Ichthyosis: Ayurveda Understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Brief Introduction of Ichthyosis – comprises a group of skin conditions. These present with dryness and scaling of the skin. Some types are limited to the skin but other forms might affect the internal organs. The genetic form of the disease is also common. Acquired types of ichthyosis occur from another medical disorder or some medications. Ichthyosis vulgaris and X-linked Recessive Ichthyosis are the two most common types of ichthyosis.

Apart from dry scaly skin, redness, skin peeling, itching, blisters, tightness of skin, formation of lines and pain are also found in ichthyosis.

Related Reading – Ichthyosis

Ichthyosis – Ayurveda Understanding

Vata Connection – Ruksha i.e. dryness is one of the qualities of vata. Vata tends to produce dryness in the body. Ichthyosis is a disease (diseases) marked by dryness of the skin which is also one of its main symptoms. Vata aggravation would cause extreme dryness anywhere in the body and also in the skin. Scaling also is due to excessive vata aggravation. It can occur after the skin has been extremely dry for long periods or together with dryness.

Skin and Vata – Skin / sense organ of touch is one of the seats of vata. So, vata is always related to the skin. This also suggests that skin will be one of the organs to be afflicted by the effect of excessive vata aggravation.

Rasa Connection – Raukshya or rukshata suggesting dryness is one of the symptoms of rasa kshaya i.e. depletion of rasa (lymph, plasma) tissue. Rasa provides nutrition to all parts of the body including the skin. If the nutrition to the skin gets less or depleted over a period of time the skin might get dry and scaly. In intrauterine life, the fetus derives its nutrition from the rasa of the mother circulating in the womb. If there is deficit nutrition to the fetus it may cause many diseases including dryness and formation of scales in the skin.

Rasavaha Srotas Connection – Skin is the indicator of the health of rasa tissue. In Ayurveda, the health of rasa tissue is explained on the basis of the health of skin. Premature wrinkling is one of the symptoms of contamination of the channels transporting rasa. So, when these channels are contaminated the skin is affected. The word premature wrinkling can be extended to understand the manifestation of conditions like dryness and scaling of skin. It is said that men suffering from ichthyosis are at increased risk of developing low sperm count and or un-descended testicles (as complications of the disease). Klaibya or impotence, a symptom of contamination of rasa transporting channels which can occur due to severe depletion of semen (sperms) is a relative condition explained in Ayurveda.

Panchabhautika Connection – Panchamahabhutas or five elements of nature participate in the formation of the fetus as per Ayurveda principles. When there is imbalance of Vayu Mahabhuta i.e. air element and Akasha Mahabhuta i.e. ether element (both of which combine to form vata dosha also) i.e. when they dominate over the other mahabhutas, skin conditions presenting with dryness and scaling naturally at birth like ichthyosis can manifest amongst other disorders. Along with this if there is imbalance of Jala / Ap Mahabhuta towards the lower side in the formation of the fetus, the moistness of the skin of the baby will naturally be less or almost nil. These factors would predispose the fetus to develop ichthyosis-like conditions after or at birth which might run ahead into adolescence and later part of one’s life.

Symptoms & complications of Ichthyosis and Dosha involvement

Dryness and scales of ichthyosis are caused by vata predominance as already discussed. The scales in ichthyosis are usually white, dark brown or gray in color. The lesions of Vata predominant Kushta (skin diseases) are said to be shyava varna or aruna varna. Shyava varna closely resembles dark brown or gray color. The skin gets rough and is associated with pain in vata predominant skin disorders; the same is the case in ichthyosis. There are cracks in the scales and the symptoms of ichthyosis worsen in cold and dry weather and get better in warmer weather. The same features can be seen in vata predominant kushta.

Other symptoms –

Likewise amongst complications of ichthyosis, frequent infections can be caused due to tridosha imbalance, dehydration and blocked sweat glands due to vata increase and kapha decrease, slow growth of hairs due to vata and pitta, depression due to kapha increase, low sperm count and un-descended testicles due to vata increase.

Other complications include vision loss and problems related to the brain and nervous system are also caused by high vata.

Diseases in Ayurveda and Ichthyosis

Though we cannot correlate any particular condition / disease explained in Ayurveda with Ichthyosis we can draw inferences from the references available in the treatises whose symptoms or appearance closely resemble the mentioned disease.

Ekakushta – The term “Ichthyosis” is derived from the Greek word for fish. This is because the skin in this condition looks like the scales of a fish.  This is the reason why some people call this ‘fish skin disease’ or ‘fish scale’. This condition can be closely correlated to Ekakushta. It is one among the eleven types of Kshudra Kushta i.e. minor skin diseases. Ekakushta is also correlated to another skin condition named Erythrodermias.

