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Journal of Natural & Ayurvedic Medicine Research Article 11 min read

Acne Vulgaris: An Ayurvedic Review

Bisht H*, Srivastava AK and Sharma B
* Corresponding author
ISSN: 2578-4986  10.23880/jonam-16000281  Received: November 18, 2020  Published: December 03, 2020
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Keywords
Acne Vulgaris Mukhadushika Yuvanpidika Kshudraroga Ayurveda
Abstract

Acne vulgaris is a very common skin disorder found in adolescent age group. It is a cutaneous disorder of the pilo-sebaceous unit involving the abnormalities in the production of sebum. It is characterized by both inflammatory (papules, pustules and nodules) and non-inflammatory (comedones, open and closed) lesions. In Ayurveda, this disease has been postulated by the name of mukhadushika and yuvanpidika. Acharya sushruta in his sushruta samhita has described this disorder under Ká¹£udra Roga adhyay. Due to imbalance in life style, stress and pollution, this problem is increasing day by day. Guru Aahar, Madyapaan, Anidra, Upvas, Krodha, Santap, Svabhav are some of the factor responsible for the development of Mukhadushika. It is generally due to vitiation of Vata, Kapha and Rakta resulting in Shalmali like eruption on face. In Ayurveda for the treatment of Yuvana pidika (Kshudra-roga) both shaman as well as shodhan chikitsa are described.

Introduction

Acne is a common chronic inflammatory condition of skin with cutaneous and psychological disease burden [1]. Acne affects both males and females but males are more prone during onset of puberty. Acne affects 80% of individuals between Pubescence and 30 years of age throughout the world [2]. Many research studies shows that acne is prevalent in 79-95% in the age group of 16-18 years. In India, the percentage of acne is 50.6% in boys and 38.13% in girls in the age group of 12-17 years [3]. Acne causes emotional distress and anxiety. This anxiety aggravates the condition of skin and creates a cycle [4]. In Ayurveda, a disease named mukhadushika has similar symptoms. As the disease is seen in adolescent age group, the term yuvanpidika is also used for same. Acharya sushruta has explained mukhdushika for first time in his sushruta samhita. This disease is mentioned under the heading of Kṣudra-roga in texts. Acharya sushruta mentions the vitiation of vata, kapha and rakta in the pathology of mukhadushika [5]. Acharya vagbhata depict the involvement of meda in the development of mukhadushika roga. This involvement of meda can be considered to show similarity with the involvement of sebum in the pathogenesis of acne.

Material and Methods

The data for study is collected from the ayurveda texts like sushruta samhita, ashtang hrudaya, yog ratnakar, nibandha sangrah etc.

Discussion

Causative factors of Yuvanpidika vis-a-vis Acne vulgaris

The causes as per modern science include excess androgen secretion. There are four major factors which are responsible for the development of acne [6]:-

  • Increased and altered sebum production
  • Follicular hyperkeratinization (leads to formation of comedones)
  • Proliferation and colonization by Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis
  • Release of inflammatory mediators including cytokines.

Only a little description is available about the causative factors of yuvanpidika in Ayurveda. Any disease is caused by abnormality of tridosha (vata, pitta and kapha) and sapta dhatus. Anything which brings abnormality to these causes yuvanpidika [7, 8, 9, 10]. Kapha dosha (in the form of sebum), Vata dosha (dry nature) and Rakta dhatu are main pathological units in the development of acne [11, 12]. The dushti of rakta dhatu is one of the chief factors responsible for acne formation according to acharya sushruta. Acharya sushruta has also mentioned several components related to sexual changes during adolescence which are related to acne formation [13]. The causative factors of acne can be divided into 4 types:- Kalaja , Aaharaja , Viharaja and Manasika.

  • Kaalaj: taarunya, madhyaahan,vasant ritu, greeshma ritu, sharad ritu
  • Aaharaj: ati katu and madhura , guru ahara, ati snigdha, dugdha varga ahara, mamsa, madya
  • Viharaj: vegadharan, ratrijagaran, nidra mithyayog, upavasa, atapa sevan
  • Mansik: ati shoka, kshobha, krodha, santapa, svabhava The changes in secondary sexual characters starts at the age of 16 years as said in Kashyap samhita [14]. Acharya sushruta and acharya vagbhata explains that the mukdushika or yuvanpidika is primarily a disease of adolescence. According to Bhavaprakash, acne is Svabhavaj. Sharangdhara samhita explains that acne is because of shukra dhatu mala [15, 16, 17].

