Acne is a common chronic inflammatory condition of skin with cutaneous and psychological disease burden. Acne affects both males and females but males are more prone during onset of puberty. Acne affects 80% of individuals between Pubescence and 30 years of age throughout the world. Many research studies shows that acne is prevalent in 79-95% in the age group of 16-18 years. In India, the percentage of acne is 50.6% in boys and 38.13% in girls in the age group of 12-17 years. It is reported more than ninety percent of population suffer from Acne at some point of their life. It is assumed that the number of people affected by Acne in India is estimated to reach twenty-three million by 2026
Ayurvedic texts have mentioned a term Mukhadushika for the disease which affects the beauty of the face. Acharya Sushruta placed Mukhadushika in the category of the Kshudra-roga. It is also termed as Yuvanpidika due to its high prevalence in the adolescent age leading to the formation of Pidika (small boils or pustules).
According to modern medicine, Acne is a skin disease of chronic nature occurring due to the blockages in the hair follicles. It can be inflammatory as well as noninflammatory in nature. There are various causes of development of Acne such as excessive production of sebum due to androgens; bacterial accumulation, formation of keratin plug, etc. This condition lead to formation of open and comedones; papules, pustules and nodules.
Acharya Vagbhata has described the following sign and symptoms of the disease:
- YUNAMVAKTRE: site of disease and the age related with disease is explained by this phrase. The common site of yuvanpidika is face and is commonly seen in adolescence.
- SHALMALIKANTAKPRAKHYA: shalmalikantak has conical shape. And it is seen in most of the patients that the pidika is conical in shape.
- PITIKAHSARUJO: it explains the painful nature of the disease. In patients, it can vary from mild tenderness to severe pain. It may be due to the involvement of vata.
- GHANA: this term is indicative of the consistency of pidika. The pidika are thick, hard, and indurated. It may be because of the involvement of Kapha.
- MEDOGARBHA: it says that the pidika are filled with meda. It correlates with the modern concept of blockage of ducts due to sebum. Other than these, symptoms like kandu, daha, paka, shotha, srava, vaivarnyata are also seen.
Types of Acne
A. Acne Vulgaris
Comedones: A comedonal acne occurs when dead keratin flakes and sebum block a hair follicle. Comedones are the most basic forms of acne with no inflammation. These are of two types – open comedones and closed comedones. Comedones are Non-inflammatory acne. Due to their non-inflammatory nature, are considered mild forms of acne. Over-the-counter medication and natural remedies are usually prescribed to treat comedones.
Whiteheads: Whiteheads are uninflamed, closed comedones that result from dead skin flakes, sebum and dirt being trapped within your pores. Whiteheads usually occur on your face, especially on the oily zones such as the nose, cheeks and chin. They can also appear in other areas such as your scalp, back and chest.
Blackheads: The major difference between a blackhead and a whitehead is that blackheads are open comedones. This makes it easier to extract the hardened impurities from a blackhead. When exposed to the air, these impurities trapped within the pore get oxidized to assume their black colour.
Papules: In a papule, the blocked hair follicle gets inflamed due to Propionibacterium acnes (a type of bacteria that lives on your skin) infection. As a result, a papule looks like a raised reddish cyst on the surface of your skin and is often painful to touch. The main difference between a papule and a pustule is that there is no pus seen on the surface of a papule. However, if left untreated, a papule can get filled with pus and turn into a pustule. Papules are inflamed acne. One or two papules are regarded as mild acne. More than that will be classified as moderate to severe acne.
Pustules: Being infected by the Propionibacterium acnes, the blocked hair follicle attracts white blood cells as an immune mechanism to fight the infection. This results in a pus-filled cyst called a pustule. Pustules have the appearance of white or yellow pus-filled bumps with a red inflamed ring around them. These acne lesions are painful to touch and often require medical treatment to cure them. Pustules are . Moderate to severe inflammatory acne. Pustules are often found occurring together with papules.
