Pemphigus Vulgaris (PV) – Ayurvedic Herbal Treatment

Pemphigus vulgaris (PV) is a rare autoimmune disease involving the formation of blisters on the skin and mucous membranes. This disease is quite significant since it is potentially life-threatening, with a high mortality rate of 5-15%, even though affecting only the skin and mucous membranes. Circulating antibodies are directed against the keratinocyte cell surfaces in the skin; this causes a loss of cell-to-cell adhesion, resulting in a breach of the skin epidermis, thereby causing blisters. These blisters are of varying size, and may appear on normal or inflamed skin. The blisters are fragile and rupture easily; these are painful and heal slowly, usually without scarring. Almost all patients present with oral cavity involvement; other mucous membranes which may be involved include the conjunctiva, esophagus, labia, vagina, cervix, vulva, penis, urethra, nasal mucosa, and anus.

Diagnosis is usually made by skin biopsy from the edge of a blister; direct immunoflourescence (DIF) on normal-appearing skin surrounding the blister or plucked hair sheaths; and indirect immunoflourescence (IDIF) using the patient’s serum. ELISA tests can detect the presence of antibodies and these titers correlate well with disease activity. While antidesmoglein 3 antibodies are present in patients having only mucosal involvement, the course of the disease correlates well to antidesmoglein 1 antibody levels. Reversion of DIF test to negative can be used as an indicator of remission and for monitoring while tapering medicines.

Treatment of PV is mainly with corticosteroids to reduce and stop the inflammation process. Immune suppressing medicines are sometimes used early on in the course of the disease as steroid-sparing medication. Fatalities are more common in the first 5 years of the disease, and are related to susceptibility to infection, as well as fluid and electrolyte imbalance. Morbidity and mortality is related to the severity and extent of the disease, the dosage of steroids required to induce remission, as well as the presence of co-morbidities. Elderly patients and patients with extensive disease have a more serious prognosis. The long term use of steroids and immune suppressants also contributes to the overall morbidity and mortality. Rituximab, sulfasalazine, pentoxyphylline, methotrexate and dapsone have been used as steroid-sparing drugs. Intravenous immunoglobin therapy and plasmapheresis have been used with some degree of success in refractory patients.

Because of the high mortality of this disease as well as the contributing toxicity of steroids and immune suppressants drugs, Ayurvedic herbal medicines have a significant role to play in the overall long term treatment and management of PV. This being an autoimmune disorder, the treatment protocol includes a multipronged approach of detoxification, proper nutrition, rejuvenation of body systems, immune modulation, as well as specific treatment for the actual systems or organs affected.

Special attention is focused on strengthening the integrity of the skin and mucous membranes. This involves the use of medicines which act specifically on the skin and mucous membranes as well as on blood vessels. Herbal medicines which have immune modulating properties as well as act specifically on skin and mucous membranes are very useful in this scenario. Medicines also need to be given to help in healing of ulcers, and for the prevention of secondary infection in the sores.

Detoxification for each patient needs to be tailor-made according to the severity and chronicity of PV lesions. While some patients may require just a few additional medicines to boost kidney and liver function, yet others may require an elaborate detoxification plan for induced emesis, induced purgation, and blood-letting. Known in Ayurveda as Panch-karma, these procedures may be used as standalone or as combination-procedures. These detoxification procedures may provide rapid remission of PV symptoms; however, patients need to be selected carefully, since most affected with PV are old or have concurrent comorbid conditions.

Depending upon the severity of the condition as well as the response of patients to treatment, Ayurvedic herbal medicines may need to be given for periods ranging from about 6 to 10 months. With regular treatment, most patients affected with PV respond well to Ayurvedic herbal treatment and more than 80 % achieve full remission. Gradual tapering of medicines, as well as suitable modifications in diet and lifestyle, can help prevent recurrence of the condition. Aggravating factors like stress and certain medications also need to be avoided. A judicious utilization of Ayurvedic herbal treatment can thus bring about significant improvement in PV and considerably minimize the mortality due to this condition.

The writer Dr A A Mundewadi is available as an Ayurvedic Consultant at https://www.mundewadiayurvedicclinic.com and  www.ayurvedaphysician.com For Ayurvedic herbal treatment of PV, kindly click here

Chronic Urticaria – Ayurvedic Herbal Treatment

Urticaria, also known commonly as hives, is an allergic reaction of the skin with characteristic red, itchy patches of various size and shape. The individual patches usually subside within 24 hours, without any pigmentation or scaling. This condition is known as chronic urticaria if lesions recur for more than 6 weeks. A more serious variant of this condition is known as angioedema, in which the swelling goes much deeper and involves the mucous membrane, usually in areas like the eyelids, lips and tongue.

