Difference Between Search & Browse Methods in Odoo 17
Tvak%20Vikar-2.pptx
1. TVAK VIKAR
Presented by : Dr Rashi Jaiswal
Guided by : Prof. Rakesh Sharma
RGGPG Ayu College,Paprola,Kangra,H.P
2. CONTENTS
Introduction
Constitution of skin
Anatomy of skin
Functions of skin
Diagnosis pf skin diseases
Examination of skin
Distribution
Primary skin lesions
Secondary skin lesions
Ahiputna
Diaper dermatitis
Sidhma kushta
Pityriasis versicolor
Pama
Scabies
Vicharchika
Atopic dermatitis
Shakuni
Impetigo
General Treatment of skin Diseases in
Ayurveda
3. INTRODUCTION
Twak
the limiting boundary of the body
(S.S, sa 5-58)
evolves out of the paaka of sukrasonitha in the garbha (S.S, sa 4-4)
attains maturity by 6th of gestation
(A.H,sa1-57)
maternal contribution (C.S sa 3-6)
5. CONSTITUTION
Prithwi, Jalam, Vayu, Agni
Seat of sparsanedriya (A.H, Sa: 3; 3)
Seat of bhrajaka pittam (A.H, Su: 12;14)
Representing rasa in sakha (A.H, Su: 12; 44)
Upadhathu of mamsa (C.S, C: 15; 17)
6. TRIDOSHA IN TWAK
Prana vayu – indriya dharana (A.H, Su: 12; 4)
Vyana vayu – indriya bodhana (A.H, Su: 12; 6)
Bhrajaka pitta – Bhrajanam (A.H, Su: 12;14)
Pacaka pitta – nourishing bhrajaka pitta (A.H, Su: 12;11-12)
Sadhaka pitta – indriyartha sadhanam (A.H, Su: 12; 13)
Avalambaka Kapha – ambu karma (A.H, Su: 12;15)
Tharpaka – Aksha tharpanam (A.H, Su: 12;17)
7. DHATU AND TWAK
Rasam – twak preenanam (A.H, Su: 11;4)
Raktham – Formation of twak (A.H, Su: 12;14)
Mamsam – base of evolution of twak (C.S, C: 15; 17)
Medas and majja – Source of sneha (A.H, Su: 11;4)
9. KOSHTANGA AND TWAK
Yakrut and pleeha – moolasthana of raktha (C.S, Vi: 5; 8)
Hrudayam – moolasthana of Rasa (C.S, Vi: 5;8)
Vrukka – Moolasthana of medas (C.S, Vi: 5;8)
10. KLEDA AND TWAK
Reservoir of sneha in the body (A.H, Su: 11; Vivruthi)
Byproduct of metabolism (A.H, Su: 11; Vivruthi)
Optimal state sustains integrity of twak
Derangement disturbs the health of twak
11. RASA AND TWAK
Madhura :varna-indriyaprasadam (A.H, Su: 10; 7)
Tiktha : kleda soshanam (A.H, Su: 10;15)
Kashayam : twakprasaadanam (A.H, Su: 10;21)
12. VEERYA AND TWAK
Anushna seetha veeryam (A.H, Su: 27;2)
Sustains the integrity (A.H, Su: 27;53)
13. SKIN
Skin is a major organ of the human body where internal diseases may be
reflected on the skin surface.
Nearly one-third of the pediatric output visits involve a dermatology
complaint.
In addition to the wide variety of primary skin disorders seen during childhood,
the skin is often a marker of underlying systemic diseases and many hereditary
syndromes.
Besides identifying the primary and secondary skin lesions and studying their
characteristics, it is also vital to examine the hair, nails and mucosal surfaces.
14. ANATOMY OF SKIN
CONSISTS OF THREE LAYERS
EPIDERMIS
DERMIS
SUBCUTANEOUS FAT / HYPODERMIS
16. EPIDERMIS
0.4mm-1.4mm thickness
Majority of the cells are keratinocytes.
Have 5 layers
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale/ germinatum
17. DERMIS
Formed by connective tissue
[collagen, elastic , reticulin]
1 mm – 4mm in thickness.
18. HYPODERMIS
Mainly constituted by adipocytes
It varies in thickness
It is absent over eye lids
It act as insulator for heat.
It stores triglycerides.