Cystic Acne: As the comedo or non-inflammatory acne continues to get filled with sebum and dead keratin flakes there is increased proliferation of Propionibacterium acnes bacteria. This triggers the body’s immune system, which releases white blood cells to curb the infection. Eventually, the thin wall of the blocked hair follicle breaks, spreading the impurities to the surrounding dermal layer. As a result, there is further inflammation and the infection travels deeper into the surface of your skin, forming large suppurative cystic acne. They are Large Inflammatory acne that measures more than 10 mm in diameter and their severity ranges from Moderate to severe depending on the depth of the acne lesion and the number of cystic acne formed in an area.
Nodules Or Nodular Acne: The major difference between cystic acne and a nodular acne lesion is that nodules are hard to touch. This happens when the impurities trapped within the infected hair follicle solidify and form a large, hardened nodule. The surrounding areas of a nodule are usually sore and may appear red and inflamed. These too, go deep into the epidermal layer and cannot be easily extracted or treated with basic topical acne medication. Noduler acne are Inflammatory acne and can be moderate to severe.
Apart from the five common types of acne lesions that come under Acne Vulgaris, there are some lesser-known acnes variations. These may be caused by similar symptoms of a blocked hair follicle and interference of Propionibacterium acnes bacteria or be triggered by a skin condition.
B. Acne Tarda
Acne Tarda is often referred to as ‘adult acne’ as it occurs or persists after adolescence. It is more common in women who have been diagnosed with some endocrine disorder or PCOS which leads to hyperandrogenism. It is characterized by inflammatory acne spreading all over your face or concentrated in the lower part of your face. This can later get severe depending on the trigger factors in your body.
C. Acne Mechanica
Acne Mechanica is similar to acne vulgaris in appearance but differs in its underlying cause. It occurs due to direct mechanical stress on your skin. Heat causes pores to dilate, creating an ideal environment for sebum, or oil, and debris to accumulate. Constant pressure, rubbing, or friction from clothes and other wearables such as watches, jewelry, masks, etc. can result in this type of acne. This is common amongst people who have acne-prone skin and are involved in excess physical activity such as sportsmen.
D. Acne Conglobata
Acne conglobata is a rare and severe form of acne where nodules and cysts form together. Being deeply embedded in the epidermal layer, this nodulocystic acne condition poses a high risk of scarring or disfiguring the face. It is more common amongst adolescent men and can break out on the chest, back, thighs and the face. These large acne lesions are filled with foul smelling pus and require medical attention to heal them.
Ayurvedic Analysis of Acne
Acne is one of the first signs of disease because, according to Ayurveda, the skin is a direct reflection of what’s happening inside of the body. Ayurveda believes that yuvana pitaka is a disease that is caused due to improper diet and other internal factors.
- Adhyashana – Consuming food at short intervals, due to which new food enters the body when the previous food is not digested
- Virudhashana – Consuming incompatible foods together such as fish and milk together, curds and milk together etc
- Vishamashana – Consuming food with disregard to the bodily cravings, such as eating when not hungry or fasting when hungry
If acne is present then there is an imbalance in all three of the Doshas: An aggravation of the Vata (hyperkeratinization), Pitta (inflamed acne lesions), Kapha (over-secretion of sebum) Doshas along with vitiation of the Rakta Dhatu (blood tissue). This may leads to small localised eruptions on the cheeks, chin, chest, back, etc
A Vata Dosha imbalance causes weakened digestion and a buildup of ama (toxins); imbalanced Pitta creates problems in the blood (Rakta Dhatu) and liver, resulting in inflammation; an excess of Kapha Dosha results in clogged pores because of the overproduction of oil. This negative combination of weak digestion, toxins and inflammation builds the ultimate environment for the growth of too much bacteria and consequently, chronic acne.
But diving deeper than that we must look at what is unbalancing the Doshas – ultimately, a diet and lifestyle that is creating toxins. Eating hot, spicy and very salty and sour foods aggravates Pitta, as well as consuming coffee, meat and alcohol. Staying up past 11pm and eating dry foods like crackers and salad aggravates Vata Dosha. Overeating, eating too much oily and sweet foods and excessive sleeping will throw Kapha Dosha out of balance. Taking medications, smoking and eating foods with preservatives will also negatively impact all three Doshas.
