Ayurvedic Medicines For The Treatment of Nodular Prurigo
Skin is the largest detoxifying organ of a human body. It covers and protects the body. The main functions of the skin include
- Preventing dehydration by retaining body fluids
- Preventing harmful microbes from getting inside body to protect infections
- Holds sensory receptors for heat, cold and pain
- Maintaining body temperature
Anything that irritates, clogs or inflames skin can result in redness, swelling, burning and itching. Many rashes, hives or other skin conditions may be due to any allergies, irritants, genetic factors, certain diseases or immune system problems.
Prurigo is a skin condition where the skin itches intensely due to cutaneous nodular lesions. This term is used when the exact cause of the itch is known or to describe a condition of unknown causes characterized by small itchy bums on the skin. The basic and biggest difference between prurigo and pruritus (itch) is that in pruritus there is an absence of primary skin lesions. The lesions in prurigo could be primary (dome shaped papules) or secondary (scratched papules).
The main types of prurigo are:
- Prurigo simplex
- Nodular Prurigo
- Prurigo Pigmentosa
We will have a detailed look into nodular prurigo in this article.
Nodular Prurigo/Prurigo Nodularis(PN)
Nodular Prurigo (also known as prurigo nodularis) is a form of prurigo skin disease. Nodular prurigo presents as multiple, hard, intensely pruritic (itchy), symmetrically distributed rash which appears commonly on the arms, legs, upper back and abdomen but may also appear on face and trunk.
Etiology / Causes
The exact cause of Prurigo Nodularis (PN) is unknown, however the symptoms are thought to be the result of dysregulation of nerves and immunity system in the skin. The epidermis and dermis of the skin is full of nerve fibers. A reduction in the number of nerve fibers, causing chronic itching of the skin, is thought to be caused by PN. Systemic diseases like kidney diseases, liver diseases, thyroid diseases, gout, etc. may also be associated to PN.
There may also be neurological causes including those related to the damage to the brain and spinal cord. Psychiatric issues may also cause PN which may include psychogenic pruritus. It is an itching sensation associated with depression and anxiety which lead to excessive scratching that may result in PN. Some chemotherapy medicines may also result in PN due to prolonged activation of the immune system post treatment.
Clinical Features / Signs & Symptoms
- Nodules are firm, symmetric, scaly, warty and hyperpigmented usually beginning on arms and legs.
- Starts as a small, red itchy bump
- Lesions are umbilicated and usually have a crusted top
- Nodules are usually follicular
- People with PN may experience burning, stinging and temperature variations in the bumps.
- May develop 2nd degree infections due to continuous scratching.
- Intense itching can be debilitating, preventing restful sleep and disrupting your daily routine.
The pathogenesis of PN is not well known, but include a form of neuronal sensitization of itch processing neurons and the development of an itch scratch cycle. Chronic mechanical trauma to the skin causes thickening of the skin. Repetitive rubbing, scratching and touching induced by a foreign body or self-induced results in plaques it nodular lichenification and hyperkeratosis
Diagnosis is usually made by a dermatologist based on clinical symptoms and response to medication. Usually skin biopsies are performed microscopically to confirm any signs of the disease such as thickening of nerves in the skin. PN can be suspected when the patient has intensely itchy skin and nodules. After diagnosis confirmation, blood tests and renal and liver function tests are suggested to rule out any underlying cause.
In Ayurveda, PN can be corelated to tridosaja kushta roga with vata kapha predominance. That means all the three doshas i.e. vata, pitta and kapha get vitiated and causing kushta with vata and kapha having major role. Here the vitiated vata is responsible for the dryness (rukshata), roughness (kharata), hardness (parushya) & dark brown (syava aruna) colour of the nodules whereas the vitiated kapha cause itching(kandu), elevation (utsedha) & heaviness (gaurava) of the nodules.
- Nodules are in mandalakruti (discrete) usually with a diameter of about 1cm or less (deerkham), dharunaka (scaly), sama akruti (symmetrical)
- Itching (kandu) is severe (teevra)
- Also have vedana (pain), srava (secretions) & burning sensation (daha)
The signs and symptoms of this disease us usually assessed with the degree of pain, itching, discharge, burning sensation and pigmentation.
This mainly includes the use of topical drugs, injections, systemic medications, etc. Therapies such as cryotherapy, phototherapy or laser treatment are also performed in some cases.
Since this disease is caused by the vitiation of three doshas treatment is administered considering the dominancy of the doshas. Kushta treatment include the sodhana therapies such as vamana, virechana and raktamokshana. After shodhana karmas, takradhara is also performed. Takradhara using kushtahara property drugs will stimulate the nervous system thereby resulting in a physical and mental relaxation of the patient. Classical virechana therapy followed by takradhara is very effective in treatment of PN and its eradication showing the importance of ayurvedic management iin tridoshaja kushta or PN.
Formulations Used in Treatment of Prurigo Nodularis
1. Radiant Skin Hair Nails Formula
This is one of the natural dietary supplements effective in maintaining a healthy skin and hair. After the classical treatment of PN this formula can be administered to regain the normal skin complexion. Its ingredients are:
1. Manjistha (Rubia cordifolia)
It is one of the herbaceous branched climbers which comes from the Rubiaceae family. Manjistha has a wide variety of action in many health issues especially in skin conditions since it has a blood purifying property. It has been grouped under the varnya group and has a major role in these type of skin conditions.
