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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 15  |  Issue : 4  |  Page : 317-321

Ayurvedic management of acne vulgaris


1 Consultant Ayurveda Physician, Astanga Ayurveda Hospital & Research Center, Kalanki, Kathmandu, Nepal
2 Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India

Date of Submission05-Oct-2020
Date of Decision29-Jul-2021
Date of Acceptance16-Aug-2021
Date of Web Publication16-Dec-2021

Correspondence Address:
Abhishek Upadhyay
Assistant Professor, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_197_20

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  Abstract 


Introduction: Acne vulgaris has always been one of the most burning problems of the young population. Acne vulgaris like presentation in Ayurveda has been described as Shalmali thorn like eruptions on the face due to vitiation of Kapha, Vata, and Rakta under the heading of Mukhadushika. Very less scientific data is available depicting the effect of Ayurvedic intervention in such cases. Main Clinical Finding: Present case reports a 26 years old female having multiple acne for the past 6 months. She had papules and pustule with itching, pain, and blackish spots on cheeks. Diagnosis: Condition was diagnosed as Acne vulgaris (Ayurvedic diagnosis – Pitta-Kapha dominant Tridoshika Mukhadushika). Interventions: The patient was treated with Kaishor Guggulu, Raktaprasadakahima, and the local application of Terminalia arjuna powder mixed with honey daily for 1 month. Outcome: The patient had relief in all the symptoms after 15 days of treatment with no new eruptions. Complete remission of the disease was observed after 1 month of treatment with the improved skin condition. Conclusion: This case study demonstrates the potential and usefulness of Ayurveda in the management of acne vulgaris.

Keywords: Ayurveda, case report, Kaishor guggulu, Sebaceous glands, Terminalia arjuna


How to cite this article:
Upadhyay A, Khanal H, Joshi RK. Ayurvedic management of acne vulgaris. J Ayurveda 2021;15:317-21

How to cite this URL:
Upadhyay A, Khanal H, Joshi RK. Ayurvedic management of acne vulgaris. J Ayurveda [serial online] 2021 [cited 2022 Jan 27];15:317-21. Available from: http://www.journayu.in/text.asp?2021/15/4/317/332603




  Introduction Top


Acne vulgaris is a common cutaneous disorder characterized by chronic or recurrent development of papules, pustules, or nodules on the face, neck, trunk, or proximal upper extremities[1] with the peak of severity in the late teenage and may persist up to the 3rd decade and beyond, particularly in females.[2] In different countries and among different age groups, the prevalence of acne varies, with estimates ranging from 35% to over 90% of adolescents having acne at some stage.[3] The primary factor for the appearance of the disease is the increase in sebum production by sebaceous glands.[4] The condition mainly affects the face (99%) and to a lesser extent the back (60%) and chest (15%). Noninflamed lesions (comedones) develop earlier than inflamed lesions in younger patients. The superficial lesions are usually papules and pustules, and the deep lesions are deep pustules and nodules.[5]

Acne in Ayurveda has been described as Mukhadushika or Yuvanapidika under the heading of Kshudraroga. Shalmali thorn like eruptions on the face due to vitiation of Kapha, Vata, and Rakta are known as Yuvanapidika or Mukhadushika or Tarunaya Pidika.[6] Sa-ruja (painful), Ghana (thick, hard, or indurate), and sebum (Meda) filled Pidika (eruptions) are hallmarks of Mukhadushika.[7] Vitiated dosha get accumulated and obstruct the Lomakupa (pilosebaceous unit) causing local swelling and micro comedone formation. Paka (inflammation) of these elements lead to papule, pustule, and cyst formation which on rupture cause Vrana vastu (scar) formation. Allopathic treatment includes the use of topical retinoid, benzoyl peroxide, oral antibiotics, steroids, and oral isotretinoin[8] although its use is limited by teratogenicity and other side effects.[9] Ayurveda has a great potential in the management of various skin disorders and in this article, a success story of the management of acne vulgaris is being reported.


