A CLINICAL STUDY ON EFFICACY OF SIYAKKAI (ACACIA CONCINNA) HAIR WASH ON DARUNAKA (PITIRIASIS CAPITIS)

Abstract

Background: Skin constantly renews itself. Dead cells fall off as new cells form beneath them. In Pityriasis capitis, this process is abnormally accelerated. Its signs and symptoms are: cells shedding in clearly visible flakes, small white or grey scales accumulating on the scalp, itching and dry or greasy hair. Darunaka is disease described in Ayurveda under Ksudra Roga. Signs and symptoms of Darunaka are: Daruna (cracked scalp), Kandura (itching of the scalp) and Ruksha (dryness of the scalp). Darunaka can be correlated with Pityriasis capitis. Aim: Sri Lankan use Siyakkai (Acacia concinna) hair wash (SHW) as an effective home remedy for Pityriasis capitis. No known scientific study has been undertaken to evaluate the efficacy of SHW. Hence, the present study was undertaken Methods: SHW is prepared by adding 10g of powdered pods of Acacia concinna to 240ml of boiled water. Seventy patients having Darunaka were selected and randomly divided into two groups, named as Groups A and B. Group A, consisting of thirty five patients, was treated with 240ml of SHW every alternative day, for twenty eight days. Group B, consisting of thirty five patients, was treated with placebo, in the same regimen. Response to treatment was recorded and therapeutic effects were evaluated through symptomatic relief. Results: Patients treated with SHW showed a significant symptomatic relief in scaling, itching, dryness and greasiness of scalp after treatment. Interval between scaling also became longer. Some patients treated with SHW complained of rhinorrhea. Conclusion: It is concluded that Darunaka (Pitiriasis capitis) can be relieved with Siyakkai Hair Wash.
Key Words: Darunaka, Pityriasis capitis, Siyakkai, Acacia concinn, hair

Full text

Jour. of Ayurveda & Holistic Medicine
Volume-II, Issue-VII
14
A CLINICAL STUDY ON EFFICACY OF SIYAKKAI (ACACIA CONCINNA) HAIR
WASH ON DARUNAKA (PITIRIASIS CAPITIS)
Sujatha Ediriweera
1
A.M.H.Y Perera
2
K.K.V.S. Peshala
3
K. M. S.P. Perera
4
E.R.H..S.S.Ediriweera
5
INTRODUCTION:
Darunaka is a disease which is described under the Kshudra
Roga in Ayurvedic texts. It is occurred by vitiation of Kapha
and Vata Doshas. According to Ayurveda signs and symptoms
of Darunaka are, Daruna (cracked scalp), Kandura (itching of
the scalp) and Ruksha (dryness of the scalp)
[1][2].
Darunaka is
correlated to Pityriasis capitis (Dandruff); a disease described
in modern medicine. Though it is not a life threatening
disease, it may become a cosmetic problem during second
and third decades of life. There are two varieties of Pityriasis
capitis; namely dry variety and greasy variety. Signs and
symptoms of dry variety are dry hair, small white or gray
scales with mild itching or without itching. Signs and
symptoms of greasy variety are; greasy hair, yellow thick
scales with moderate or severe itching
[3][4]
. Acacia concinna
(Family: Leguminosae; Sanskrit name: Saptala; Tamil name:
Sheeyakay; English name: Soap pod) is a climbing or scandent
shrub, that grows in tropical jungles throughout India. It is a
plant which is used as an aperients, expectorant and a
detergent
[5].
A. concinna is used by Sri Lankans as a natural
substance to clean and wash hair as a home remedy for
Darunaka (Pityriasis capitis). But, no scientific clinical study
has been conducted to evaluate the efficacy of A .concinna in
Darunaka (Pityriasis capitis). So, present study was
undertaken to evaluate the effect of A. concinna in Darunaka
(Pityriasis capitis).
MATERIAL AND METHODS:
Study design: A randomized single blind, parallel, placebo
controlled clinical study.
Selection of drug:
Sri Lankans use Siyakkai (Acacia concinna) hair wash as an
effective home remedy to manage the disease Darunaka
(Pitiriasis capitis). Hence SHW was selected for this study.
Preparation of Siyakkai hair wash:
Pods of the A. concinna were brought from the market and
authenticated. The pods were powdered and stored in an
airtight container. To prepare the hair wash, 240 ml of boiled
water is added to 10g of powder of A.concinna, and allowed
ABSTRACT:
Background: Skin constantly renews itself. Dead cells fall off as new cells form beneath them. In Pityriasis capitis, this
process is abnormally accelerated. Its signs and symptoms are: cells shedding in clearly visible flakes, small white or
grey scales accumulating on the scalp, itching and dry or greasy hair. Darunaka is disease described in Ayurveda under
Ksudra Roga. Signs and symptoms of Darunaka are: Daruna (cracked scalp), Kandura (itching of the scalp) and Ruksha
(dryness of the scalp). Darunaka can be correlated with Pityriasis capitis. Aim: Sri Lankan use Siyakkai (Acacia concinna)
hair wash (SHW) as an effective home remedy for Pityriasis capitis. No known scientific study has been undertaken to
evaluate the efficacy of SHW. Hence, the present study was undertaken Methods: SHW is prepared by adding 10g of
powdered pods of Acacia concinna to 240ml of boiled water. Seventy patients having Darunaka were selected and
randomly divided into two groups, named as Groups A and B. Group A, consisting of thirty five patients, was treated
with 240ml of SHW every alternative day, for twenty eight days. Group B, consisting of thirty five patients, was treated
with placebo, in the same regimen. Response to treatment was recorded and therapeutic effects were evaluated
through symptomatic relief. Results: Patients treated with SHW showed a significant symptomatic relief in scaling,
itching, dryness and greasiness of scalp after treatment. Interval between scaling also became longer. Some patients
treated with SHW complained of rhinorrhea. Conclusion: It is concluded that Darunaka (Pitiriasis capitis) can be
relieved with Siyakkai Hair Wash.
Key Words:
Darunaka
, Pityriasis capitis, Siyakkai,
Acacia concinn,
hair wash.
1
MD (Ayu). Banaras Hindu University, Varanasi, India.
2
Professor, Institute of Indigenous Medicine, University of
Colombo, Rajagiriya, Sri Lanka.
3,4,5
Medical officer, Department of Ayurveda, Sri Lanka.
Corresponding author email: ayurvedadocsujatha@yahoo.com
Access this article online: www.jahm.in
Published by Atreya Ayurveda Publications, Ilkal-587125 (India) all
rights reserved.
Received on: 19/09/14, Revised on: 21/09/14, Accepted on:
22
/
09
/14

