Ayurvedic management of acne vulgaris

Abstract

Introduction: Acne vulgaris has always been one of the most burning problems of the young population. Acne vulgaris like presentation in Ayurveda has been described as Shalmali thorn like eruptions on the face due to vitiation of Kapha, Vata, and Rakta under the heading of Mukhadushika. Very less scientific data is available depicting the effect of Ayurvedic intervention in such cases. Main Clinical Finding: Present case reports a 26 years old female having multiple acne for the past 6 months. She had papules and pustule with itching, pain, and blackish spots on cheeks. Diagnosis: Condition was diagnosed as Acne vulgaris (Ayurvedic diagnosis – Pitta-Kapha dominant Tridoshika Mukhadushika). Interventions: The patient was treated with Kaishor Guggulu, Raktaprasadakahima, and the local application of Terminalia arjuna powder mixed with honey daily for 1 month. Outcome: The patient had relief in all the symptoms after 15 days of treatment with no new eruptions. Complete remission of the disease was observed after 1 month of treatment with the improved skin condition. Conclusion: This case study demonstrates the potential and usefulness of Ayurveda in the management of acne vulgaris.

Full text

© 2021 Journal of Ayurveda | Published by Wolters Kluwer - Medknow 317
Introduction
Acne vulgaris is a common cutaneous
disorder characterized by chronic or
recurrent development of papules, pustules,
or nodules on the face, neck, trunk, or
proximal upper extremities[1] with the peak
of severity in the late teenage and may
persist up to the 3rd decade and beyond,
particularly in females.[2] In different
countries and among different age groups,
the prevalence of acne varies, with
estimates ranging from 35% to over 90% of
adolescents having acne at some stage.[3]
The primary factor for the appearance of
the disease is the increase in sebum
production by sebaceous glands.[4] The
condition mainly affects the face (99%) and
to a lesser extent the back (60%) and chest
(15%). Noninflamed lesions (comedones)
develop earlier than inflamed lesions in
younger patients. The superficial lesions are
usually papules and pustules, and the deep
lesions are deep pustules and nodules.[5]
Acne in Ayurveda has been described as
Mukhadushika or Yuvanapidika under the
heading of Kshudraroga. Shalmali thorn like
eruptions on the face due to vitiation of
Address for correspondence:
Dr. Abhishek Upadhyay,
Assistant Professor, Department
of Kayachikitsa, National
Institute of Ayurveda Deemed to
be University, Jaipur, Rajasthan,
India.
E‑mail: dr.abhishek82@gmail.
com
Access this article online
Website: www.journayu.in
DOI: 10.4103/joa.joa_197_20
Quick Response Code:
Abstract
Introduction: Acne vulgaris has always been one of the most burning problems of the young
population. Acne vulgaris like presentation in Ayurveda has been described as Shalmali thorn
like eruptions on the face due to vitiation of Kapha, Vata, and Rakta under the heading of
Mukhadushika. Very less scientic data is available depicting the eect of Ayurvedic intervention
in such cases. Main Clinical Finding: Present case reports a 26 years old female having multiple
acne for the past 6 months. She had papules and pustule with itching, pain, and blackish spots on
cheeks. Diagnosis: Condition was diagnosed as Acne vulgaris (Ayurvedic diagnosis – Pitta‑Kapha
dominant Tridoshika Mukhadushika). Interventions: The patient was treated with Kaishor Guggulu,
Raktaprasadakahima, and the local application of Terminalia arjuna powder mixed with honey daily
for 1 month. Outcome: The patient had relief in all the symptoms after 15 days of treatment with no
new eruptions. Complete remission of the disease was observed after 1 month of treatment with the
improved skin condition. Conclusion:This case study demonstrates the potential and usefulness of
Ayurveda in the management of acne vulgaris.
Keywords: Ayurveda, case report, Kaishor guggulu, Sebaceous glands, Terminalia arjuna
Ayurvedic Management of Acne Vulgaris
Case Report
Abhishek Upadhyay,
Hari Khanal,
Ram Kishor Joshi1
Consultant Ayurveda Physician,
Astanga Ayurveda Hospital
& Research Center, Kalanki,
Kathmandu, Nepal, 1Department
of Kayachikitsa, National
Institute of Ayurveda Deemed to
be University Jaipur, Rajasthan,
India
How to cite this article: Upadhyay A, Khanal H,
Joshi RK. Ayurvedic management of acne vulgaris.
J Ayurveda 2021;15:317-21.
Submitted: 05-Oct-2020 Revised: 29-Jul-2021
Accepted: 16-Aug-2021 Published: 16-Dec-2021
Kapha, Vata, and Rakta are known as
Yuvanapidika or Mukhadushika or Tarunaya
Pidika.[6] Sa‑ruja (painful), Ghana (thick,
hard, or indurate), and sebum (Meda) filled
Pidika (eruptions) are hallmarks of
Mukhadushika.[7] Vitiated dosha get
accumulated and obstruct the Lomakupa
(pilosebaceous unit) causing local swelling
and micro comedone formation. Paka
(inflammation) of these elements lead to
papule, pustule, and cyst formation which on
rupture cause Vrana vastu (scar) formation.
Allopathic treatment includes the use of
topical retinoid, benzoyl peroxide, oral
antibiotics, steroids, and oral isotretinoin[8]
although its use is limited by teratogenicity
and other side effects.[9] Ayurveda has a great
potential in the management of various skin
disorders and in this article, a success story
of the management of acne vulgaris is being
reported.
Case Report
A 26-year-old married, non-smoking, non-
alcoholic Hindu female, registered vide
outpatient department number 4011122019,
presented with complaints of multiple
eruptions on cheeks for 6 months. Eruptions
were distributed all over the face but
This is an open access journal, and arcles are
distributed under the terms of the Creave Commons
Aribuon‑NonCommercial‑ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creaons are
licensed under the idencal terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
[Downloaded free from http://www.journayu.in on Saturday, December 18, 2021, IP: 10.232.74.26]

