39 THE ANTISEPTIC September 2016 Introduction Health and beauty are the subjects of socio-medical importance since from the age old days. Acne particularly the comedonal form, occurs in 80% of adolescents. 1 Acne is most common manifestation of Increased level of androgens by increased size & Secretions of Sebaceous Follicles & apocrine gland during adolescence. Over 80% teenagers suffer from it. 2 Acne is disorder of pilosebaceous unit (follicle and associated A clinical study on effect of vatadi lepa over lodhradi lepa on tarunyapitika (Acne Vulgaris) VIKRAM T. GANPATIL, SAVITA BUTALI, NEERAJKUMAR GUPTA, RAMDAS S. PAWAR Dr. Vikram T. Ganpatil, PG Scholar, Dr. Savita Butali, Assistant professor, Dr. Neerajkumar Gupta, PG Scholar, Dr. Ramdas S. Pawar, PG Scholar, Dept. of Kaumarbhritya, KLE Shri BMK Ayurveda Mahavidyalaya, Belagavi, Karnataka. Specially Contributed to "The Antiseptic" Vol. 113 No. 9 & P : 39 - 43 ABSTRACT Background and Objectives: Acne is most common manifestation of Increased level of androgens by increased size & Secretions of Sebaceous Follicles & apocrine gland during adolescence. Over 80 % teenagers suffer from same. It is nearly compaired with the Tarunyapitika in Ayurveda which is caused due to the vitiated kapha, vata and rakta which is characterized by the lesions resembling in shape that of Shalmalikantaka. Among various drugs mentioned for topical applications for Tarunyapitika “Vatadi Lepa” and “Lodhradi Lepa” are selected for the study. Methods : The study was randomized comparative clinical trial with lodhradi lepa & Vatadi Lepa as control & trial group respectively with 20 subject in each group for the duration of 10 days & follow up is done on 7th ,15th ,30th day for the observing & assessment for the condition. Results : Considering the improvement, both the groups Vatadi Lepa and Lodhradi Lepa showed similar results in symptoms of tarunya pitaka. The Subjective parameter (Number of pitika & pain at pitika) has shown better response in trial group as compared to control group. Interpretation and Conclusion: The present study reveals that the present drug is found to be equally significant against control group on the decreasing pitika as well as in relieving the symptoms, without the occurrence of any kind of complication or adverse effect. Key Words: Acne vulgaris, Lodradhi lepa, Tarunya pitika, Vatadi lepa. sebaceous gland) 3 . It affects most people during their lives but is typically a disease of adolescents & young adults. 4 Tarunyapitika is one of the skin disease described in Ayurveda under the kshudrarogaprakarana 5,6 . It is primarily seen on face (vaktra) and is having parlance with Acne Vulgaris in modern dermatology. It is an exceedingly common problem faced by many patients in adolescence. Modern cosmetology was born-albeit less than half a century ago as compared to Ayurveda, which had a varnya concept centuries ago. Many topical antibiotics formulations are available, either alone or in combination. They inhibit the growth of Propioni bacterium acne and reduce inflammation. Topical antibiotics such as erythromycin and clindamycin are the most popular in the management of acne. 7 Though, Modern medicine has treatment comprising of comedolytics, sebostatics, topical retinoid’s, hormones, topical and oral antibiotics, still the population is looking towards Ayurveda, for its safety and simple procedures. From the view of cosmetics also, there is more demand for cleansers, soaps, face wash, for acne which commonly comprise various chemicals, hydrocarbons 8 etc. But these are having many adverse reactions. Thus there is necessity of safer measures. All these facilitated for searching a better remedy from the natural resources. There is a need for the treatment which is simple, effective and not having any adverse reactions therefore this study comprising of “Vatadilepa’’ 9 has been undertaken.
Transcript
39 THE ANTISEPTIC September 2016
Introduction
Health and beauty are the subjects of socio-medical importance since from the age old days. Acne particularly the comedonal form, occurs in 80% of adolescents.1 Acne is most common manifestation of Increased level of androgens by increased size & Secretions of Sebaceous Follicles & apocrine gland during adolescence. Over 80% teenagers suffer from it.2 Acne is disorder of pilosebaceous unit (follicle and associated
A clinical study on effect of vatadi lepa over lodhradi lepa on tarunyapitika (Acne Vulgaris)VIKRAM T. GANPATIL, SAVITA BUTALI, NEERAJKUMAR GUPTA, RAMDAS S. PAWAR
Dr. Vikram T. Ganpatil, PG Scholar, Dr. Savita Butali, Assistant professor, Dr. Neerajkumar Gupta, PG Scholar, Dr. Ramdas S. Pawar, PG Scholar,Dept. of Kaumarbhritya, KLE Shri BMK Ayurveda Mahavidyalaya, Belagavi, Karnataka.
