Presenting as inflammation, itching, swelling or abnormality across the body’s outer surface, skin conditions are treated in Ayurveda with herbs such as neem, kachnar, aloe and ashoka.
Understanding skin conditions
Pathological conditions that affect the surface of the body, including skin, nails, and hair, as well as the associated glands, are known as skin diseases. They can present as inflammation, infection or growths, and can involve many or all layers of the skin (1). Skin conditions can arise due to allergies, genetic makeup, irritants, or an immunological response (2). These skin diseases can significantly affect quality of life, mental health, and ability to carry out daily tasks (3). The mental and emotional burden of these conditions can significantly outweigh the physical impact (4).
Factors determining the prevalence and pattern of skin disease include race, gender, environment, diet, socio-economic status, hygiene and quality of medical care (5). Since these conditions are often not life threatening, the substantial social and psychological impact is often underestimated or neglected.
Although the mortality rate from these conditions is lower than other life-threatening conditions, skin diseases require attention for the following reasons (6):
- Skin conditions are common and can often affect vulnerable groups including children and thus should not be ignored.
- Morbidity can be significant due to disability, disfigurement, poor quality of life and symptoms such as itching.
- In 2013, the skin and subcutaneous diseases accounted for 39 million YLDs (year lost due to disability) and 41.6 million DALYs (disability adjusted life years). These numbers place skin conditions as the 18th cause of DALYs globally. Worldwide, they are the fourth leading cause of disability excluding mortality. Between 1990 to 2017, these conditions increased in prevalence by 46.8% (7).
- The most common skin conditions in Europe are acne, eczema, and atopic dermatitis (8). In the UK, 60% of the population have experienced or are currently living with a skin condition. Hospital admissions in England and Wales have significantly increased due to skin or subcutaneous diseases and infection (9).
How does skin health work?
There are numerous theories to explain the pathophysiology of skin disease. The three most common ones are discussed below:
Immune response
Dysregulation of the normal immune response leads to the inflammatory changes contributing to immune-mediated inflammatory diseases (IMIDs). This condition includes skin diseases like atopic dermatitis, psoriasis, acne, lichen planus etc. The genome- wide association studies (GWAS) have suggested a link between IMIDs and genetics at loci. The pathogenesis of the disease may vary, but it has common features such as immune system stimulation, a genetic component, and chronic inflammation. The triggering factor for skin conditions can be multifaceted and complex.
External factors include microorganisms, allergens, diet, trauma, drugs or smoking.Internal triggers include autoantigens (psoriasis, lichen planus), stress (psoriasis, atopic dermatitis) and metabolic disorders (psoriasis). The immune response can be both specific and non-specific, regarding adaptive and innate immunity respectively.
Psoriasis involves a non-specific response, stimulating innate lymphoid type 3 cells, mast cells, macrophages and neutrophils. In the case of atopic dermatitis, there is a stimulation of basophils, eosinophils, and innate lymphoid type-2 cells. Specific response includes CD8(+) lymphocytes in lichen planus and psoriasis, D4+ Th2 and B lymphocytes in acute phase and Th7 and Th1 in the chronic phase of acute dermatitis. These cause an increase in pro-inflammatory chemokines and cytokines in the skin. This leads to an influx of neutrophils, lymphocytes, eosinophils, and macrophages in the skin causing inflammation (10).
Gut–skin axis
Inflammatory conditions are commonly linked with gastrointestinal dysbiosis. A connection has been found between dermatoses and gastrointestinal disorders, with between 7–11% of IBD patients also reporting the presence of psoriasis (11). The gut–skin connection is mediated by the immune system, as the gut microbiome works to maintain homeostasis. The intestinal microbiota produces neurotransmitters which enter the bloodstream by crossing the intestinal barrier and elicit systemic effects (12). Similarly, short-chain fatty acids (SCFAs) like acetate, propionate and butyrate are produced by the intestinal bacteria. These SCFAS (mainly butyrate), decrease intestinal barrier permeability and enhance the barrier function of epithelial layer (13). Therefore, these compounds derived from the gut microbiome can interact with skin receptors altering the skin’s bacterial balance.
Oxidative stress
There are several environmental pollutants which catalyse reactive oxygen species (ROS) production resulting in increased oxidative stress. ROS activate cell signalling, altering apoptosis and resulting in the pathogenesis of skin disorders including cutaneous malignancy and photosensitivity diseases. ROS influence the molecular pathways responsible for inflammatory processes, which, in normal levels contribute to wound healing and angiogenesis. However, when ROS production is in excess, it can lead to structural damage of the skin resulting in chronic inflammation and disease as well as atherosclerosis and ischemia-reperfusion injury (14).