Upadhyay, et al.: Ayurvedic management of acne vulgaris
318 Journal of Ayurveda ¦ Volume 15 ¦ Issue 4 ¦ October-December 2021
maximum on the cheeks [Figure 1]. Symptoms started with
a single eruption on her right cheek and within 15 days
multiple eruptions spread all over the face. History of
purulent discharge from pimples was present along with
pain and itching. The pain was mild to moderate in nature
and aggravate on manual rupturing of pimples. The itching
was worse during evening and night hours and on exposure
to dust and sunlight. Blackish spots on the face were
present as leftover marks of pimples. According to the
patient, she had used some allopathic medicines but did not
get significant relief. The local use of soaps, face wash,
and creams were worsening the symptoms sometimes. The
patient had no history of associated fever, psoriasis,
eczema, melasma, or any other chronic illness such as
diabetes, hypertension, tuberculosis, thyroid disorder,
polycystic ovaries, or surgical interventions. Her appetite
was good with normal bladder and bowel movements. On
examination of the eruptions, they were 2–4 mm wide
erythematous papules and pustules on the face with both
variety of comedones (blackheads and white head) and
scarring in a few of the lesions. Mild tenderness was
present on palpation over the pimples. The rest of the skin
was normal in texture with normal elasticity. Recorded
blood pressure was 110/70 mm of Hg, pulse was 74/min,
and other vital signs were within normal limits. No other
significant abnormal clinical finding was detected during
the systemic examination.
Therapeutic intervention
Vitiated Tridosha along with the vitiation of Rakta (blood)
and Meda (Sebum) are the main pathognomic factors in
Mukhadushika. In the present case, symptoms such as
Shula (pain) and Vrana Vastu (scar) were due to vitiated
Vata whereas Paka (Inflammation) and Daha (burning
sensation) were due to vitiated Pitta and Rakta. Vitiated
Kapha is responsible for the development of Puya (pus),
Sotha (swelling), Srava (discharge), and Kandu (itching) in
the lesions. The patient was diagnosed with Pitta‑Kapha
dominant Tridoshic Mukhadushika. Hence, two oral drugs
Kaishor Guggulu[10] and Raktaprasadaka hima having
Pitta‑Kapha pacifying actions and Rakta shodhaka (blood
purifier) properties were selected. For local application
powder of bark of Arjuna[11] was selected.
Oral intervention
The posology of oral intervention is mentioned in Table 1.
Method of preparation and use for Raktaprasadaka hima
The patient was advised to soak 6 g of Raktaprasadaka
hima powder in one cup (50 ml) of cold water for at least
12 h during the night. After soaking for the required
duration, the mixture was mashed properly and filtered
through a clean cloth. The patient was instructed to
consume the filtrate empty stomach.
Drug for external application
The patient was asked to take 6 g of fine powder of the
bark of Arjuna and mix it with honey in sufficient quantity
and apply it on the face once daily. The medicated
paste (Lepa) was leftover the face for half an hour and then
rinsed off using cold water. Fresh powder was used every
time to make the paste. Bark of Terminalia arjuna Roxb.
has Varnya (good for skin color), Twachaya (beneficial for
skin problems), Kandughna (reduces itching), and Vrana
Ropana (wound healing) properties.[12]
Diet and Lifestyle advised during treatment
Pathya (Do’s)
Green leafy vegetables, wheat, rice, moong dal, fruits,
lukewarm water in sufficient quantity to drink, homemade
food.
Apathya (Don’ts)
Junk food, curd, cold drinks, nonveg, tea, alcohol, excess
sweets, excess spices, fried, and food articles having excess
fat content. Ratrijagaran (night awakening), Divaswapna
(daytime sleeping), manual rupturing of acne, excessive
exposure to sunlight, and dust.
Table 1: Ayurveda oral drug intervention
Name of drug Dose Frequency Anupana Duration (month)
Raktaprasadaka
hima
50 ml Once a day
Empty
stomach
Cold
water
1
Kaishore
guggulu
1 g Twice a day
After meals
Luke
warm
water
1
Table 2: Grading of sign and symptoms
Sign and
symptoms
None (0) Mild (1) Moderate (2) Severe (3)
Number of
lesions (acne)
0 1 (1-4) 2 (5-8) 3 (>8)
Pain 0 1 2 3
Itching 0 1 2 3
Number of
black heads
0 1 2 3
Table 3: Changes in sign and symptoms after Ayurvedic
intervention
Sign and symptoms Before
treatment
1st follow up 2nd follow up
Acne 3 2 0
Pain 2 1 0
Itching 3 1 0
Number of black heads 3 3 1
[Downloaded free from http://www.journayu.in on Saturday, December 18, 2021, IP: 10.232.74.26]

