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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 201-205

Influence of psychiatric comorbidity on patient with Switra (vitiligo)


1 Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, New Delhi, India
2 Department of Biochemistry and Forensic Science, Gujarat University, Ahmedabad, Gujarat, India

Date of Submission25-Jan-2021
Date of Decision01-Jun-2021
Date of Acceptance07-Aug-2021
Date of Web Publication28-Sep-2021

Correspondence Address:
Dr. Amin Hetalben
Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, New Delhi.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_5_21

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  Abstract 

Background: As per Ayurveda, Switra is the skin disorders of depigmentation of localized or whole body. The disease is somatic in nature which affects the psychology of the patient with chronicity. The patient with Switra experiences severe psychological and social problems. Sattvavajaya (psychological methods) is one among the three principal treatment modalities that is specially designed for treating psychological disorders. Aim: The current case will discuss the psychological aspect of Switra in the early remission of disease as per Ayurveda in terms of Sattavavajaya Chikitsa. Materials and Methods: Sattavavajaya Chikitsa combined with Yukti Vyapashraya Chikitsa (physicopharmacological) was used for four months of treatment. In present study, Avalgujadi lepa (as Yuktivyapashraya Chikitsa) and counseling (as Sattvavajaya Chikitsa) were administered. Result: The present case demonstrates clinical promising results in re-pigmentation without developing new areas of de-pigmentation. The case was not uncommon but it reflects the importance of the psychological problem in Switra. The present case supports the psychological aspect concern with Switra and signifies that psychological management can also give early management. Conclusion: Satvavajaya Chikitsa shows remarkable improvement in the immediate recovery of Switra along with Yukti Vyapashraya Chikitsa.

Keywords: Ayurveda, Chikitsa, psyche, Sattvavajaya, Switra, vitiligo


How to cite this article:
Hetalben A, Chayal V. Influence of psychiatric comorbidity on patient with Switra (vitiligo). J Indian Sys Medicine 2021;9:201-5

How to cite this URL:
Hetalben A, Chayal V. Influence of psychiatric comorbidity on patient with Switra (vitiligo). J Indian Sys Medicine [serial online] 2021 [cited 2021 Dec 4];9:201-5. Available from: https://www.joinsysmed.com/text.asp?2021/9/3/201/326844




  Introduction Top


Vitiligo is a disease that creates white patches of skin,[1] and it causes partial or complete loss of the skin pigmentation. It is commonly known as leukoderma.[2] It is a common disorder of the skin; it is an acquired, progressive, and common pigmentory disorder that is characterized by well white macules, devoid of identifiable melanocytes.[3] Vitiligo is a disease related to a cosmetic problem and it has a great psychosocial impact. As a cosmetic problem, it is a source of great embarrassment to dark-skinned people. Although the life span of patients remains unaffected, the patient feels distressed and stigmatized by the condition.[4]

Satvavajaya encompasses a whole sweep of sciences that deal with the mind—its physiology, morphology, and morbidity and also the management of psychological as well as psychosomatic diseases. Ayurveda psychotherapy has the right combination of nonpharmacological methods such as Dhyana (concentration), Yoga, and pharmacological components, which render it more balanced. However, one factor that bestows it with a special status is the incorporation of Sadvritta (moral code). There are many techniques prevailing in medical science for control over the mind.

Ayurved is a prehistoric health science. It covers health maintenance and the disease condition. According to Ayurved, vitiligo is equated to Switra.[5] The main cause of Switra is an autoimmune, genetic, psychological, and endocrine disorder; chemical contact; and adverse drug interaction. Vitiligo symptoms occur during the early stages of life and they occur in men and women equally.[6] The current case will discuss the psychological aspect of vitiligo in early remission of the disease as per Ayurveda in terms of Sattavavajaya Chikitsa (psychological methods) combined with Yukti Vyapashraya Chikitsa (physicopharmacological).


  Case Presentation Top


Patient Information

The patient was a 35-year-old married housewife in Ahmedabad, Gujarat. Her height was 170 cm, and her weight was 75 kg.

Present Medical History

A 35-year-old married housewife in Ahmedabad, Gujarat complained of white patches over the skin of both hands from elbow to fingers for the past two years; the size of the patches varied from 20 × 20 cm to 10 × 10 cm. Initially, the lesions were small and discrete; later, they progressively increased in size and then spread to the upper portion of the hands. No associated complaints were linked to the lesions, such as an itching or burning sensation. No environmental, occupation history was found. Addiction was also not found. The patient had also taken conventional treatment for a period of one year.

Personal History

The patient was fond of fermented food items, bakery items, and nonvegetarian food items. She could not tolerate warmth and did not have control over her anger. In terms of number and size, the de-pigmented patches were increased gradually. Allopathic and homeopathic medications had not provided satisfactory relief, therefore the patient had opted for Ayurvedic treatment for the management of her condition. It was observed that she was having symptoms of anxiety and depression.