- Pitta Acne: The pitta dosha governs your metabolic system called the agni or digestive fire in a person. When digestion and metabolism are good, there is no metabolic waste generated. The metabolic waste formed when the Agni is weak is called Ama. This Ama penetrates all the Dhatus or tissues of the body. Rasa (plasma), Rakta (blood), Lasika (lymph), and Mamsa (muscle) Dhatus are all closely linked to skin issues. The more severe the problem the more Dhatus are involved. An aggravation of pitta can increase the heat in your body, that also leads to to inflammation. Redness, inflammation and pain are characteristic of Pitta acne. It is usually found on the cheeks. This is the first Dosha to focus on balancing when healing skin disorders.
- Vata Acne : A Vata Dosha imbalance causes weakened digestion and a buildup of ama (toxins); This negative combination of weak digestion, toxins and inflammation builds the ultimate environment for the growth of too much bacteria and consequently, chronic acne. Dryness, pain and blackheads characterize Vata acne. It will typically be on the lower half of the face from the nose down. Bringing Vata back into balance is essential to balancing Pitta Dosha.
- Kapha Acne: An excess of Kapha Dosha causes overproduction of oil. It blocks the normal excretory function of skin and the waste material stagnates inside, producing symptoms like results in clogged pores, itching, pustules and nodules formation. You will have acne usually be on the forehead and upper cheeks.
Vitiated doshas produce toxins that block the Srotas (Microscopic channels) of the affected areas leading to pimple formation. The condition of acne can also be aggravated by excessive intake of oily, spicy, salty and sour foods, Constipation and Irritable Bowel Syndrome. Even if the Scalp has more Oil and that can lead to Acne and Pimples.
Dermatological Analysis of Acne
A healthy pilosebaceous unit regulates sebum production and natural disposal of dead skin cells. An imbalance of the pilosebaceous unit usually due to hormonal changes can result in over-secretion of sebum and an increase in keratinocytes. This leads to the blockage of hair follicles giving rise to comedonal acne.
Non-inflammatory comedonal acne when infected by Propionibacterium acnes bacteria can turn into a severe form of inflamed acne (pustules, nodules). The pus within the hair follicle is due to an immune response which attracts white blood cells to the site of infection.
This disorder of the pilosebaceous unit causing acne can be triggered by one of the various factors that are mentioned below:
- Hormonal changes during puberty that leads to increased levels of the androgen hormone. Androgen levels also increase during early pregnancy. This is why some women experience acne problems till their second trimester.
- Changes in the levels of your estrogen and progesterone can play a role in acne formation. Hence, many women experience acne problems before or during their menstrual cycle.
- Genetic skin disorder.
- More common in women diagnosed with polycystic ovarian syndrome.
- Use of skincare products that are comedogenic.
- Consumption of oily, spicy foods or foods that have high sugar content.
- Stress leading to imbalances in metabolism and accumulation of toxins in the body.
- Over exposure to heat, friction and sun.
- Skin diseases leading to dry skin or skin barrier impairment.
- Lack of good hygiene and a proper skincare routine.
- Certain medicines (lithium, androgenic steroids, corticosteroids) can also trigger acne.
Modern day medicine follows an approach to get rid of acne by focusing on preventing an over-growth of bacteria in the skin, regulating the production of oil and managing hormone levels. However, this is a very superficial approach and most of the time it requires taking heavy dosages of medications: the chronic use of antibiotics and harsh (not to mention very expensive) lotions that do more harm than any good. Using broad-spectrum antibiotics will create an excess of the yeast Candida albicans – this infection will likely make the acne even worse and then must be treated with still more antibiotics – an unfortunate cycle (Kumar et al., 2005)!
We need to understand that excess of bacteria growth is just a symptom of the underlying problems that are actually the root cause of the breakouts. This is exactly why trying to get rid of acne with topical and oral antibiotics might never clear up your skin. Focusing on changing the chemistry within the body is what is needed to completely heal from the inside out and that is where the ayurvedic holistic healing protocols for the treatment are much more successful.