19. FUNCTIONS OF SKIN
Protection
Thermoregulation
Storage
Vitamin D formation
Absorption
Excretion
20. Sensation
Psychology
Immune surveillance
Mechanical function
Cosmetic function
Lubrication
Body odor
21. DIAGNOSIS OF SKIN DISEASES
DEPENDS ON
Accurate use of lexicon of dermatology
Ability to identify primary and secondary skin lesions
Recognition of various patterns formed by the lesions
A good history taking and detailed physical examinations are important
22. PRESENTING COMPLAINTS
Subjective symptoms-itching, pain, parasthesia
Objective symptoms-rash, ulcer
For each symptom, following question should be asked
Duration
Site of 1st involvement
Evolution
Diurnal variation
Precipitating factors
Relieving factors
Associated features
23. PAST HISTORY
History of medical disorders like DM, hypertension, tuberculosis, seizures
Any medications received recently
Any past illness, therapy thereof, drug eruption
24. FAMILY HISTORY
Genetic disorders – Ichthyosis, neurofibromatosis
Infections and infestations – scabies
OTHER HISTORY
Social
Occupational
Travel
Recreational
26. PHYSICAL EXAMINATION
The affected part should be completely exposed.
Adequate illumination
Skin [ head – foot ]
Mucous membrane in mouth and genitals
Hair & Nails
27. INSPECTION
Shape
Color
Oozing
Micro organisms if any
Area
Number of lesions
Odour
Stage of lesion
33. PRIMARY SKIN LESIONS
Macule are flat, well-defined lesions that are detected because of a change in
color. Macules larger than 1cm are described as patches.
Papules are palpable, elevated, circumscribed solid lesions less than 0.5-1 cm
size, larger lesions are called as nodules.
Plaques are elevated flat-topped lesions, larger than 1cm.
Vesicles are elevated fluid filled lesions containing purulent material.
Wheals are transient, edematous and elevated flat topped lesions of various sizes,
duration and configuration that represent dermal collection of edema fluid.
Cysts are circumscribed ,thick walled lesions present deep in the skin which are
covered by a normal skin and contain either fluid or semisolid material.
34.
35. SECONDARY LESIONS
These can evolve from primary lesions.
Scales are compressed layers of desquamated epithelium.
Erosion is a break in the continuity of the epidermis.
Ulcers signify a deeper involvement and extend into the dermis and tend to
heal with scarring.
Fissures are cracks in the skin.
Crusts are dried up serum, exudates, blood or pus and epithelial debris on the
skin surface.
Lichenification is thickening and hyperpigmentation of the skin with
accentuation of skin margins caused by chronic scratching or inflammation.
Scars are end-stage lesions of inflammation which are formed due to fibrosis
and may be flat, depressed or raised.
36.
37. AHIPUTNA (Napkin Rashes)
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dsfprekr`dknks’kaonUR;U;svfgiwrue~ Ai`’Vk:xqndqVVapdsfpPpreukfedke~AA vgzm 2%69@70
It is one of the kshudra rogas mentioned by Acharya sushruta and Vagbhatta.
It has no relation to the putna ,andhaputna or the sheetaputna balgrahas of our texts.
Etiology:
Lack of cleansing of the diaper area of the infant soon after passage of stools and
urine
Infrequent bathing of the infant who sweats a lot
Vitiated breast milk
38. Doshas and Dushyas involved in Ahiputana
Ahiputana is caused by vitiated rakta (blood) and kapha-dosha as per Sushruta and
Vagbhata.
Dalhana in Nibandhasangraha says ‘ahiputanam kapha-raktajam jneyam.’
While describing the management of ahiputana, Vagbhata has considered the
involvement of kapha and pitta doshas in the mother and child as causing the
disease and has advised treatments pacifying kapha and pitta for breastfeeding
mother.
Pitta vrana chikitsa (management of pitta predominant wounds/ulcers) and
raktamoksha (bloodletting) indicate the importance of pitta and rakta in ahiputana.
The dhatu involved is twak (skin) which represents rasa (first dhatu or tissue
formed after digestion).
The involvement of malas- sakrit, mutra and sweda is not only due to upalepa or
smearing on perianal region but also due to vitiation especially of sakrit (faeces)
caused by kapha-pitta vitiated breast milk.
39. PROBABLE PATHOGENESIS
• Due to lack of proper cleansing of anal region after passage of stools and lack of
bathing of a sweating child, smearing of urine, faeces and sweat over anal region
occurs and utkleda (wetting or moistening) by sweda and mala occurs which
cause rakta and kapha vitiation of the skin.
