The skin is the principal seat of the sense of touch and is regarded as a covering for the protection of the deeper tissues. It plays significant role in the regulation of the body temperature. For better understanding of the disease process, it is important to understand the basic structure of the skin.
Fig: Structure of skin.
Different Parts of Skin
Skin is divided into two parts:
- Epidermis or cuticle.
- Dermis or true skin.
- Epidermis (as shown in the diagram) is the outer layer which provides protection to the inner layers. On the surface of the skin are the sensitive papillae and within, are sweat glands, hair follicles, and sebaceous glands. Sebaceous glands (see diagram) are found in the moist parts of the skin but are abundant in scalp (head region) and face. These glands manufacture sebum which lubricates the skin. Sweat glands (see diagram) are situated in small pits on the under surface of the dermis. Hairs and nails are outgrowth of the epidermis.
- Dermis is tough, flexible, and highly elastic. It is very thick in the palms of the hands and soles of the feet. The color of the skin is due to pigment known as melanin.
Some Common Skin Diseases
Some common skin-diseases seen in clinical practice along with Ayurvedic purview are enumerated below.
Yuvan-Pindika or Pimples (Acne vulgaris)
The disease results from increased production of sebum because of sensitivity of sebaceous glands towards hormones. Acne is commonly seen on the face and neck and rarely on arms, legs and buttock. The disease strikes during adolescence. The main finding of the disease is comedones (white heads and black heads), which are seen before the development of classical clinical features of the acne. The comedones may develop infection which may result in formation of pus points. Sometimes deeper lesions are formed and it leads to cyst formation which results in scarring.
Khalitya or Indralupta or Baldness (Alopecia)
Like other skin diseases, emotional disturbances are linked with the incidence of Alopecia. It is also associated with skin diseases like ringworm, dandruff, and liver diseases. Male type baldness is known as androgenic alopecia. In Alopecia, there is one or more patch on the scalp region. It can be seen in beard region also. The spots are pale and shining.
Vayanga or Freckles (Cholasma)
Cholasma are symmetrical patches of diffuse brown pigmentation of the skin due to exposure to sun. These are commonly seen at the mid forehead and cheeks. Cholasma is seen in pregnancy or at menopause. It disappears after childbirth. Some physicians are of the view that the incidence of cholasma is linked to stress.
Viverchika or Eczema (Dermatitis)
Dermatitis is inflammation (swelling) of skin and several types of dermatitis are known. Atopic dermatitis and contact dermatitis are two common varieties. The disease during childhood is known as infantile eczema.
In atopic dermatitis patients may have associated allergic rhinitis (nasal discharge and sneezing) or asthma. Contact dermatitis occurs due to allergy to substance which comes in contact with the skin. Chemical substances present in hair dyes, lipsticks, plants and vegetables are responsible for this type of dermatitis.
Parents inherit an increased tendency of sensitization to their children. These patients have pallor (yellowness) on the skin particularly face. The lesions are itchy, reddish and scaly. These appear on cheeks and spread to other parts of the body. The first lesions appear during first two years. In children, lesions are mostly encountered in back of the forearms and thigh. The disease is aggravated by exposure to allergens (factors causing allergy), fungal infection and worm infestation.
The course of contact dermatitis disease is similar to other types of dermatitis. Best clue to the allergen (factor causing allergy) lies in distribution of skin lesions on the body.
Palitya (Grey hair)
The exact cause of the condition is not known. It is met in the age group of 35-60 years. Emotional disturbances, use of electric dyers and hair dyes are also linked with the incidence of grey hair. Grey hairs can be seen in patients having prolonged history of
Shivtra (Leucoderma or vitiligo)
Cause: Exact cause of the disease is not known. Some patients may give history of contact with plastic as starting point of the disease.
It is characterized by appearance of white patches (as shown in the photo) on the skin. The disease is not infectious. It may be localized or generalized. According to Ayurveda, disease appearing on the mucus membrane and joints is difficult to cure. The disease requires early treatment.
The white patches are painless but they cause embarrassment to patient from cosmetic point of view. Old believes like consumption of fish and milk together as possible cause of leucoderma are baseless.