Psychological History

On counseling, she expressed thus: “my family members and relatives are not supporting me due to my appearance. Even though, I am not allowed to go for social functions because of my condition. Moreover, everyday, family members are taunting on my appearance. Till now, I have done my treatment as well as tried many home remedies but no cure. My personal life is ruined and my entire dreams have shattered.”

Past Medical History

There was no family history of Switra. Her childhood history had no significant events.

Clinical Findings

De-pigmented patches involving most of the area of both hands from elbow to fingers with clear demarcated margins involving hairs over the affected areas were also noted. A similar skin condition was not found in the family. On examination, it was found that she had no systemic illness such as diabetes mellitus, hypertension, etc. All her vitals were normal. Assessment score is described in [Table 1].
Table 1: Clinical improvement and interventions

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Local Examination

(1) Site of lesion: elbow joints, (2) distribution: asymmetrical, (3) color: white, (4) itching: present; severity: mild, (5) inflammation: absent, (6) discharge: absent, (7) superficial sensation on lesion: pain absent; swelling absent.

Systemic Examination

  • Respiratory system examination: no abnormal sounds, trachea centrally placed


  • Cardiovascular system examination: chest bilaterally symmetrical


  • Per abdomen examination: soft, non-tender, no organomegaly


Ayurvedic Examination

Ashtavidha Pariksha (eight-fold examination): (1) Naadi (pulse): 80/min, Vishama; (2) Mutra (urine): 600–800 mL/day, Avritti (quantity), Dhara (flow), Varna (color), Gandha (smell): Samyaka (normal); (3) Mala (stool): Samyaka, Nirama (normal), semisolid, Pita (yellowish); (4) Jihva (tongue): Anavruta (not coated), Raktabha (reddish); (5) Shabda (voice): Manda (low); (6) Sparsha (touch) Tvaka (skin): Snigdha (unctuous); (7) Svabhavika (normal) Drika (eyes), Twakvaivarnya (hypo/de-pigmentation); (8) Krisha Akriti (appearance).

Ayurveda Interpretation of the Patient’s Condition

Switra is the term used for vitiligo in Ayurveda.[7]Kushtha (Skin diseases) and Switra (Vitiligo) have same causative factors.[8] Incompatible food, suppression of vomiting, excess intake of sour, sweet, salt, and pungent food, curd, heavy intake of fresh grains, curd, and fish, teasing and disrespecting elders, sinful acts, etc. are the causative factors for Switra.[9]

Diagnostic Assessment

According to the clinical presentation, that is, symptoms and signs in Ayurveda terms, Switra is known as Vitiligo vulgaris. Kaphaja Switra was described by Sushruta.

Pathophysiology (Samprapti)

Tridosha are aggravated with skin, blood (Rakta), muscles (Mamsa), and watery element (Udaka). They are altogether involved habitually in different grades, and hence varieties of skin disorders are being caused. If lymph (Rasa) and blood (Rakta) are involved, they cause vitiligo, that is, Switra-Kushta.[10]

Therapeutic Intervention

Avalgujadi Lepa[11] (a herbal compound of Psoralea corylifolia Linn seed 192 g, arsenic trisulfide 48 g and cow’s urine 125 mL for each trituration) was advised (as Yuktivyapashraya Chikitsa) to apply daily twice on the affected area whereas counseling and motivation was done by the physician in every seven days as Sattvavajaya Chikitsa. The patient was followed up every seven days for counseling for 30 min in each sitting. [Table 1] indicates the intervention and clinical improvement in every follow-up.

Follow-Up and Outcome

The patient’s follow-up was done for four months to note the changes on the skin as well as her psychological condition. During the treatment, the de-pigmented patches gradually started becoming pinkish and brown with mild itching over the area. After some days, the skin became reddish brown with more itching. The small sports of pigmentation started developing over both hands. After almost three months of treatment, the pigmented spots became larger and were converted into normal skin color. In this case, oral drug administration was not done; therefore, hemogram, renal function tests, and liver function tests were not carried out. This case demonstrates clinical promising results in re-pigmentation without developing new areas of de-pigmentation [Figure 1].
Figure 1: Photograph before and after treatment

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Patient’s Perspective on Treatment Received

“Though, I was tough enough to combat any type of psychological condition in my whole life but after developing skin de-pigmentation of vitiligo, my confidence was gradually become lower down. My family and relatives’ ignorance for me made me more depressed. I have tried therapies suggested by family and relatives but no hope. De-pigmented area was gradually become wider and my depression level was also increasing. But after starting treatment from Ayurveda, the treatment I received was beyond my expectation. Although, I have taken numbers of medicines for my treatment before, I didn’t want to take Ayurveda medicines internally. I was becoming confident as well as motivated after receiving counseling and external medication. I had also observed that my skin patches had also started to become reddish brown and tuning to normal skin gradually. Within 3 month of my treatment I had observed that, I felt such as relief in my condition. Right now, I am feeling incredible thanks to Ayurveda and the physician who counseled me not only for my physical condition by also my psychological condition.”