Jour. of Ayurveda & Holistic Medicine
Volume-II, Issue-VII
15
to cool in the normal temperature.
Preparation of placebo:
Permitted brown food colouring was added to 240ml boiled
and cooled water.
Selection of patients
Sampling: Randomization was done by using a random
numbers table.
Sample size: 70 patients
Study setting:
The patients suffering from Darunaka (Pityriasis capitis),
were selected from Ayurveda Teaching Hospital, Borella, Sri
Lanka from July 2007 to September 2009
Diagnostic criteria:
Cracking and itching in the scalp, excessive flaking and
abnormal shedding of the skin, and dryness or greasiness in
the scalp are the diagnostic criteria of Darunaka (Pityriasis
capitis).
Inclusion criteria:
The patients with Darunaka (Cracking of the scalp), Kandu
(Itching of the scalp), Ruksha (Dryness of the scalp)
Greasiness of hair, hair falling and scaling of the scalp were
included in the present study.
Exclusion Criteria:
Patients suffering from psoriasis, allergic conditions of the
scalp and nutritional disorders were excluded from the
research. Some patients who are affected with dandruff
suffer from self-esteem problems and seemed to be anxious
or depressed due itching and/or large amounts of ungainly
flaking. Such patients were also excluded from the study.
Grouping
In this study, the patients were randomly divided in to two
groups namely as Group A and Group B and each group
consisting of thirty five patients.
These patients were instructed to take their normal diet and
to avoid use of shampoo and soaps in hair washing during the
treatment period.
After selection of patients, they were informed about the
study and their written consent was obtained. Further,
patients were made to understand that they are able to
withdraw from the study any time without prior notice.
Lab Investigation:
Routine examination on blood (WBC/DC, Hb %) and urine Full
report were done but no special laboratory investigation
were carried out.
Intervention
Group A-
Drug: Siyakkai Hair Wash
Dose: 240ml of Siyakkai hair wash was applied on the scalp
and hair, kept for 20 minutes and rinse off with portable
water.
Duration: Every alternative day, for 28 days
Follow up: One month
Group B
Drug: Placebo for Siyakkai Hair Wash
Dose: 240ml of placebo for Siyakkai Hair Wash was applied
on the scalp and hair, kept for 20 minutes and rinse off with
rectify water
Duration: Every alternative day, for 28 days
Follow up: One month
Criteria for Assessment
Responses to the treatment were evaluated by using a
specially prepared grading scale for clinical features. Grading
of the Signs and Symptoms of Darunaka (Pitiriasis capitis) are
given below.
A) Darunaka (Cracking of the scalp)
0 = No Cracking
1 = Cracking is limited to 5-10cm area
2 = Cracking is limited to 10-20cm area
3 = Cracking is limited to 20-30cm area
4 = Cracking can be seen all over the scalp
B) Kandu (Itching of the scalp)
0 = No Itching
1 = Occasionally feels Itching sensation
2 = Intermittently feels Itching sensation
3 = Often feels Itching sensation
4 = Always feels Itching sensation
C) Ruksha (Dryness of the scalp)
0 = No Dryness
1 = No Dryness in appearance but slight Dryness can be felt
in the scalp
2 = Mild Dryness in the scalp that can be seen and felt
3 = Moderate dryness in the scalp that can be easily seen
and felt
4 = Coarse dryness in the scalp that can prominently be
seen and felt
D) Scaling of the Scalp
4a) Grading according to Duration of recurrence of scaling
0 = No Scaling from Scalp
1 = Scaling at four day intervals
2 = Scaling at three day intervals
3 = Scaling at two day intervals
4 = Scaling daily
4b) Grading according to the scaled area of the scalp
0 = No Scaling of the Scalp
1 = Scaled area limited to 5-10cm
2
of the scalp
2 = Scaled area limited to 10-15cm
2
of the scalp
3 = Scaled area limited to 15-20cm
2
of the scalp

