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AYUSHDHARA ISSN: 2393-9583 (P)/ 2393-9591 (O)
An International Journal of Research in AYUSH and Allied Systems
AYUSHDHARA | January - February 2019 | Vol 6 | Issue 1
2040
MANAGEMENT OF VITILIGO (SHVITRA) ACCORDING TO AYURVEDA: A CASE STUDY
Rupali R. Patil
Lecturer, Department of Kaychikitsa, Hon. Shri. Annasaheb Dange, Ayurved Medical College, Ashta, India.
KEYWORDS: Vitiligo, Shvitra,
Bakuchi, Autoimmune.
ABSTRACT
The color of the skin is important biologically, cosmetically and socially.
Vitiligo is an acquired condition where melanocytes are absent in
affected area. The worldwide prevalence of Vitiligo is lesser than 1%.
Though the condition is rare and non communicable, patients who are
suffering from Vitiligo may experience cosmetically disfiguring and
psychological problems like depression. It is not clear why the
melanocytes disappear from the skin. Theories regarding the Vitiligo
include an autoimmune cause because of association with other
autoimmune disorders, presence of antimelanin antibodies and
lymphocytic infiltrate in early lesions. In Ayurveda, all the skin diseases
are described under the heading of ‘Kushta’, which are further divided in
to two namely ‘Mahakushta’ and ‘Kshudra Kushta’. Shvitra has been
mentioned separately. Based upon clinical features of Shvitra, it can be
correlated with Vitiligo. Aacharya Charak has mentioned Shvitra under
the ‘Rakta Pradoshaj Vikara’. Considering the limitations of modern
medical system and side effects associated with long term use of
medicines, Ayurveda has much more convincing treatment modalities for
Vitiligo. In present study emphasis has been made to study efficacy of
Shvitrahara Vati and Shitrahara Lepa in Shvitra (Vitiligo).
INTRODUCTION
The color of the skin is important
biologically, cosmetically and socially. The color of
the normal skin is consequent to the presence of
melanin, carotene and oxy and reduced hemoglobin.
Of these melanin is by far the most important.
Melanin protects the skin from harmful effects of
the ultraviolet components UVB and UVA in
atmospheric light. Total absence or insufficient
amount of melanin in the skin results in early
‘ageing’ of skin and development of cutaneous
malignancies. Disorders of cutaneous pigmentation
may result from a reduction of pigment e.g. Vitiligo.
Vitligo is an acquired condition where melanocytes
are absent in affected area. The lesions are typical
with sharply demarcated hypo pigmented, round or
oval patches over skin. It can be chronic,
progressive and cosmetically disfiguring.[1]
It is not clear why the melanocytes
disappear from the skin. Theories regarding the
vitiligo include an autoimmune cause because of
association with other autoimmune disorders,
presence of anti melanin antibodies and
lymphocytic infiltrate in early lesions. It is very
common amongst Indians and other colored people.
Family history is available in quarter or more of
patients. The worldwide prevalence is lesser than
1%. Though the condition is rare and non
communicable, patients who are suffering from
vitiligo may experience psychological problems like
depression.[2]
The lesions may start at any age, but
generally in early adolescence or adult life. Any part
of the body may be affected though the sites of
trauma are more prone. The primary lesions are
well defined, circumscribed, depigmented macules.
Lesions are symmetrical or may gradually appear
on the other parts of the body and may become
confluent to cover large areas or even the whole
skin surface. The hair is initially unaffected but may
also loose pigmentation. The course of the disease
and prognosis are unpredictable. The lesions in the
peripheral and non-hairy regions of the body are
Case Study
*Address for correspondence
Dr. Rupali R. Patil
Lecturer,
Department of Kaychikitsa
Hon. Shri. Annasaheb Dange
Ayurved Medical College, Ashta.
Email: rpcoolrupali@gmail.com
Rupali R. Patil. Management of Vitiligo (Shvitra) according to Ayurveda
AYUSHDHARA | January - February 2019 | Vol 6 | Issue 1
2041
less likely to pigment even with therapy than those
in the truckle hairy areas.
Shvitra has been mentioned along with
Kushta but not included in the types of Kushta. The
difference between Shvitra and Kushta is based on
non secretary and non infectious disease with
Twaka involvement only. In modern dermatology, it
can be correlated with Vitiligo and Leuoderma. The
aim of treatment in Vitiligo is to repopulate the skin
with active melanin synthesizing melanocytes
mostly derived from the hair follicles, though
occasionally melanocytes from the adjoining
normal skin may repopulate the depigmented
patch. Pigmentogenic photosensitizes such as
psoralens are employed for this purpose. In modern
science PUVA (Psoralen+ Utra violet A rays)
therapy and corticosteroids are mainly used for the
treatment of vitiligo.[3] Considering the limitations
of modern medical system, Ayurveda has much
more convincing treatment modalities for vitiligo.
Thus, in present study emphasis has been made to
study efficacy of Shvitrahara Vati and Shitrahara
Lepa in Shvitra (Vitiligo).
