It is the inflammation of skin and characterized by itchy, erythematous, vesicular, weeping and crusting patches. The term eczema is also commonly used to describe atopic dermatitis or atopic eczema. The term eczema is broadly applied to a range of persistent skin conditions. These include dryness an recurring skin rashes that are characterized by one or more of these symptoms: redness, skin swelling, itching and dryness, crusting, flaking, blistering, cracking, oozing or bleeding.

CAUSES:

The exact cause of eczema is unknown but is presumed to be a combination of genetic and environmental factors.

• Environmental factors:• (1)Un hygiene surroundings (2)Increased exposure to polluted surroundings etc
• Genetic factors:A number of genes have been associated with eczema, one of which is filaggrin.

CLASSIFICATION:

The term of eczema refers to a set of clinical characteristics. A type of eczema may be described by location (eg: hand eczema), by specific appearance (eg: eczema craquele), or by possible cause (eg: varicose eczema).

In some languages, deramatitis and eczema are synonyms, while in other languages dermatitis implies an acute condition and eczema is a chronic condition. The two conditions are often classified together.

COMMON ECZEMAS:

• Atopic dermatitis: it is an allergic disease believed to have hereditary component, and often runs in families whose members also have asthma. Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks.
• Contact dermatitis: it can be of allergic or irritant resulting dermatitis.
• Xerotic eczema: it is a dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather and limbs and trunk are most often affected. The itchy tender skin resembles a dry cracked river bed.
• Seborrhoeic dermatitis: it is a condition sometimes classified as a form of eczema that is closely related to dandruff. It causes dry or greasy peeling of the scalp, eyebrows, and face and sometimes trunks.

LESS COMMON

• Dyshidrosis: only occurs on pals, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles thickening and cracks are accompanied by itching, which gets worse at night and also in warm weather.
• Discoid eczema: its characterized by round spots of oozing or dry rash, with clear boundaries often on lower legs.
• Venous eczema:Occurs in people with impaired circulation, varicose veins, and edema particularly common in the ankle area of people over 50.
• Dermatitis herpetiformis:Causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back.
• Neurodermatitis: it is an itchy area of thickened , pigmented eczema patch that results from habitual rubbing and scratching.
• Autoeczematization:it is an eczematous reaction to an infection with parasites, fungi, bacteria or viruses.

SIGNS AND SYMPTOMS:

Dermatitis symptoms vary with all different forms of the condition. They range from skin rashes to bumpy rashes or including blisters. There are some signs which are almost common to all and includes redness of the skin, swelling, itching and skin lesions with sometimes oozing and scarring.

• Atopic dermatitis:symptoms vary from each persons and the most common symptoms are dry, itchy, red skin and typically affected on folds of the hands, the back of knees, wrists, face and hands.
• Dermatitis herpetiformis: itching, stinging and a burning sensation.papules and vesicles are commonly present.
• Seborrheic dermatitis: tend to appear gradually from dry or greasy scaling of the scalp to hairloss.in severe cases, pimples may appear along the hairline, behind the ears, on the eyebrows, on the bridge of the nose, around the nose, on the chest and on the upper back.

DIAGNOSIS:

• Diagnosis is based mostly on the history and physical examination.
• Complete blood count including ESR, Eosinophil count.
• Tests like:  Skin biopsy,  Skin prick test,  Patch test.

PROGNOSIS:

Most cases are well managed with topical treatments and UV light. Above 2 % of cases however are not and in more than 60% of the conditions goes away by adolescence.

MANAGEMENT:

There is no cure for eczema, with treatment aiming to control symptoms by reducing inflammation and relieving itching.

