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INTRODUCTION
Chronic contact eczema is a recurrent inflammatory skin disorder caused by repeated exposure to irritants or allergens, leading to symptoms such as itching, erythema, dryness, scaling, and oozing that impair quality of life (Kliegman et al., 2016). In Ayurveda, this condition is correlated with Vicharchika, classified under Kshudra Kushtha, and described with features including kandu (itching), raga (redness), rukshata (dryness), srava (oozing), and shyavata (discoloration), reflecting Kapha-Pitta predominance (Arya et al., 2016). Conventional management often relies on corticosteroids and immunosuppressants, which provide symptomatic relief but are associated with recurrence and adverse effects (Lawrence et al., 2023). Ayurvedic management emphasizes Shodhana (purification therapies), Shamana (pacifying therapies), and lifestyle modifications to correct dosha imbalance and achieve sustained outcomes. The classical Samhitas do not provide a specific or detailed line of treatment for Vicharchika. Therefore, its management is primarily based on assessing the predominant Dosha. The therapeutic approach should be formulated considering both Roga Bala (severity of the disease) and Rogi Bala (strength of the patient). In most cases, patients with Vicharchika who experience limited relief from modern medical treatments turn to Ayurveda in search of more effective and lasting remedies for their condition.
Patient information
Case History
A female patient of age 38 years came to Kayachikitsa OPD complaining of widespread scaly lesions over the lower limbs affected, accompanied by intense itching for 2.5months and serous discharge with burning sensation and discolouration, since approximately 2 months. It was provisionally diagnosed as Stravi Vicharchika.
History of present illness
The patient presented with clinical signs and symptoms including Kandu (itching sensation) for 2.5 months, Shyava Varna (dark brownish discoloration) and Bahusrava (profuse discharge) and Daha (burning sensation) for 2 months. Despite receiving allopathic treatment from a general physician at a private hospital (corticosteroids and antibiotics) for 2 months, she experienced no significant relief and subsequently approached at Kayachikitsa OPD for further management.
Personal / Past/ Medical/ Family history
The patient reported disturbed sleep for the past two months, primarily due to severe itching and a persistent burning sensation. Her dietary habits included frequent intake of curd and milk (twice daily), spicy and oily foods, and tea consumption three times a day. She had no prior history of Diabetes Mellitus, Hypertension, or any other notable medical or surgical conditions Family history was non-contributory. On psychological evaluation, the patient appeared to be under considerable stress, which was largely attributed to her ongoing discomfort, including the intense itching, burning sensation, and disrupted sleep pattern. Clinical evaluations, including Ashtavidha Pariksha and Dashavidha Pariksha, showed no abnormalities. The differential diagnosis includes Kitibha, Dadru, Charmakeela and Pama Kushtha (a scabies-like condition), while the final diagnosis is chronic contact eczema, also known as Stravi Vicharchika (Tables 1-6).
| Chief complaints | Duration |
|---|---|
| Kandu | 2.5 months |
| Strava | 2 months |
| Shyavata/ vaivarnyata | 2 months |
| Daha | 2 months |
| Parameters | Findings |
|---|---|
| Nadi | 78/min, pitta-kaphaj |
| Mala | Niram, 1-2 times/day |
| Mutra | Niram, 5-6 times/day |
| Jivha | Ishatsaam (coated) |
| Shabda | Spashta (clear) |
| Sparsha | Anushnasheeta (normal) |
| Druk | Prakrit (no pallor, icterus present) |
| Akriti | Madhyam (medium) |
| Sl. No. | Examination | Observation |
|---|---|---|
| 1 | Prakruti (constitution of the patient) | Pitta-kapha |
| 2 | Vikruti (pathological variations) | Dosha (Bodily humors)-Kapha-vata Dhatu (Body tissues)- Rasa, Rakta, Mamsa Strotas (channels)- Rasavaha, Raktavaha, Mamsavaha |
| 3 | Sara (quality of tissues) | Madhyam (average) |
| 4 | Samhanana (built of the body) | Madhyam (average) |
| 5 | Praman (anthropometric measurements) | Weight-58 kg, Height-5.6 |
| 6 | Satmya (adaptability) | Madhyam (average) |
| 7 | Satva (mental strength) | Madhyam (average) |
| 8 | Aahar Shakti (food and digestion capacity) | Madhyam (average) |
