Gahalawat

Preeti and Kumar Pankaj / Int. J. Res. Ayurveda Pharm. 12 (1), 2021

Case Study
www.ijrap.net (ISSN:2229–3566)

AYURVEDIC MANAGEMENT OF PITYRIASIS ALBA (SIDHMA KUSTHA): A CASE STUDY

Gahalawat Preeti 1* and Kumar Pankaj 2
1
Final Year Student, Ayujyoti Ayurvedic College and Hospital, Jodhpuria, Sirsa, Haryana, India
2
Assistant Professor, Department of Panchakarma, Ayujyoti Ayurvedic College and Hospital, Jodhpuria Sirsa, Haryana,
India
Received on: 19/10/20 Accepted on: 11/02/21

*Corresponding author
E-mail: preetimanpreet157@gmail.com

DOI: 10.7897/2277-4343.12018

ABSTRACT

A skin rash that sometimes begins as a large spot on the chest, abdomen, hands or back followed by pattern of smaller lesions. Pityriasis refers to hypo
pigmentation of skin. Pityriasis alba have symptoms like ill-defined patches, round and oval, often with mild scaling and sometimes with mild pruritus.
They are most commonly noticeable in people with darker skin type. Clinical examination shows decreased melanin production in affected areas.
Pityriasis alba is commonly caused by atrophic sebaceous glands, iron deficiency anemia, low level of serum copper and sun exposure. It occurs
commonly in children aged 3-16 years with 90% of occurring in children younger than 12 years. An estimated 5 % of children in US may be affected.
Studies have showed a higher prevalence in Egypt 18% and Mali 20%. There is no clear racial predominance of Pityriasis alba found. Duration of the
rash is variable. According to Acharya Sushruta Sidhma Kustha is kapha pradhana vyadhi most commonly occurs in Urdhva kaya i.e., hasta, ura, mukha
and lalata. Diseases start with mild kandu and result in formation of white thin patches without pain. A female patient of 24 years attended our OPD
with complain of various circular, whitish, discoloured patches of irregular edges with moderate pruritis on bilateral upper limbs and neck root region
anteriorly. Finally, on the basis of all sign and symptoms it was diagnosed as Sidhma Kustha. In treatment repeated Vamana karma and Virechana
karma were done. Given treatment mainly pacifies kapha along with vata dosha.

Keywords: Pityriasis alba, Sidhma Kustha, Shodhana.

INTRODUCTION diagnosed as Sidhma Kustha. I am delighted to let you know that

this is my own case of Sidhma Kustha.
Pityriasis alba is a common benign skin disorder occurring
predominantly in children and adults. Pityriasis refers to its Hypo MATERIAL AND METHODS
pigmentation. Pityriasis alba is characterised by ill-defined
patches, round and oval, often with mild scaling and sometimes A female patient from Sonipat, Haryana at the age of 24 years,
with mild pruritus. They are most commonly located on face, consulted our college (Ayujyoti Ayurvedic college and hospital
arms and upper trunk and are most noticeable in people with Jodhpuria, Sirsa, Haryana, India) physician for complain of
darker skin type. It is noncontagious and non-infectious diseases. various circular, whitish, discoloured patches of irregular edges
Histopathology shows decreased melanin production in affected with moderate pruritis on bilateral upper limbs and neck root
areas1. Most common cause of Pityriasis alba are atrophic region anteriorly. She consulted allopathic physicians many
sebaceous glands, iron deficiency anemia, low level of serum times but got no satisfactory results. Along with this she was also
copper and sun exposure. having a history of severe acne vulgaris from about 10 years. For
that she consulted allopathic physicians’ multiple times. In
It is more common in children aged 3-16 years with 90% of February. 2019 she was advised to take salt isotretinoin in a dose
occurring in children younger than 12 years. An estimated 5% of of 10 mg twice a day for duration of 6 months. After that her acne
children in US may be affected. Studies have demonstrated a got resolved but as isotretinoin capsule do atrophy of sebaceous
higher prevalence in Egypt 18% and Mali 20%. There is no clear glands and reduces the amount of natural oil made by skin. So as
racial predominance. a side effect of this drug she developed dry eyes, mouth and lips.
Her skin became photosensitive. After one month she developed
On the basis of sign and symptoms Pityriasis alba is very similar these white patches on bilateral upper limbs and neck root region.
to Sidhma Kustha mentioned by Acharya Sushruta in Ayurveda. As pityriasis alba also have aetiology of occurring by atrophic
Sidhma Kustha is one of the most common but miserable Twak sebaceous glands, sun exposure etc. So, we may say that she
vikara affecting all the age of population still stands as a developed the diseases as a side effect of isotretinoin salt. So, she
challenge to different medical systems2. Many research works switched over to Ayurvedic treatment by consulting with
have been done on skin disorders in modern medical science, but physician in our college hospital. She was admitted in hospital
no drug has yet been claimed to cure this skin diseases completely for treatment. After 2 months of treatment, she got 100% relief
and prevent its recurrence. According to Acharya Sushruta in whitish patches and itching.
Sidhma Kustha is kapha pradhana vyadhi most commonly occurs
in Urdhva kaya i.e., hasta, ura, mukha and lalata3. Diseases start Study is carried out as per International conference of
with mild kandu and result in formation of white thin patches Harmonization-Good Clinical Practices Guidelines (ICH-GCP)
without pain. Finally, on basis of all sign and symptoms it was or as per Declaration of Helsinki guidelines.