• Itching develops in the anal region from vitiation of rakta (vitiated blood) and
kapha dosha.
• Kanduyana or scratching results in ulceration and quick eruption of
sphota/pitaka (papules and pustules) along with srava (discharge).
• The eruptions lead to ulceration or wounds which blend or coalesce to form a
horrible and dreadful large rash which is called Ahiputana. It is also said to be
ghora or severe with bhuri-upadrava (numerous complications).
40. SIGNS AND SYMPTOMS
• Kandu (pruritus in and around guda or anal region)/ kanduyana
(intense itching)
• Daha (burning sensation)
• Ruja (pain)
• Tamra-vrana (coppery coloured ulcer)
• Sphota/pitaka (papule/pustule)
• Srava (discharge
41.
42. MANAGEMENT
Purification of breast milk: Pitta-Sleshmahar dravya to be used.
Preparation of Rasanjan mixed with honey should be given.
Decoction made with Triphala, Kola and Khadir to be used as Parishek (shower).
External application: application of Rasount (rasanjan) and honey over the lesions.
Paste of Kaseesa, Gorochan, Tuth, Hartal and Rasanjan and Saindhav Lavana should be
prepared with kanji and applied over the affected area.
Churna for local application- Kasees churna (FeSO4)
Kapal and Tutha churna
Madhuka, Shankh, Sauviranjan, Sariva , Shankhnabhi churna
Raktamokshan: If the affected region is erythematous with intense itching, bloodletting
using jalauka (leech therapy) may be considered.
43. Internal use of Ghrita sidha with Patola, Triphala and Rasanjana.
44. DIAPER DERMATITIS
Napkin dermatitis is a contact dermatitis exclusively localized in the region covered by
diapers in infants. It is more common in artificially fed infants and those with poor
perineal hygiene.
PATHOGENESIS
Multiple causative factors interplay with each other such as feces, urine, friction,
moisture, temperature, chemical irritation, and diaper material.
Fecal enzymes such as proteases and lipases act as irritants in an atmosphere of
increased moisture .
Candida albicans infection may also play a role.
45. CLINICAL FEATURES
There is presence of erythematous ,glazed, well demarcated lesions on the
diaper area.
Convex surfaces: the skin appears red, parchment like and scalded, which soon
becomes infected giving rise to pustular erosions.
Involvement of skin folds: retention of sweat makes the area moist and
macerated. Constant rubbing of skin causes erosion and denudation of the skin.
Bacteria grow easily in this environment and cause secondary infection.
46. Tidemark dermatitis – Eruptions confined to margin of napkin area.
Jacquet’s dermatitis – Erosive form with small eruptions and vesicles which may
develop into shallow round ulcers.
Chronic diaper dermatitis - Hypertrophic flat topped papules and infiltrative nodules .
Candidal Dermatitis – Rash is surrounded by satellite papules and pustules (1-
2mm).Papulo-vesicular , bullous and erosive lesions are frequent.
The peri-anal skin, inguinal folds , perineum, lower abdomen is usually involved . In
males entire scrotum and penis is involved with an erosive balanitis. In females,
lesions may be found on vaginal mucosa and labia.
47. MANAGEMENT
Parents have to be advised to frequently change the diaper as it becomes wet,
and to expose the skin to air.
Over washing should be avoided.
Keep area dry, use disposable diapers.
Use of impervious or plastic undergarments should be avoided
Lubricants such as petrolatum can be applied.
A mild topical corticosteroid cream combined with an antibacterial or
antifungal agent can be used to treat the contact irritant dermatitis.
When candida infection is suspected, nystatin dusting powder or clotrimazole
may be applied locally.
48. SIDHMA KUSHTHA
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i:’kkf.k fo”kh.kZcfgLruwU;r%fLuX/kkfu “kqDyjDrkoHkklkfu cgwU;YiosnukU;Yid.Mwnkgiw;ylhdkfu
y?kqleqRFkkukU;YiHksnfdzeh.;ykcqiq’iladk”kkfufl/edq’Bkuhfrfo|kr~AA pfu 5
According to Charaka, Sidhma is a type of Maha Kushta, the signs and symptoms are
Parusha Aruna Varna, the periphery it is fissured and then in center it is smooth white and
red shade. It appears in large number and there is less pain, itching, burning sensation,
Puya, Lasika, Srava i.e., pus and serous discharge. There is formation of ulcers and
sluggish in nature and get infected by Krimi. It appears like flower of Alabu and it is at
Kapha Vata predominance.