Chronic urticaria is usually diagnosed clinically with the help of a detailed medical history and physical examination. Further investigations may be required in case of a concurrent history of parasitic infection, thyroid disorder, or autoimmune disorder. Rarely, a skin biopsy may be required if the lesions persist for more than 24 hours at a time, or there are accompanying features of skin bleeds, autoimmunity, fever or arthritis.

Chronic urticaria is usually divided into three subsets: 1) Physical or inducible urticaria, also known as symptomatic dermatographism, cholinergic urticaria, and pressure urticaria. About 20 % of patients present with this subtype, in which the trigger is some consistent, identifiable factor such as mechanical stimuli (pressure, vibration), temperature changes, sweating, stress, sun exposure, and water contact.2) Chronic urticaria secondary to some underlying medical condition; however, this is very rare. 3) The largest subtype is known as chronic idiopathic urticaria or chronic spontaneous urticaria. No definite causative factor can be attributed to this subtype; however, in about 20-45 % of such patients, there may be an underlying autoimmune process driving the disease.

The standard management of chronic urticaria includes the use of anti-histamines to reduce the rash as well as itching. Most people with mild symptoms can be managed well with these medicines itself. For those with moderately severe symptoms, additional medicines like colchicine, dapsone, and steroids are given for a limited time period. Those with an autoimmune process may require immune modulating drugs, while a small percentage may require anti-thyroid medications.

It is equally important to avoid triggers like mental stress, overtiredness, tight fitting clothes, alcohol, aspirin and other non-steroidal anti-inflammatory drugs. Application of soothing ointments can help relieve itching; night time pruritis can be alleviated by lukewarm baths. Chronic urticaria may last from months to years; however, about 50 % patients experience remission within a year with proper treatment. With the exception of angioedema, this disease is not life threatening; however, it can significantly affect the quality of life.

Ayurvedic herbal medicines can be used with very good results in the treatment of chronic urticaria, especially in those patients who do not respond to conventional therapy. Herbal medicines can be used to reverse the basic pathology of the disease. Medicines which strengthen the skin tissue, treat allergy, and prevent recurrence, are used to reduce symptoms. Medicines useful in this condition are those which act on the skin, subcutaneous tissue, mucus membranes, capillaries, and blood.

Ayurveda also differentiates the treatment protocol for chronic urticaria based on the symptoms and specific causes. Urticaria with predominantly ‘Vata’ dosha symptoms is known as ‘Sheeta-pitta’;  with dominant ‘Pitta’ symptoms, it is known as “Utkotha”; while with dominant ‘Kapha’ symptoms, it is known as ‘Udarda’. Each of these types of urticaria is treated differently, according to the clinical presentation, causative factors, and severity. For patients with refractory symptoms, purification Panchkarma procedures like induced emesis, induced purgation, and bloodletting are utilized, either as stand-alone procedures, or as combinations, or even as repeat combination-procedures, if indicated.

Ayurvedic herbal medicines also need to be given to treat chronic gastro-intestinal symptoms, repeated worm infestations, thyroid disorders, chronic stress, latent infections, and chronic inflammation. For patients with an underlying autoimmune process driving chronic urticaria, an elaborate treatment needs to be planned, which includes detoxification; treatment of chronic inflammation; healing of damaged organs, tissues and body systems; rejuvenation using tonifying medicines; provision of specific nourishment; gradual immune modulation; and providing treatment for the specific type of chronic urticaria.

With proper and regular treatment, most patients having chronic urticaria can be fully treated in about 4-8 months. Before commencing treatment, it is important to do a thorough examination and accurate diagnosis, in order to achieve a quick remission. Depending upon the severity, patients with autoimmune disease may require treatment for longer periods. It is equally important to adopt suitable lifestyle modifications and avoid know triggers.

The writer, Dr A A Mundewadi, is available as an Ayurvedic Consultant at https://www.mundewadiayurvedicclinic.com  and  www.ayurvedaphysician.com  For Ayurvedic herbal treatment of chronic urticaria, kindly click on this link https://www.mundewadiayurvedicclinic.com/product-page/urticaria-chronic