Jour. of Ayurveda & Holistic Medicine
Volume-II, Issue-VII
16
4 = Scaled area is more than 20cm
2
4c) Grading according to the size of the Scales
0 = No Scaling of the Scalp
1 = powder like scales are visible
2 =1 mm scales are visible
3 =1-2mm scales are visible
4 = Scales are larger than 2mm in size
E) Greasiness of Hair
0 = Normal hair
1 = Normal in appearance but feel slightly greasiness to
touch.
2 = Mild greasiness that can be seen and felt
3 = Moderate greasiness that can be seen and felt
4 = Heavy greasiness making the hair excessively greasy to
touch and in appearance
Statistical analysis:
Statistical analysis was done by using Mann–Whitney U test.
Observations and results
These patients differ from each other in many ways such as
Prakriti (body constitution), psychique and habits. They
complained mostly of scaling, itching and dryness of the scalp
and also of hair falling. The therapeutic effect was evaluated
through symptomatic relief and results are given in Table 1, 2
and Fig. 1. In Group A, 62.85% of patients treated with
Siyakkai Hair Wash reported complete absence of scaling
after the treatment. Among the rest of the patients in Group
A, the size of the scales was reduced to fine powder after the
treatment. Longer time span between scaling was observed.
Among the most patients in Group A, abnormal hair falling
was stopped. More than 70% of patients treated with
Siyakkai Hair Wash reported complete absence of itching,
dryness and greasiness of the scalp after the treatment.
18.4% of patients treated with Siyakkai Hair Wash
complained about rhinorrhoea and three patients gave up
the treatment due to rhinorrhoea.
The follow up of the patients was done for one month after
discontinuing the treatment. Recurrent attacks were not
observed in the patients who were completely relieved
during the follow up period.
Table 1: Percentages of symptomatic relief during the treatment with Siyakkai Hair Wash and Placebo in Darunaka (Pityriasis
capitis)
SYMPTOMS Placebo Group Treated Group
Completely
relieved
Partially
relieved
Unchanged Completely
relieved
Partially
relieved
Unchanged
Daruna (cracking of the
scalp)
00.00% 00.00% 100.00% 62.85% 37.15% 00.00%
Kandu (itcing of the
scalp)
5.00% 10.00% 85.00% 73.33% 26.67% 00.00%
Ruksha (dryness of the
scalp)
10.00% 20.00% 70.00% 83.87% 6.45% 9.68%
Greasiness of the hair 00.00% 00.00% 100.00% 100.00% 00.00% 00.00%
Table 2: Symptomatic relief during the treatment with Siyakkai Hair Wash and Placebo in Darunaka (Pityriasis capitis).
Symptom
Placebo group (mean ± SE) Treated group (mean ± SE)
Before treatment After treatment Before treatment After treatment
Daruna (cracking of the
scalp)
3.40 ± 0.16 3.40 ± 0.16 3.40 ±0.16 0.49 ± 0.12 *
Kandu (itching of the
scalp)
1.23 ± 0.21 1.14 ± 0.21 2.06 ± 0.20 0.26 ± 0.09 *
Ruksha (dryness of the
scalp)
1.54 ± 0.18 1.29 ± 0.17 1.63 ± 0.17 0.14 ± 0.09 *
Greasiness 0.31 ± 0.15 0.31 ± 0.15 0.23 ± 0.14 0.23 ± 0.14
* p < 0.05compare to control