Specially Contributed to "The Antiseptic" Vol. 113 No. 9 & P : 39 - 43
ABSTRACT
Background and Objectives: Acne is most common manifestation of Increased level of androgens by increased size & Secretions of Sebaceous Follicles & apocrine gland during adolescence. Over 80 % teenagers suffer from same. It is nearly compaired with the Tarunyapitika in Ayurveda which is caused due to the vitiated kapha, vata and rakta which is characterized by the lesions resembling in shape that of Shalmalikantaka. Among various drugs mentioned for topical applications for Tarunyapitika “Vatadi Lepa” and “Lodhradi Lepa” are selected for the study. Methods : The study was randomized comparative clinical trial with lodhradi lepa & Vatadi Lepa as control & trial group respectively with 20 subject in each group for the duration of 10 days & follow up is done on 7th ,15th ,30th day for the observing & assessment for the condition.Results : Considering the improvement, both the groups Vatadi Lepa and Lodhradi Lepa showed similar results in symptoms of tarunya pitaka. The Subjective parameter (Number of pitika & pain at pitika) has shown better response in trial group as compared to control group.Interpretation and Conclusion: The present study reveals that the present drug is found to be equally significant against control group on the decreasing pitika as well as in relieving the symptoms, without the occurrence of any kind of complication or adverse effect.Key Words: Acne vulgaris, Lodradhi lepa, Tarunya pitika, Vatadi lepa.
sebaceous gland)3. It affects most people during their lives but is typically a disease of adolescents & young adults.4
Tarunyapitika is one of the skin disease described in Ayurveda under the kshudrarogaprakarana5,6. It is primarily seen on face (vaktra) and is having parlance with Acne Vulgaris in modern dermatology. It is an exceedingly common problem faced by many patients in adolescence. Modern cosmetology was born-albeit less than half a century ago as compared to Ayurveda, which had a varnya concept centuries ago.
Many topical antibiotics formulations are available, either alone or in combination. They inhibit the growth of Propioni bacterium acne and reduce inflammation. Topical antibiotics such as erythromycin and clindamycin are the most popular in the management of acne.7
Though, Modern medicine has treatment comprising of comedolytics, sebostatics, topical retinoid’s, hormones, topical and oral antibiotics, still the population is looking towards Ayurveda, for its safety and simple procedures. From the view of cosmetics also, there is more demand for cleansers, soaps, face wash, for acne which commonly comprise various chemicals, hydrocarbons8 etc. But these are having many adverse reactions. Thus there is necessity of safer measures. All these facilitated for searching a better remedy from the natural resources. There is a need for the treatment which is simple, effective and not having any adverse reactions therefore this study comprising of “Vatadilepa’’9
has been undertaken.
September 201640 THE ANTISEPTIC
Method of Preparation:
These dry drugs were collected. They were powdered separately and mixed together. Lodradi Lepa was prepared by mixing 10 g of powdered mixture mentioned above with sufficient quantity of water. This freshly prepared lepa is applied on face allowed to drying ,as soon as lepa start to dry ask the patient to wash the face.In the same way Vatadi lepa was prepared and applied.Assessment criteria-
Comedonecounting
(no of Pitikas)12
0 No lesion
1 0 - 18 Comedones
2 19 – 30 Comedones
3 31 – 38 Comedones
4 >39 Comedones
Pain:13
0 No pain
1 Occasionally pain on deep pressure
2 Pain on mild pressure
3 pain on touch
4 Continuous pain even without touch
Burning Sensation:14
0 No burning sensation 1 Occasionally burning sensation2 Burning sensation on rubbing3 Burning Sensation on deep touch4 Intolerable burning sensation
Demograhical Observations
1. The demographic data collected during the study is as follows –Distribution of the patients
according to age.