| 9 | Vyayam Shakti (exercise capacity) | Madhyam (average) |
| 10 | Vaya (age) | Madhayam Avastha (Middle age) |
| Symptoms | Gradation | Score |
|---|---|---|
| Kandu (Itching) | No itching Itching present rarely Itching disturbing patient's attention Severe itching disturbing patient's sleep | 0 1 2 3 |
| Strava (Discharge) | No Strava Occasional Strava after itching Mild Strava after itching Profuse Strava making clothes wet | 0 1 2 3 |
| Shyavata /vaivarnyata (Discoloration) | Normal skin colour Brownish red discoloration Blackish red discoloration Blackish discoloration | 0 1 2 3 |
| Daha (Burning sensation) | Absence of burning sensation in affected part Rarely burning sensation in affected part Continues burning sensation in affected part Disturbing patient's sleep | 0 1 2 3 |
| Sl. No. | Name Of Medications | Dose With Anupan | Duration |
|---|---|---|---|
| 1 | Gandhaka rasayana (250 mg) | 2 tablets, two times a day with water, after meals | 30 days |
| 2 | Sutshekhar rasa (250 mg) | 1 tablet, three times a day orally chewing, before meals | 30 days |
| 3 | Patolkaturohinyadi kashayam | 20 mL, two times a day with warm water, after meals | 30 days |
| 4 | Karanj tailam | Local application, twice a day | 30 days |
| 5 | Panchatikta ghrita | 2 tsp, two times a day with warm water, before meals+local application once a day | 30 days |
| 6 | Gandharva Haritaki churna | 5 g, with warm water, at bed time | 15 days |
| Symptoms | Before treatment | After 15 days | After treatment on 30th day |
|---|---|---|---|
| Kandu | 3 | 2 | 0 |
| Strava | 2 | 1 | 0 |
| Shyava varnata | 3 | 2 | 1 |
| Daha | 3 | 2 | 0 |
Examination on the basis of Ayurveda parameters
Assessment Parameters
Shamana chikitsa
Pathya-Apathya: (Dietary Regimen)
The patient was advised to follow a strict dietary and lifestyle regimen to support the management of Stravi Vicharchika. She was instructed to consume a light and easily digestible diet including moong dal, old rice, bottle gourd, bitter gourd. She was strictly advised to avoid curd, milk, fermented foods, sweets, seafood, oily and spicy items, as these aggravate Kapha and Pitta. Lifestyle modifications included maintaining skin hygiene, avoiding synthetic clothing, exposure to heat, dust, and chemical irritants, along with ensuring adequate sleep and practicing stress-reducing activities like meditation (Figure 1).
OBSERVATION
DISCUSSION
Eczema (dermatitis) is one of the most prevalent and distressing allergic skin conditions. In the acute phase, it is mainly characterized by fluid accumulation within the epidermis (spongiosis) and the formation of blisters (intraepidermal vesicles). As the condition becomes chronic, thickening of the epidermis (acanthosis) becomes more prominent (Arya et al., 2016). Eczema, a type of dermatitis, typically develops after exposure to irritants or allergens. Among children, the most prevalent form is atopic dermatitis. The term “eczema” is broadly used to describe various chronic or recurring skin rashes, which may manifest with symptoms such as redness, swelling, intense itching, skin cracking, crust formation, fluid discharge, or even bleeding (Kliegman et al., 2016). In Ayurveda, it is correlated with Vicharchika. It is classified under Kshudra Kushtha in Ayurveda and is typically characterized by symptoms such as kandu (itching), strava (discharge), and daha (burning sensation). The condition can manifest in both acute and chronic forms, involving significant discomfort and variable clinical presentation (Ranade, 2013).
The classical Samhitas do not provide a specific or detailed line of treatment for Vicharchika. Therefore, its management is primarily based on assessing the predominant Dosha. The therapeutic approach should be formulated considering both Roga Bala (severity of the disease) and Rogi Bala (strength of the patient). In most cases, patients with Vicharchika who experience limited relief from modern medical treatments turn to Ayurveda in search of more effective and lasting remedies for their condition. Therefore, the treatment approach should be individualized based on the dominant Dosha involved and the strength of the disease (Roga Bala) as well as the patient’s strength (Rogi Bala). The medications used for treatment possess anti-inflammatory and antiseptic qualities. They help alleviate itching, discharge, pain, and discoloration of the affected skin over the feet.
