Switra (Leucoderma) Its Different Treatment Modalities

By Dr Deepti Patil Dept. 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

Nidana

Viharaja

Papa karmaja

BHEDA
Vataja
Pittaja
Kaphaja

Aruna Varna Tamra Varna Sweta Varna

Conti..
Vranaja

2 Types
Doshaja

LAKSHANA
VATAJA SWITRARuksha, Aruna Varna, Rakta Dhatu Ashrita

PITTAJA SWITRATa ra varna, Ka ala atravat, Sadaha, L avidwa si, Ma sa Dhatu ashrita

KAPHAJA SWITRASweta varna, Ghana, Guru, Kanduyukta, Medha Dhatu ashrita

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 S 
As 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 laboratorytransplant 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.ayurvedap hysician.com

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