Management of hydradenitis suppurativa – a case study

Summary of article contents:

Hydradenitis suppurativa (HS), also known as Acne inversa, is a chronic, often debilitating disease primarily affecting axillae, perineum and inframammary regions. Prevalence rates of upto 4% have been estimated. This condition is more seen in females than in males. Our understanding of the disease has changed over time. HS is now considered as a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. HS while in severe instances may lead to scaring, functional impairment and rarely squamous cell carcinoma. The clinical features of HS can be compared with Nadivrana which is mentioned in our classics. Treatment modalities of nadivrana i.e ksharasutra and Kshara taila purana are adopted in the present study. A case report of patient suffering from HS since 2 years (c/o tenderness, pus discharge, and multiple sinus tracts with hard indurated epithelium which used to recur after healing.) was treated for the same by a number of Allopathic physicians but with minimum relief. But it recurred again and again. The patient was under Ayurveda treatment for approximately about 3 months and the pus discharge, hardness and recurrence of sinus/abscesses were regressed completely. Patient was treated with Gandhaka rasayana, Triphala guggulu, Apamarga kshara taila infiltration and Guggulu based chitraka kshara sutra applied to the communicating sinuses. Patient was advised to maintain local hygiene. These formulations and treatment modalities have given the excellent result Keywords: Nadivrana, Ksharasutra, Ksharataila, Gandhaka rasayana, Triphala guggulu INTRODUCTION HS is a disorder of the terminal follicular epithelium in the apocrine gland bearing skin. It has highly variable clinical course. Mild cases may present as recurrent isolated nodules, while severe instances of the disease with chronic inflammation may lead to scaring, contractures, keloid and rarely squamous cell carcinoma. While genital factors,patient characteristics, hormones and infection play a role in disease expression. Clinically the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscess INTERNATIONAL AYURVEDIC MEDICAL JOURNAL International Ayurvedic Medical Journal, ( ISSN: 2320 5091) (September, 2017) 5(9) MANAGEMENT OF HYDRADENITIS SUPPURATIVA – A CASE STUDY Nirupama Bhat MA 1 , Syeda Ather Fathima 2 1 Final year MS ( Shalyatantra ), 2 Professor and HODDepartment of PG Studies in Shalyatantra GAMC, Benagaluru, Karnataka, India Email: drnirupambhat@gmail.com ABSTRACT Hydradenitis suppurativa (HS), also known as Acne inversa, is a chronic, often debilitating disease primarily affecting axillae, perineum and inframammary regions. Prevalence rates of upto 4% have been estimated. This condition is more seen in females than in males. Our understanding of the disease has changed over time. HS is now considered as a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. HS while in severe instances may lead to scaring, functional impairment and rarely squamous cell carcinoma. The clinical features of HS can be compared with Nadivrana which is mentioned in our classics. Treatment modalities of nadivrana i.e ksharasutra and Kshara taila purana are adopted in the present study. A case report of patient suffering from HS since 2 years (c/o tenderness, pus discharge, and multiple sinus tracts with hard indurated epithelium which used to recur after healing.) was treated for the same by a number of Allopathic physicians but with minimum relief. But it recurred again and again. The patient was under Ayurveda treatment for approximately about 3 months and the pus discharge, hardness and recurrence of sinus/abscesses were regressed completely. Patient was treated with Gandhaka rasayana, Triphala guggulu, Apamarga kshara taila infiltration and Guggulu based chitraka kshara sutra applied to the communicating sinuses. Patient was advised to maintain local hygiene. These formulations and treatment modalities have given the excellent result Keywords: Nadivrana, Ksharasutra, Ksharataila, Gandhaka rasayana, Triphala guggulu INTRODUCTION HS is a disorder of the terminal follicular epithelium in the apocrine gland bearing skin. It has highly variable clinical course. Mild cases may present as recurrent isolated nodules, while severe instances of the disease with chronic inflammation may lead to scaring, contractures, keloid and rarely squamous cell carcinoma. While genital factors,patient characteristics, hormones and infection play a role in disease expression. Clinically the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscess INTERNATIONAL AYURVEDIC MEDICAL JOURNAL International Ayurvedic Medical Journal, ( ISSN: 2320 5091) (September, 2017) 5(9) MANAGEMENT OF HYDRADENITIS SUPPURATIVA – A CASE STUDY Nirupama Bhat MA 1 , Syeda Ather Fathima 2 1 Final year MS ( Shalyatantra ), 2 Professor and HODDepartment of PG Studies in Shalyatantra GAMC, Benagaluru, Karnataka, India Email: drnirupambhat@gmail.com ABSTRACT Hydradenitis suppurativa (HS), also known as Acne inversa, is a chronic, often debilitating disease primarily affecting axillae, perineum and inframammary regions. Prevalence rates of upto 4% have been estimated. This condition is more seen in females than in males. Our understanding of the disease has changed over time. HS is now considered as a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. HS while in severe instances may lead to scaring, functional impairment and rarely squamous cell carcinoma. The clinical features of HS can be compared with Nadivrana which is mentioned in our classics. Treatment modalities of nadivrana i.e ksharasutra and Kshara taila purana are adopted in the present study. A case report of patient suffering from HS since 2 years (c/o tenderness, pus discharge, and multiple sinus tracts with hard indurated epithelium which used to recur after healing.) was treated for the same by a number of Allopathic physicians but with minimum relief. But it recurred again and again. The patient was under Ayurveda treatment for approximately about 3 months and the pus discharge, hardness and recurrence of sinus/abscesses were regressed completely. Patient was treated with Gandhaka rasayana, Triphala guggulu, Apamarga kshara taila infiltration and Guggulu based chitraka kshara sutra applied to the communicating sinuses. Patient was advised to maintain local hygiene. These formulations and treatment modalities have given the excellent result Keywords: Nadivrana, Ksharasutra, Ksharataila, Gandhaka rasayana, Triphala guggulu INTRODUCTION HS is a disorder of the terminal follicular epithelium in the apocrine gland bearing skin