अस्वेदनं महा वास्तु यत् मत्स्य शकल उपमम्।
तद् एक कुष्ठं, (च.चि.७/२१)
asvedanaṃ mahā vāstu yat matsya śakala upamam|
tad eka kuṣṭhaṃ, (ca.ci.7/21)

Symptoms of Ekakushta – The minor skin disease in which lesion is spread over an extended area of the skin (large lesion) resembling the skin of a fish in appearance and contour, appears scaly and does not sweat (absence of sweating around the lesion) and is predominantly caused by vitiation of vata and kapha is known by the name Eka Kushta.

Vata Pradhana Kushta – The symptoms of skin disorders in which there is predominant aggravation of vata have been mentioned above. To sum up –

• Kharatva – roughness of the skin
• Shyava aruna varna – brownish black or reddish yellow discoloration of the skin
• Ruksham – dryness of the skin
• Vedana – pain

All these symptoms are present in ichthyosis.

The Kushtas included in this category are –

1. Kapala Kushta

कृष्ण अरुण कपालाभं यद् रूक्षं परुषं तनु।
कापालं तोद बहुलं तत् कुष्ठं विषमं स्मृतम्॥(च.चि.७/१४)
kṛṣṇa aruṇa kapālābhaṃ yad rūkṣaṃ paruṣaṃ tanu|
kāpālaṃ toda bahulaṃ tat kuṣṭhaṃ viṣamaṃ smṛtam||(ca.ci.7/14)

The Kushta in which the lesions or eruptions resemble a Kapala i.e. piece of saucer or earthen pot is called Kapala Kushta. In this, the lesions are either blackish brown, grey or yellowish red (golden yellow) in color. It may be of reddish black or blackish red in color with a muddy shine. They look dry and are rough and hard on touch, thin on the surface and in level to the skin surface, spread abruptly in a haphazard way, associated with excessive pricking / throbbing pain. This is a kind of Mahakushta (greater skin diseases) and is predominantly caused by vata dosha vitiation.

2. Vicharchika

स कण्डूः पिडकाः श्यावा बहु स्रावा विचर्चिका॥ (च.चि.७/२६)
sa kaṇḍūḥ piḍakāḥ śyāvā bahu srāvā vicarcikā|| (ca.ci.7/26)

Vicharchika presents with multiple itchy boils or eruptions or blisters of blackish brown or bluish black color which are oozing, associated with excessive discharges (exudation) and severe itching sensation and is predominantly caused by vitiated kapha dosha. Vicharchika is compared with eczema which is a complication of ichthyosis.

3. Rshyajihwa Kushta

कर्कशं रक्त पर्यन्तं अन्तः श्यावं स वेदनम्।
यद् ॠष्य जिह्व संस्थानं ऋष्यजिह्वं तद् उच्यते॥(च.चि.७/१७)
karkaśaṃ rakta paryantaṃ antaḥ śyāvaṃ sa vedanam|
yad ṝṣya jihva saṃsthānaṃ ṛṣyajihvaṃ tad ucyate||(ca.ci.7/17)

This Kushta typically resembles the shape of the tongue (jihwa) of a Rushya / Rishya (type of deer or bear), rough or coarse in appearance and touch, red colored at the margins and bluish black at the centre, associated with pain and is caused by predominant vitiation of vata and pitta doshas.

4. Charma Kushta

चर्माख्यं बहलं हस्ति चर्मवत्॥(च.चि.७/२१)
carmākhyaṃ bahalaṃ hasti carmavat||(ca.ci.7/21)

The skin around the lesion appears (resembles) like the skin of an elephant in Charma Kushta, the skin is thick and devoid of layers and is predominantly caused by vata and kapha doshas.

5. Ekakushta

Explained above

6. Kitibha Kushta

श्यावं किण खर स्पर्शं परुषं किटिभं स्मृतम्। (च.चि.७/२२)
śyāvaṃ kiṇa khara sparśaṃ paruṣaṃ kiṭibhaṃ smṛtam| (ca.ci.7/22)

The part of the skin afflicted by Kitibha Kushta is blackish brown in color and gives a feel of wound scar i.e. rough on touch, dry (rough, hard) and is caused by vitiation of vata and kapha doshas.

7. Sidma Kushta

श्वेतं ताम्रं तनु च यद् रजो घृष्टं विमुञ्चति।
अलाबू पुष्प वर्णं तत् सिध्मं प्रायेण उरसि॥(च.चि.७/१९)
śvetaṃ tāmraṃ tanu ca yad rajo ghṛṣṭaṃ vimuñcati|
alābū puṣpa varṇaṃ tat sidhmaṃ prāyeṇa urasi||(ca.ci.7/19)

Sidhma Kushta resembles (has the color of) Alabu Pushpa (flower of Lagenaria sicareria), white or coppery in color, has thin lesions, yield dusty particles (peeling of skin) on rubbing or scratching. It is generally manifested on the chest and is caused by vitiated vata and kapha doshas.