Case Report
Patient Name: XYZ
Age: 34 years
Gender: Female
Occupation: House wife
Chief Complaints
A 34 years old female patient complaining
of hypo pigmented patches over both legs came in
OPD of our college for the treatment. The lesions
were oval in shape, without any discharge, non
itchy hypo pigmented patches.
History
History revealed that patient is non
hypertensive, non diabetic and did not have any
symptoms of endocrinal disorders.
Family history: Nil
Personal History
Aahar: Akal Bhojan, Vishamashan, Virudha aahar
Vihar: Diwaswapa (Sleep during day time)
Medicinal History
She has taken allopathic treatment for 2
years but doesn’t get relief, so the patient came for
Ayurved treatment in our hospital.
Past History
She has history of hypo pigmented patches
over hands and both the legs since childhood. She
has taken allopathic treatment for few years but
does not get any relief. As the size of hypo
pigmented patch is gradually increasing, she came
for the Ayurved treatment.
On examination
Pulse: 84/min
BP: 120/80 mm of Hg
Systemic examination
CVS: S1S2 Normal
CNS: Conscious, Oriented
RS: AEEBS
Local examination
Color: White
Appearance: Hypopigmented, Macular, Oval
Shaped Patch
Discharge: Nil
Prakruti: Vata Pitta
Dosha: Vata (++), Kapha (++), Pitta (++)
Dushya: Rasa, Rakta
Strotas: Rasavaha, Raktavaha
Agni: Jathargnimandya, Rasadhatwgnimandya
Satwa: Madyam
Diagnosis:
Shvitra (Vitiligo)
Ayurvedic Review
In Ayurveda, all the skin diseases are
described under the heading of ‘Kushta’, which are
further divided in to two namely ‘Mahakushta’ and
‘Kshudra kushta’. However Shvitra has not been
mentioned in these two types. Shvitra has been
mentioned separately. Based upon clinical features
of Shvitra, it can be correlated with vitiligo.
Aacharya Charak has mentioned Shvitra under the
‘Rakta Pradoshaj Vikara’. Hence the factors causing
Raktadushti can be also considered as causative
factors of Shvitra.[4]
Nidana
1. Virodhi anna-paan, Snigdha guru aahar (intake
of wrong food combination). E.g: milk and fish
2. Suppression of natural urges
3. Physical exercise in excessive heat and after
taking heavy meal.
4. Nava Dhanya
5. Excessive intake of Mash (black gram), Mulaka
(raddish), Tila (sesum seeds), and Jaggery.
6. Sleep during day time.
7. Untruthfulness, Ungratefulness, Disrespect for
the god, Insult of preceptors, sinful acts,
misdeeds of past lives, and intake of mutually
contra indicated food are the causative factors
of Shvitra.
In very rare causes, Patients of leaucoderma
who are free from the effect of their sinful acts get
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cured by the administration of medicines,
Bloodletting and by following diet properly.[4,5]
Shvitra is of 3 varieties.
1. Daruna
2. Charuna
3. Kilasa
All of them are generally caused by the
simultaneous vitiation of all the three Doshas.
If located in Rakta (blood) it is red in color.
If located in Mansa (muscle tissue) it is Coppery in
color.
If located in Medas (fat) it is white in color.
The subsequent ones are more serious than the
previous ones.
Dosha- Tridosha
Dushya- Tvak, Rakta, Mansa, Ambu
These taken together, constitute the seven fold
pathogenic substance of Kushta. (Kushtha dravya
sangraha).
Treatment Principle
Nidan and Samprapti of Shvitra Roga is
similar to Kushta. So the treatment principal of
Kushta Chikitsa will be applied in Shvitra Chikitsa.
Depending upon the intensity of vitiated Dosha’s
appropriate therapy should be selected. In addition,
if Shamana drugs are administered after proper
course of Shodhana, then it provides additional
relief and thus helps in eradicating the diseases
completely. Vitiligo being a disease with Auto
immune pathology both systemic and local
treatments are necessary. Patients with more
vitiated Doshas (Bahudosha) Shodhan will be given
for several times with a lot of care (Abyantar
Parimarjan). With some stimulatory drugs function
of Brajaka Pitta should be reestablished (Bahya
Parimarjan).[4,6]
Treatment Scheduled:
Shodhana Chikitsa
The drug was administered after Sharir
Shudhi i.e., the patient was subjected to Anuloman
with Eranda Sneha.
Shamna Chikitsa
Internal Medicine
1) Tb. Shvitrahara Vati ( Kamdhenu Pharm.) 250
mg 2 tab After the meal two times a day along
with luke warm water.
2) Tb. Haridra Ghana Vati (Kamdhenu Pharm.)
250mg 2 tab after the meal two times a day
along with luke warm water.
3) Gomurasava[9] (Kamdhenu Pharm.) 20ml After
the meal two times a day along with luke warm
water.
4) Tb. Gandharva Haritaki 250mg 2 tab at night
along with luke warm water.