Upadhyay, et al.: Ayurvedic management of acne vulgaris
Journal of Ayurveda ¦ Volume 15 ¦ Issue 4 ¦ October-December 2021 319
Follow-up and outcome
The outcome was assessed based on the improvement in
clinical signs and symptoms. Criteria on which
improvement was observed were the number of lesions
(acne), pain, itching, and the number of black heads
[Table 2]. The patient was assessed for 1 month with
follow-up at the interval of 15 days. Photographs at fixed
megapixel under the same intensity of light, posture, and
distance were obtained before intervention and at every
follow-up visit to observe the improvement. Significant
improvement in all signs and symptoms was observed after
Ayurvedic interventions [Table 3]. The patient did not
develop new eruption of papules after intervention and had
relief in pain and other symptoms after 15 days of treatment
[Figure 2] whereas complete remission was achieved after
1 month of treatment [Figure 3].
Discussion
In the present case, there was a history of regular
consumption of Vidahi (sour and pungent), Abhishyandi
(potential elements causing obstruction in channels), and
Virrudha (incompatible) food such as fast food, salty, and
oily substances with the habit of Adhyashana (consuming
food without earlier meal completely digested), Ratri
Jagaran (late night sleep), and Divaswapana
(day time sleep). These etiological factors may be the cause
for vitiation of Kapha‑Pitta and Rakta, further causing
secondary vitiation of Vata due to Srotas
avarodha (sebaceous glands in this pathogenesis) resulting
in the formation of Pidika (eruptions) on the face with
clinical presentation as acne with pain, itching, and
discoloration of skin [Figure 3]. Kapha‑Pitta‑Rakta
pacifying treatment was planned according to the principles
of the management of Mukhadushika.
Hima kalpana a type of Panchavidha kashaya kalpana is
one of the best Pitta Shamak Kalpana (formulation).[13]
Raktaprasadaka hima contains Solanum nigrum Linn.,
Hemidesmus indicus R. Br., Phyllanthus urinaria Linn.,
Rubia cordifolia Linn., and Vetiveria zizanioides Linn. These
ingredients possess a blood purifier, Kushthagna (beneficial
for skin disease), Shothahara (reduces swelling), Varnya
(good for skin color), Twakdoshahara (beneficial for skin
problems), Dahaprashamana (reduce burning sensation),
and wound healing properties. Hemidesmus indicus R. Br.
and Rubia cordifolia Linn. the main ingredients of
Raktaprasadaka hima have shown anti-inflammatory activity
in research studies by suppressing the Propionibacterium
induced reactive oxygen species and proinflammatory
cytokines, the two important inflammatory mediators in acne
pathogenesis.[14] The antiacne effects of Rubia cordifolia
include four mechanisms i.e., antibacterial, anti-inflammatory,
antioxidant, and antiandrogen activities.[15]
Kaishor guggulu having Guduchi, Triphala, and Guggulu
as main ingredients has Kaphaghna and Medoghna effect
due to Katu, Tikta, and Kashaya Rasa dominance. It helps
in eliminating the vitiated Kapha which is mainly
responsible for increased sebum production and thus
obstructing the ducts of the sebaceous glands.
Kaishor Guggulu has antiallergic, antibacterial properties
Figure 2: Image taken at second visit to outpatient department after 15 days
Figure 3: Image taken at third visit to outpatient department after 1 month
Figure 1: Image taken at rst visit to outpatient department
[Downloaded free from http://www.journayu.in on Saturday, December 18, 2021, IP: 10.232.74.26]