• Life style modification: bathing , personal hygiene, diet modifications, skin friendly clothes
• Moisturizers
• Medications like sedative antihistamines
• Corticosteroids
• Immuno suppressants
• Light therapy : using UV light
• Alternative medicines

AYURVEDIC MANAGEMENT

There are so many of skin diseases mentioned in Ayurveda by our Acharyas Vagbhata, Charaka and Susrutha. Among them, the skin disease (Kushta roga or twak vikara) which is more similar to Eczema is –Vicharchika

Nidana (casuses):

For all the kushta roga / twak vikaras, the nidana (Causes) are described generally including both ahara (dietary factors) and vihara (Physical factors). That are clearly quoted by our great Acharyas, likely:

“virodinyannapanani dravasnigdha guruni cha”………………………papam karma cha kurvatham” (Madhavanidana. Kushtanidana)

• Virudhanna and pana
• Snigdha evam guru ahara
• Vegadharanam
• Adhyashana
• Vyayamam cha api ajeerne etc

Samprapthi (Pathophysiology):

“Vataadayastrayo dushtastwagraktham mamsamambu cha Dooshayanthi sa kushtanam………………………………………………” (Madhavanidana. Kushtanidana)

By all these reasons, doshas including Vata, Pitta and Kapha got vitiated and the vitiated dosha further vitiate dhathus like Rasa, Raktha and Mamsa and finally manifest over skin.

Lakshana (Symptoms)

“Sa kandoo pidaka shyava laseekadya vicharchika” (Ashtanga hridaya- Kushta Nidana) It describes the twak vikara as: the skin lesion having eruptions which are itchy, black and full of ooze is called vicharchika

Chikitsa (Treatment):

• Snehana and swedana
• Sodhana
• Samana

Snehana/Oleation

“Kushtinam snehapanena poorvam sarvamupachareth” (Ashtangahridaym.Kushta -chikitsa)

The patient with vicharchika can be treated first with internal snehana. For that , the body must be prepared by giving Deepana and Pachana medicines internally

Eg: Citrakadi vati and panchakola churna/ Vaishwanaram churna.If one shows agni deepthi and good ahara pachana, we can start internal snehana with medicated sneha (Ghee or thaila) based on the condition and also on the dosha predominant.

The internal snehana is termed as “Snehapana”, in which the medicated sneha is given in the arohanakrama mathra (Increasing dosage) day by day and the person will be under observation and provided only light foods which are easy to digest. Finally if the samyak snigdha lakshana observed, then the snehapana got stopped and external snehana (Abhyangam) and swedana (Ushmasweda, ushnajala snanam etc) are administered.

Examples for snehapana dravya:

Mahatikthakam ghritham, Tikthakam ghritham, Aragwadhamahatikthakam ghritham, Nimbamriterandam thailam

Sodhana

After proper snehana and swedana, the liquefied doshas has to be expelled out by the sodhana methods selected accordingly.

Based on the dosha predominant with the vikara, sodhana is selected.Commonly used sodhana karmas are:

• Vamana :its mostly administered in kapha predominant conditions and done with appropriate medicines described in each context and dosha expelled out through oral route.
• Virechana:its used in Pitta predominant condition, medicines appropriate for the condition is selected and doshas expelled through anal route.
• Rakthamokshana : 1) along with sodhana for other doshas, Raktha also need sodhana because the raktha is one of major base of skin disease and its already got vitiated by other doshas.For that, we commonly used rakthamokshana techniques are:
• Jalookavacharana (Leeching)
• Prachana (Pricking)
• By all these karmas, the internal dosha got reduces, but the sodhana may trigger vata to vitiate, so internal snehana can be again started like samana mathra (10-20 ml /day). By this the vata got pacified and, now it’s the time for samana.

Samana:

In this state, the doshas are in samana avastha, so they has to be further stabilized by

• Internal medications
• External application of lepa etc
• Diet modifications
• Vyayamadi vihara
• Internal medication is having a major role in clearing the balance dosha and in maintaining the balanced state of dosha and also the skin health.
• Commonly used internal medications in skin conditions are: Mahamanjishtadi kashaya, Aragwadadi Kashaya, Kaisoruguggulu, Gandhak rasayana, Khadirarishta etc

Rasayana in Vicharchika:

Usually rasayana in Ayurveda is given for the complete cure of diseases and prevention of the disease in the future.Eg: Guduchi is commonly used as Rasayana in Vicharchika.

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