YES
No
Materials and Methods
Adolescents Diagnosed With signs & Symptoms of Tarunyapitika
Preliminary Examination, Inclusion And Exclusion Criteria
Assessed for 7 days along with the treatment & F/U according to F/U Shedule
Drug preparation:
A) “Vatadi Lepa”[9] was prepared with following ingredients in GMP certified KLE Ayurveda pharmacy As per classics.11
Sr. Plant Scintific Name Part Proportion no.1. Yellow Leafs of Vata Ficus bengalensis Linn Leaf 1 part2. Chameli Jasminum officinale Leaf 1 part Leafs Linn3. Rakta Pterocarpus sanctanalis Heart 1 part Chandana Linn wood 4. Kushta Saussurea lappa CB Dried 1 part Clarke root5. Aguru Aquilari aagallocha Dry 1 part Roxb wood 6. Lodhra Symplocos racemosa Stem 1 part Roxb bark B.“Lodhradi Lepa” Sl. Plant Scientific name Part proportion No. 1. Lodhra Symplocos racemosa Dried stem 1 Part Roxb bark 2. Dhanyak Coriandrum sativum Dried ripe 1 Part Linn fruit 3. Vacha Acorus calamus Linn Rhizome 1 Part
41 THE ANTISEPTIC September 2016
Age in Group- Group- Total % yrs A B 13 0 1 1 2.5 14 0 0 0 0 15 5 4 9 22.5 16 15 15 30 75 Total 20 20 40 100
Among 40 patients, maximum numbers of 30 patients in 16 yr age group (75%),9 patients in 15 yr age group (22.5) & 1 patient in 13 yr age group (2.5) were enrolled in study .
Among 40 patients, maximum numbers of 36 Hindu patients (90%) were enrolled in study. 4 Muslim patients (10%) were enrolled in study.
Distribution of the patients according to sex.
Gender Group-A Group-B Total % Female 2 3 5 15 Male 18 17 35 85 Total 20 20 40 100
Among 40 patients, maximum numbers of 35 male patients (85%) were enrolled in study . 5 female patients (15%) were enrolled in study
Distribution of the patients according to Prakruti. :-
Among 40 patients, maximum numbers of 11 numbers of Pitta-vata patients (27%), 9 numbers of Vata-pitta prakruti patients (22.5), 7 numbers of Pitta-kapha prakruti patients (17.5%), 6 numbers of Vata-kapha prakruti patients (15%), 5 no of Kapha-vata prakriti were enrolled in study (12.5%), 2 numbers of Kapha-pitta pakruti patients (5%) were enrolled in study.
Distribution of the patients according to religion. :-
Religion Group-A Group-B Total % Hindus 17 19 36 90 Muslims 3 1 4 10 Total 20 20 40 100
Results
No of pitika
Group A Group B Mean difference P value Significance Mean difference P value Significance BT-F1 3.25.54 0.0001 **** 3.255.86 0.0001 ****BT-F2 5.453.78 0.0001 **** 5.454.72 0.0001 ****BT-F3 6.252.60 0.0001 **** 6.304.35 0.0001 ****
MD-0.345 P=0.784 NS
September 201642 THE ANTISEPTIC
2. Effect on Pain at Pitika
Pain is considered as shula which is due to involvement of Vata dosha.
Assessment of Pain at pitika showed the mean score before treatment and after treatment in both the groups was significantly reduced with the p value (Vatadi group shows 0.001 Sig & Lodhradi group 0.005 Sig)
Vatadi group gives 94.2 % relief & Lodhradi group gives 100 % relief.
During the FU2 & FU3 in both Group A & group B showed highly significant results in pain except at FU1 P VALUE (<0.22)ns
3. Effect On Burning at the site of Pitika
There were minimal subjects with the symptoms of Daha / Burning
There are no significant results seen in both Group A and group B before and after treatment, At FU1, FU2
At FU3 in Vatadi group statistically there was significant results observed with the p value <0.0001 as compared to Lodhradi group .
Comparison between the groups was statistically not significant with (P value 0.124 NS).
Discussion on results
Vatadi lepa was said to have rich in flavinoids are proven good anti oxidants. These will protect skin from oxidative damage. Tannins promote healing process by increasing capillary formation. All ingredients said to be possess anti inflammatory ,anti microbial action, antibacterial analgesic action which helps to reduce the local inflammation. Hence pain, burning, no of pitikas were come down.
Discussion on Results
1. Effect on number of pitika -
Showed the mean score before treatment and after treatment in both the groups was significantly reduced with the p value < 0.001 The doshas Vata and Kapha are vitiated involving rakta as main
dushya and lodges in the pores of skin which causes pitika. Both the groups have vatakaphahara property it might have reduced the number of pitika.