Upadhyay, et al.: Ayurvedic management of acne vulgaris
320 Journal of Ayurveda ¦ Volume 15 ¦ Issue 4 ¦ October-December 2021
acts as a natural blood cleanser and is indicated in
different skin diseases.[16] Kaishore guggulu is having
Raktaprasadaka, Vataghna, Shothahara (reduces
swelling), Vrana ropaka (wound healing properties), and
Rechaka (laxative) properties by virtue of which it was
helpful to reverse the underlying pathogenesis
Arjuna twaka is Sheeta Veerya in nature and has Kashaya
Rasa, Laghu, Ruksha guna, Pitta shamaka, and Rakta
Prasadaka properties. Due to Kashaya Rasa and
Sheeta Veerya properties, it encounters vitiated Pitta
and Rakta Dosha, removes the Twaka Vaivarnayata, and
helps to maintain the normal skin color. The Rakta Prasadaka,
Varnaya (good for skin color), Vranaropaka (wound healing),
and Twaka Prasadaka actions of Arjuna pacify the locally
accumulated Dosha and help in mitigating the external
manifestation of the disease. The flavonoid components
present in Arjuna have anti-inflammatory, antioxidant, and
antibacterial properties[17,18] which help to fight the root cause
of acne vulgaris. Honey was used for making a paste with
Arjuna Twaka powder because in different studies honey has
shown antiseptic, antimicrobial, anti-inflammatory,
antioxidant, healing, and cleansing properties.[19]
In the present study, during the first follow-up, significant
relief in all signs and symptoms of acne was observed.
There was disappearance of already present acne with no
new eruptions, complete relief in itching and the pain was
observed with significant improvement in blackish spots
over the face in 1-month duration.
Conclusion
Acne vulgaris is a common skin disorder which affects
almost all individuals at least once during life. It is a
chronic disease having relapsing nature and is difficult to
manage if not dealt with appropriately at the right time
with appropriate treatment strategies. The present case
study clearly demonstrates that Ayurvedic principles and
drugs are very effective in the management of acne
vulgaris. However, a clear understanding of the Pancha
Nidana (Ayurvedic diagnostic method) and appropriate
selection of drugs are essential to get the desired results.
Raktaprasadaka hima, Kaishore guggulu, and the local
application of Arjuna bark powder with honey were found
to be effective in acne vulgaris in present case with no
untoward side effects.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient (s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The
patients understand that their names and initials will not be
published and due efforts will be made to conceal their
identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conflicts of interest.
References
1. Thiboutot D, Zaenglein A, Levy ML, Dahl MV. In: Ofori A,
editor. Pathogenesis, Clinical Manifestations, and Diagnosis of
Acne Vulgaris. Waltham, Massachusetts: UpToDate; 2014.
2. Colledge NR, Walker BR, Ralston S, Davidson S. Davidson s
Principles and Practice of Medicine. 21st ed. Edinburgh; New
