Dr . Manjeet Kaur

Introduction

Acne is a common skin issue affecting millions globally. Modern medicine focuses on the role of hormones, bacteria, and clogged pores, while Ayurveda sees acne as an imbalance within the body, particularly related to the doshas (Pitta, Kapha, Vata). By integrating these two perspectives, we can develop a more holistic approach to treating acne.

The skin is the largest organ of the body and acts as the main protective barrier against damage to internal tissues from trauma, ultraviolet light, temperature, toxins, and bacteria. Everyone wants their face to look attractive, clean, and healthy. Even a small spot on the face, especially for younger people, can cause worry. This is one of the social stigmas associated with acne. Acne is a common issue, especially in youth. Acne vulgaris, which is frequently seen in teenagers, is a chronic inflammatory condition of the pilo-sebaceous units. It is characterized by the development of comedones, papules, pustules, and less commonly, nodules.

According to the Global Burden of Disease (GBD) study, acne vulgaris affects about 85% of young adults aged 12-25 years. Research has reported acne in 79-95% of individuals aged 16-18 years. In India, studies show that acne affects 50.6% of boys and 38.13% of girls aged 12-17 years. Acne primarily affects the skin on the face, upper chest, and back.

Modern Medical Understanding of Acne(pimples)

Causes of Acne In modern medicine, acne occurs when hair follicles become clogged with oil and dead skin cells. Several factors contribute to this:

Hormonal fluctuations: Hormones like androgens increase during puberty, leading to excess oil production. This is also seen during pregnancy and menstrual cycles.

Excess sebum production: The skin produces too much oil, which clogs pores. During puberty, sebaceous glands become larger, and more sebum (oil) is produced. There’s a clear connection between the amount of sebum and the severity of acne. Without sebum, acne doesn’t occur. Androgens (hormones) are mainly responsible for this increase in sebum.

Follicle blockage: Hair follicles can get blocked by a mix of sebum and dead skin cells (keratinocytes), which leads to the formation of small cysts known as comedones.

Bacterial infection: Propionibacterium acnes can infect clogged pores, leading to inflammation and pustules.The bacteria Propionibacterium acnes grows inside the comedones, releasing fatty acids from the sebum. This causes inflammation and can make the cyst rupture.

Inflammation: When the cyst bursts, it releases oily and keratinous material, triggering an inflammatory reaction in the skin.

Genetics and lifestyle: Family history and factors like diet and stress can exacerbate acne.

Types of Acne:

Acne develops due to the interaction of four main factors:

1. Increased sebum production: During puberty, sebaceous glands become larger, and more sebum (oil) is produced. There’s a clear connection between the amount of sebum and the severity of acne. Without sebum, acne doesn’t occur. Androgens (hormones) are mainly responsible for this increase in sebum.
2. Follicle blockage: Hair follicles can get blocked by a mix of sebum and dead skin cells (keratinocytes), which leads to the formation of small cysts known as comedones.
3. Bacterial growth: The bacteria Propionibacterium acnes grows inside the comedones, releasing fatty acids from the sebum. This causes inflammation and can make the cyst rupture.
4. Inflammation: When the cyst bursts, it releases oily and keratinous material, triggering an inflammatory reaction in the skin.

Clinical Features:

The symptoms of acne vulgaris is the appearance of comedones, which are small white bumps (1-2 mm in size) that become more noticeable when the skin is stretched. These comedones can lead to inflammatory acne.

There are two types of comedones:

• Closed comedones (whiteheads): These are small, flesh-colored bumps with tiny openings that trap their contents inside. When sebum and dead skin cells continue to build up, they can cause the follicle wall to break, leading to inflammation.
• Open comedones (blackheads): These have larger openings and are filled with oxidized, darkened oily debris. Blackheads rarely cause inflammation.

In addition to comedones, acne also presents with inflamed lesions like papules, pustules, or nodules. Acne usually appears on the face, neck, chest, back, and sometimes the arms. The earliest signs of acne in teenagers are usually mild comedones on the forehead, followed by more typical inflamed lesions on the cheeks, nose, and chin. While acne mainly affects the face, it’s not uncommon to see it on the chest and back as well. In some cases, people develop large, inflamed cysts or nodules that can drain and cause scarring.