  Case Report Top


A 26-year-old married, non-smoking, non-alcoholic Hindu female, registered vide outpatient department number 4011122019, presented with complaints of multiple eruptions on cheeks for 6 months. Eruptions were distributed all over the face but maximum on the cheeks [Figure 1]. Symptoms started with a single eruption on her right cheek and within 15 days multiple eruptions spread all over the face. History of purulent discharge from pimples was present along with pain and itching. The pain was mild to moderate in nature and aggravate on manual rupturing of pimples. The itching was worse during evening and night hours and on exposure to dust and sunlight. Blackish spots on the face were present as leftover marks of pimples. According to the patient, she had used some allopathic medicines but did not get significant relief. The local use of soaps, face wash, and creams were worsening the symptoms sometimes. The patient had no history of associated fever, psoriasis, eczema, melasma, or any other chronic illness such as diabetes, hypertension, tuberculosis, thyroid disorder, polycystic ovaries, or surgical interventions. Her appetite was good with normal bladder and bowel movements. On examination of the eruptions, they were 2–4 mm wide erythematous papules and pustules on the face with both variety of comedones (blackheads and white head) and scarring in a few of the lesions. Mild tenderness was present on palpation over the pimples. The rest of the skin was normal in texture with normal elasticity. Recorded blood pressure was 110/70 mm of Hg, pulse was 74/min, and other vital signs were within normal limits. No other significant abnormal clinical finding was detected during the systemic examination.
Figure 1: Image taken at first visit to outpatient department

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Therapeutic intervention

Vitiated Tridosha along with the vitiation of Rakta (blood) and Meda (Sebum) are the main pathognomic factors in Mukhadushika. In the present case, symptoms such as Shula (pain) and Vrana Vastu (scar) were due to vitiated Vata whereas Paka (Inflammation) and Daha (burning sensation) were due to vitiated Pitta and Rakta. Vitiated Kapha is responsible for the development of Puya (pus), Sotha (swelling), Srava (discharge), and Kandu (itching) in the lesions. The patient was diagnosed with Pitta-Kapha dominant Tridoshic Mukhadushika. Hence, two oral drugs Kaishor Guggulu[10] and Raktaprasadaka hima having Pitta-Kapha pacifying actions and Rakta shodhaka (blood purifier) properties were selected. For local application powder of bark of Arjuna[11] was selected.

Oral intervention

The posology of oral intervention is mentioned in [Table 1].
Table 1: Ayurveda oral drug intervention

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Method of preparation and use for Raktaprasadaka hima

The patient was advised to soak 6 g of Raktaprasadaka hima powder in one cup (50 ml) of cold water for at least 12 h during the night. After soaking for the required duration, the mixture was mashed properly and filtered through a clean cloth. The patient was instructed to consume the filtrate empty stomach.

Drug for external application

The patient was asked to take 6 g of fine powder of the bark of Arjuna and mix it with honey in sufficient quantity and apply it on the face once daily. The medicated paste (Lepa) was leftover the face for half an hour and then rinsed off using cold water. Fresh powder was used every time to make the paste. Bark of Terminalia arjuna Roxb. has Varnya (good for skin color), Twachaya (beneficial for skin problems), Kandughna (reduces itching), and Vrana Ropana (wound healing) properties.[12]

Diet and Lifestyle advised during treatment

Pathya (Do's)

Green leafy vegetables, wheat, rice, moong dal, fruits, lukewarm water in sufficient quantity to drink, homemade food.

Apathya (Don'ts)

Junk food, curd, cold drinks, nonveg, tea, alcohol, excess sweets, excess spices, fried, and food articles having excess fat content. Ratrijagaran (night awakening), Divaswapna (daytime sleeping), manual rupturing of acne, excessive exposure to sunlight, and dust.