Chikitsa(treatment) in Ayurveda can be divided into two forms. The one being shodhan chikitsa and the other shaman chikitsa.
Shodhan Chikitsa consist of Vaman, Virechan, Nasya, Rakta Mokshna etc. Shaman chikitsa is the treatment through medication and application of drugs on the lesion for relief.
The Shodhan Chikitsa includes the panchakarma procedures and the Shaman Chikitsa has internal medication and external application of drugs. Line of treatment prescribed by different acharya’s is as follows:
- Sushruta samhita – Vamana, Lepan
- Ashtang Hridaya – Lepana, Vamana, Nasya, Siravyadh
- Bhavaprakasha- Lepana, Vamana, Abhyanga
- Yoga Ratanakara- Shiravedha, Pralepa, Abhyanga [
- Sarangadhara samhita- Lepana
- Bhaishajjya Ratnavali- Siravedha, Pralepa, Abhyanga
- Chakrapani: Siravedha, Vamana, Abhyang, Lepana
How to select treatment protocol from various Shodhan Procedures:
- Vamana: Vaman Karma (emesis) is a procedure of removing vitiated Doshas through mouth. Both Acharya Sushruta and Vagbhata have mentioned Vamana Karma to cure the disease. As Vamana is the main therapy for Kaphaja abnormalities, Kapha is one of the main Dosha involved the pathogenesis. Vaman Karma is one of best therapy along with topical and oral Ayurvedic medication.
- Nasya: is the procedure of administering drugs through nasal passage. For treating Yuvanpidika, Tila taila as Pratimarsha nasya can be used. Vagbhata has indicated Nasya Karma for the treatment of Mukhadushika. Acharya Charaka has also advocated the Nasya Karma in Urdhva Jatrugata Vikara. Mukhadushika usually affects mukha which is in urdhavajatru part of body.
- Virechana Karma is used to remove the aggravated Pitta Dosha from the Guda Marga. Virechana is also useful in treating Raktaja Vikaras.
- Raktamokshan: Raktmoksana (bloodletting) is the preferred way of treatment in Raktaj disorders as per Ayurvedic texts. Raktamokṣana removes the vitiated blood and clears the Srotāvarodha (blockage in channels), thus breaking the samprapti (Evolution of disease)
For management of any disease, careful observation on Vyadhi Avastha (present condition of the disease) should be done. For Yuvanpidika/ Acne, it can be understood by knowing the involved Skin Layer. To understand this hypothetical classification of skin layers was made.
Classification of Skin
Sushruta Samhita (1000-500 BC), One of the main textbooks of Ayurveda describes the seven layers of the skin as follows:
- Avabhasini (reflective layer):Avabhasini in Sanskrit means “reflection.” This is the outermost layer which determines the beauty and complexion of an individuals’ skin. While it does not have its own color, it reflects the aura of the individual.
- Lohita(reddish layer): The color of this layer resembles the molten iron and hence the name Lohita, which in Sanskrit means “iron.” This layer indicates quality of the blood (raktadhatu).
- Shweta (white layer):Shweta means “white color” in Sanskrit.
- Tamra (pigment layer):Taamra is the copper colored layer as the word Taamra in Sanskrit means “copper.”
- Vedini (sensory layer):The word Vedini is derived from Vedana which in Sanskrit means “pain” as this level is responsible for the sensation of pain.
- Rohini (proliferating layer):The name Rohini has been derived from the word Rohana which in Sanskrit means “proliferation.” This layer is responsible for healing and regeneration. Any imbalance in this layer delays healing.
- Mamsadhara (muscle supporting layer):Mamsa in Sanskrit means “muscle” and Dhara means “support.” This layer provides firmness to the skin. The suppleness and youthfulness of skin depend on this layer of the skin.
Based on the thickness of each layer mentioned in Ayurveda, these layers can be correlated with the layers of the skin described in modern medicine. The first four layers resemble the epidermis. As we know in modern science, the thickness of the epidermis is about 0.5 to 1.5 mm and the collective sum of Avabhasini (1/18th of a Vrihi: Vrihi is a small grain), Lohita (1/16th of Vrihi), Shweta (1/12th of Vrihi), and Tamra (1/6 of Vrihi) is around 0.5 to 1 mm.
