Urticarial Vasculitis : Causes, Symptoms, Diagnosis & Treatment

ABSTRACT

Urticarial vasculitis is a condition that involves inflammation of small blood vessels that supplies the skin. This condition shows early clinical manifestation including red erythematous wheals or patches that may persist for more than 24 hours that resembles the patches in Urticarial lesions. In Ayurveda, due to many common features this condition can be best correlated with Vata Pittaj Visarpa (Agni Visarpa) described by Acharya Charka in Chikitsa sthan 21^st chapter i.e. Visarpa Rog. Let’s discuss the modern & Ayurvedic aspect of the disease & the best possible treatment method according to Ayurveda.

INTRODUCTION

Urticarial vasculitis (UV) is a rare form of auto-immune disorder with key features like the vasculitis i.e. inflammation of small cutaneous blood vessels, which ultimately leads to the damage to vital structures or organs due to reduced blood flow.

Based on whether the levels of complement proteins are found to be normal or low on blood testing: Weather the complement proteins are present in low or normal levels in the blood, Urticarial vasculitis is considered to be of two types:

THE TWO TYPES OF UV ARE

1. NORMOCOMPLEMENTEMIC : URTICARIAL VASCULITIS

The less severe form of UV in which there is normal level of complement proteins is found and the manifestations in this type are generally seen locally, without affecting the other vital structures.

2. HYPOCOMPLEMENTEMIC : URTICARIAL VASCULITIS

This condition of UV is more severe as it has systemic involvement i.e. it can affect various other organs other than skin such as joints, lungs, GI Tract, kidneys and eyes etc. This condition is mostly found to be associated with some systemic connective tissue disorder such as SLE (systemic lupus erythematosus). This diseased condition is having low levels of complement proteins.

CAUSES OF URTICARIAL VASCULITIS

The exact cause of Urticarial vasculitis is not known. Some possible risk factors that may lead to disease formations include:

Blood cancers or other internal malignant tumors.
As a result of viral infectious conditions like glandular fever, Hepatitis B etc.
Side effect or toxic reaction to a drug.
Systemic connective disorders like SLE
Immunodeficiency disorders & autoimmune disorders.

Causes mentioned in Ayurveda for Visarpa roga include:

(Charka Chikitsa 21/16-21)

Nij hetu
Aagantuj hetu

Nij Hetu (Internal Factors)

Excessive consumption of salt, sour, pungent & hot food articles.
Over use of curd, vinegar, beer, and other alcoholic beverages.
Increased or regular intake of heavy food items like til (sesame), urad (Vigna mungo), kulthi (Macrotyloma uniflorum), pistak (the flour form of grains), gramya maans (rotten meat) and lasun (garlic).
Daily use of Prklinn (stale food), aastamya (unfavorable food items), and adverse foods such as oily junk foods.
Atibhojan (overeating), divasvapan (sleeping during day hours), ajeeran (indigestion) and adhyashan (eating before while the previously taken meal is undigested).
Suppressing the urge to vomit.

Aagantuj Hetu (External Factors)

Over exposure to sunlight or wind.
Exposure to contaminated wind/ environment.
Falling from height etc.

SYMPTOMS OF URTICARIAL VASCULITIS

This condition usually starts with clinical features like red spots or wheals on the skin. But as the condition progresses and remains untreated it may start to manifest the features systematically i.e. affecting the multiple organs.

Fever
Inflammation in lymph glands.
Multiple joint pain
Inflammation of tissues under skin.
Dyspnea (breathlessness)
Swelling in multiple organs like eye, kidney or heart etc.

AYURVEDIC SIGN & SYMPTOMS OF AGNI VISARPA

This shloka by Acharya Charka mentioned in Charaka Chikitsa Sthana 21/36 describes the clinical features of Vata-pitta Visarpa (Agni Visarpa). Some key features of the shloka are:

Fever having symptoms of Vata-pitta, vomiting, diarrhea, thirst, fatigue, pain in bones & joints, reduced digestive power, difficulty in breathing, reduced appetite etc.
Burning sensation in the whole body.
The affected part is filled with burn-like blisters.
Insomnia (loss/reduced sleeping hours)
There is reddish, bluish and ultimately coal like blackish discoloration in the regions where the disease is progressing.
Episodes of unconsciousness, hiccups, anxiety and in very severe cases death can also occur.