49. Cont…
In Chikitsa Sthana of Charaka, symptoms such as Shweta, Tamra Varna, Tanu,
Rajoghrushta and Alabu Pushpavat are explained.
According to Acharya Susrutha, Sidhma is characterized by Kandu, Shweta Varna,
Apayi, Tanu, and generally this disease occurs in Urdhwakaya.
Susrutha considers Sidhma as Kaphahdika Kushta.
According to Vagbhata, the Sidhma Kushta appears to be externally dry, internally it is
moist in nature and while scratching scales like dust will be seen. It is smooth to touch,
skin over the effected part is Tanu (soft) and it looks like Daugdhika Pushpa with
whitish brown colour and most commonly appears in Urdhwakaya. Dosha involved is
Vata Kapha.
50. NIDAN
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O;k;keefrlarkiefrHkqDRoksilsfouke~ A “khrks’.ky³ukgkjku~ Øea eqDRok fu’ksfo.kke~AA
?keZJeHk;krkZukanzqra“khrksEcqlsfouke~ A vth.kkZ/;f”kuka pSo iapdekZipkfj.kke~A
uokUunf/keRL;kfryo.kkEyfu’ksfo.kke~ A ek’kewydfi’VkUufry{khjxqMkf”kuke~ AA O;ok;a
pkI;th.kZs·Uusfunzka p Hktrka fnok A foizku xq:u~/k’kZ;rkikia deZp dqoZrke~AA pfp 7@4---8
51. SAMPRAPTI CHAKRA
Vatadi tridosha prakopa
Teeryak-gata sira gaman
Twacha-rakta-mamsa-lasika dushita and shithilta
Dosha-dushya ka tvak sthana-sanshraya
Mandal-utpatti and vaivarnyata Kushtha roga-utapatti
Nidaan sewan
56. PITYRIASIS VERSICOLOR/TINEA
Sidhma can be compared with Tinea versicolor in modern
medical science.
Definition-It is a fungal infection that causes small patches of
discolored spots on skin.
These patches may be lighter or darker in color than the
surrounding skin and most commonly affect the trunk and
shoulders.
It is not painful or contagious.
Found mostly in children between 2-6 years of age.
Also common among teenagers due to hormonal fluctuations.
However, it can affect people of all ages and genders.
57. CAUSES
The rapid growth of fungus causes the discoloration of skin resulting in
Pityriasis Versicolor.
Certain biological and environmental factors can cause overgrowth of fungi on
the skin.
Weak immune system.
Hormonal imbalance.
Excessive oily skin.
Living in hot and humid weather.
Excessive sweating.
Genetic history
58. SYMPTOMS
Hypopigmentation
In some cases hyperpigmentation.
Dry skin.
Itchy skin.
Formation of red, white or brown color patches.
Permanent tanned skin.
59. TREATMENT
Treatment involves the combination of lifestyle changes and medicines.
Antifungal medications to prevent the infections from spreading to other parts
of body.
Creams and lotions containing pyrithione zinc or ketoconazole .
Avoid prolonged exposure to UV rays.
Avoid going out in hot and humid weather.
Bath daily to avoid excessive accumulation of oil and dirt on the skin.
Fluconazole tablets and oral solutions.
The lesions are self limiting, clearing spontaneously in a few months to couple
of years.
60. PAMA KUSHTHA
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Pama is one amongst the eleven types of kshudra kushtha caused by vitiation of
kapha and pitta dosha.
It is characterized by whitish dark and red papules accompanied by severe
itching.
It is one of the krichrasadhya types from kshudra kushta.
61. SCABIES
Pama can be compared to scabies based on clinical features.
Scabies is caused by Sarcoptes scabiei var hominis and it is highly contagious
transmitted by close contact with infested humans.
CAUSES
Close physical contact and less often, sharing clothes and bedding with an infected
person .
Clinical features:
patients present with itchy lesions which are worse at night, present in a characteristic
distribution
The primary lesion is a burrow, a grey thread-like serpentine line with a minute papule at
the end, papules and papulovesicles may also be seen.
62. Secondary lesions consist of pustules, eczematized lesions and nodules.
Lesions are seen in webs of hands, on-wrists, ulnar aspects of forearms,
elbows, axillae, umbilical area, genitalia, feet and buttocks.