Jour. of Ayurveda & Holistic Medicine
Volume-II, Issue-VII
17
Symptoms
mean ± SE
Figure 1: Symptomatic Relief during the treatment with
Siyakkai hair wash and Placebo in Darunaka (Pityriasis
capitis) (mean ±
±±
± SE)
DISCUSSION:
The patients treated with placebo did not show statistical
significant symptomatic relief in scaling, itching of the scalp,
dryness and greasiness of the scalp after the treatment.
The powder of A.concinna is slightly acidic and contains
saponine which helps to cleanse the scalp without stripping
of natural oils. Darunaka is a disease which occurs due to
vitiation of Vata and Kapha Dosha. According to Ayurveda, A.
concinna has the properties of Kashaya Rasa, Ruksha Guna
and Katu Vipaka
[6].
These properties of A.concinna pacifies
vitiated Kapha Dosha. This plant also has the property of
Guru Guna,
[6]
which pacifies vitiated Vata Dosha. A. concinna
pacifies vitiated Vata and Kapha Dosha in the body.
Pacification of Vata and Kapha Dosha in Darunaka would
result in significant symptomatic relief in scaling, itching of
the scalp, dryness and greasiness of the scalp after the
treatment with Siyakkai Hair Wash.
Wuthi-udomlert and Vallisuta
[7]
reported that ethanolic and
chloroform extract from Soxhlet extractor, and lyophilized
extract and macerated ethanolic extracts of Acacia concinna
possess average inhibitory zone diameter (IZD) compared to
that of ketoconazole's. From the averaged IZDs of all fungal
isolates, the antifungal effectiveness of lyophilized,
chloroform, ethanolic (Soxhlet) and ethanolic (macerated)
extract was at 18.38, 18.34, 16.67 and 14.06 mm,
respectively. Natarajan, V. and Natarajan, S.
[8]
were recorded
that ethanol, ethyl acetate and hexane extracts of pods of
Acacia concinna possess significant antidermatophytic
against the dermatophyts Trichophyton rubrum, Trichophyton
mentagrophytes, Trichophyton violaecum, Microsporum
nanum and Epidermophyton floccosum with the MIC value of
62.5µg/ ml. According to findings of Wuthi-udomlert et al.
and Natarajan et al., A. concinna has the properties to control
Darunaka (Pitiriasis capitis).
Some patients treated with Siyakkai Hair Wash complained
about rhinorrhea. A.concinna has the property of Sheeta
Veerya
and this may cause rhinorrhea among some patients
CONCLUSION:
It can be concluded that the Siyakkai Hair Wash completely or
partially relieves the Darunaka (Pityriasis capitis), especially
scaling, itching of the scalp, dryness and greasiness of the
scalp
REFERENCES:
1. Susruta, Susruta Samhita, Nidanasthana, Ksudra Roga Adhyaya
13/35, Srikantha, K.R.(ed and trans), Chaukhambha
orientalia,India, 2000;550.
2. Bhavamisra, Bhavaprakasa Vol 11, Madhyama Kanda, Ksudra
Roga Adhyaya 61/15, Srikantha,K.R(edand
trans),Chowkhambia Krishnadas Academy, India, 2005; 654
3. Dawber, R. and Neste, D.V., Hair and scalp disorders, Martin
dunitz Ltd, London, United Kingdom, 1997; 191-193.
4. Behl, P.N., Agraval, A.and Srivastava,G., Practice of
dermatology, CBS publishers, India, 2004; 403.
5. Nadkarni, K.M., Indian Materia Medica, Popular prakashan
private ltd., Mumbai, India, 1996; 13-14
6. India curry.com, Shikakai (Acacia Concinna), 2012, [Cited 2012
July 12], Availabe from:
www.indiacurry.com/ayurveda/shikakai.htm
7. Wuthi-udomlert, M. and Vallisuta, O., In vitro Effectiveness of
Acacia concinna Extract against Dermatomycotic Pathogens,
Pharmacognosy Journal [serial on the Internet] 2011, [cited
2014 Sept 21]; 3 ( 19 ): 69-73 Available from:
http://cabdirect.org/abstracts/20113319625.html
8. Natarajan, V. and Natarajan, S., Antidermatophytic Activity of
Acacia concinna, Global Journal of Pharmacology [serial on the
Internet] 2009, [cited 2014 Sept 21]; 3 (1): 06-07 Available
from: www.idosi.org/gjp/3(1)09/2.pdf
Cite this article as: Sujatha Ediriweera, A.M.H.Y Perera,
K.K.V.S. Peshala, K. M. S.P. Perera, E.R.H..S.S.Ediriweera. A
Clinical Study on efficacy of Siyakkai (Acacia Concinna) Hair
Wash on Darunaka (Pitiriasis Capitis). J of Ayurveda and Hol
Med (JAHM); 2014;2(7):14-17.
Source of support: Nil, Conflict of interest: None Declared