DIAGNOSIS

Diagnosis is mainly based on the patient’s history, clinical signs & symptoms. Skin biopsy is considered the gold standard of diagnosis. Other investigations include blood examinations and other investigations to rule out other systemic diseases.

PROGNOSIS

Urticarial vasculitis if becomes chronic can create many troubles in treatment, and can lead to very major health ailments or even to death. Hence, this disease must be treated at early stages before the systemic involvement of the disease.

Acharyas had also mentioned sadhyaasdhyata (prognosis) of Visarpa roga as:

The Visarpa roga which is bhairmarg gat (i.e. limited to skin only) is easily treatable, the diseased condition in which there is depletion of body tissues (antarmarg gat) are krich sadhya i.e. difficult to treat.

Also the specific mention about the prognosis of Agni Visarpa is also described that Agni Visarpa if present with uncomplicated state and the condition is not affecting the other vessels- tendons-muscles-body fluid & other body tissues, then it is treatable. And if Agni Visarpa is treated with negligence then it can kill the person like a poisonous snake. (Charka Chikitsa 21/42)

TREATMENT

Treatment of Urticarial vasculitis depends on the severity of systems & by proper accessing the condition & its involvement with whole body. Modern medicine has antihistamines for reducing allergic reactions & NSAIDs (Non-steroidal Anti-inflammatory Drugs) for dealing with pain & inflammations and other symptomatic treatment.

Ayurvedic line of management for VATAJ-PITTAJ Visarpa roga include:

Nidana Parivarjana
Shodhan Chikitsa
Shaman chikitsa
Pathya- Apathya

1. Nidana Parivarjna – Avoidance of causative & risk factors of the disease as mentioned above in this article.

2. Shodhan Chikitsa include the treatment methods that consist of few procedures that are useful in detoxification of body & body tissues.

Virechan (Therapeutic purgation) with medicated ghee such as Trayaman ghrit or amalaki ghrita.
Raktamokshan (Bloodletting therapy) is beneficial in early stages of the disease when the disease is limited to the skin
Vaman (Therapeutic emesis): This procedure is considered as the best for skin disorders.
Basti (Medicated enema): Best procedure for vataj disorders. This procedure is also considered as the half treatment. A well prepared basti of pittashamak or raktashodhak dravyas ksheer (the herbs which are either pita calming or blood purifier along with milk) is preferable.

3. Shaman Chikitsa include various formulations given by Acharyas for oral administration or local applications:

For oral administration :

Tablet formulations such as Rasmanikya, Gandhak Rasayan, Amrita satva, kaishore guggul, arogyavardhini vati, sanshamani vati, navkashaya guggul
Decoctions or syrups such as Mustadi kwath, Chandanadi kwath, Sarivaadi kwath, Patoladi sheet kwath, Manjisthadhyarishta, Sarivadyarista, Khairarista
Medicated ghee such as Shatdhot ghrit, panchatikta ghrita, Mahapadma ghrit, Trayaman ghrit, Shouryadi ghrit, Durvadi ghrita

For local application :

Parlepa/ Pradeha such as Dashang lepa, udumbara pardeha, sarvadi pralepa, triphaladi
Medicated oils such as karanjadi taila which contain drugs such as karanj (Millettia pinnata), langali (Gloriosa superba), Snuhi (Euphorbia neriifolia) etc.

Single drugs which are beneficial for this diseased condition :

Chandan (Santalum album)
Nimba (Azadirachta indica)
Amrita (Tinospora cordifolia)
Shigru (Moringa oleifera)
Manjistha (Rubia cordifolia)
Haridra (Curcuma longa).

PLANET AYURVEDA IS AN HERBAL MANUFACTURING COMPANY THAT MAKES MEDICINAL FORMULATION WITH STRICT ADHERENCE TO AYURVEDA. THE PRODUCTS WHICH ARE MADE HERE ARE OBTAINED FROM 100% NATURAL SOURCES AND ARE WELL PROCESSED, PURIFIED AND THEN FORMULATED ACCORDING TO THE ANCIENT TIME TESTED FORMULAS.