Understanding the root of good skin
According to Ayurveda, all skin related conditions fall under ‘kushta roga’. Classic Ayurvedic texts suggest possible causative factors include:
- Diet: Excessive consumption of liquid and unctuous food (fatty, oily or greasy); food that is difficult to digest; eating hot and cold food together; excessive portion sizes; excessive fasting, eating when already full; eating during indigestion; overconsumption of curd, fish or black gram (urad bean) or eating a combination of foods which are incompatible together.
- Lifestyle: Suppression of natural urges, especially vomiting; excessive exercise and sun exposure; having a bath or drinking water immediately after physical exertion and excessive sleeping.
- Treatment adherence: Failure to implement recommended treatment and long term recovery plans (panchakarma).
- Behaviour: Excessive indulgence in unkind or unethical deeds.
Due to the above causes, all the three dosha, (vata, pitta and kapha) are affected which further affects the twak (skin), rakta (blood), mamsa (muscle tissue), and ambu (body fluid).
The imbalance in all these elements leads to the manifestation of kushta roga (skin diseases or skin disorders) (15).
Signs and symptoms
- Loss of sensation in affected area
- Excessive or absence of sweating
- Itching
- Pricking pain
- Horripilation (goosebumps)
- Physical and mental fatigue
- Significant pain surrounding ulcers
- Numbness
- A burning sensation
- Elevated skin patches
- Discoloration
- Sudden appearance and persistence of ulcers.
Herbal solutions
Neem (Azadirachta indica)
Neem leaf extract has been shown to reduce boils and blisters (16). A study was conducted on mice with DMBA (a chemical used to induce cancerous skin tumours). The experimental group was given an aqueous extract of neem leaves for 20 weeks, three times a week at a dose of 300 mg/kg body weight. This study concluded that neem possesses a potential chemoprotective property against murine skin carcinogenesis (17). Other studies conducted support its anti-inflammatory, antiulcer and wound healing actions (18,19).
Kachnar (Bauhinia variegata)
The bark is used internally to treat skin diseases, sore throats, asthma and abdominal discomfort.Externally, it is applied on skin ulcers. After a DMBA + croton oil induction in mice, the subsequent treatment with kachnar tree bark was found to reduce the number and appearance of papillomas. Following a 50% methanolic extract administered in mice for 30 days at doses of 500 and 1000 mg/kg, it was found to significantly reduce the size of the tumour and increase life span. The formation of a micronucleus and aberration of chromones were significantly prevented by administration of camel’s foot tree (20).
Saffron (Crocus sativus)
Saffron is known for its antispasmodic, carminative, diaphoretic and sedative properties. It is used as an effective treatment of psoriasis. It induces the cellular defence mechanism of the body; therefore inhibiting the skin carcinoma induced by DMBA (21). It is used to improve skin complexion, skin discoloration, pimples, acne, freckles and melasma. It is also used to clean and disinfect wounds.
Aloe vera (Aloe vera)
Aloe vera is very commonly used in skin conditions. It’s effective in managing pigmentation, stretch marks and wrinkles. It accelerates wound healing by improving the circulation of blood to the affected area as well as preventing cell death. A study was conducted in mice with spontaneous AD (atopic dermatitis) skin lesions and concluded that aloe vera relieved symptoms of AD when applied orally at a dose of 0.8 mg/kg. This effect is associated with to the reduction of IL-5 and IL-10 interleukin levels (22). Aloe vera gel has antibacterial as well as antimicrobial properties. The skin plaques in psoriasis were reduced after four weeks in a study using a cream with 0.5% of aloe (23). Aloe also helps in treating burns, frostbite injuries and skin damage due to radiation.
Ashoka (Saraca asoca)
Ashoka root is applied in a paste to treat conditions like external inflammation, ulcers, freckles and other skin diseases. The crushed flowers are rubbed onto the skin to control itching in dermatitis, psoriasis, eczema, and herpes. It is a herb of choice for tinea pedis, pruritis and scabies. An external application of L. inermis and ashok flowers macerated in coconut oil can be applied twice daily to treat scabies and eczema (24).
Holistic solutions
Diet
Ayurvedic dietary recommendations include consuming food which are easy to digest, bitter tasting green vegetables, wholegrains and cereals, food prepared with infused ghee including triphala and neem, green gram and pointed gourd.
Foods to avoid include sour food, milk, curd, jaggery, sesame, fish and foods which are difficult to digest.
Herbal external application
A herbal pack can be applied on the affected area. The specific herbs are chosen according to the body type as well as the type of skin disorder.
Decoction
A decoction of various herbs can be made and applied directly to the skin or made into a bath. Similarly, the specific herbs are chosen according to the type of skin disease and the patient’s symptoms and constitution.
References
- Nature News, www.nature.com/subjects/skin-diseases. Accessed 15 Aug. 2023.
