Effect of mukhalepa visha chikitsa in mukhadushika w.s.r. to acne vulgaris- An open labelled clinical trial

Acne vulgaris is one of the most prevalent chronic inflammatory dermatoses worldwide, primarily affecting the pilosebaceous units of the face, chest, and back. Globally, it is estimated that 9.4 percent of the population is affected by acne, making it the eighth most prevalent disease. From an Ayurvedic perspective, Mukhadushika is described under Kshudra roga, characterized by Shalmali kantaka sadrisha pidakas predominanatly on the face.

In India, recent epidemiological studies suggest that acne affects up to 60 to 70 percent of adolescents and young adults, with increasing incidence in females aged 15 to 30 years. Current therapeutic approach includes topical and systemic retinoids, antibiotics, benzoyl peroxide and hormonal agents for symptomatic relief. Long term use poses challenges like antibiotic resistance, photosensitivity, teratogenicity, relapse post-therapy, and limited tolerability. Factors like poor diet, urban pollution and altered gut skin axis can lead to a state resembling Visha dushti, manifesting as twak vikara.Visha Chikitsa, traditionally used to neutralize and expel toxins, can be conceptually extended to manage skin conditions where toxic byproducts, immune hypersensitivity, or impaired dhatvagni may be involved.

In Mukhadushika clinically, the lesions are described as Shalmali Kantakopama Pidaka, eruptions resembling the thorns of Shalmali tree, indicating hard, painful, and inflamed lesions consistent with acne. Parallelly, Ashtanga Sangraha in the context of Visha Chikitsa describes a condition known as Mukhalepa Visha, presenting with symptoms such as Padmini Kantaka Pidaka, which are elevated eruptions resembling the thorns of a lotus plant. Although attributed to toxic external applications, the morphological similarity of these eruptions to those seen in Mukhadushika is notable.

The present clinical trial proposes the application of madhukapayasyadi lepa, and administration of Bilwadi agada internally, having pharmacological activities, which are Vishghna ,Shothaghna, Janthughna and Krimighna. Studies have shown it to be anti-microbial, antiseptic and antifungal. This dual approach aims to not only treat acne but also to explore the therapeutic versatility of Agada Tantra in dermatology and support long term dermal health without the drawbacks of conventional drugs.