switra - critical understanding
TRANSCRIPT
Switra (Leucoderma) Its Different Treatment
Modalities
ByDr Deepti
PatilDept. of
Dravyaguna
INTRODUCTION
“Black spot on white skin is a blessing; white spot on black skin is a curse”
• No pain, itching etc.• Causes more anxiety and social stigma in
Indian society.• Disturbs the sufferer cosmetically more and
rarely functionally.
DEFINATION
• A whitish discolouration of the skin(sweta varna twacha) is called switra
• VITILIGO- (Vitellos-Latin-White Sheep)• 'Leuco' means 'white' and 'derma' means
'skin', thus leucoderma means abnormal whiteness of the skin LEUCODERMA
STIPULATION WORLD WIDE
• Ranges from 40-50 million.
• About 1 to 2% of people in the world.
• 2 to 5 million people have the disorder in the
United States.
• Affects all races and both sexes equally.
• 95 % of its victims are below the age of 40yrs.
INCIDENCES AND RISK PERSONALITIES
• More markedly noted in the dark people of the tropical countries.
• Most commonly affected areas are face, neck, back, wrist, hand, groin, genitals, armpits, etc.
• Occurance of leucoderma about 42 % is Stress related , 28% Heriditory and 30%. Is Worms infested.
MYTHS……
NIDANA
Aaharaja
Viharaja
Papa karmaja
Nidana
BHEDA
Vataja •Aruna Varna
Pittaja •Tamra Varna
Kaphaja •Sweta Varna
Conti..
Vranaja
Doshaja
2 Types
LAKSHANA
DIFFERENCE B/W SWITRA & KUSTA
SWITRA
• Sravarahita
• Caused due to vitiation of
one of the tridosha
• Involvement of only rakta,
mamsa, and meda dhatu
KUSTA
• Sravayukta
• Caused due to the vitiation
of all the tridosha
• Involvement of all the
saptadhatus.
SADHYA LAKSHNA
• Ashukla loma
• Thin skin
• No overlapping of patches
• Newly manifested
• Anagni dagda
ASADHYA LAKSHNA
• Switra in Guhya Sthanas like Linga, Yoni, Guda
• Switra in Pani, Tala, & Osta
• Agnidagda
- Asadhya Irrespective Of Purana & Naveena
LEUCODERMA• Leucoderma is not a medical term
• Any white/light coloured skin patch
• Fed-up acquired skin disorder, making skin
white due to loss of the melanin pigment.
• Non-contagious disease.
• Also termed as vitiligo.
CAUSES • Immune Hypothesis - Melanocyte destruction and
dysfunction or both may result into Hypo pigmentation.
• Neural Hypothesis - Neurochemical inhibitors are
released at nerve endings that destroy the melanocytes
or inhibit their functioning.
• Melanocyte Self-Destruction Hypothesis - Proposes that
an intermediate in melanin synthesis causes
melenocyte destruction.
Conti…
• Dietary deficiency of Proteins and Cupro minerals is a major factor for causing vitiligo. Serum skin and cerebro-spinal fluid copper levels are low in these cases.
• GI Disorder like Chronic amoeboisis, chronic Dyspepsia and Intestinal Worms .
• Use of Broad Spectrum Antibiotics ,especially Chlormphenicol and Streptomycin
• Local irritation caused by wearing the sari or Trousers too tightly.
• Composite Hypothesis : None of the theories alone is entirely satisfactory.
• Actual mechanism of inhibition or destruction of melanocytes is much more complex.
SYMPTOMS • Odd, Harmless, White Spots Patches on the
skin surface
• More common in women than in men and is
mostly seen on the hands, neck, back and
wrist
• Mostly, no other symptoms can be noted
except whiteness of the skin.
Contd..• May cause itching sometimes, due to
exposure to the sun or coming in contact with chemicals
• Shows easy friability and susceptibility of the skin.
• Sometimes appears pale, sometimes red and some other times, milky white.
IS EVERY WHITE PATCH LEUCODERMA…..???????
OTHER CONDITIONS WITH WHITE PATCHES
Halo nevus - a pale mole with surrounding hypo pigmentation
Skin injury - causes a white or pale patch during skin recovery.
Tinea versicolor
Lichen sclerosis et atrophicus
Leprosy
Morphea
Pityriasis Alba
Halo nevus - a pale mole with surrounding hypo pigmentation
Tinea versicolor
Lichen sclerosis et atrophicus
Leprosy
Morphea
Pityriasis Alba
White patch will in all probability be
Leucoderma if it:
Has an outline darker than the skin.
Is irregular in appearance.
Gradually increases in size.
Appears milky white under an ultraviolet light.
IS LEUCODERMA HEREDITARY?
HEREDITARY FACTOR
• 28% Hereditary
• Parents where one or both have Leucoderma
are only at a fraction of a higher risk than the
general population.
• Even the general population is at a risk of
1-2 %.
DIAGNOSIS AND INVESTIGATION
• No other special investigations are necessary
for diagnosing the complaints.
• there won't be any change in blood or urine.
• Biopsy can reveal the absence of pigments.
PREVENTION OF SPREAD
• Maintain good general health and immunity.
• Non communicable disease.
• Any patch should be thoroughly examined first.
• Application of any unconfirmed tropical medication
on skin should be avoided.
