An Ayurvedic management on Atopic Dermatitis

Atopic Dermatitis affects the estimated 1-5% of world population.It affects more than 10-20% of children.Atopic Dermatitis(ad) is a chronically relapsing skin disorder with an immunologic basis The clinical presentation varies from mild to severe.In the worst cases,atopic dermatitis may interfere with normal growth and development.The etiopathological study of eczema reveals the factors of psychosomatic nature of the disease with associated epidermal barrier dysfunction; genetic determination, allergy, and impaired innate immunity play an important role in pathogenesis of eczema.According to Ayurveda,Vicharchika can be co-related with AD.Ayurveda Treatment modality emphasis on Quality of Life considering holistic approach incase of Atopic Dermatitis.


Introduction
Eczema is a Clinical term that embraces a number of conditions with varied underlying etiologies.Atopic Dermatitis or Eczema ,is the most common chronic relapsing skin disease seen in infancy and childhood.It affects 10-30% of children worldwide and frequently occurs in families with other atopic diseases. 1Atopic dermatitis is a common chronic or relapsing dermatitis characterized by severe pruritis, erythema, oedema, papulo-vesicular and exudative lesions of the face (cheek and infra-auricular area), scalp and extensor aspect of the lower limbs occurring primarily in infants and children. 1 Children with atopic dermatitis often have asthma and allergic rhinitis, termed as Atopic Triad. 2 While AD reflects Genetic predisposition,recent genetic studies have identified polymorphisms associated with increased risk in genes that encode proteins involved in keratinocyte barrier function, innate immunity, and T cell function. 2

Pathology & Pathogenesis
Acute AD are characterized by spongiosis.Chronic type AD is characterized by a hyperplastic epidermis with hyperkeratosis and minimal spongiosis.AD have overlapping clinical presentations.Severely dry skin is a hallmark of AD This results from compromise of the spidermal barrier,which leads to transepidermal water loss,allergen penetration and microbial colonization.AD have overlapping clinical presentations.Severely dry skin is a hallmark of AD. 2

Clinical Manifestation
AD typically begins in infancy.Approximately 50% of patients experience symptoms in the 1st yr of life, and an additional 30% are diagnosed between 1 and 5 yr of age.Intense pruritus, especially at night, and cutaneous reactivity are the cardinal features of AD.Scratching and excoriation cause increased skin inflammation that contributes to the development of more pronounced eczematous skin lesions.

Laboratory Finding
here are no specific laboratory tests to diagnose AD.Many patients have peripheral blood eosinophilia and increased serum IgE levels.Serum IgE measurement or skin-prick testing can identify the allergens (foods, inhalant/microbial allergens) to which patients are sensitized.The diagnosis of clinical allergy to these allergens requires confirmation by history and environmental challenges.

Diagnosis
AD is diagnosed on the basis of 3 major features: pruritus, an eczematous dermatitis that fits into a typical pattern of skin inflammation, and a chronic or chronically relapsing course .Associated features, such as a family history of asthma, hay fever, elevated IgE, and immediate skin test reactivity, reinforce the diagnosis of AD.

AD according to Ayurveda
Each form of eczema has a unique Vikalpa Samprapti, according to Ayurveda.In most cases, srava is the primary characteristic and the disease is Kapha dominating.Vicharchika and this are relatively comparable.When eczema is acute, the dosha is Kapha; however, when it persists, the dosha is Vata.It is justified for Vata to work with Ruksha and Parushatha if there are fissures and fractures.It is extremely important to diagnose and treat eczema using the Vyadhi Avastha.With a particular focus on Dhatusara, Vyadhikshamatva is being diminished in AD.When changed Vyadhikshamatva is involved, Agni situated in Koshta would cause ailments in Shakha similar to twak.. 2

Treatment Principle
Important in this case is Vyadhi Avastha.To remove the Kleda sitting in the Twak in the event that Kandu Kaphahara Chikitsa is called.At this time, the Kaphahara concepts of Shodhana and Shamana can be used.Kshalana, Lepana, and parisheka, three different types of Bahirmarjana, are very significant.Vatahara Chikitsa follows the initial Kapha shamana engagement.Vatahara Chikitsa should refrain from agitating Kaphadosha, nevertheless.Improving Twak Sara requires Balya Chikitsa.Drugs from the Ojokara tribe are used to treat immune system-related problems.For pigmentation and associated issues, use varnaprasadan.Herbs with a lipophilic character that can penetrate all the way to the stratum corneum are Sneha Kalpanas for hydration.

Shodhan Chikitsa
Medicines given after Shodhana tend to be more effective.AsShodhana Chikitsa is adviced in Kushta Vyadhi management as termed as Dushchikitsya.Hence due to Shodhan,it helps in alleviating the root cause .Thus it carries prime importance.For eg.Virechana with Avipattikara churna and Trivitchurna ,these yogas are Raktaprasadana and Kaphapittahara.

Shamana Chikitsa
After Shodhan Chikitsa,Shaman is indicated so as the Doshas get pacified.Its beneficial in those subjects,who are unable to undergo Samshodhan.Tikta and Kashay herbs are advised after Shodhan by Acharya Charaka.Lasika srava is reduced by the decoction of Kaphahara dravyas.Incase of Kaphaj samprapti herbs like indrajav and patha kalka administered with sukhoshna jala.In the first stages of Vicharchika, Kashay with Vranashodhan property is favoured.Aragwadhadi Kashay reduced Kleda when she was sat in Twak, which decreased Kandu.By bringing down kapha in the koshta, Patoladi Kashay reduces the potency of further doshagati.Balya to dhatus from Indukanta Kashya.Treatment-induced and Vyadhi-based Vatakopa is prevented by medicated ghrit formulations.

Sneha Kalpanas used externally
Medicated Ghrit abhyang alongwith dusting of herbs like Lodhra,Yashtimadhu,Daruhaldi ,Amalki,Dalchini and Tejpatra Churna is adviced by Acharya Kashyapa in pittaj vikara. 2 Eladi Keram is the Varnaprasdana, whereas Nalpamaradi Tailam is the Varnaprasadan.Extreme Rukshata Jeevantyadi Yamaka in crevices.The lipids in the oil will strengthen the skin barrier and provide more effective moisture barriers.The anti-pruritic and shyaavavarnatha (blackish discolouration) properties of Kalyanaka Ghritha serve as varnya.The lipids in ghrita enhance the skin barrier and help to keep moisture in.Also these restore the composition of lipid bilayers in the stratum corneum and reduce skin permeability.It aids to soften the skin.

Conclusion
Atopic Dermatitis though commonly seen in childhood, Ayurveda treatment modality prove to be beneficial considering the holistic approach.Ayurveda suggests the utilization of various herb infused soaks,oils and dusting powder alongwith Shodhan-Shaman Chikitsa according to Doshic involvement and dietary regimen,to improve the skin.Thus it do serve to be beneficial to improve Immunity and Quality of Life .