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