• Use of synthetic clothes should be restricted.
• Avoid excess intake of Sour things.
• Avoid Steroids.
DO'S• Take medicines regularly in the early days itself, so
that complete cure can be achieved.
• Don't worry about Leucoderma, since effective
treatment can arrest the course of the disease and
cure it.
• Use umbrella when out in the hot sun.
• Track all your eatables and habits to streamline all
the irritants or chemicals.
DON'TS• Avoid direct exposure to sun rays.
• Avoid fast foods, citrus fruits, coffee, tea, cold
drinks, alcohol, beer, non-veg , egg, etc.
• Avoid multiple drugs or drug cocktails.
• Avoid chemical soaps.
Different Treatment Modalities
CHIKITSA
• Included under Raktaja roga.• Virechana, raktamokshana, upavasa• First samshodhana followed by shamana
chikitsa.
TAILA
• Visha taila (Y.R)
• Jyotishmati taila (Y.R)
• Bhallatakadi taila (A.Hru)
• Aragvadadi Taila (Ck.D)
• Marichyadi Taila (Ck.D)
• Krishna sarpa bhasma sidda taila (su.sa)
GHRITAS
• Somaraji Ghrita (B.P)
• Mahaneela ghrita
• Tilvaka ghrita
• Mahatiktaka ghrita
KASHAYA’S
• Khadiradi Kashaya/Dhatrikhadira Kashaya
LEPA’SAs per Charaka Samhita Kustha Chiksta 8th
chapter• Mansiladi lepa• Mayur pita + manasila• Bakuchi (Seed) + Laksha + Gorochana + Anjana
(Rasanajan And Sauveera Anjana) + Pippali + Loha(Krishna) bhasma
• Kathguular + Baakuchi + Chitraka + Gomutra etc.
Cont…
As per Chakardatta (Kustha chikista)• Pootika Lepa• Gajadicharma masi Lepa• Avalgujabeeja Lepa etc.
As per Sushruta Samhita
• Pootikadi lepa• Krisnasarpa bhasma lepa• Kilasahara lepa• Shivtrahara lepa • Tutthyadi lepa• Tilavakadi lepa etc.
Cont…As per Bhavaprakasha • Bakuchi + Haratala + Manasila + Gunja (Seed)
+ Chitraka (Moola) + Gomutra• Neela Aparajeta (moola) lepa etc.As per Yogaratnakar• Shiladi lepa• Triphaladi lepa• Ayorajadi lepa etc.
Cont…
As per Baishijya Ratnavali• Pootikadi lepa• Pootikeetadi lepa• Shwetajayantimoola lepa• Osta switra nashaka lepa
EFFECTIVE HERBS IN SWITRA CHIKITSA
• Bakuchi
• Khadira
• Triphala
• Nileeni
• Brungaraja
GOMUTRA
PROPERTIES OF GOMUTRA (Acc to Yogaratnakara)
• RASA: Katu, Tikta, Kshara.
• GUNA: Ushna, Laghu.
• KAGMA: Deepana, Medhya, Sara, Lekhana.
• DOSHAKRIYA: Kaphavatanashaka, Pittakara.
• ROGANASHAN: Shoola Gulma, Udara, Anaha
Conti…
• Mainly its Kshar guna is highlighted.
• It contains various minerals- Copper, Iron,
Calcium, Sodium, Magnesium, Potassium,
Phosphate, Sulphur.
PATHYAPATHYA
PATHYA
• Laghu anna• Tikta Shakas• Nimba yukta anna• Ghrita prayoga• Jangala pashu-pakshi mamsa• Water kept in copper vessel
APATHYA
• Amla• Lavana• Maricha• Dadhi• Dugda
• Guda• Anupa mamsa• Tila • Masha • Tikshna Aahara
GENERAL TREATMENT
• There is no scheduled, conservative treatments at all.
• No single therapy for Leucoderma produces good results in all patients.
• Treatment course and medicines always vary and are unpredictable.
• Treatment is a long process which may take months or years.
Cont…
• To control the disease
• To produce pigmentation
• Surgical treatment
• Melanocyte culture
• Cosmetic treatment
MEASURES TO CONTROL THE DISEASE
• Replacement of vitamins and minerals• Topical steroids• Short course of systemic steroids
FOR PIGMENTATION
• Photo chemotherapy (PUVA therapy for psoralens and UVA)
• Narrow band UVB (NBUVB)• Targeted phototherapy
SURGICAL TREATMENT
• Removing of vitiligenous skin and
replacing with an autologous graft
• Useful in stable disease
• Segmental vitiligo
MELANOCYTE CULTURE
• Culture melanocytes in the laboratory-transplant them in to affected area.
Treatment of future
COSMETIC TREATMENT
Micropigmentation
Introduction of Iron pigments into the dermis
COMPLICATIONS
• Common side effects of photochemotherapy
like nausea, vomiting, catatact, skin
cancer(long term treatment).
CONCLUSION
REFERENCES
• Charaka Samhita
• Susruta Samhita
• Astanga Hrudaya
• Astanga Samgraha
• Yogaratnakara
• Chakradatta
• Bhavaprakasha
• Baishajya Ratnavali
• Sahasrayoga
• http://
www.ayurvedaphysicia
n.com
THANK YOU