Article was published in leading newspaper of Nagaland ie Nagaland Post on 4/june/2017
In the present era due to stress, increasing pollution, hormonal changes, changes in diet, change in life style number of young individual suffering from a very common problem of acne vulgaris. . It has been found that adolescence are mostly susceptible to Acne vulgaris. In current era Acne Vulgaris is one of the most burning problems The term acne is derived from Greek word―acme which means ―prime of life. Although generally considered to be a benign, self-limiting condition, acne may cause severe psychological problems or disfiguring scars that can persist for a lifetime. . Although acne is not a life-threatening condition, it can have detrimental effects on the quality of life of affected individuals. Fortunately, acne is readily responsive to the wide-range of available medications, with the goals of therapy being to clear the lesions, prevent scarring, and limit any treatment-related side-effects and psychosocial sequelae. Acne manifest at any time during life but it most commonly presents between ages of 12-24, which estimates of 85% of population affected. In Ayurveda it is termed as Mukhadushika, mukhadushika is described under the heading of Ksudrarogas. .
Acne may be classified according to predominance of specific skin lesions: -Comedonal (non-inflammatory) – mild Papular (inflammatory) – mild-to- moderate Pustular (inflammatory) – moderate Nodulocystic – severe This order also follows increasing severity, with cutaneous scarring as the ultimate result.
1. Increased Sebum Secretion:- Sebaceous glands activity is controlled by androgens. . Androgens are male hormones produced in the testis and in female, adrenal glands and ovaries produce androgens. The most important androgen is testosterone, which affects the face, pubic area and arm pits. Acne is closely related with the sex hormones. Both the sexes are affected by the disease acne but the majority of the patients were females because of involvement of major hormonal changes like Oestrogen occurs during menarche. The increased production of sex hormones makes the sebaceous glands hyper active.
2. Microbial Colonisation:- Propionibacterium acnes are a normal commensal of the pilosebacious apparatus plays an important role in the pathogenesis of acne.
3. Occlusion of Pilosebacious Duct:-In the acne pelosebacious orifice is occluded by a keratinous plug induced by Chemicals. Thus results in retention of sebum. Further encouraging growth of micro- organisms resulting in acne.
4. Other include exogenous substances such as tars, chlorinated hydrocarbons, oily cosmetics also the patient treated with corticosteroids, lithium, oral contraceptive and anticonvulsants.
ACNE GETS WORSE DUE TO:
Menstrual cycle – Girls and women with acne tend to get it worse one or two weeks before their menstrual period arrives. This is probably due to hormonal changes that take place. Some people say they eat more chocolate during this time and wonder whether there may be a connection. However, experts believe the worsening acne is not due to chocolate, but rather to hormonal changes.
Anxiety and stress – Mental stress can affect levels of some hormones, such as cortisol and adrenaline, which in turn can make acne worse.
Oil based makeups – moisturizing creams, lubricating lotions, and all makeup that contains oil can speed up the blocking of your pores.
Hot and humid climates – when it is hot and humid we sweat more. This can make the acne worse.
Greasy hair – some hair products are very greasy and might have the same effect as oil based makeup.
Squeezing the pimples – if you try to squeeze pimples your acne is more likely to get worse, plus you risk scarring.
STAGES OF ACNE:-There are various terms that describe different forms of acne, such as comedones, papules, pustules, nodules, and cysts. Basically, comedones (plural for comedo) are the name given to plugged follicles: an open comedo is called a blackhead because the surface is visible and turns ―black when it’s exposed to air. A closed comedo is a whitehead, which is like a blackhead, but is closed at the surface. Plugged follicles can become irritated and swollen enough to burst, thus affecting surrounding tissues. If a plugged follicle erupts above the skin’s surface, it becomes a pimple; when iterupts below the surface, it forms a red lump, such as a nodule or cyst. There are basically three levels of severity: Mild acne consists of a few lesions that are close to the surface, and not deep or inflamed. Moderate acne is marked by deeper nodular lesions and some redness. Severe acne involves many lesions, multiple cysts, and a great deal of redness and inflammation
A number of descriptive terms are applied to clinical variant of acne.