Face is usually spared, except in infants in whom face, scalp, palms and soles
are also involved known as infantile scabies.
Secondary infections are common. Secondary streptococcal infection may
result in acute glomerulonephritis.
63. DIAGNOSIS
DEFINITE DIAGNOSIS
A definite diagnosis is made by taking skin scraping from burrows and identifying the
mites, their eggs or faeces by microscopy.
PRESUMPTIVE DIAGNOSIS
It is often difficult to find burrows and obtain suitable specimens, therefore presumptive
diagnosis relies on history and clinical appearance.
64.
65. MANAGEMENT
General measures: All close contact of the patient, even if asymptomatic, should
be treated. Overzealous laundering of bed linen and clothes is not warranted.
Specific measures: Antibiotics are given, if secondary infection is present.
Antihistamines are given for 1-2 weeks to reduce pruritis. The topical scabicide
should be applied all over body below the neck, including on the free edge of
nails, genitals, soles of feet after hydration of body with a bath.
Scabicides available include: permethrin 5%-overnight single application is TOC
in children older than 2 months of age.
Pramoxine lotion : To control the itch.
Ivermectin-single dose of 200ug/kg body weight, in children older than 5 years
is the treatment of choice for epidemics.
Treat all close family whether itchy or not.
66. VICHARCHIKA
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• According to Achary Charak, the skin lesion along with kandu (itching), pidka (boil), shyava
(darkness) and bahusrava( profuse oozing) is Vicharchika. Acharya Charak described it Kapha
Pradhan tridoshaj vyadhi.
• Acharya Sushrut defined vicharchika comprising of marked linings, excessive itching and
pain along with dryness at the skin lesion under Pitta Pradhan tridoshaj vyadhi.
• Achary Vagbhat added lasikadhya instead of bahusrava other lakshan are same as Charak
1. Kandu- It is a condition of severe itching and is most distressful symptom.
2. Pidika- In Charak it has been explained that, when the vitiated Pitta gets accumulated in
Twacha and Rakta creates inflammation and redness then it is known as Pidika.
3. Srava- Acharya Charak described Bahusrava meaning profuse discharge.
4. Shyava-this is characteristic feature of the lesions of Vicharchika.
5. Raji- Sushruta has described this symptom. Raji means linings. Raji is caused by vitiated
Vata.
6. Rukshata- It indicates the dryness in the lesion.
7. Ruja- Ruja means Vedna i.e. pain to the patient due to chronic nature of the disease.
67. ATOPIC DERMATITIS (ECZEMA)
It is an acute ,subacute or chronic relapsing, endogenous eczema,
characterized by dry skin and recurrent, pruritic, symmetric dermatitic
lesions.
It occurs primarily in infants and children.It affects 5-15 % of school
children and 2-10 % 0f adults.
68.
69. ATOPIC DERMATITIS CHILDHOOD TYPE
Ill defined lichenified papules and plaques with excoriations and dyspigmentation
70. ETIOPATHOGENESIS
The disease arises as a result of complex interplay between various genetic,
immunological and environmental factors.
Atopic dermatitis clearly has a hereditary basis.
The environmental factors include :
a) Physical factors like sweating, climate, warm surrounding, detergents and
soap, synthetic and woollen fabrics, cigarette smoke.
b) Physiological factors.
c) Food items including tomato, orange and citrus fruits, fish.
d) Allergens such as house dust mite, animal hair, pollen, plants and others such
as Staphylococcus aureus and release of exotoxins and saliva in small children.
71. CLINICAL FEATURES
Lesions develop in infancy, anytime after 3 months of age. In children two
distinct patterns are recognized.
I. Infantile pattern: manifests as itchy ,erythematous papulovescicles, on the
face, but may become generalized. The lesions clear by 18 months of age in
40% and evolve into childhood pattern in the rest.
II. Childhood pattern: it is characterized by dry, lichenified and crusted plaques,
seen mainly on antecubital and popliteal fossa, the neck and face. Most (70%)
clear by 10 years of age.
III. Sub-acute eczema is characterized by either grouped or scattered scaly,
erythematous papules pr plaques over an erythematous skin.
72. IV. Chronic condition includes thickening of the skin with lichenification (
increased skin markings), secondary to scratching and rubbing.
