selected on the basis of patient examination (rogi pariksa) and disease (roga). Step 3 is exposure of lesions to the sun rays as long as the patient can tolerate (Soorya pada santhapam in Ayurveda). Patient receives Gruel (peya) for the following 3 days. If bullae arise after a sun bath they must be punctured using a sterile needle. For the last 3 days, the patient receives decoction (kwatha) made of Ficus hispida (malayu), Pterocarpus marsupium (asana), Calllicarpa macrophylla (priyangu), Peusedanum graveolens (satapuspa), Coleus vettiveroides (ambhasa), and alkaline extract of Butea monosperma (palasa ksara), along with an alcoholic preparation of jaggery (the preparation is called phanitha in Ayurveda). On these 3 days, the diet should be salt-free and should contain buttermilk.[10]

Ayurveda recommends any of the following medicines alone or in combination, following the four steps of initial therapy mentioned earlier.


  Preparations That May or May not Contain Minerals (Herbo-Mineral Preparation) Top


Topical applications (Lepa)

Ankollakadi Lepa, Avalgujadi Lepa, Bakucyadi Lepa, Balyadi Lepa, Bhallatakadi Lepa, Bhringarajadi Lepa, Gandhakadi Lepa, Girikarnika yoga, Grhadhumadi Lepa, Gunjadi Lepa, Gunjaphaladi Lepa, Katukalabvadi Lepa, Manasiladi Lepa, Maricadi Lepa, Panca Nimbava Lepa, Pathyadi Lepa, Patrakadi Lepa, Putikadi Lepa, Talakadi Lepa, Triphaladi Lepa, and Vayasyadi Lepa. [10]

Bakuci bija yoga, Bakuci prayoga, Bhadrodumbarikadi yoga, Dhatryadi kwata, Kakodumbarika kasaya, and Khadiradi Kashayam.

Simple or compound powders made up of medicinal plants (Curna)

Bakucyadya Curna, Kakodumbarikadi yoga, Khadira saradi Curna, and Pancanimba Curna.[10]

Herbalized ghee preparations similar to paste (Ghrita)

Jatyadi Ghrita, Mahamarkara Ghrita, Mahaneela Ghrita, Mahatiktaka Ghrita, Maha vajraka Ghrita, Neelaka Ghrita, Neeli Ghrita, Neeli nyadi Ghrita, Somaraji Ghrita, and Tiktaka Ghrita.[10]

Semi-solid preparations taken orally by licking (Avaleha)

Bhallatak avaleha and Vidangadi loha.[10]

Herbalized oil preparations (Thaila)

Thaila or "Tel" in Ayurveda is oil. Such oils which are likely to be effective are Aragwadhayadya Thaila, Citrakadya Thaila, Jyotishmati Thaila, Kusta Kalanala Thaila. Kusta raksasa Thaila, Laghu maricadya Thaila, Maha Vajra ka Thaila, Manasiladya Thaila, Maricadya Thaila, and Visha Thaila. When treating skin disorders, Thaila may be applied topically with a massage (Abhyanga), instilled into the nostrils in combination with oil massage of the face, or could be given orally (Pana).[10]

Fermented solutions (Asava-Arista)

Kanakabindvarista and Madhwasava.[10]

Tablets (Vati/Gutika)

Swayambhu Guggulu, Triphala Gutika, and Brhat Swayambhuva Guggulu.[10]


  Preparations That Always Contain Minerals Top


Formulations containing processed minerals and metallic salts (Rasousadha). These are Chandraprabha Vati, Galitakustari Rasa, Khageswara Rasa, Kustebhakesari Rasa, Medani Sara Rasa, Pittala Rasayana, Tarakeswara Rasa, and Vijayeswara Rasa.[10]


  Combined Formulations and Single Herbs Top


In addition to the above-mentioned treatment options, classical books list many more combined formulations and single herbs that do not have any specific names. These may be topical or oral medications; or herbal or herbomineral. As such preparations are described under the section vitiligo, many practitioners do prescribe them.[10]

An Ayurvedic preparation consisting of dried ginger, black pepper, pippali, and leadwort root fermented in cow's urine was given internally and paste of several herbs with Psoralea corylifolia used for external application were prescribed to 10 patients of vitiligo. It was found that six of them had sustained positive response. The effect of the formulation may be due to increased immunostimulation, hepatic function, and photoreaction.[11]

Bakuchi oil is Ayurvedic medicinal oil prepared from the dried fruits of P. corylifolia, and sesame oil used widely in the treatment of vitiligo in Sri Lanka. The treatment consists of applying the oil to the affected areas of the skin and exposing them to sunlight. The major secondary metabolite found in P. corylifolia is the furanocoumarin, psoralen. Psoralen stimulates repigmentation by sensitizing the skin to ultraviolet light.[12] Purified psoralen extracts in the tablet or capsule form is also used for the treatment of vitiligo in modern medicine.