  Discussion Top


As this case was not uncommon but it reflected the importance of a psychological problem in Switra, it supports the psychological aspect concern with Switra and signifies that psychological management can also provide early management with regard to the same.

Vitiligo disorder is caused by a loss of skin pigmentation due to immune attacks on melanocytes.[12] Psychiatric morbidity found in 16% to 35% of patients with vitiligo,[13] suicidal thoughts (10%), suicidal attempts (3.3%), anxiety (3.3%), depression (10%), etc. have been found in those affected with vitiligo. It also affects forming relationships, social avoidance, and sexual difficulties.[14] Presently, the main treatment includes topical and systemic corticosteroids, ultraviolet (UV) radiation, topical calcineurin inhibitors, etc.; however, these have adverse effects and limitations as well.[15]

Switra (Vitiligo) is a chronic disease (Deergha Roga) and it should be treated immediately. Ayurveda has a different approach to the understanding and treatment of Switra, which requires extensive research. Although medicines and a holistic approach may contribute in terms of significant benefits to the patients with Switra, the scientific rationale behind the use of these medications needs to be further explored with modern methods and research. A patient with Switra experiences severe psychological and social problems. Patients with vitiligo generally experience embarrassment, which further leads to social isolation and low self-esteem.[16] The emotional distress interferes with their employment due to their fear of rejection.[17]

According to Acharya Charaka, Shodhana before Shamana treatment is important in Switra.[18] As per Ayurveda, incurable patches are described, which are fire burn, patches over lips, hands, feet, and genital organs, red hair, fused patches, etc.[19] Psychodermatology examines psychiatric manifestations of dermatologic conditions.[20]Sattvavajaya Chikitsa is the withdrawal of the mind from unwholesome objects. Thus, it includes methods of Manonigraha (withdrawal of the mind from unwholesome objects).[21]Sattvavajaya is one among three principal treatment modalities that are specially designed for treating psychological disorders. It is a group of remedies that are targeted to conquer and make Manas alert and prepared for immediate challenges. Sattvavajaya advocates a comprehensive psychosomatic spiritual approach for mental health.[22]

In the present Study, Yukti Vyapashraya Chikitsa; Avalgujadi lepa was administered. It contains Tikta Pradhana Dravya, and this causes Ama Pachana and pacifies Pitta Dosha. All ingredients have Vata Kapha Nashaka property; since these drugs have anti-inflammatory and immunomodulatory properties, the application of Lepa followed by Atapa sevana (sun exposure) helps in stimulating melanocyte formation. Therefore, Avalgujadi Lepa was advised to apply daily twice on the affected area. The Sattvavajaya Chikitsa as counseling and motivation was done to develop self control to the patient for psychological treatment. The result of the present study, shows the early recovery in both physical and mental health of the patient. Therefore, it can be advised to physician to include Sattvavajaya Chikitsa as the main part of their treatment.[23]


  Conclusion Top


The recognition of physical and psychological factors is important for a better treatment response for a healthy life. Satvavajaya is one of the three principal treatment modalities that is specially designed for treating psychological disorders and as a treatment it makes the mind alert and prepared for immediate challenges. In the present study, Satvavajaya Chikitsa shows remarkable improvement in the immediate recovery of Switra with Yukti Vyapashraya Chikitsa. Satvavajaya Chikitsa is found to be a better tool for providing early relief in Switra. The consorted approach of management explored by the present study may serve as a ray of hope toward the search of ideal treatment of Switra. The effect of Sattvavajaya Chikitsa in the treatment of Switra (Vitiligo) should be applied to more patients to prove the Ayurveda intervention for early recovery of patient.

Recommendation

The case discussed regarding Sattvavajaya Chikitsa (psychological aspect) for early remission of Switra condition which may apply for implementation of Sattvavajaya Chikitsa set up in skin disorders clinics especially for Switra. People should be educated enough to withstand such suffering and they should be motivated to cope with their psychological condition. Physicians should pay personalized attention and motivate the patients to defeat the psychological stress that arises from Switra. Future research should be conducted to identify the effect of Sattvavajaya as well as Yukti Vyapashraya Chikitsa in the early management of Switra.

Limitation

As this is a single case study, a larger sample should be studied. A standard protocol for the treatment of COVID-19 should be adopted for future studies.

Strengths

The patient’s condition did not deteriorate in the study. Thus, it can be supposed that the Sattvavajaya Chikitsa combined with Yukti Vyapashraya Chikitsa has the potential for early recovery in psychosomatic diseases such as Switra.

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

Central Council for Research in Ayurvedic Sciences, New Delhi, India.

Conflicts of interest

There are no conflicts of interest.



 
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[PUBMED]  [Full text]  
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