Herbal remedies suggested by experts of Planet Ayurveda for Urticarial Vasculitis are:

Aller-G Care
Gandhak rasayan
Pitta balance
Kamdudha ras plain

PRODUCT DESCRIPTION

1. Aller-G Care : 1-2 capsules twice daily, after meals.

It is a poly herbal formulation consisting of 4 herbs available in capsule form. The four ingredients include Shrisha (Albizia lebbeck), which is the plant well known in Ayurveda for its vish-ghan properties i.e. removing poisons from the body. Thus by removing the excess toxins from the body Shirsha helps in faster wound healing & better recovery. The next ingredient is Neem (Azadirachta indica) which is a famous drug for various blood and skin related disorders. It has antiseptic & disinfectant properties which prevents the disease from progressing further & aids healing. The third ingredient is Haridra (Curcuma longa) which is also known as Curcumin. Haridra is the most useful drug in any of the allergic conditions, due to its antioxidants and anti- septic, anti-inflammatory & analgesic properties it is the drug of choice to be added in this formulation for rapid recovery. The fourth and last drug in this formulation is Ashwagandha (Withania somnifera), this drug is the best drug for enhancing immunity & providing strength to the body to fight from other infections as well. Thus, also checking the progression of the disease

2. Gandhak Rasayan : 2 tablets twice daily, with plain water.

Gandhak Rasayan is a potent classical mineral preparation that contains a solo ingredient i.e. purified Sulphur which is available in tablet form. Gandhak Rasayan is well known for its effects in various skin related disorders due to its sheet virya and pitta shamak properties. As we’ve discussed in this article, Agni visarpa is caused due to cumulative vitiation of vata and pitta dosha. So, Gandhak Rasayan is very much helpful in this condition as it reduces various pittaj symptoms like by calming the burning sensations of the blisters.

3. Pitta Balance : One capsule twice daily.

This product is the best preparation provided by our experts for reducing the effects of vitiated pitta. It contains five minerals or mineral compounds, along with stem extract of one herb that is Tinspora cordifolia which is a sheet virya drug having immune boosting properties. The other five ingredients having cool potency including kamdudha ras (an Ayurvedic mineral compound), praval pishti (coral calcium) etc. All these minerals along with Guduchi provide a perfect combination to combat with excess vitiation of pitta and thus treating the root cause. This formulation is available in capsule form.

4. Kamdudha Ras : 1 tablet twice daily.

When we talk of the best Ayurvedic compound for balancing pitta Kamdudha ras is one of them. Kamdudha ras is a classical Ayurvedic formulation which contains Giloy satva (extract of Tinospora cordifolia) along with other mineral drugs that are having a great role in reducing pitta related manifestation and also treating the root cause of the disease side by side.

Pathya- Apathya (Dos & don’ts)

Use of fresh leafy vegetables should be promoted in diet.
Avoid sleeping late during night hours as it causes vitiation of vata dosha which will increase the manifestations of the disease.
Keep the body hydrated. Drinking adequate amounts of fluid will help in maintaining electrolyte balance in the body and also compensate for fluid loss.
Use of seasonal fruits should be promoted. Fruits are a rich source of carbohydrates, vitamins & minerals that help the body to provide excess nutrients to improve the diseased condition faster.
Avoid use of junk foods, spicy or oily foods.
Practice yoga & Pranayam for better mental & physical health which will indirectly promote immunity & enhancing the speed of treatment.
Avoid using non vegetarian food articles such as meat, chicken, pork beef, fish or eggs daily.
The dietary items that can be consumed on daily basis include Mudga (Phaseolus mudga), honey, yava (millets), sasthi shali chawal (Oriza sativam), and Saindhav lavan (pink salt), go dugdh (cow’s milk), go ghee (cow’s ghee).

CONCLUSION

Here in this article as we can see modern medicine is focused on symptomatic treatment which no doubt provides relief in very small amounts of time but that too for shorter duration of time and the chances of recurrence are very much high & also having various side effects. While Ayurvedic drugs which are obtained from natural sources and are comparatively having less side-effects and more therapeutic effects. These Ayurvedic products along with detoxification procedures that are mentioned above and some life & dietary modification can treat the root cause of the disease with very much less chances of recurrence of disease. Hence, there is better scope of Ayurveda in treating Urticarial vasculitis.

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