V. When it appears on the eyelids and around the eyes, it can result in cataract,
darkening of the skin, and an extra fold of skin under the eye.
DIAGNOSIS
The diagnosis is based on Hanifin and Rajaka criteria.
75. MANAGEMENT
General measures- care takers and child should be counselled about the chronicity of the disease and
that the child should avoid contact with irritants (woolens and chemicals).
Measures to reduce exposure to house dust mite (using barriers on pillows and mattresses, regular
vacuuming of rooms) may help.
There is no contraindications to vaccination except in children specially allergic to eggs, in whom
influenza and yellow fever vaccines are avoided.
Dietary restrictions are usually not warranted and breast feeding is encouraged as it may decrease the
chance of the infant developing the disease.
Skin care : mild soaps and cleansing lotions are to be used for bathing followed immediately by
application of moisturisers to skin.
Acute lesions are treated with wet dressing and topical steroids. antibiotics and
antifungal(topical/systemic) are used when indicated.
Oral antihistaminics are often prescribed.
Chronic lichenified lesions are managed by hydration followed by application of emollients (like
petroleum) and a short course of topical steroids.
It is preferred to use the least potent steroid which reduces symptoms, avoided on face and genitalia.
Topical immunomodulators are useful because of their steroid sparing and anti-pruritic action.
76. o Daily moisturizing and bathing.
o Take at least one bath or shower daily.
o Bathe or shower in lukewarm, not hot, water for 10 to 15 minutes
o Avoid scrubbing.
o Use gentle cleanser, not soap, that is dye and fragrance- free.
o During flare-ups, limit use of cleansers.
o Moisturize within three minutes of bathing or showering Use a high oil
content moisturizer to improve hydration.
o Moisturize hands every time you wash them or they come into contact with
water.
o Schedule bathing and moisturizing before bed to help skin retain moisture.
BATHING AND MOISTURIZATION
80. MANAGEMENT
Parishek – Vetas, Amrapatra and Kapithapatra kwath, Ksheeri vriksha
Kashaya
Abhyang- Nyagrodhadi Kashaya kwath, Kakolyadi kalka siddha taila
abhyanga
Lepa- “kdqU;ka e/kqdgzhcsjks”khjlkfjokin~edksRiyefta’Bkyks/kzfiz;axqxsSfjdS% iznsg% A v la 6%30
Mukhapaka- Arjuna phala ,lodhra, madhuyashti, udumbar and vacha churna
with madhu to be applied on mukha.
Ghritpana- Ghrita told in Skandapasmaara Graha to be used. (Kheeri vriksha
Kashaya, kakolyadi gana sadhit kalka)
Dhupan- like Skandagraha – LdUnksDr/kwi% A dkdfiPNsu ok
xksckyksxzxU/kkj{kks?u?k`re;wjpUnzdS% ok AA v la 6%32
81. IMPETIGO
A pyoderma is a superficial purulent bacterial infection of the skin.
Primary pyoderma: occurs on normal skin has a characteristic morphology and is
initiated by a single organism. These include impetigo, ecthyma, folliculitis, furuncle,
carbuncle, cellulitis and paronychia
Secondary pyoderma: occurs on pre-existing skin lesion like cuts, eczema. They have a
variable morphology and are caused by a variety of different organisms.
Impetigo is the most frequently diagnosed superficial bacterial skin infection involving
the upper epidermis.
82. CAUSES
Caused by S. pyogenes.
But S. aureus either alone or in combination with S. pyogenes has emerged more recently
as the principle cause of impetigo.
The bullous form is caused by strains of S. aureus capable of producing exfoliative toxins.
2 Varieties :
a) Non bullous impetigo-occurs mainly on face and limbs. It begins as a reddish macule,
turns into a transient flaccid vesIcles, which ruptures, and the oozing fluid dries to form a
honey colored crust. Healing occurs without scar formation.
b) Bullous impetigo-appears as large fluid filled blisters, which rupture to form superficial
erosions. Face, palms, soles and mucosa are involved.
83. PATHOPHYSIOLOGY
Bullous impetigo is caused by staphylococci producing exfoliative toxin that contains
serine proteases acting on desmoglein, a structurally critical peptide bond in a molecule
that holds epidermal cell together.
This process allows Staphylococcus aureus to spread under the stratum corneum in the
space formed by the toxin, causing the epidermis to split just below the stratum
granulosum. Large blisters then form in the epidermis with neutrophil.