Acne conglobata: It refers to the severe form of acne characterized by large polyporous comedon, severe inflammatory lesions including abscesses and cysts, marked scarring and sinus formation.
Acne Excoriee : It is a condition of young women, who attacks the smallest of papules by scratching or squeezing them to turn into excoriations with crusts.
Acne Fulminans : It refer to the presence of severe acne accompanied by fever,joint pain and markers of systemic inflammation such as raised ESR.
Topical acne: Acne prone individual working in hot,humid environment experience aggravations of acne with involvement of lower torso, thighs, and arms. The lesions are inflammatory and monomorphic.
Infantile acne: It is a rare and is thought to be due to the sebotrophic effect of maternal hormone on the infant.
Drug induce Acne : Acne can be triggered or aggravated by androgens, progestogens, anabolic steroids, topical and oral corticosteroids, halogens.
Occupational acne: Occupational exposure to chlorinated chemicals, oil and petrolium products can result in acneform eruption.
Pomade acne : Individuals who regularly use hair oils or pomades develop whiteheads with occasional papule on the temples and along the frontal hairline.
AYURVEDIC MANAGEMENT: In Ayurveda mainly two type of chikitsa are described i.e. Shodhana chikitsa and Shamana chikitsa. Shamana chikitsa is that, which neither expels nor excites the dosha but mitigates the increased doshas and maintain the normalcy of doshas within the body
(1) Vaman- (Emesis): It is the best procedure to subside the Kaphaja abnormalities and in Mukhadushika(Acne).
(2) Nasya (Errhine): The medicines are to be taken through nasal route in Urdhvajatrugata Rogas(disease above the clavical) and also in disease of Mukhadushika(Acne).
(3) Virechana: This therapy is specific for Pitta Dosha, or Pitta samsarga Doshas. The purgative drugs remove the excess Pitta from the Guda Marga.
SHAMANA CHIKITSA/ EXTERNAL TREATMENT: As the disease has local spread over the face, the local or external applications have immediate impact upon the characteristic features of the Mukhadushika(Acne) such as burning sensation, itching etc. Different ayurvedic preparations are prescribed for the topical use in the form of powder, paste, oil, ghee, gel, etc. The method advised for the application. Lepa prepared Chandana, Maricha, Bark of Arjuna tree and milk, Manjistachurna with Madhu, Washing the face with varunadi kwata , Kumkumadi Taila Abyanga can also be done, Sarpi(ghee), Nimba churna(neem powder) and parpati is to be given internally, Haridradilepa(turmeric application) can be applied for face. Manjistadi taila to be over the face, Masuradal fried with milk and applied over the face, haridrachurna with arka ksheera
Surgical and Para-Surgical Treatment: If the medical treatment does not give better results, surgical and parasurgical procedures like Chedana (excision) , Agni Karma, Kshara Karma, Rakta Mokshana or Siravyadha. Above said procedures are not easy to encounter and may have complications, so usually patients are reluctant to accept these therapies. Line of treatment prescribed by different Acharyas can be summarized as follows- Vamana(Medicated vomiting), Lepana(facial pack), Nasya(Nasal Administration), Mukha Abhyanga (face massage)
Apathya (things to avoid in Acne):- Avoid Hot [Ushna], Spicy, Oily, Fried and Pungent Food, Junk Food, Fast Food, and Out Side Food. Virudha Ahara- Food that is incompatible to each other such as Milk with Fish Etc.
Pathya (things good in Acne):– Food items with bitter taste like Patola, Giloya, Methika etc. Fresh green and leafy vegetables, enough water intake (specially Luke warm water), keep skin clean, mental relaxation techniques like meditation and Yoga
CONCLUSION: In current era one of the most burning problems found in adolescence are mostly Mukhadushika(Acne). The lepa (face pack) is described as a Shamana chikitsa in minor stages of Mukhadushika while in severe cases Shodhana Chikitsa should be applied. Modern text described Acne as a chronic inflammatory disorder of sebaceous follicles characterized by the formation of comedone, papules and pastules, less frequently nodules or cysts. The treatment should be changed according to the severity of acne.
NOTE: Ayurvedic medicines and treatments should be taken under Qualified Ayurvedic Doctor/Physician. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician.
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