The next two layers Vedini (1/5th of Vrihi) and Rohini(1 of Vrihi) can be correlated to the papillary layer and reticular layer of the dermis respectively. Modern instruments measure the total thickness of the dermis around 2mm, although this can vary based on the anatomical site. The papillary layer is 1/5th of the Dermis and 1 Vrihi is considered around 2 mm.
Ayurveda states that “Swedovaha Strotas” (channels for sweat) are in the skin, similar to Western anatomy. According to Ayurveda, the Bhrajak pitta dosha is responsible for skin color and its seat is the skin. This correlates to the melanocytes (the melanin pigment-producing cells that are responsible for skin color) situated in the skin.
In this way, we see lots of similarities in the description of the skin in both perspectives.
Avabhasini and Lohita have pitta pradhanta, as for Avabhasini, acharyas have said “sarva varna avabhasini panchavidhachhaya prakashayati”. In Lohita, the disorders like Tilkalaka,Nyaccha, Vyanga are seen and pitta is the common dosha among them
Shweta, Tamra, Vedini, and Rohini have diseases like Ajagallika, Mashak, Kilaskustha, Alaji, granthi etc. which possess Vata-Kapha Samprapti. Mamsadhara has diseases like Vidradhi, Arsha, Bhagandar which are Tridosha in nature. So this layer can be considered as “Tridosha Bhuyistha”.
So, while treating acne vulgaris, the following points should remain in mind:
- If the lesions show pitta dominant lakshanas like small pidika, pain, burning sensation etc., and are associated with kapha and rakta, it means avabhasini or lohita are involved then pittahara and raktaprasadan chikitsa should be done. Virechana and raktamokshan will be beneficial in these cases. Rasapachak and raktaprasasdana dravyas should be given for internal use.
- If the lesion show Kapha dominancy lakshan like big, deep rooted pidika, Ghana, puyaprachiti, medogarbhata, and is associated with vata and rakta, then kledohara kaphahara and rakta prasadana should be done. In these types of cases, vaman, nasya and raktamokshana will be beneficial.
How Tejasvani looks at the ACNE Treatment Protocol
At Tejasvani we have developed the holistic protocol to heal acne from the inside out. We will follow the protocols as suggested in Ayurveda basis of individual body composition. We expect a 20-25 % improvement in the existing condition during the first month of Phase 1 treatment. The same treatment shall continue for 1 or 2 months or more depending upon the condition of the patient to reach around 40-45 % improvement during Phase 1. In Phase 2 we will do based on the Individual’s progress (so each one doing it will have to keep track on their own preferably with pictures after every 10-15 days and share the same with us. In that Phase 2, we will attempt to bring back elasticity in the skin, firm up skin, close pores, and heal the skin, and each Individual’s protocol will be different. Hence, one needs to keep patience and follow the protocol as suggested. We expect the healing window of acne is between 3 to 6 months. The cost of treatment will be approximately INR 1700 to INR 2500 per month.
Note: The guidelines as given to follow the protocol should be strictly followed to get optimum results.
The Broad Treatment shall include the following protocol but the composition will vary depending upon the recovery and phase of treatment:
- INTERNAL CLEANSING:
Special ark (500 ml) for drinking developed post understanding the individual body formation. that will help improve the digestive system, improve blood circulation, blood purification, and stress reduction.
- EXTERNAL TREATMENT:
Day time Skincare Routine For Acne
- Step1: Skin Cleansing: Cleansing Facewash with neem leaf, Tagar, aloe ark, etc. to clean the pores and help in healing.
- Step 2: Steaming & Exfoliation: Steaming helps in opening up the clogged pores in your skin. Then, the deep-rooted dead skin and sebum plugs can be eliminated from your skin pores through gentle exfoliation. Tejasvani Face Exfoliator (Scrub) is mild on your skin and do not use over-pressure while scrubbing your face. Ensure the exfoliants you use are soft and non-abrasive on your skin. Exfoliate your acne-prone skin twice or thrice a week. Over-exfoliation can damage your skin tissue. Avoid exfoliation when you have nodules or cysts as they can rupture, leading to severe acne breakout.