2. Parpataka (Fumaria officianalis)
Parpataka is the Sanskrit name of the herb which comes from Papaveraceae family. It is mainly indicated in treating eczema and other dermatological conditions since it is a blood purifier and an anti-allergic agent. Hence it can be used in the treatment of PN. Since eradication of this type of skin diseases may hinder the etiology of PN it will help to reduce itching in PN.
3. Chirata (Swertia chirata)
Comes from the family Gentianaceae. Its actions include relieving burning sensation, reduces itching, purifies blood and produces sweat. Chirata is indicated in kushta, charma roga, kandu (itching), vrana, shotha, etc. So, this drug will help in relieving the symptoms of PN.
5. Ghritkumari (Aloe barbadensis)
Aloe Vera from the family Aloeaceae is well known for its wide range of action on skin problems such as skin injuries, skin complexions and other skin eruptions. It is known as kushta vinashini i.e., one that eradicates all types of skin diseases. PN can be treated with formulations containing aloe vera since this improves skin complexion, moisturizes the skin and thereby preventing dryness, heals wounds and ulcers. Therefore, radiant skin hair nails formulation is an excellent formulation in the treatment of PN along with other classical managements.
Dose: 1-2 caps twice daily after meal with plain water
2. Neem Capsules
Neem capsules are prepared from the extract of neem tree (Azadirachta Indica). Neem capsules are a rich source of immunity boosters and also blood purifiers. Its antibacterio-fungal and blood purifying properties helps in regaining glowing and healthy skin by eliminating the blood impurities post PN treatment. This also has anti inflammatory properties which helps to reduce the redness of itching in PN thereby maintaining the texture if the skin. It also has an anti-ageing property.
Dose: 1 capsule twice after meal with plain water
3. Gandhak Rasayana
Gandhak raasayana is an ayurvedic formulation made from Sulphur usually available in herbal powder or tablet form. It can be administered in PN since it improves immunity, cures skin diseases, improves skin complexion and is an anti-aging medicine. It also reduces itching which is one of the main symptoms of PN.
Dose: 2 tablets daily or as directed by the physician.
4. Kaishora Guggulu
Kaishora guggulu is one of the well known ayurvedic classical formulation available in tablet form. Its main ingredients are:
1. Triphala: 2g
- a. Haritaki – Terminalia chebula
- b. Vibhitaki – Terminalia bellirica
- c. Amalaki – Phyllanthius emblica
2. Water: 6 lit
3. Amrit (Tinospora cardifolia): 768 g
4. Guggulu (Commiphora makul): 768 g
5. Trikatu: 72g
- Pepper long – Piper nigrum
- Pepper – Piper longium
- Ginger – Zingiber officinale
6. Vidanga (Embelcia ribes): 24 g
7. Danti root (Baliospermum montanum): 12 g
8. Trivrit (Operculina turpenthum: 12 g
Kaishora guggulu can be indicated in tridoshaja kushta since it helps in clearing the toxins from blood thereby reducing rakta dushti. It also helps to reduce the inflammation of the nodular sites.
Dose: 1 or 2 tablets twice or thrice daily or as directed by the physician.
Scientifically known as Rubia Cordifolia is a perennial climber well known for its blood purification and lymphatic support. The lymph is responsible for the human body immunity. It is considered one of the most potent drugs in Ayurveda. Manjistha calms vitiated pitta and breaks up congested kapha.
- Taste (Rasa) – Bitter, sweet, astringent
- Virya (energy) – cooling
- Post digestive quality (vipaka) – Pungent
- Quality (Guna) – Heary (guru), dry (Ruksha)
- Dosha – Pitta / Kapha ↓ Vata ↑
Manjistha is so powerful at promoting circulation within the body and skin.It creates a natural radiance on the skin from within. By increasing the circulation, it brings freshly oxygenated blood to the skin surface and helps in lymphatic drainage which helps to get rid of the toxins from the skin. Therefore, it has a wide action on skin diseases. Manjisthadi kashayam with majistha as the main ingredient is indicated in kushta since it reduces rakta dushti. Formulations with manjistha can therefore be used in tridoshaja kushta or PN along with the sodhana and shamana therapies after assessing the conditions in detail.
Dose: If capsule,1 capsule daily or as directed by physician.
5. Neem Oil
Neem oil is extracted from the seed of the neem tree. Neem oil contains many ingredients that are extremely beneficial to the skin. Some of them are fatty acids, vitamin E, triglycerides, calcium, antioxidants, etc. Neem oil can be used to treat symptoms of psoriasis, eczema, PN and other skin conditions. In PN, neem oil can be used for external applications since this disease is intensely itchy in nature. Neem oil can reduce itching to a great extent. It also has anti inflammatory and anti-bacterial properties thereby preventing skin infections. In PN, application of neem oil reduces the drynessand roughness of the skin and helps regenerate hair follicle growth and function.
Popular uses are
- Hyperpigmentation treatment
- Wrinkle reduction
- Skin and hair repair
- Skin moisturizing
- Burns and abrasions healing
- Fungal infections treatment
Dose: Can be applied externally on all types of skin diseases (kushta)
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Dr. Vikram Chauhan
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