Vitiligo is a progressive, idiopathic, pigmentation disorder of the skin, characterized by hypopigmented white lesions (Depigmented patches appear on the skin, hair, mucous membranes and the retina.). Shwitra or Shwet-Kushtha can be co-related with skin disease vitiligo, It is of two types, that is, Kilas and Varuna. However, some authors consider these are synonymous. Modern science explains it as a condition caused due to improper distribution of the melanin beneath the skin surface and It can begin at any age.
In Ayurveda direct or indirect causes for vilitigo (shwitra)-
According to Ayurveda, the skin is one of the essential sense organs. Vata and bhrajaka pitta reside in the skin ( twak ). As the skin covers the whole body, bhrajaka pitta should be maintained in a proper state, and it needs continuous care. An imbalance in Vata and bhrajaka pitta may cause skin diseases
Causes-
Shvitra is caused by various dietic and behavioral factors which aggravate the tridoshas, especially the Kapha dosha vitiating the Meda dhatu.
incompatible food (Viruddhahara ), suppression of vomiting ( chardivegadharana ), excess food intake, Atyamla(excessive sour), Lavana(salt), Madhura(sweat), Katu Rasa Sevana (pungent food, navanna, dadhi, matsyabhakshana (heavy intake of fresh grains, curd, and fish), vipra-guru gharshana (teasing and disrespecting the elders), papakarma (sinful acts), etc.
Other causes-
Vitiligo associated with other diseases like hypothyroidism, anemia, diabetes, hypertension, tuberculosis, RA, SLE, etc. and its patches that rapidly spread and become associated with redness, blister formation, itching during therapy or as such.
Due to one or all of the above said reasons, three doshas – Vata, pitta, and Kapha are aggravated in association with skin, blood (Rakta), muscles (Mamsa), and watery element (Udaka). These altogether involved invariably in different grades, and hence varieties of skin diseases are caused. If lymph (Rasa) and blood (Raktha) are significantly involved, it results in vitiligo that is, shwitra-kushta. The lesions of vitiligo appearing in palm, sole, genitalia, and lips are incurable.
The causative factors for skin diseases (kusta) and vitiligo (Shwitra) are the same and affect the same basic body tissue (dhatu) levels. Shwitra differs from other skin disorders by the normal functioning of all but the skin tissue (twak) resulting in discoloration of the skin (twak vaivarnyata), without discharge (aparisravi).
Treatment-
Vitiligo is chronic disesase and should be treated immediately. PUVA therapy is the treatment of choice in the modern system of medicine.
Ayurveda recommend four steps of treatment-
Step 1- purification therapies (shodhana karma) using an herbal decoction
Step 2- oil massage
Step 3 - exposure of lesions to the sun rays as long as the patient can tolerate (Soorya pada santhapam in Ayurveda). Patient receives Gruel (peya) for the following 3 days. If bullae arise after a sun bath they must be punctured using a sterile needle. For the last 3 days, the patient receives decoction On these 3 days, the diet should be salt-free and should contain buttermilk.
Many Ayurvedic drugs are well known for the regeneration of melanocytes, among which Bakuchi is one.
Topical applications (Lepa)-
Avalgujadi Lepa, Bakucyadi Lepa, Balyadi Lepa, Bhallatakadi Lepa, Bhringarajadi Lepa, Gandhakadi Lepa, Girikarnika yoga, Grhadhumadi Lepa, Gunjadi Lepa, Gunjaphaladi Lepa, Katukalabvadi Lepa, Manasiladi Lepa, Maricadi Lepa, Patrakadi Lepa, Putikadi Lepa, Triphaladi Lepa, and Vayasyadi Lepa.
Single drug-
Bakuchi is a renowned herb with many therapeutic properties. It has been extensively used in hypopigmention with great success. It contains psoralens, which on exposure to the sun bring out melanin in the depigmented lesions.
Haridra-its beneficial effects on the skin.IT is adaptogenic, hypoglycemic, antimicrobial, antiallergic, hepatoprotective and antioxidant properties. Here, its role is to protect the skin from the irritating effects of Bakuchi and as an emollient.
Chakramarda and Chakshusya are bestowed with similar properties and are popular for skin disorders, and have antimicrobial and antiallergic properties. Purified Haratala, an arsenic compound, was used in the ointment.
Purified Haratala is immune modulating properties. It is one of the ingredients of the Mallasindoor, Talakewar Ras, which is widely used for some autoimmune disorders like psoriasis, allergic bronchial asthma, etc
Bakuchi and Haratala have no toxic effects on the body. It was also noticed that modern PUVA therapy was associated with considerable side effects like GI upset, itching and painful blisters, thereby limiting its use in patients.
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