York: Churchill Livingstone Elsevier; 2010. p. 1276.
3. Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of
acne vulgaris in the community. Aust J Dermatol 1997;38:115-23.
4. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo
J. Harrison’s Principles of Internal Medicine. 19th ed., Vol. 2. United
States of America: McGraw Hill Education; 2015. p. 319.
5. Archer CB, Cohen SN, Baron SE; British Association of
Dermatologists and Royal College of General Practitioners.
Guidance on the diagnosis and clinical management of acne.
Clin Exp Dermatol 2012;37 Suppl 1:1-6.
6. Susruta Samhita, Nidana Sthana, Kshudraroganidanam,
13/39. Available from: http://niimh.nic.in/ebooks/
esushruta/?mod=read. [Last accessed on 2020 Dec 20].
7. Ashtanga Hridyam, Uttar Sthana, Kshudrarogavigyaniya,
31/5. Available from: http://vedotpatti.in/samhita/Vag/
ehrudayam/?mod=read. [ Last accessed on 2021 Nov 19].
8. Rathi SK. Acne vulgaris treatment: The current scenario. Indian
J Dermatol 2011;56:7.
9. Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet
2012;379:361-72.
10. Mishra SN. Bhaisajya ratnavali. Reprint edition 2011., Ch. 27.,
Ver. 104113. Varanasi: Chaukhamba Surbharati Prakashan; 2007.
p. 582.
11. Tripathi JP. Chakradatta. 7th ed., Ch. 55., Ver. 44. Varanasi:
Chaukhamba Sanskrit Series Oce; ???. p. 426.
12. Sharma PV. Dravyaguna Vijnnaana. Reprint edition 2009., Vol.
2. Varanasi: Chaukhamba Bharati Academy; 2009. p. 195.
13. Sharangdhar.Tripathi B. Sarngadhara Samhita. Reprint edition
2006., Madhyam Khanda, Ch. 4. Varanasi: Chaukhamba
Surbharti Prakashan; 2006. p. 165.
14. Jain A, Basal E. Inhibition of Propionibacterium acnes-induced
mediators of inammation by Indian herbs. Phytomedicine
2003;10:34-8.
15. Meena V. Manjistha (Rubia cordifolia) – A helping herb in cure
of acne. J Ayurveda Holist Med 2015;3:11-7.
16. Lather A, Gupta V, Bansal P, Sahu M, Sachdeva K, Ghaiye P. An
Ayurvedic polyherbal formulation Kaishore Guggulu: A review.
Int J Pharm Biol Arch 2011;2:497-503.
17. Mandal S, Patra A, Samanta A, Roy S, Mandal A, Mahapatra TD,
et al. Analysis of phytochemical prole of Terminalia arjuna
bark extract with antioxidative and antimicrobial properties.
Asian Pac J Trop Biomed 2013;3:960-6.
18. Nema R, Jain P, Khare S, Pradhan A, Gupta A, Singh D.
Antibacterial and antifungal activity of Terminalia arjuna leaves
extract with special reference to avonoids. Basic Res J Med
Clin Sci 2012;1:63-5.
19. Al-Waili N, Salom K, Al-Ghamdi AA. Honey for wound healing,
ulcers, and burns; data supporting its use in clinical practice.
ScienticWorldJournal 2011;11:766‑87.
[Downloaded free from http://www.journayu.in on Saturday, December 18, 2021, IP: 10.232.74.26]

Upadhyay, et al.: Ayurvedic management of acne vulgaris
Journal of Ayurveda ¦ Volume 15 ¦ Issue 4 ¦ October-December 2021 321


         
  
                     
    
                  
            
  
           

[Downloaded free from http://www.journayu.in on Saturday, December 18, 2021, IP: 10.232.74.26]