- Step 3: Toning: Toners help in enclosing the open skin pores which are susceptible to the accumulation of sebum, dead skin, and dirt. Toners are also useful in removing excess sebum from your skin, thus helping in preventing acne.
- Rosewater – Best for any skin type, especially acne-prone skin.
- Jasmine water – Best for dry and sensitive skin types.
- Lavender water – Best for oily skin
- Step 4: Moisturization: Moisturization is an important step to shield your skin from harsh weather, pollution, heat damage, etc. It keeps your skin hydrated and nourished. The medicated Aloe vera Gel of Tejasvani Organics is a non-greasy and lightweight formulation apt to moisturize acne-prone skin helping you keep your elevated doshas in balance.
- Step 5: Apply Sunscreen: Do not skip applying sunscreen before you step out in the sun, no matter what your skin type is. Applying sunscreen before doing makeup prevents skin damage and tanning caused by harmful UV radiation. Tejasvani has created a formulation free from harmful chemical ingredients that may damage your skin as well as the environment in the long term.
Night Skincare Routine For Acne
- Step 1: Cleansing: At night, it’s important to cleanse off the dirt, sweat, pollutants, and makeup residue accumulated on your face throughout the day. Hence, repeat the cleansing step from your morning routine. You can use the same face cleansing agent. Ensure you do not go to bed with makeup on your face.
- Step 2: Toning: After cleansing your face, you can repeat this step using the same toner that you used in your morning routine.
- Step 3: Night Serum: Using a herbal night serum can help you in controlling acne by balancing your skin pH levels. Also, it helps in fading the acne scars by repairing the damaged skin. Use a dropper to apply the night serum to your acne breakouts and blemishes. You can spread the serum evenly around the affected area using your finger nibs.
- Step 4: Night Cream: 100X washed medicated ghee of Tejasvani Organics is the lightweight alternative to all those commercial moisturizers available in the market. It not only moisturizes the skin but also has cooling and healing properties to speed up the recovery. It also reduces signs of aging and enhances the natural radiance of your skin
- Face Pack: Tejasvani Face Packs are formulated using selective Herbs to balance the relevant doshas and heal the topical inflammation. Clean your face with the Tejasvani cleanser and tap dry. Apply face pack twice a week before going to bed followed by steps 2,3,4 of regular night regime.
- Yoga For Acne: Apart from topical and oral remedies, practicing certain yoga asanas can also help to reduce stress and balance your hormones thereby checking acne-causing factors. Asanas such as Matsyasana, Sarvangasana, Pranayam, Uttanasana, Chakrasana, Halasana can help control acne with regular practice.
Do’s and Don’ts with Acne
- Unsweetened lemon or plain water, either hot or cold, should be drunk.
- Have 8 hours of good sleep.
- Measures should be adopted to eradicate constipation.
- Emphasis should be on raw foods, especially fresh fruits and vegetables, sprouted seeds, raw nuts, and whole-grain cereals, especially millet and brown rice.
- Yoga and proper personal hygiene.
- Keep your hair clean by washing it regularly and don’t let your hair fall on your face.
- Wash your face often (plain water splashes).
- Steam your face at least twice a week.
- Use a separate face towel and soap.
- Eat a healthy balanced diet rich in fruits and vegetables.
- Inform your doctor if you are taking any other oral. medications like oral contraceptive pills, hormones, etc.
- Ask your doctor for any clarification regarding your medications.
- Do not pinch/ pluck at your pimples or even touch them. They can scar.
- Do not stop your medications abruptly without consulting your doctor.
- Do not use any strong medicated soap.
- Do not use oily cosmetics. Do not put on excess makeup. Remove your makeup before sleeping.
- Restrict starchy, protein, and fatty foods
- Avoid meats, sugar, strong tea or coffee, pickles, refined and processed foods.
- Citrus fruits, bananas, dried, stewed, or tinned fruits should not be taken.
- Avoid soft drinks, candies, ice cream, and products made with sugar and white flour.