Integrative Dermatology: Applying Knowledge of Ayurvedic Skin Care and Experience of the Past 20 Years at the Bedside

Abstract

During the past two decades, the Institute of Applied Dermatology (IAD) has integrated therapeutics of Ayurveda with biomedicine, even though the pathological basis is interpreted differently. Irrespective of background understanding, a mutually oriented multisystem medical (MSM) team with international advisors is able to effectively combine therapeutics from Ayurveda and biomedicine. IAD developed guidelines as a routine patient care protocol. The diagnosis is made as per the standard literature in each system, namely, as provisional diagnosis in dermatology or samprapti in Ayurveda. A dialogue aimed at the establishment of the mutual orientation and understanding of the therapeutics in each system of medicine for the same disease is done at the bedside by the MSM team and is now reviewed. Findings in a patient are analysed against the background of a literature review on the same disease, in all systems of medicine, with particular reference to treatment, possible drug interactions, and prognosis. On this basis the MSM team decides on the combination or serial order of the system and modality of therapies to be administered. The guidelines formulated in the chosen system(s) of medicine represented the basis of drug therapy. Clinical presentation, investigations, follow-up, and adverse effects are documented and supported by photographs and electronic medical records. Biomedical clinical outcome measures are used to decide the prognosis of treatment.

In this chapter we consolidate methods of such interventional studies practised by Ayurvedic dermatology. A short illustrated clinical narrative to determine the integrated clinical approach for chronic skin diseases is given using example of vitiligo. We also included an overview of treatment protocols of integrated medicine for lymphoedema. The annexe gives a list of tips for patient safety from biomedical dermatology that should not be ignored by practitioners of Ayurveda and integrative medicine.

Annexe 1: Biomedical Dermatology’s Tips for Recognizing Acute Skin Conditions That Require Urgent Care by Dermatologists

Most skin disease can be recognized clinically; some reflect on internal disease. Experience in clinical dermatology is especially important to spot skin diseases. Histopathology is used when diagnosis is not certain. When the following skin conditions are encountered, refer such patients for acute dermatology care (Table 9.1).

Table 9.1 Fitzpatrick’s ‘serious skin signs in sick patients (4 S) table’

1.1 Mucocutaneous Signs of Internal Malignancy

The common presentation is a nodule as indurated plaque of melanoma or adenocarcinomas. Paraneoplastic syndromes present as vasculitis, dermatomyositis, and acanthosis nigricans. They may be associated with tuberous sclerosis or Peutz-Jeghers syndrome. Cutaneous metastasis is characterized by one to multiple nodules. They are firm, indurated, inflammatory, or ulcerated. They are typical patterns of cutaneous involvement by internal malignancy. Examples are well-defined macules or plaques of erythema with actively spreading border (breast and ovarian carcinomas), telangiectatic metastatic carcinoma, sclerodermoid plaques around the chest, and dilated capillaries in erysipelas like plaques or macules. Paget’s disease is sharply demarcated in erythema and scaling occurring on the nipple or areola. Large intestine cancers generally manifest over abdomen, perineal area, and head and neck. A pyogenic granuloma over the head and neck could be due to hypernephroma. Sister Mary Joseph nodules, migratory necrolytic erythema tripe palms, Leser-Trelat syndrome, and acquired ichthyosis are other classical examples. Salient features of epidermal precancers and malignancies are briefly listed below:

• Cutaneous epithelial cancers are known as non-melanoma skin cancers. They originate from keratinocytes or adnexal structures. They are common in fairer skin of white populations.

• Pigmented skin has lesser UV damage and melanomas are rare. Hyperkeratotic papules or plaque are called keratosis and could have dysplastic cells.

• All cutaneous horns should be biopsied by excision. The base of these horns may show benign lesions or invasive squamous cell carcinoma.

• Arsenical keratosis of palms, solar keratosis, pigmented keratosis (spreading), Bowenoid actinic keratosis, and human papillomavirus-induced intraepithelial lesions are precancerous and should be regularly followed up.