Whiteheads and blackheads: Non-inflammatory types where pores are blocked but not infected.

Papules and pustules: Small bumps, with pustules containing pus.

Nodules and cysts: Deeper, more painful forms of acne.

Modern medicine offers several ways to treat acne:

Local treatment: Regular washing with soap and water, use of keratolytic agents like benzoyl peroxide, or salicylic acid to prevent comedone formation. Antibiotic creams like minocycline, Azelaic acid, clindamycin are also applied to fight the bacteria.

• Systemic treatment: Oral antibiotics such as Azithromycin or doxycycline for severe acne. In some cases, isotretinoin (a strong acne medication) or oral contraceptives are used for women. Retinoids can cause side effects, including birth defects, so they must be used with caution.

Lifestyle changes: Dermatologists may recommend diet changes, stress management, and proper hygiene.

Ayurvedic Perspective on Acne

In Ayurveda, acne is referred to as ‘Yuvana Pidika’ or “adolescent eruptions.” It is linked to an imbalance of Pitta dosha, the energy that governs heat and metabolism. When Pitta becomes aggravated, often during adolescence, it leads to inflammation and skin issues like acne.

Causes (Nidaan):

In Ayurveda, acne is referred to as Yuvana Pidika, a condition mentioned by Acharya Sushruta in the chapter on Kshudra Roga (minor diseases). Acharya Sharangdhara also described it as a problem associated with impurities in the Shukra Dhatu (reproductive tissue) and oily skin.

Pitta imbalance: Excess heat in the body leads to oil overproduction and inflamed skin.

Toxins (Ama): Poor digestion creates toxins that circulate in the blood (Rakta dhatu) and manifest as skin problems.

• Diet: Spicy, heavy, sweet, oily, or fermented foods; milk; salty foods; alcohol; overeating.
• Lifestyle: Suppressing natural urges, lack of sleep, fasting, too much sun exposure, not letting blood out when necessary, and emotional stress such as sadness, anger, or frustration.
• Seasonal factors: Acne can worsen during spring, summer, and autumn.

Pathogenesis (Samprapti):

• Doshas involved: Kapha and Vata
• Tissues affected: Rasa (plasma), Rakta (blood), Meda (fat)
• Waste products: Sweat and oil from the skin
• Channels affected: Sweat-carrying channels (Svedavaha Srotas) are blocked, leading to acne formation.
• Imbalance in digestion (Agni): Weak digestion leads to the formation of toxins.
• Location: Acne primarily affects the skin of the face.
• Origin: Imbalances in the stomach.

Symptoms (Rupa):

Acne appears on the face as small, painful eruptions, resembling the thorns of the Shalmali tree (Bombax malabaricum). These lesions are caused by imbalances in Kapha, Vata, and Rakta doshas and are commonly seen in youth.

Ayurvedic Classifications Ayurveda classifies acne based on the dosha involved:

Pitta-type acne: Red, inflamed, and hot acne.

Kapha-type acne: Cystic, oily, and slow-healing acne.

Vata-type acne: Dry, flaky, and irregular acne.

Diagnosis:

In most cases, no specific tests are needed for acne. If acne is caused by underlying conditions, further investigation may be required.

Ayurvedic Treatment (Chikitsa):