Hence Statistically highly significant results showed for this parameter in both groups
Comparison between the two groups was statistically no significant both after medication (0.655 NS). Even though indicates the similar effects in each group
During the FU1, FU2 & FU3 in both Group A & group B showed marked reduction in number of pitika.
Pain
Group A Group B Mean P Signi- Mean P Signi- SE value ficance SE value ficance BT-F1 0.30.49 0.2289 NS 0.450.47 0.0155 * BT-F2 0.650.3 0.0001 *** 0.80 0.0001 *** BT-F3 0.650.21 0.0001 *** 0.850 0.0001 **** MD-0.345 P=0.784 NS
Burning sensation (daha)
Group A Group B MeanSE P value Signi- MeanSE P value Signi- ficance ficanceBT-F1 0.20 0.39 NS 0.05 0 0.9985 NS BT-F2 0.30 0.544 ns 0.05 0 0.9985 Ns BT-F3 0.350 <0.0001 *** 0.05 0 0.998 ns MD=2.34 p=0.26 ns
43 THE ANTISEPTIC September 2016
Conclusion
Considering the improvement, both the groups Vatadi Lepa and Lodhradi Lepa showed similar results in symptoms of tarunya pitaka.
The Subjective parameter (No of pitika & pain at pitika ) has shown better response in trial group as compared to control group.
Hence we can conclude that the present drug is found to be Slightly significant against control group on the decreasing pitika as well as in relieving the symptoms, without the occurrence of any kind of complication or adverse effect.REFERENCES:-
1. Nelson Textbook of Pediatrics,19 th edition 2012,Kliegman, Stanton, St.Geme, Schor &Behrman, Title- Acne, Part XXXI The Skin, Joseph G. Morelli, Page no- 2322,Publication- SAUNDERS An imprint of Elsevier , ISBN : 978-1-4377-0755-7.
2. The Short Text book of Pediatrics, By Dr. Suraj Gupte, 10 thEdition,JaypeePublication, Chapter-4 Adolescence, Dermatological Problems, Page no- 62, 2004.
3. Pubmed, [http://www.ncbi.nlm.gov/pubmed/24552409]Evaluation and treatment of acne from infancy to preadolescence. Admani s, Barrio VR 2013 Nov;26(6):462-6. doi: 10.1111/dth.12108 PMID: 24552409.
4. Manual Of Pediatric Therapeutics, John W. Graef, Joseph I, Wolfsdorf, David S. Greenes Seventh edition 2008 by Lippincott Williams & Wilkins, South Asian Edition. Chapter -Dermatologic Disorder – Stephen Gell is. Page no- 517
6. Dr. BrahmanandTripati edited, Astanga Hrydayam, uttarsthana, Chapter-31, Shloka-5 edition and reprint 2013, publication- Chowkamba Sanskrit prakashana, Page No. 1113.
7. Indian J Dermatol.[http://www.n c b i . n l m . n i h . g o v / p m c / a r t i c l e s /PMC3088940/] 2011 Jan-Feb; Title-ACNE VULGARIS TREATMENT : THE CURRENT SCENARIO , By-Sanjay K RathiPMCID: PMC3088940,56(1): 7–13.doi: 10.4103/0019-5154.77543. http://www.emedicine.medscape.com.
8. Taber’s Cyclopedic Medical Dictionary, editor-Donald Venes, M.D., M.S.J., Copyright- 2009 F.A. Davis Company.Page no – 31.
11. Vangasenasamhita, ksudrarogadhikara Chapter no- 32, Vyakhyakara- Pt. Hariharaprasad Tripathi , Choukhambhasanskrit series office, Varanasi 2009 ,Page no -388, Sloka no – 44.
12. “Comparative clinical study on effect of Vamana followed by lepa and only lepa in Youvana pidaka (acne vulgaris)” by Anil s. Managuli Dissertation global acne grading system objective parameter Page no. 118.
13. “Comparative clinical study on effect of Vamana followed by lepa and only lepa in Youvana pidaka (acne vulgaris)”by Anil s. Managuli Dissertation subjective parameter Pain assessment Page no. 116.
14. “Comparative clinical study on effect of Vamana followed by lepa and only lepa in youvana pidaka (acne vulgaris)”by Anil s. Managuli Dissertation subjective parameter Burning sensation assessment Page no. 116
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