In bullous impetigo, the bullae rupture quickly, causing superficial erosion and a
yellow crust.
While in non-bullous impetigo, Streptococcus typically produces a thick walled
pustules with an erythematous base.
Histology of non-bullous established lesions show a thick surface crust composed of
serum and neutrophils in various stages of breakdown with parakeratotic material.
84.
85. MANAGEMENT
For self limiting pyodermas, simple measures such as removal of crusts with
Condy’s compresses (KMnO4) or tepid water and careful washing with
antibacterial soaps may be useful.
Systemic oral antibiotics (erythromycin, cloxacillin ,or cephalexin) limit the
spread of infection and prevent complications.
Topical application of 2% mupirocin ointment with oral erythromycin and may be
used for limited infections.
Topical application of 2% Fusidic acid ointment.
86. GENERAL MANAGEMENT OF SKIN
DISEASES IN AYURVEDA
In Ayurveda, skin disorders like any other diseases are treated with Samsodhana and
Samsamana Chikitsa. As mentioned above, Samshodana Chikitsa plays a vital role in
the management of skin disorders. Treatment of various skin disorders according to
various Acharyas of Ayurveda are illustrated below.
In Vataja kusta (skin disorders dominated by Vata), medicated ghee is first
administered internally.
In Pittaja kusta (skin disorders dominated by Pitta), Raktamokshana (blood-letting)
and Virechana (Therapeutic Purgation) should be
administered, Raktamokshana (blood-letting) should be performed in the less acute
stage of kusta by pracchana (rubbing with a coarse device) and in more acute stage
of kusta by venesection.
Kaphaja kusta (skin disorders dominated by kapha) is treated
with Vamana (Therapeutic Emesis).
87. Sneha panam (Internal administration of medicated Sneha (oleaginous
substances)
Prior to Samshodana, Snehana is done with internal administration of
following Snehas :
Mahatiktaka ghrita
Tiktaka ghrita
Vajraka ghritam
Swedana (Sudation) is done one day prior to Vamana (Therapeutic Emesis) or
three days in case of Virechana (Therapeutic Purgation). Usually Mridu swedana is
done like exposure to sun or taking hot water bath etc.
88. Vamana (Therapeutic Emesis) is done with
Kutaja (Holarrhena antidysenterica )
Madanaphala (Randia dumetorum )
Madhuka (Glycyrrhiza glabra ) mixed with the juice or decoction of Patola
(Trichosanthes dioica )
Nimba (Azadirachta indica )
Virechana (Therapeutic Purgation) is done with
Trivrt (Operculina turpethum )
Danti (Baliospermum montanum )
Triphala (Emblica officinalis)
Manibhadra gudam
Avipatikara choornam
Depending upon the intensity of sodhana, Samsarjana krama (administration of
regulated diet after the therapy) from 3 to 7days should be followed.
89. In patients with excess of Vata dosa after Virechana (Therapeutic
Purgation), asthapana vasti (Medicated Decoction Enema) and anuvasana vasti
(Medicated oil enema) should be administered.
Nasya (inhalation therapy) with rock salt, Danti (Baliospermum
montanum ), Maricha (Piper nigrum L.), Phanijjhaka (Origanum majorana L.),
Pippali (Piper longum ) and fruit of Karanja (Pongamia pinnata ) cures kustha
caused by aggravation of kapha and krimi.
Vairecaniya dhuma (eliminative type of smoking therapy) cures krimi (worms),
kusta and kilasa (vitiligo).
After Samshodana, administration of following drugs are advised.
90.
91. Herbal or herbo-mineral pastes or alkalies are used as external applications.
Sulphur preparations: Administration of sulphur internally and externally is
regarded as remedy par excellence for the cure of all types of skin diseases.
(Ca. Ci.7:70)
Siddhartaka snana : The water boiled with Musta (Cyperus
rotundus ), Madana (Randia dumetorum ), Triphala (Terminalia
chebula , Terminalia bellerica & Phyllanthus emblica , Karanja (Pongamia
pinnata ), Aragvada (Cassia fistula ), Indrayava (Holarrhena
antidysenterica ), Darvi (Berberis aristata ) and Saptaparna ( Alstonia
scholaris ) should be used for bath.
Vomiting should be induced every fortnight, purgation should be done every
month, blood-letting in small amounts should be done twice a year and snuffs
should be given every third day. This is done for chronic and recurrent skin
disorders.