Gandhak Rasayan
This Ayurvedic formulation, primarily indicated for the healing of skin ailments, is recognized for its potent antibacterial, antiviral, and antimicrobial properties, as described in the Rasayan Adhikar section of Yogratnakar. The key ingredient is Gandhak (purified sulfur), known for its Kandughna (anti-itching) and Krimighna (anti-parasitic) effects. This detoxification step is essential to neutralize its potential toxicity and enhance its therapeutic efficacy (Shastri, 2013). Gandhak Rasayana works by purifying the blood and skin (Rasa-Rakta Dhatus), reducing infection and inflammation, normalizing skin turnover, and rejuvenating tissues.
Sutshekhar Rasa
It helps balance Pitta and Vata Doshas, thereby preventing the recurrence of related disorders (Patil and Jadhav, 2024). Its key ingredients, Parada and Gandhaka, detoxify and purify the blood; Tankana provides antiseptic balance; Shankha and Kapardika Bhasma soothe inflammation; Dadima offers antioxidant support; and Ghrita nourishes the skin. Together, these ingredients help purify the Rasa-Rakta Dhatus and promote healing of eczema lesions.
Patolkaturohinyadi kashaya
This formulation is classified under the Shodhanadi Gana in the Ashtanga Hridaya and is rich in Tikta Rasa (bitter-tasting herbs), which play a vital role in the purification (Prasadana) of Rasadhatu (plasma fluids) and Raktadhatu (blood) by pacifying the vitiated Kapha and Pitta Doshas (fundamental bio-energetic forces governing body functions) (Gaud, 2013). It functions as a blood purifier (Raktashodhaka), anti-pruritic (Kandughna), effective in skin disorders (Kushtaghna), and enhances complexion (Varnya). Additionally, Pippali in the formulation contributes significantly to enhancing the bioavailability of the other ingredients (Chavan et al., 2011).
Karanja tailam
Karanja based formulations have shown effectiveness in managing chronic plaque psoriasis due to the presence of active compounds like karanjin and pongapin. Molecular docking studies revealed that both karanjin and pongapin exhibited binding affinities with various target receptors that were comparable to those of methotrexate, a standard drug used in psoriasis treatment. These findings suggest that pongapin and karanjin could serve as potential natural alternatives for the management of psoriasis (Saste and Mytrhey, 2022).
Panchatikta Ghrita
For Snehapana (internal oleation), the patient was given Panchatikta Ghrita. It is composed of Nimba, Patola, Vyaghri, Guduchi, Vasa, Haritaki, Vibhitaki, Amalaki, and Goghrita. These ingredients possess Raktaprasadaka (blood-purifying) and Kushtaghna (anti-skin disorder) properties. The predominant Tikta Rasa (bitter taste) in this formulation is particularly effective in managing Pitta-dominant conditions and Rakta Vikara (blood disorders). Therefore, in this case, the formulation was administered both internally and applied topically to the affected areas, providing a soothing and therapeutic effect (Singh et al., 2020).
Gandharva Haritaki churna
Haritaki is mainly used in Vata-Kaphaja conditions of Vyadhi (ResearchGate, 2022). Gandharva Haritaki Churna is a traditional polyherbal Ayurvedic formulation known for its gentle purgative action, which is considered more potent than that of Triphala. As indicated by the name itself, the primary components of this formulation are Haritaki and Eranda Taila (castor oil). Its detoxifying and lightening action supports skin restoration and reduces redness in Pitta-prone dermatoses. Gandharva Haritaki is a traditional Ayurvedic formulation commonly employed to promote digestion, aid detoxification, and enhance overall vitality. Its key constituents, Haritaki and Trivrit, are extensively recognized in classical texts for their medicinal benefits. It supports the digestion of toxins (Ama), purifies the system, and promotes bowel cleansing, thereby facilitating the proper formation of Raktadhatu, which precedes Rasadhatu (Patil, 2020).
CONCLUSION
Thus, in this case study, Ayurvedic herbs when administered alongside strict dietary regulations have proven to be highly effective in very less time in the management of Vicharchika (Eczema). This therapeutic approach not only provided symptomatic relief but also addressed the root cause and samprapti vighatana, contributing to long-term disease control and improved quality of life.