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 Gahalawat Preeti and Kumar Pankaj / Int. J. Res. Ayurveda Pharm. 12 (1), 2021

Physical examination On basis of all finding’s patient was diagnosed with Sidhma
Kustha (Kshudra Kustha) mentioned by Acharya Sushruta.
On inspection white circular patches with irregular edges were
seen on bilateral upper limbs and root of neck anteriorly. Treatment

Investigations Shodhana Chikitsa

Table 1: Investigations
Table 2: Shodhana Chikitsa
Prakriti Pittakaphaja
Aahar Shakti Madhyama Vamana Karma 5/9/2019
Vyayama Shakti Avara Virechana Karma 20/9/2019
Samhanana Madhyama Jalaukavacharna 20/10/2019
Dosha kapha Raktamokshana 22/10/2019
Dhatu Rasa dhatu Virechana Karma 13/11/2019
Strotas Rasavaha strotas, Swedovaha strotas
Strotodusti Sanga

Shamana Aushadhas
Table 3: Shamana Aushadhas

Vidangarishta + Khadirarista6 + 1 gm Gandhaka 30 ml TID (after food)

Vijayasara choorana7 6 gm BD mixed in food
Lepa- Yavakshara + Gandhaka Bhasma + Sarshapa taila Local application
Anuloma- Viloma
Surya Namaskara
Sarvangasana

Vamana Karma
Table 4: Vamana Karma

Deepana Pachana Panchakola Phanta – 100 ml TID 4 Days

Snehapana Tiktaka Ghrita4 1st day - 60 ml
2nd day - 30 ml
3rd day - 45 ml
4th day - 80 ml
5th day – 150 ml
Sarvanga Abhyanga Bhritamarichadi taila For 1 Day in Visrama kala
Followed by Bashpa Sweda (Dashmoola kwatha)
Vamana Madanphala pippali5 20 gm Vega -6
Vacha - 3 gm Pittanta vamana
Yashtimadhu - 8 gm
Saindhava – 8 gm
Pippali - 4 gm
Honey - QS

After Vamana karma she got 30% relief in patches and her Shamana Aushadha were continued. 10 days after Vamana karma,
Virechana karma was planned for her.

Virechana Karma
Table 5: Virechana Karma

Deepana Pachana Panchakola Phanta - 100 ml TID 4 Days

Chitrakadi vati- 1 TID (before food)
Snehapana Mahatiktaka Ghrita 1st day - 40 ml
2nd day - 90 ml
3rd day - 160 ml
Sarvanga Abhyanga Bhritamarichadi taila For 3 Day in Visrama
Followed by Bashpa Sweda (Dashmoola kwatha) kala
Virechana Trivrit avleha8 Vega -30
Drakshasava Kaphanta Virechana
Triphala 28 ashaya

After that she got 50% relief in all sign and symptoms. But she was not satisfied with results. So, after one-month Jalaukavacharna
near patches and Siravedha were done. But there was no further improvement. Same Shamana aushadhas were continued during this
whole period. After 15 days again Vamana was planned.

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 Gahalawat Preeti and Kumar Pankaj / Int. J. Res. Ayurveda Pharm. 12 (1), 2021

Vamana karma
Table 6: Vamana Karma

Deepana Pachana Panchakola Phanta -100 ml TID 4 Days

Snehapana Tiktaka Ghrita 1st day - 60 ml
2nd day - 30 ml
3rd day - 45 ml
4th day - 80 ml
5th day – 150 ml
Sarvanga Abhyanga Bhritamarichadi taila For 1 Day in Visrama kala
Followed by Bashpa Sweda (Dashmoola kwatha)
Vamana Madanphala Pippali – 20 gm Vega -5
Vacha -3 gm Pittanta vamana
Yashtimadhu - 8 gm
Saindhava – 8 gm
Pippali - 4 gm
Honey - QS

After Vamana Karma she got 100% relief in all sign and symptoms.

Grading parameters

Kandu
Table 7: Kandu

0 No itching
1 Mild itching
2 Moderate itching
3 Severe itching

Sweta Varna
Table 8: Sweta Vrana

0 Normal skin color

1 Reddish white color
2 Pearly white color
3 White color

Number of Lesion
Table 9: Number of lesions

0 No lesion
1 1-3 lesion
2 4-6 lesion
3 > 6 lesion

Diameter of Lesion
Table 10: Diameter of Lesion

0 No lesion
1 Lesion of diameter 1-2 cm
2 Lesion with diameter 2-4 cm
3 Lesion with diameter 5 cm or more

RESULT AND DISCUSSION

Table 11: Result

Before Treatment After Treatment

Kandu 3 0
Sweta Vrana 4 0
No. of Lesions 4 0
Diameter of Lesion 3 09-11

In this case of Sidhma Kustha, the main treatment procedure for every 6 months, Lepa for every 3 days; cure of diseases
adopted here were Vamana and Virechana Karma. Ayurveda become easier due to removal of root cause.
emphasises treatment of diseases in holistic approach
particularly correcting the root cause through Samshodhana, Vamana Karma expels out toxins present in Rasadi dhatu and
specifically for skin diseases like Pityriasis alba; Vamana karma purifies dushya of skin diseases. Vamana clears channels which
and Virechana karma are advised. By nature, Kustha is difficult improves process of body nourishment. It further clears Bahya
to cure. So, it is called Dushchikitsya. But by using shodhana rogamarga and increases Indriya bala of Twak thus reduces
therapy repeatedly as mentioned by Acharya Sushruta Vamana severity of skin disorders.
for every 15 days, Virechana for every 30 days, Raktamokshana

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 Gahalawat Preeti and Kumar Pankaj / Int. J. Res. Ayurveda Pharm. 12 (1), 2021

Virechana Karma pacifies vitiated pitta dosha and also help in Charakokta and Sushrutokta Type 1 Sidhma and Type 2
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