A Case Report: Management of Mukhadushika (Acne Vulgaris) with Ayurveda

Background: Acne vulgaris is a chronic inflammatory condition of skin in youth. In Ayurveda, acne has been elaborated as one of the Kshudra Rogas . In this modern era, this is a burning problem in the adolescence. Symptoms of Mukhadushika show close resemblance with bacterial infection and inflammatory factors of acne. In Ayurveda, it can be correlated with Mukhadushika . Vitiation of Kapha Dosha , Vata Dosha and Rakta Dhatu lead to development of Mukhadushika. Methods: A 25-year-old patient presented with complaint of Pidaka (Papules and putules) on face and neck including Medogarbhatva (filling material), Todavat peeda (Piercing pain), Daha (Burning sensation), Srava (Discharge) and Kandu (itching) associated with irregular bowel and recurrent comedones, since 1 year. Management done with OPD based treatment. Here in this case report treatment chosen was i.e. Avipattikar churna orally and Lodhradi lepa for external application along with Baspa Sweda (take a steam) for 1 month followed by Kumkumadi Taila for next 15 days. Result: There was marked improvement in symptoms Pidaka (Papules and pustules) on face and neck including Medogarbhatva (filling material or nodules), Todavat peeda (Piercing pain), Daha (Burning sensation), Srava (Discharge) and Kandu (itching) associated with irregular bowel and recurrent comedone with the treatment of 1.5 month. Conclusion: Significant result was observed with this treatment protocol in the management of Mukhadushika (Acne vulgaris).


Introduction
Acne vulgaris, a chronic inflammatory disorder in adolescents consists of the pilosebaceous follicles, characterized by comedones, papules, pustules, cysts, nodules and often scars, chiefly on face, neck etc (1). It is a skin condition that occurs due to the clogging of oil glands (sebaceous glands) of the skin (2). The oil (sebum) that normally lubricates the skin gets trapped in blocked oil ducts. Hormone changes during the teenage cause the body to make more of this oily substance (sebum), thus are clogging the follicles. Bacteria can get inside the follicle or oil gland and cause redness, swelling, and pus. It is one of the most common dermatologic condition that affects nearly everyone at some point in their lifetime. Adult acne is becoming increasingly popular. It is a disease of the skin which can be painful for those suffering from moderate to severe acne (3). Acne vulgaris mostly affects the areas of skin with the densest population of sebaceous follicles these areas include the face, the upper part of the chest, and the back (4).The cause of acne is unknown. It is presumed to be activated by androgens Once thought as a condition only affecting teenagers, prevalence in adulthood has been increasing, especially in women 25 years of age and older (5). The earliest abnormalities in acne are: • Increased sebum production due to which the skin looks greasy(seborrhea) • Formation of horny plugs (comedone) In Ayurveda, it can be correlate with Mukhadushika which is explained by Acharya Sushruta under Kshudra Rogas (6) and is considered as swatantra vyadhi in the ayurvedic literature. It is characterized by Shalmali Kantaka Sadrusha Pidikas on face. These Pidikas destroy the beauty of the face and cause disfigurement of the face therefore they are also called as "Mukhadushika" 7). Face is the index of mind and a beauty. Cosmetic impact of deformities on the face is far reaching and in order to improve the complexion various Soundarya Vardhak Dravyas were used in older times as similar to today's scenario. This created an interest to study the various aspects of the disease. In Ayurveda, mainly two types of Chikitsa (treatments) have been used to treat acne i.e. Shodhana (purification of body) and Shamana (conservative treatment by oral and topical medicines). Shodhana includes Vaman and Nasya, whereas Shamana includes Lepa, Upanah and Kshara application. Lepa procedure is described in many Samhita, it harnesses the effect of Mukhadushika as well as increase the Mukhakanti. In this case study, management of Mukhadushika (Acne vulgaris) has been elaborated with Shamana Chikitsa.

Case Report
A 25-years-old patient presented with complaint of Pidaka (Papules and putules) on face and neck including Medogarbhatva (filling material), Todavat peeda (Piercing pain), Daha (Burning sensation), Srava (Discharge), Kandu (itching) associated with irregular bowel and recurrent comedones, since 2 year at Shalakya Tantra (ENT) OPD of IPGT & RA hospital, GAU, Jamnagar on date 18/8/2020. Same problem was arising before three years. Patient have apparently good and healthy skin before 2 years. Gradually patient suffered with Comedones, Red papules (Rakta Pidaka), Pustules, Nodules around cheek and neck. For that patient approached contemporary medical sciences for treatment. But patient's complaints did not get satisfactory result. So patient came to our hospital, and patient was treated with Avipattikar churna orally and Lodhradi lepa for external application along with Baspa Sweda (steam therapy) for 1 month followed by Kumkumadi Tailm for 15 days.  Easily recognizable, less than half of the affected area is i n v o l v e d , m a n y s m a l l c o m e d o n e s , p a p u l e s a n d pustules

Results
On the first follow up i.e. on 15 th day of treatment patient told mild relieved in the symptoms. She felt moderate relief in pustules on face and neck. Patient felt mild relief in pain, burning and itching. There was marked relief in pus discharge and she felt less in oily skin. Her digestion power was improved and relief in constipation. There was no relief in papules.

Image: 7 After treatment Relived all signs Symptoms Front view of face
Image: 8 after treatment relived all signs lateral view of face After completion of 2 month skin was normal, glowing and shiny of Grade -0 acne scale. And no any pain, burning, itching, discharge was present not any pustules, papules or comedones.

Discussion
Mukhadushika (Acne Vulgaris) is mostly seen in adolescence age group i.e. in Dhatuvivardhamana Awathstha 16-30yrs, specially the starting period of functional state of Shukradhatu (Abhivyakti and Vridhi). This is also the age of predominance of Pitta and Shukra Dhatu, along with consumption of unbalanced food, alternate mode of lifestyle, which causes the vitiation of Dosha and Doshya (8). So, the patient was advised for Nidanaparivarjana. Most of the Acharya has mentioned in Vaman, Virechan, Nasya, Raktamokshan for Mukhadushika along with Samana Chikitsa and local application.
Steam therapy can help minor pore blockages and blackheads be extracted. Steam therapy soften blemishes and make them easier to extract but steaming alone won't clear up acne (9).
Avipattikar Churna was prescribed to the patient for 1 month. Avipattikar Churna contains, Zingiber officinalale Roscoe.  Lepas (pastes) act as Astringent, Antiinflammatory and Antibacterial agents. Lepas not only treat the acne but also increase the skin complexion.
In Ayurveda, Lepas have been especially advised for application on oily skin whereas Tailas (oils) have been advised for dry type of skin. Lodhradi Lepa was selected for external application.
All the drugs except Lodhra are Ushna Veerya so they are Vata Kapha Shamaka and Sheeta Veerya of Lodhra pacifies the Dushita Rakta. Vacha has Lekhana property so it helps in Subsiding Medogarbha Pidika. Thus, the combination of drugs helps in reversing the pathogenesis of Mukhadushika (Acne Vulgaris).