- “Skin Diseases.” National Institute of Arthritis and Musculoskeletal and Skin Diseases, 3 Apr. 2023, www.niams.nih.gov/health-topics/skin-diseases
- Eckert, L., Gupta, S., Amand, C., Gadkari, A., Mahajan, P., & Gelfand, J. M. (2017). Impact of atopic dermatitis on health-related quality of life and productivity in adults in the United States: an analysis using the National Health and Wellness Survey. Journal of the American Academy of Dermatology, 77(2), 274-279.
- Ayer, J., & Burrows, N. (2006). Acne: more than skin deep. Postgraduate medical journal, 82(970), 500-506.
- Dunwell, P., & Rose, A. (2003). Study of the skin disease spectrum occurring in an Afro‐Caribbean population. International journal of dermatology, 42(4), 287-289.
- Disease control priorities in developing countries (second edition … (n.d.). https://elibrary.worldbank.org/doi/book/10.1596/978-0-8213-6179-5
- Karimkhani, C., Dellavalle, R. P., Coffeng, L. E., Flohr, C., Hay, R. J., Langan, S. M., … & Naghavi, M. (2017). Global skin disease morbidity and mortality: an update from the global burden of disease study 2013. JAMA dermatology, 153(5), 406-412.
- Richard, M. A., Paul, C., Nijsten, T., Gisondi, P., Salavastru, C., Taieb, C., … & EADV Burden of Skin Diseases Project Team. (2022). Prevalence of most common skin diseases in Europe: a population‐based study. Journal of the European Academy of Dermatology and Venereology, 36(7), 1088-1096.
- Samannodi, M. (2022, October). Hospital admissions related to infections and disorders of the skin and subcutaneous tissue in England and Wales. In Healthcare (Vol. 10, No. 10, p. 2028). MDPI.
- Disease control priorities in developing countries (second edition … (n.d.). https://elibrary.worldbank.org/doi/book/10.1596/978-0-8213-6179-5
- Huang, B. L., Chandra, S., & Shih, D. Q. (2012). Skin manifestations of inflammatory bowel disease. Frontiers in physiology, 3, 13.
- Lyte, M. (2014). Microbial endocrinology and the microbiota-gut-brain axis. Microbial endocrinology: the microbiota-gut-brain axis in health and disease, 3-24.
- Mariadason, J. M., Catto-Smith, A., & Gibson, P. R. (1999). Modulation of distal colonic epithelial barrier function by dietary fibre in normal rats. Gut, 44(3), 394-399.
- Bickers, D. R., & Athar, M. (2006). Oxidative stress in the pathogenesis of skin disease. Journal of Investigative Dermatology, 126(12), 2565-2575.
- Charak Samhita. (2023, March 7). Kushtha Chikitsa. Charak Samhita. https://www.carakasamhitaonline.com/index.php?title=Kushtha_Chikitsa
- Joshi, A. R., & Joshi, K. (2007). Ethnomedicinal plants used against skin diseases in some villages of Kali Gandaki, Bagmati and Tadi Likhu watersheds of Nepal. Ethnobotanical leaflets, 2007(1), 27.
- Arora, N., Bansal, M. P., & Koul, A. (2011). Azadirachta indica exerts chemopreventive action against murine skin cancer: studies on histopathological, ultrastructural changes and modulation of NF-κB, AP-1, and STAT1. Oncology Research Featuring Preclinical and Clinical Cancer Therapeutics, 19(5), 179-191.
- Biswas, K., Chattopadhyay, I., Banerjee, R. K., & Bandyopadhyay, U. (2002). Biological activities and medicinal properties of neem (Azadirachta indica). Current science, 1336-1345.
- Bhardwaj, R. L., & Rajput, R. (2010). Wound healing properties of neem oil (Azadirachta indica Juss) and turmeric powder (Curcuma longa). Indian Journal of Veterinary Surgery, 31(1), 59-61.
- Agrawal, R. C., & Pandey, S. (2009). Evaluation of anticarcinogenic and antimutagenic potential of Bauhinia variegata extract in Swiss albino mice. Asian Pac J Cancer Prev, 10(5), 913-6.
- Das, I., Das, S., & Saha, T. (2010). Saffron suppresses oxidative stress in DMBA-induced skin carcinoma: A histopathological study. Acta histochemica, 112(4), 317-327.
- Kim, J., seok Lee, I., Park, S., & Choue, R. (2010). Effects of Scutellariae radix and Aloe vera gel extracts on immunoglobulin E and cytokine levels in atopic dermatitis NC/Nga mice. Journal of ethnopharmacology, 132(2), 529-532.
- Syed, T. A., Ahmad, S. A., Holt, A. H., Ahmad, S. A., Ahmad, S. H., & Afzal, M. (1996). Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo‐controlled, double‐blind study. Tropical Medicine & International Health, 1(4), 505-509.