Follow-up and outcome

The outcome was assessed based on the improvement in clinical signs and symptoms. Criteria on which improvement was observed were the number of lesions (acne), pain, itching, and the number of black heads [Table 2]. The patient was assessed for 1 month with follow-up at the interval of 15 days. Photographs at fixed megapixel under the same intensity of light, posture, and distance were obtained before intervention and at every follow-up visit to observe the improvement. Significant improvement in all signs and symptoms was observed after Ayurvedic interventions [Table 3]. The patient did not develop new eruption of papules after intervention and had relief in pain and other symptoms after 15 days of treatment [Figure 2] whereas complete remission was achieved after 1 month of treatment [Figure 3].
Figure 2: Image taken at second visit to outpatient department after 15 days

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Figure 3: Image taken at third visit to outpatient department after 1 month

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Table 2: Grading of sign and symptoms

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Table 3: Changes in sign and symptoms after Ayurvedic intervention

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  Discussion Top


In the present case, there was a history of regular consumption of Vidahi (sour and pungent), Abhishyandi (potential elements causing obstruction in channels), and Virrudha (incompatible) food such as fast food, salty, and oily substances with the habit of Adhyashana (consuming food without earlier meal completely digested), Ratri Jagaran (late night sleep), and Divaswapana (day time sleep). These etiological factors may be the cause for vitiation of Kapha-Pitta and Rakta, further causing secondary vitiation of Vata due to Srotas avarodha (sebaceous glands in this pathogenesis) resulting in the formation of Pidika (eruptions) on the face with clinical presentation as acne with pain, itching, and discoloration of skin [Figure 3]. Kapha-Pitta-Rakta pacifying treatment was planned according to the principles of the management of Mukhadushika.

Hima kalpana a type of Panchavidha kashaya kalpana is one of the best Pitta Shamak Kalpana (formulation).[13] Raktaprasadaka hima contains Solanum nigrum Linn., Hemidesmus indicus R. Br., Phyllanthus urinaria Linn., Rubia cordifolia Linn., and Vetiveria zizanioides Linn. These ingredients possess a blood purifier, Kushthagna (beneficial for skin disease), Shothahara (reduces swelling), Varnya (good for skin color), Twakdoshahara (beneficial for skin problems), Dahaprashamana (reduce burning sensation), and wound healing properties. Hemidesmus indicus R. Br. and Rubia cordifolia Linn. the main ingredients of Raktaprasadaka hima have shown anti-inflammatory activity in research studies by suppressing the Propionibacterium induced reactive oxygen species and proinflammatory cytokines, the two important inflammatory mediators in acne pathogenesis.[14] The antiacne effects of Rubia cordifolia include four mechanisms i.e., antibacterial, anti-inflammatory, antioxidant, and antiandrogen activities.[15]

Kaishor guggulu having Guduchi, Triphala, and Guggulu as main ingredients has Kaphaghna and Medoghna effect due to Katu, Tikta, and Kashaya Rasa dominance. It helps in eliminating the vitiated Kapha which is mainly responsible for increased sebum production and thus obstructing the ducts of the sebaceous glands. Kaishor Guggulu has antiallergic, antibacterial properties acts as a natural blood cleanser and is indicated in different skin diseases.[16] Kaishore guggulu is having Raktaprasadaka, Vataghna, Shothahara (reduces swelling), Vrana ropaka (wound healing properties), and Rechaka (laxative) properties by virtue of which it was helpful to reverse the underlying pathogenesis

Arjuna twaka is Sheeta Veerya in nature and has Kashaya Rasa, Laghu, Ruksha guna, Pitta shamaka, and Rakta Prasadaka properties. Due to Kashaya Rasa and Sheeta Veerya properties, it encounters vitiated Pitta and Rakta Dosha, removes the Twaka Vaivarnayata, and helps to maintain the normal skin color. The Rakta Prasadaka, Varnaya (good for skin color), Vranaropaka (wound healing), and Twaka Prasadaka actions of Arjuna pacify the locally accumulated Dosha and help in mitigating the external manifestation of the disease. The flavonoid components present in Arjuna have anti-inflammatory, antioxidant, and antibacterial properties[17],[18] which help to fight the root cause of acne vulgaris. Honey was used for making a paste with Arjuna Twaka powder because in different studies honey has shown antiseptic, antimicrobial, anti-inflammatory, antioxidant, healing, and cleansing properties.[19]

In the present study, during the first follow-up, significant relief in all signs and symptoms of acne was observed. There was disappearance of already present acne with no new eruptions, complete relief in itching and the pain was observed with significant improvement in blackish spots over the face in 1-month duration.