Pathogenesis of Acne Vulgaris

The pathophysiology of acne is a multifactorial process. Initially, obstruction of sebaceous glands occurs. Acne vulgaris starts at adolescence as hormonal changes are on peak in the body. Androgens are involved in the regulation of cell proliferation and lipogenesis on the skin locally [18]. Follicular hyperkeratinization may also be affected by hormones. Staphylococcus epidermidis and Propionibacterium acnes colonizes the skin surface which are prone to acne [19]. Some experimental studies have suggested that P. acnes are the main organism which plays an important role in pathogenesis of acne vulgaris. The overgrowth of P. acnes hydrolyses sebum triglycerides, producing free fatty acids and release inflammatory mediators (cytokines) which may lead to inflammatory lesions including papules, pustules, cysts and nodules [20]. With the light of Ayurveda, the samprapti of acne can be understood. Nidan sevan leads to vitiation of kapha, vata and rakta. These vitiated doshas blocks the lomakup which in turns leads to localized swelling and formation of microcomedones. Paka in microcomedones cause pustule, papule and cyst formation [21, 22] . Also, the involvement of Vata dosha and Rakta dhatu may also cause hyperpigmentation of skin (vyanga) [23, 24].

Rupa

The symptoms of acne vulgaris are as follows:-

  • Blackheads
  • Whiteheads
  • Pustules
  • Redness and inflammation around eruptions.
  • If acne is severe, cysts , abscesses Acharya Vagbhata has described the following sign and symptoms of the disease
  • Yunamvaktre: site of disease and the age related with disease is explained by this phrase. The common site of yuvanpidika is face and is commonly seen in adolescence.
  • Shalmalikantakprakhya: shalmalikantak has conical shape. And it is seen in most of the patients that the pidika is conical in shape.
  • Pitikahsarujo: it explains the painful nature of disease. In patients, it can vary from mild tenderness to severe pain. It may be due to involvement of vata.
  • Ghana: this term is indicative of the consistency of pidika. The pidika are thick, hard and indurated. It may be because of involvement of kapha.
  • Medogarbha: it says that the pidika are filled with meda. It correlates with the modern concept of blockage of ducts due to sebum.

Other than these, symptoms like kandu, daha, paka, shotha, srava, vaivarnyata are also seen.

Treatment

The treatment includes use of topical and/or systemic agents. Topical medications include antibiotics, benzoyl peroxides and vitamin A acid derivatives. Benzoyl peroxides are antioxidants and bacteriostatic agents and are found in different strengths. These can be used as combination with topical antibiotics. The commonly prescribed topical antibiotics are Clindamycin (1% to 4%) and erythromycin (1.5% to 2%). A vitamin A acid derivative, Tretinoin increases the turnover of cells lining the follicular wall. Tretinoin decreases their stickiness and allows the expulsion of micro- comedones. Vitamin A acid derivatives are available as a cream and gel, in percentages varying from 0.01% to 0.1% with Dryness as a side-effect [25]. Antibiotics are also used as systemic medications along with isotretinoin. Commonly prescribed antibiotics include tetracycline, erythromycin and minocycline. Tetracycline is contraindicated before the age of eight years and during pregnancy [26]. Minocycline is a tetracycline derivative that has the advantage of once daily dosing. Loading doses of minocycline may cause dizziness in some patients [27]. In a tetracycline-allergic patient, erythromycin can be used as an alternative. For the treatment of nodulocystic Acne, scarring Acne and Acne that is recalcitrant to other forms of therapy Isotretinoin is indicated [28]. Common side effects include dryness of skin and mucous membranes, photosensitivity, myalgias, night blindness and depression [25]. Mukhadushika is a kshudraroga so its chikitsa sutra is same as that for kshudraroga. Chikitsa in Ayurveda can be divided into two forms. The one being shodhan chikitsa and the other shaman chikitsa. The shodhan chikitsa includes the panchakarma procedures and the shaman chikitsa has internal medication and external application of drugs. Line of treatment prescribed by different acharya’s is as follows:

  • Sushruta samhita – Vamana, Lepan [29]
  • Ashtang Hridaya – Lepana, Vamana, Nasya, Siravyadh [30]
  • Bhavaprakasha- Lepana, Vamana, Abhyanga [31]
  • Yoga Ratanakara- Shiravedha, Pralepa, Abhyanga [32]
  • Sarangadhara samhita- Lepana [33]
  • Bhaishajjya Ratnavali- Siravedha, Pralepa, Abhyanga [34]
  • Chakrapani: Siravedha, Vamana, Abhyang, Lepana

Reason behind selection of various shodhan procedure

  • Vamana: Both Acharya Sushruta and Vagbhata have mentioned Vamana Karma to cure the disease. As Vamana is the main therapy for Kaphaja abnormalities, Kapha is one of the main Dosha involved the pathogenesis.
  • Nasya: Vagbhata has indicated Nasya Karma for the treatment of Mukhadushika. Acharya Charaka has also advocated the Nasya Karma in UrdhvaJatrugata Vikara. Mukhadushika usually affects mukha which is in urdhavajatru part of body.
  • Raktamokshan: Raktmoksana (bloodletting) is the preferred way of treatment in Raktaj disorders as per Ayurvedic texts. Raktamokṣana removes the vitiated blood and clears the Srotāvarodha (blockage in channels), thus breaking the samprapti.

For management of any disease, careful observation on vyadhiavastha should be done. For yuvanpidika, it can be understood by knowing the involved skin layer. To understand this hypothetical classification was made.

  • Avabhasini and lohita have pitta pradhanta, as for avabhasini acharya have said sarva varna avabhasini panchavidhachhaya prakashayati [35]. In lohita the disorders like tilkalaka, nyaccha, vyanga are seen and pitta is the common dosha among them [35].
  • Shweta, tamra, vedini and rohini have disease like ajagallika, mashak, kilaskustha, alaji, granthi etc. which possess vata-kaphaj samprapti.

• Mamsadhara has disease like vidradhi, arsha, bhagandar which are tridoshaj in nature. So this layer can be considered as tridosha bhuyistha.

So while treating acne vulgaris, following points should remain in mind [36].

  • If the lesions show pitta dominant lakshanas like small pidika, pain, burning sensation etc, and are associated with kapha and rakta, it means avabhasini or lohita are involved then pittahara and raktaprasadan chikitsa should be done. Virechana and raktamokshan will be beneficial in these cases. Rasapachak and raktaprasasdana dravyas should be given for internal use.
  • If the lesion show kapha dominancy lakshan like big, deep rooted pidika, Ghana , puyaprachiti, medogarbhata, and is associated with vata and rakta, then kledohara kaphahara and rakta prasadana should be done. In these types of cases, vaman, nasya and raktamokshana will be beneficial.

According to Doṣha and symptoms of Mukhadushika drugs having KaphaVatahara properties, Strotoshodhaka and which purifies the blood can be used internally. Some herbal drugs useful in the treatment of Mukhadushika are Shalmali, Haridra, Sariva, Vacha, Dhanyaka, Lodhra, Daruharidra, Manjistha, Nimba, Khadira, Guduchi, Methika, Jatiphala, Kakamachi etc. Other than these, many lepa are mentioned for mukhadushika. These include Yashtimadhvadi lepa, Kaliyakadi Lepa, Sharapunkhadi lepa, Masuradi lepa, Lodhradi lepa, Shalmali kantakadi lepa, Arjunadi lepa, Jatiphaladi lepa, Siddharthadi lepa, Marichyadi lepa.

Conclusion

Acne vulgaris is a chronic inflammatory disorder which is seen commonly. The description is not vivid in Ayurveda texts, with yukti, samprapti can be understood and the line of treatment varies accordingly.

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@article{bisht2020,
  title   = {Acne Vulgaris: An Ayurvedic Review},
  author  = {Bisht H, Srivastava AK and Sharma B},
  journal = {Journal of Natural & Ayurvedic Medicine},
  year    = {2020},
  volume  = {4},
  number  = {4},
  doi     = {10.23880/jonam-16000281}
}
Bisht H, Srivastava AK and Sharma B (2020). Acne Vulgaris: An Ayurvedic Review. Journal of Natural & Ayurvedic Medicine, 4(4). https://doi.org/10.23880/jonam-16000281
TY  - JOUR
TI  - Acne Vulgaris: An Ayurvedic Review
AU  - Bisht H, Srivastava AK and Sharma B
JO  - Journal of Natural & Ayurvedic Medicine
PY  - 2020
VL  - 4
IS  - 4
DO  - 10.23880/jonam-16000281
ER  -