1. Avoiding Causes (Nidana Parivarjana): The first step is to avoid triggers that cause acne.
2. Purification Treatment (Shodhana Chikitsa):
   • Vamana (vomiting therapy): This helps remove excess Kapha from the body, which is one of the main causes of acne.
   • Raktamokshana (bloodletting): Used in stubborn cases where other treatments have failed. The mildest form is leech therapy (Jalauka), which removes impure blood. Simple way can be blood donation in month of october as it is pitta kaal.
   • Nasya (nasal therapy): Medicinal oils are administered through the nose to remove toxins from the head region. It helps balance Kapha and Vata doshas.
3. Pacification Therapy (Shamana Chikitsa):
   • Various Ayurvedic medicines are used to treat acne, such as:
     • Rasa Aushadhi: Gandhaka Rasayana, and Rasamanikya Ras.
     • Tablets (Vati): Kaishore Guggulu, Arogyavardhini Vati, and Panchatikta Guggulu.
     • Herbal Ghee (Grita): Mahatiktaka Grita, Khadiradya Grita.
     • Herbal Powders (Churna): Panchnimba Churna, Triphala Churna.
     • Decoctions (Kwath): Mahamanjisthadi Kwath, Khadirarishta.
     • Herbal Jams (Avaleha): Hridrakhanda.
     • Local (Lepa): salmali kantaka (Bombax ceiba) mixed with milk applied locally.
       • Aloevera gel mixed with turmeric can also be applied.
         • Gochanaadi lepa.
       • Lodhraadi lepa.

These medicines are usually taken with warm water, herbal decoctions, or milk on an empty stomach, twice daily, depending on the severity of the condition.

Integrative Approach:

Combining Ayurveda and Modern Medicine

Detoxifying and Cleansing Ayurveda recommends internal detoxification:

Panchakarma therapies: Virechana (therapeutic purgation) helps eliminate toxins that contribute to skin disorders.

Dietary Adjustments

Modern cleansing: Regular exfoliation and using gentle cleansers help keep pores clear without irritating the skin.

Ayurveda: Avoid heat-inducing foods like spicy, fried, or junk foods. Newly harvested cereals. Black gram (udad dal). Radish, sour and heavy to digest food, milk, curd, sugars. Include cooling foods like old barley, wheat, rice , green gram, pigeon pea, masoor dal, patola leaves, cucumber, coconut water, bitter tasting food, old ghee, mustard oil, nimba oil and aloe vera to balance Pitta.

Modern advice: Avoid high-glycemic foods (sugars, refined carbs) and dairy products, which are linked to acne. Include anti-inflammatory foods like omega-3 fatty acids (fish, flaxseeds) and zinc-rich foods (pumpkin seeds, chickpeas).

Topical Remedies

Ayurvedic herbs: Neem, turmeric, sandalwood, and manjistha have antibacterial and anti-inflammatory properties, helping to reduce acne.

Modern treatments: Benzoyl peroxide, retinoids, and salicylic acid are widely used in creams to treat acne by targeting bacteria and reducing inflammation.

Stress Management

Ayurveda: Stress increases Pitta, so practices like meditation, pranayama (breathing exercises), and yoga help calm the mind and balance the body.

Modern techniques: Mindfulness and stress management are vital as stress hormones (cortisol) can trigger acne flare-ups.

Natural Ayurvedic Remedies for Acne:

Herbal face packs can reduce acne naturally:

Turmeric and sandalwood: Known for their anti-inflammatory and antibacterial properties, these are often mixed with honey or rose water.

Neem: Used to clear infections and purify the skin.

Internal Cleansing with Ayurvedic

Herbs Ayurveda focuses on internal health for clear skin:

Triphala: A blend of three fruits that helps in detoxifying the digestive system.

Guduchi and Aloe vera: Purify the blood and reduce Pitta, helping clear skin issues.

Oils and Ubtans Ayurvedic oils, like kumkumadi oil, are applied for skin rejuvenation and blemish removal. Ubtans (herbal pastes) exfoliate and cleanse the skin naturally.

Skin Care Routine

Morning routine: Cleanse your skin with a mild Ayurvedic or modern cleanser, apply a natural toner (rose water), and moisturize with non-comedogenic creams or oils like kumkumadi oil.

Evening routine: Use a face pack (turmeric, neem, sandalwood), followed by gentle exfoliation and a night cream containing Ayurvedic herbs or modern acne treatment ingredients.

Conclusion

Achieving clear skin requires more than just topical treatments. Both Ayurveda and modern medicine emphasize the importance of balancing internal health with external care. By integrating practices from both systems, one can effectively manage acne in a holistic manner that addresses root causes and provides lasting results.