Here the skin lesions are itchy, shiny, violaceous colored scales occurring on the trunk, arm, and legs with special predilection for upper surface. Face however is not involved. Lesions are pink or light and show criss-cross streaks on the surface. Sometimes the disease is limited to the mucus membrane particularly mouth. Rather in sixty per cent of the patients have this disease confined to the mouth only. Lacy pattern of the mucosal lesions is the chief feature of the disease.
In ten per cent of the patients, the disease is confined to the nails. In mild cases the nails may be rough, brittle and having longitudinal ridging. In severe cases, nail plate may disappear. Rarely the disease is found confined to the nails only, no skin or mouth involvement is there.
Pemphigus is an auto-immune disease. Separation of epidermal layers is the cause for the disease. Pemphigus vulgaris is the common form of the disease. It mostly occurs between the ages of twenty to forty years. It manifests as appearance of blisters which are flaccid and situated on normal looking skin. The blisters then dry up and forms crusts or they rupture to leave behind superficial ulcerated area.
The disease can attack any part of the body and has uniform pattern. It mainly involves mucosa of the mouth, nose, sex organs and eye. Mouth ulcers refuse to heal for long period. There is difficult in eating and drinking. Sometimes mouth ulcers are the only finding of the disease. In rare cases, bleeding form nose and hoarseness of voice are also encountered. Drugs induced pemphigus is also known to exist.
Arushinka or Dandruff (Pityriasis Versicolor)
It is caused by a fungus known as Malassezia furfur. The disease is again common in young adults. Scaly hypo pigmented (white) patches appear on the upper part of the neck and spread to other parts of the body. The earliest lesions are located around hairs but later on they merge. The disease is aggravated in the summer season.
Chambal or Kitibha (Psoriasis)
According to Ayurvedic view, wrong food causing vitiation of blood and emotional factors contribute towards pathogenesis of the disease. In modern science the cause of the disease is not known.
Plaque type of psoriasis is common form of the disease. The disease is characterized by well defined reddish plaques which are covered with loosely adherent silver colored scales (see photo).The color of the scales become more prominent when they are removed. The lesions are mostly found on the front side of arms and legs, lower back and scalp region.
Psoriatic arthritis is encountered in chronic cases of psoriasis. The disease attacks the nails also resulting in brown discoloration and irregularity of the nail plate. If observed minutely, multiple pin point pits are observed on the nails. The incidence of the psoriasis during childhood is one per cent.
Dad or Dadru or Ringworm (Tinea)
Ringworm is caused by fungus Tinea.
- Tinea capitis: The infection primarily involves the scalp hair (see picture). It is more common in children.
Tinea mainly occurs in two forms:
- Scaly grey patch consisting of an itchy area of baldness. Here the skin has dry appearance with mild redness and hairs are dry, lusterless and broken at various lengths from surface of skin. There may be single or multiple patches.
- Black dot variety which has dry scaly appearance but with less incidence of scaling and itching. There is a picture if black spots in areas of baldness.
- Tinea barbae: Sometimes ringworm may involve beard region. Infected hairs can be easily pulled out without causing much pain.
- Tinea corporis: In the skin the disease presents with different picture. Here lesions are irregular having well defined borders made of scales while central part showing hyper pigmentation and slight scaling. This pattern can occur in any part of the skin but belt region in women is easily prone to the disease.
Scabies is caused by a mite named Acarus scabiei. The person develops hypersensitivity (reaction) to secretions of mite or its excreta. Severe itching at night is the main finding of the disease. Skin lesions are distributed on all part of the body except the face. Space between fingers, forearm, axilla, lower abdomen, thighs, and sex organs are commonly involved. Infection can be caused by repeated itching. In hygiene loving persons, the disease is confined to trunk only.
Chapaki or Wheals or Shita-pitta (Urticaria)
Drugs like tetracycline, morphine and sulphonamide are known to cause urticaria. Foods including meat, fish, egg, milk, rice, pulses, and potato are sometimes cause of the disease. In majority of the patients allergens (factors causing allergy) like pollen and spores are the causes.
The attack of urticaria is associated with headache, nausea, vomiting, and abdominal pain. Fever is encountered in children. In rare cases, joint pains and albumin (type of protein) is met in urine
Skin diseases are quiet prevalent today. These include eczema, psoriasis, leucoderma and contact dermatitis. In modern medicine there is no permanent cure for diseases like psoriasis, leucoderma and pemphigus. Ayurvedic remedies have been used for centuries for curing skin diseases.