External Medicine
Shvitrahar lepa was prescribed as a local
applicant along with internal medicine. Shvitrahara
lepa was prepared by making a paste of Shvitrahar
lepa tablets in Gomutra. A thin layer of that paste
was applied over the affected area and followed by
exposure to sun rays in the morning. The follow up
was taken once in a month.
Duration of Trial
Total duration was 6 months with monthly follow
up.
Efficacy of the drug was assessed by improvement
in signs and symptoms as follows.
Assessment Criteria
Surface Area
1
Circular area < 1 cm radius
2
Circular area with a radius of 1-2 cm
3
Circular area with a radius of > 2 cm
Number of Patches
1
< 5 Patches
2
5-10 Patches
3
>10 Patches
Color of Patches
1
Normal skin color
2
Reddish/Erythmatous
3
Whitish in color
Color of Hairs
1
Normal Hair color
2
Whitish Hair color
Observation and Results
S. No
Symptoms
BT
AT
Relief in
percentage
1 Month
2 Month
3 Month
4 Month
1
Surface Area
3
3
3
2
1
66%
2
Number of Patches
3
3
3
2
1
66%
4
Color Of Patches
3
3
2
2
2
33%
5
Color Of hairs
2
2
2
1
1
50%
Rupali R. Patil. Management of Vitiligo (Shvitra) according to Ayurveda
AYUSHDHARA | January - February 2019 | Vol 6 | Issue 1
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DISCUSSION
Shvitradhna Vati is found to be beneficial in
case of Shvitra. This formulation is a combination of
fine powders of Shuddha Bakuchi Beej, Shuddha
Gairik and Shuddha Gandhak. Bakuchi is the main
component of the formulation. It is a renowned
herb with many therapeutic properties. In
Ayurvedic system of medicine, Bakuchi seeds are
used for the treatment of Vitiligo[6,7,8]. It contains
Psoralen which on exposure to the sun results in re-
pigmentation of patches by melanin synthesis.
Psoralen is an active component which is used
topically as well as systemically in the treatment of
vitiligo. Suddha Gandhak is also useful in various
types of skin diseases internally as well as
externally. As it is having Rasayana properties it is
widely useful in autoimmune disorders like
psoriasis, bronchial asthma, vitiligo etc. In case of
vitiligo the deranged immune system destroys the
pigment synthesizing melanocytes. Gandhak breaks
this pathogenesis and prevents the self destruction
of melanocytes. In case of Kushta cow urine is very
beneficial having Shodhana as main property.
Gomutra Asava stimulates liver and spleen, thereby
regulating the function of Pachak Pitta, Ranjak Pitta
and Bhrajaka Pitta. Being Yogavahi (Catalyst) it acts
fast and enhances the action of Bakuchi. It also acts
as Raktaprasadan Draya.[9,10,13] The combination of
these three components is expected to work
synergistically and it is very effective in
normalization of skin complexion. In this clinical
trial the first two months of therapy the initial
response to the treatment was erythema of the
lesion. After 8-10 weeks of therapy erythema was
followed by re-pigmentation. Haridra Ghana Vati
which is having antimicrobial, anti allergic, hepato
protective and anti oxidant properties is given to
protect the skin from the irritating effect of Bakuchi.
Shuddha Gairik is also shows beneficial effects in
skin diseases as it is having sweet, astringent, anti
phlegmatic anti bilious and cooling properties.[11]
CONCLUSION
1) Shvitra is Krichra Sadhya, Tridoshaj pigmentation
disorder of skin and can be correlated with
Vitiligo.
2) It is caused by various dietic and behavioural
factors which aggravates Tridosha’s. Virudha
Aahar plays important role in the pathogenesis
of disease.
3) Bakuchi, Haridra and Gomutrasava has
significant results in Shvitra (Vitiligo).
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4) As far as the disease chronicity is concerned, for
more effective results the treatment duration
should be lengthened.
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Medicine for students, 25th edition 2017, The
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L, Editors. Chapter Introduction:00-01. New
York: Cambridge University Press;2005.
3. Harrison’s Principles Of Internal medicines, 17th
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4. Agnivesha, Charak Samhita, Kashinath Shastri, Y
Upadhyay Vol.2 Chikitsa Sthana, 7/161-178.
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9. Vagbhata, Astang Hriday A compendium Of The
Ayurvedic System, 6th Edition 1939, Nirnaya
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10. Sushrut, Sushruta Samhita edited by Ambika
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Chowkhamba Sanskrit Prakashan Page 186
11. Rasatantrasara and Siddha Prayog Sangrah
Edition 8th, part II page 233.
12. Ajay Dhanik, N Sujatha, N P Rai, Clinical
evaluation of the efficacy of Shitrahara kashay
and lepa in vitiligo,www.ayujournal.org Feb 14
13. Raman Belge, Clinical Evaluation Of the efficacy
of Gomutra Asava In Shitra Vis-A- Vis Vitiligo,
IOSRJPBS Vol 2, Issue 3 July-Aug 2012 page 10-
13.
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Cite this article as:
Rupali R. Patil. Management of Vitiligo (Shvitra) according to Ayurveda: A Case Study. AYUSHDHARA,
2019;6(1):
2040-2044.
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