8. Alasa Kushta

कण्डूमद्भिः स रागैः च गण्डैः अलसकं चितम्॥ (च.चि.७/२३)
kaṇḍūmadbhiḥ sa rāgaiḥ ca gaṇḍaiḥ alasakaṃ citam|| (ca.ci.7/23)

Alasaka presents in the form of itching boils or eruptions, reddish color and associated with itching sensation and is predominantly caused by vitiation of vata and kapha doshas.

9. Vaipadika Kushta

वैपादिकं पाणि पाद स्फुटनं तीव्र वेदनम्॥ (च.चि.७/२२)
vaipādikaṃ pāṇi pāda sphuṭanaṃ tīvra vedanam|| (ca.ci.7/22)

Vaipadika Kushta presents with cracks in the palms and soles associated with severe (excruciating) pain and are caused by vitiation of vata and kapha.

All the above described conditions can be included under the umbrella of ichthyosis due to the proximity of clinical features.

10. Shukra-Shonitagata Kushta – The fetus formed by fertilization of the sperm of man and ovum of the woman suffering from kushta will also be a kushti – victim of skin disorders. This can be closely compared to Inherited / X-linked / genetic ichthyosis.

Twakgata Vata

Dryness of the skin and cracking of skin (peeling, lines) are amongst the symptoms of twakgata vata i.e. vitiated vata localized in the skin.

Vata Vyadhi in general

In general most vatavyadhi (specific and special vata disorders) will have various gradients of dryness on the skin and inside the body as well. To consider this is important from the treatment perspective.

Acquired Ichthyosis and Ayurveda – Whichever systemic disease explained in Ayurveda presents with excessive dryness and scaling of the skin as explained in ichthyosis shall be considered to be causal. In these cases treating the main disease will take care of dryness and scaling of skin. Example – dryness of the skin is one of the symptoms of panduroga (often compared to anemia, also includes liver disorders). Here treating panduroga will clear the dryness of the skin. The same principle shall be followed if ichthyosis-like symptoms are found in any systemic disease explained in Ayurveda.

Ayurveda treatment principles for ichthyosis (treatable)

Ichthyosis doesn’t have a cure, mainly the genetic types of ichthyosis. The other treatable types of ichthyosis should be treated to the best of one’s capacity. The success of the treatment depends on the severity of the disease, choice of interventions and regularity of treatment.

Ichthyosis shall be treated by administering the therapies, medicines, dietetic regimen and lifestyle changes mentioned in the below mentioned conditions explained in Ayurveda. The choice of these depends on the judgment of the physician and may vary from person to person and condition to condition.

Treatment principles of the below mentioned shall be considered –

• Kushta Chikitsa – skin diseases explained in Ayurveda
• Vataja Kushta Chikitsa – skin diseases of vata origin (includes all types of kushtas which fall in this category)
• Kshudra Kushta Chikitsa with special reference to Eka Kushta
• Rasavaha sroto dushti chikitsa – treating the contamination of rasa conveying channels in the body  
• Vata Vyadhi Chikitsa – treatment of special vata disorders
• Twak Gata Vata Chikitsa – treatment of vata localized in the skin

Dealing with Vata

Since the entire picture of ichthyosis is dominated by vata, all treatment strategies should be focused on bringing vata to a state of balance by all possible methods. The below mentioned will be the key strategies. Apart from external and internal therapies, diet and lifestyle recommendations to balance vata should be implemented.

External Therapies

Oil is the best enemy for aggravated vata. It can be used externally as well as internally and also along with foods.

Snehana – oleation –In ichthyosis the skin needs to be kept moist and lubricated as often as it can. Many oil therapies can be done on the skin including pouring of medicated oils in streams / showers (Parisheka / Sneha dhara / Kaya seka / Pizhichil), bathing the body in a tub filled with medicated oil (Avagaha) and herbal oil massage (Abhyanga).

Internal Therapies

Panchakarma Therapies –

Sneha Vasti – Enema with medicated oil / ghee or combination of both should be administered in ichthyosis. Anuvasana Vasti may be administered. On the other hand regular administration of lubrication enema with medicated fats in small doses may be frequently administered – Mata Vasti.

Vamana or Virechana – Therapeutic emesis or purgation may be required in acquired / secondary ichthyosis to treat the main diseases causing ichthyosis and also to purify the body of its morbid doshas and toxins.

Parent / parents suffering from ichthyosis, if planning to conceive children, should undergo Panchakarma therapies followed by Rasayana therapies before conceiving.

Useful formulations for ichthyosis