P. corylifolia, commonly known as Babchi, is a popular herb, which has since long been used in traditional Ayurvedic and Chinese medicine for its magical effects to cure various skin diseases.[13]

In this study, 120 cases of vitiligo receiving psoralen were analyzed. Forty patients were treated with topical psoralen, another 40 patients were given oral psoralen, and the remaining 40 patients used both oral and topical psoralens. Treatment was given once daily followed by sun exposure for 6 months. Fourteen cases using topical psoralen, 22 patients receiving oral psoralen l mg, and 24 patients receiving combined treatment showed partial repigmentation. Only 15% cases using oral psoralen alone showed complete repigmentation. Combined treatment was the most effective, leading to complete repigmentation in 30% patients.[14]

Wholesome diet and habits

Vrata-pooja-patha-dana (fasting, worship, enchanting the sacred hymens, donation, etc.,), offering food daily to poor on charity basis, visit to pilgrimage places, old rice (Puranashali), Wheat (Godhuma), Green gram (Mudga), light food (Laghuahara), Patola (bitter gourd), Kadirodaka (hot infusion of Khadira), etc.[15]

Unwholesome food and habits

Viruddhahara (incompatible food), Guru ahara (heavy food), Vidahiahara (spicy, pungent food), Vishtambhiahara (constipatives), Anupamam sa (aquatic animals), Kanda-Moola (roots and tubers), Masha (black gram), Amla–katu-lavanarasa (sour, pungent, salty food), Kritaghnata (being thankless), Deva-guru ninda (speaking ill of teachers and gods), etc.

In summary, Ayurveda has different approach to the understanding and treatment of vitiligo which requires extensive research. Although medicines and holistic approach may contribute significant benefits to patients of vitiligo, scientific rationale behind use of these medications need to be further explored with modern methods and research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Vrudha Jeevaka. Kasyapa Samhita Kustachikitsitadhyaya. Varanasi, India: Chowkhamba Viswabharati; 2002. p. 2.  Back to cited text no. 1
    
2.
Bhavamishra. Bhavaprakasha, Kustachikitsitadhyaya. India, Varanasi: Chowkhamba Orientalia; 2010. p. 211.  Back to cited text no. 2
    
3.
Charaka. Kusta chikitsitam. In: Dridhabala C, editors. Charaka Samhita. Varanasi, India: Chowkhamba Sanskrit Series Office; 2002.  Back to cited text no. 3
    
4.
Krishnamurty MS. Vitiligo-Ayurveda Perspectives and treatment options. Available from http://www.easyayurveda.com.(Last accessed on 2014 Mar 23)  Back to cited text no. 4
    
5.
Madhava. Madhava Nidana Kusta Nidanam. Varanasi, India: Chowkhamba Orientalia; 2001. p. 174.  Back to cited text no. 5
    
6.
Chakrapani. Kusta chikitsitam. In: Dridhabala C, editors. Charaka Samhita. Varanasi, India: Chowkhamba Sanskrit Series Office; 2002. p. 174.  Back to cited text no. 6
    
7.
Vagbhata. Astanga Samgraham Kusta Krimi Nidana Adhyaya. Varanasi, India: Chowkhamba Krishnadas Academy; 2005. p. 39.  Back to cited text no. 7
    
8.
23. Vagbhata. Astanga Hrudaya Kusta Switra Krimi Nidana Adhyaya. Varanasi, India: Chowkhamba Krishnadas Academy; 2000. p. 37.  Back to cited text no. 8
    
9.
Krishnamurthy MS. Ayurveda Perspective and Treatment Options. Available from: http://www.easyayurveda.com. [Last accessed on 2014 Mar 23].  Back to cited text no. 9
    
10.
Narahari SR, Aggithaya MG, Suraj KR. A protocol for systematic reviews of Ayurveda treatments. Int J Ayurveda Res 2010;1:254-67.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.
Donata SR, Keshvan M, Austin SR, Mohan KS, Vijaygopalan K. Clinical Trial of certain Ayurvedic medicine indicated in vitiligo. Anc Sci Life 1990;IX: 202-6.  Back to cited text no. 11
    
12.
Mahendra AA, Bandara GK, Rohinie GA, Disala JC. Studies on the composition and standardization of "Bakuchi Oil", an ayurvedic medicinal oil prepared from psoralea corylifolia L. used in the treatment of Vitiligo. International journal of research in Ayurveda and pharmacy. 2012; 3: 411-415   Back to cited text no. 12
    
13.
Khushboo PS, Jadhav VM, Kadam VJ, Sathe NS. Psoralea corylifolia Linn.-"Kushtanashini". Pharmacogn Rev 2010;4:69-76.  Back to cited text no. 13
    
14.
Kar PK, Snehi PS, Jha PK. Treatment of vitiligo with psoralen. Indian J Dermatol Venereol Leprol 1990;56:121-2.  Back to cited text no. 14
  Medknow Journal  
15.
Krishnamurthy MS. Vitiligo – Ayurveda Perspective and Treatment Options. Available from: http://www.easyayurveda.com. [Last accessed on 2014 Mar 23].  Back to cited text no. 15
    




 

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Abstract
Introduction
Etiology (Nidana)
Ayurvedic Pathop...
Treatment (Chikitsa)
Preparations Tha...
Preparations Tha...
Combined Formula...
References

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