  Conclusion Top


Acne vulgaris is a common skin disorder which affects almost all individuals at least once during life. It is a chronic disease having relapsing nature and is difficult to manage if not dealt with appropriately at the right time with appropriate treatment strategies. The present case study clearly demonstrates that Ayurvedic principles and drugs are very effective in the management of acne vulgaris. However, a clear understanding of the Pancha Nidana (Ayurvedic diagnostic method) and appropriate selection of drugs are essential to get the desired results. Raktaprasadaka hima, Kaishore guggulu, and the local application of Arjuna bark powder with honey were found to be effective in acne vulgaris in present case with no untoward side effects.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their 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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Thiboutot D, Zaenglein A, Levy ML, Dahl MV. In: Ofori A, editor. Pathogenesis, Clinical Manifestations, and Diagnosis of Acne Vulgaris. Waltham, Massachusetts: UpToDate; 2014.  Back to cited text no. 1
    
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Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of acne vulgaris in the community. Aust J Dermatol 1997;38:115-23.  Back to cited text no. 3
    
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Archer CB, Cohen SN, Baron SE; British Association of Dermatologists and Royal College of General Practitioners. Guidance on the diagnosis and clinical management of acne. Clin Exp Dermatol 2012;37 Suppl 1:1-6.  Back to cited text no. 5
    
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Susruta Samhita, Nidana Sthana, Kshudraroganidanam, 13/39. Available from: http://niimh.nic.in/ebooks/esushruta/?mod=read. [Last accessed on 2020 Dec 20].  Back to cited text no. 6
    
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Ashtanga Hridyam, Uttar Sthana, Kshudrarogavigyaniya, 31/5. Available from: http://vedotpatti.in/samhita/Vag/ehrudayam/?mod=read. [ Last accessed on 2021 Nov 19].  Back to cited text no. 7
    
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Rathi SK. Acne vulgaris treatment: The current scenario. Indian J Dermatol 2011;56:7.  Back to cited text no. 8
    
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Mishra SN. Bhaisajya ratnavali. Reprint edition 2011., Ch. 27., Ver. 104113. Varanasi: Chaukhamba Surbharati Prakashan; 2007. p. 582.  Back to cited text no. 10
    
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Tripathi Indradeva. Chakradatta. Reprint Edition 2014., Ch. 55., Ver. 44. Varanasi: Chaukhambha Sanskrit Bhawan; 2014. p.315.  Back to cited text no. 11
    
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Sharma PV. Dravyaguna Vijnnaana. Reprint edition 2009., Vol. 2. Varanasi: Chaukhamba Bharati Academy; 2009. p. 195.  Back to cited text no. 12
    
13.
Sharangdhar.Tripathi B. Sarngadhara Samhita. Reprint edition 2006., Madhyam Khanda, Ch. 4. Varanasi: Chaukhamba Surbharti Prakashan; 2006. p. 165.  Back to cited text no. 13
    
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Jain A, Basal E. Inhibition of Propionibacterium acnes-induced mediators of inflammation by Indian herbs. Phytomedicine 2003;10:34-8.  Back to cited text no. 14
    
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Meena V. Manjistha (Rubia cordifolia) – A helping herb in cure of acne. J Ayurveda Holist Med 2015;3:11-7.  Back to cited text no. 15
    
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Lather A, Gupta V, Bansal P, Sahu M, Sachdeva K, Ghaiye P. An Ayurvedic polyherbal formulation Kaishore Guggulu: A review. Int J Pharm Biol Arch 2011;2:497-503.  Back to cited text no. 16
    
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Mandal S, Patra A, Samanta A, Roy S, Mandal A, Mahapatra TD, et al. Analysis of phytochemical profile of Terminalia arjuna bark extract with antioxidative and antimicrobial properties. Asian Pac J Trop Biomed 2013;3:960-6.  Back to cited text no. 17
    
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Nema R, Jain P, Khare S, Pradhan A, Gupta A, Singh D. Antibacterial and antifungal activity of Terminalia arjuna leaves extract with special reference to flavonoids. Basic Res J Med Clin Sci 2012;1:63-5.  Back to cited text no. 18
    
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Al-Waili N, Salom K, Al-Ghamdi AA. Honey for wound healing, ulcers, and burns; data supporting its use in clinical practice. ScientificWorldJournal 2011;11:766-87.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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