Role of Nasal Instillation with Ayurvedic Polyherbal Formulation in Melasma: A Case Study

Introduction

Beauty is a combination of qualities, such as shape, colour, or form, that pleases the aesthetic senses. External beauty of an individual mainly dependent upon the quality of skin. A healthy skin gives self- confidence and pleasure to the onlooker. In some professions skin health and beauty is the means of success.For a healthy skin, you have to invest time and effort, there is no instant miracle. There are many causes which disturb texture of the facial skin and one of them is melasma. The term “melasma” is derived from Greek word ‘Melas’ meaning black. It is one of the most common acquired hyper-pigmentation disorders characterized by gary brown symmetrical hyperpigmented macules on face. The prevalence of melasma varies between 1.5% and 33.3% depending on the population [1, 2]. Its prevalence in pregnancy is around 50-70% and affects predominantly Hispanics and Indians [3, 4].

Cause of melasma is multi factorial and includes pregnancy, exposure to sunrays, hormone therapy, use of cosmetics, and racial or genetic effects. Some of the major causes are sun exposure, pregnancy, or oral contraceptives. On the basis of signs and symptoms it can be correlated with Vyanga in Ayurveda. Acharya Sushruta was the first to give a detailed and separate description of this disease under “Kshudra Roga” [5]. Doshas responsible for manifestation of the disease, are Vata and Pitta, they are aggravated due to different Manasika nidana (psychological factors) and affects the Mukha Bhaga (face). It is associated with an assortment of sign and symptoms like Niruja (painless), Tanu(thin) and shyavabarna Mandalas (bluish-black patches) on face over Mukha Pradesha [6]. Proper diagnosis with severity is very essential for treating this disease. In modern medical science, treatment varies according to cause of the disease, there is no such specific treatment for eradication of this disease but topical steroids have been described. However, the topical steroids are not completely free from adverse effects such as irritation, rashes etc. Therefore, there is a need for a better and effective treatment to overcome this disease. Ayurveda can contribute a lot in the field of cosmetology with its holistic approach. This particular case study means to prove scientifically the role of Nasya with Kumkumadi Taila in management of melasma with satisfactory result.

Case Report

A 25 year old female, known case of melasma since last 5 years attended OPD of Panchakarma department Rishikul campus. After assessing the Nidan and Samprapti, she was planned for Nasya with Kumkumadi Tailam along with some herbo-mineral compound. Allopathic medication which she had been taking for the same problem was reduced in tapering dose and after 1 week she was completely on ayurvedic management. During the total study period (56days) the patient was assessed for five times during which she had shown significant improvement in symptoms like darkness, area involvement, itching, swelling, dryness related to the patches. Subjective and Objective parameters of the study is observed and assessed with the criteria as per the modern cosmetology.

Results

After the course of treatment there was satisfactory result in area of involvement and pigmentation (analysed by MASI score, (Table 4) and Fair and Lovely Fairness Meter (Table 5). Associated symptoms like itching, dryness, burning sensation and facial swelling were reduced with due time (Table 6). Significant improvement was noticed in the symptoms of facial swelling, itching and burning sensation. Patient had given up her allopathic treatment after 1 week of beginning of Ayurvedic treatment. Her problem of whitish discharge per vagina was getting stopped. Other vitals were within normal limit in the whole course of the study.

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Discussion

Melasma is a chronic, acquired cutaneous, relapsing hyper melanosis characterized by hyperpigmented patches on sun-exposed areas of the face, neck, and forearms [8]. On the basis of signs and symptoms it can be co- related with Vyanga. In Ayurveda Vyanga is explained under the heading of Kshudra Roga. Psychological factors like Krodha (anger), Shoka (grief) and Shrama (exhaustion) plays a very important role in the Samprapti of Vyanga that’s why while describing the etiological factors of Vyanga, Acharya has given special emphasis towards psychological factors. Acharya Charaka has mentioned that the aggravation of Pitta along with Rakta is the chief culprit for initiation of the pathology. Vyanga is a Rakta Pradoshaja Vyadhi, hence the very first Dosha affected is Rakta Dhatu [9]. However due to etiological factors like Krodha and Shoka mainly Pitta vitiation takes place which in turn affects the Jatharagni and normal functioning of Ranjaka Pitta. Here Ranjaka Pitta is responsible for the conversion of Rasa Dhatu into Rakta Dhatu which results in the formation of normal skin color. Based on Ashraya-Ashrayee Bhavas, the derangement of Pitta Dosha leads to abnormality of Rakta Dhatu.i.e., Varnotpatti. Shrama and Shoka will lead to Udana Vata vitiation. Thus, these vitiated Dosha (Ranjaka Pitta, Rakta Dhatu as well as UdanaVata) travel in the body through Dhamanis and get Sthana Samshraya in Mukhagata Twacha and causes vitiation of Bhrajaka Pitta giving rise to discoloration of the skin.

It is clearly mentioned in Ashtang Hridyatha that Nasya is the main Chikitsa for Vyanga [10]. It is described “Shamanamneelikavyangakeshadoshaakshirajishu” [11]. In Ashtanga Hridya Uttartantra Kumkumaditailam is mentioned as the best medication for Vyanga because of all the ingredients almost all are Varnya and tridoshaghna, sheetavirya, madhurvipak and act on Rasavaha and Raktavaha Srotas [12]. Thus, karma of kum kumaditaila is to pacify mainly vata-pitta disorders and Rakta pradosajavikar.

In this case, patient has been habituated to irregular food habit, taking too much oily food, late night sleeping, sun exposure, over thinking and too some extent worried in nature. These all nidanas in long term caused prakopa of vata dosha which in turn vitiated bhrajak pitta on face region. Patient was advised to modify her lifestyle correction and simultaneously treatment was planned. Nasa is said to be the gateway to Shira. Shiras is considered as most important part of the body since it is the seat of five sense organs and the abode of Prana. Hence it is termed as the Uttamanga. While explaining the Phalashruti of Taila, Acharyas have said that Taila mitigates Vata and at the same time it does not increase the Kapha.

After the instillation of Nasya Dravya in nostrils, the lipid soluble substances diffuse through the plasma membrane of nasal mucosa due to greater affinity of passive absorption and reaches to olfactory receptor cells and finally reaches toShringatakmarma (Table 7). From there the medicine gets distributed into Murdha, Siramukha of netra, karna, kantha etc [13]. That doesn’t mean that it is directly connected to brain but somehow pharmacodynamically through olfactory nerve and blood vessels. When drug is administered it causes irritation due to which blood circulation increases and it snatches out the morbid Dosha from all the mentioned regions of the supra clavicular region (like the removing Munjagrass from its stem) [14].

Drugs of Kumkumadi oil are mostly sheeta virya, madhur vipak and act on rasavaha, rakta vaha shrotas. Thus karma of kumkumadi taila is to pacify mainly vata-pitta disorders and raktapradosaja vicar-vyanga. In the phalashruti of kumkumadi taila it is clearly indicated for vyanga. Though vyanga is urdhajatrugata vyadhi, so kumkumadi taila was given in the form of nasya. The treatment applied showed significant result in the normal colouration of Melasma spots and other associated symptoms like facial swelling, itching and burning sensation.

Conclusion

Melasma is common cosmetic problem in white female. Indian women also have been suffering from this problem in recent days. The treatment protocol of this disease may vary according to it’s causative and predisposing factors. In this case analysing the Samprapti of the disease, management was planned. She got marked relief from the ayurvedic panchakarma treatment. This is a ray of hope for the ayurvedic management of melasma.