MANAGEMENT OF

SKIN & SOFT TISSUE INFECTIONS WITH AYURVEDA w.s.r. Ayurvedic Rasayan

Chikitsa

DR.SHAILESH S. PHALLE MD (AYURVEDA MEDICINE )

Ayurved consultant at Ayusanjivani ayurvedawww.ayusanjivani.com

INTRODUCTION : Suffered by everyone at least once in life time,

most common infection and challenge to a physician in his day today practice but unfortunately the most misdiagnosed and mismanaged these days.

SSTI s can be defined as an inflammatory microbial invasion of the epidermis ,dermis and subcutaneous tissues.

‘‘ Over use of antibiotics is a global problem’’.

Anatomy of skin :

Skin and Soft Tissue InfectionsGeneral Considerations : Primary vs. Secondary infections Portal of entry(micro organism entry) Status of host defenses (IMMUNITY ) Associated manifestations

Toxicity, severity of illness Localization and morphology of lesions Environmental exposure

SSTI may be classified according to the 1.Layer of infection2.Severity of infection 3.Microbiologic aetiology.(A-The practice guidelines of the infectious Diseases Society of America (IDSA) For the diagnosis element of SSTI’s)Classifies into five categories -1-Superficial uncomplicated infection : (includes Impetigo,Erysipelas and Cellulitis)2-Necrotising infection3-Infections associated with bites and animal contact4-surgical site infections5-Infections in the immunocompromised host

Classification :

Classifications :B-Classification according to the layer affected : Epithelium :Varicella and measels Keratin layer :Ring worm (Dermatophyte fungi ) Epidermis :Impetigo (streptococcus pyogenes , staph.aureus) Dermis :Erysepelas (streptococcus pyogens ) Hair follicles :Folliculitis ,boils,carbuncles(S.aureus) Sebum glands :Acne (Propionobacterium acnes) Subcutaneous fat: Cellulitis (Beta hemolytic Strepto. ) Fascia : Necrotising fascitis (strept.pyogenes and

anaerobic infection) C-Purulent OR non –purulent :

1-Purulent : e.g. Furuncle,abscess,carbuncles,Folliculitis2-Non –purulent : e.g. cellulitis,erysipelas,Impetigo

Classification :continued

D-Eron classification ,based on the severity of local and systemic signs is also useful

1-class1:SSTI but NO signs or symptoms of systemic toxicity or co-morbidities.

2-Class 2 :Either systemically unwell or systemically well but with COMORBIDITY that may complicate or delay resolution.

3-CLASS-3: TOXIC AND UNWELL (Fever,tachyacardia,tachypnoea and or hypotension )

4-class 4 :SEPSIS SYNDROME and life threatning infection.

SECONDARY PYODERMAS

Bite wounds

Infections of burns, wounds, or underlying dematitis

Diabetic wound infections

Decubitus ulcers

Surgical wound infections

Manifestation Characteristics Microbiology CommentsPurulent SSTIs :

Abscess : Collection of pus within dermis, erythema with fluctuance on palpation, overlying pustule may be present

Polymicrobial, commonly skin flora (staphylococci and streptococci), organisms from adjacent mucous membranes

Considered complicated if perianal or perineal areas are affected

Folliculitis:Inflammation of hair folliclesPurulence limited to epidermisCommon on beared,arms back,buttocks

Immunocompetent patients: Staphylococcus aureus Immunocompromised patients: gram-negative organisms (e.g., Klebsiella, Proteus, or Enterobacter species)

Common in body areas associated with friction and heavy perspiration

Furuncle :Purulence surrounding hair follicles and more extensive than follculitisextends to subcutaneous tissue .Carbuncle is mixture (coalescence ) of several furuncles.

Immunocompetent patients: S. aureus Immunocompromised patients: gram-negative organisms (e.g., Klebsiella, Proteus, or Enterobacter species)

Common in body areas associated with friction and heavy perspiration

Nonpurulent SSTIs :

Cellulitis Unlike erysipelas,the borders are not elevated or sharpely demarcated, warmth edema,

Pain

Regional lymphadenopathy

Streptococci without abscess formation, staphylococci with abscess

Often occurs with trauma; sequelae may include lymphangitis,

necrotizing infections, gangrene

ErysipelasIntense erythema; well-demarcated border

painful plaque

Beta-hemolytic streptococci, commonly Streptococcus pyogenes

More common with extremes of age (very young or old)

ImpetigoCrusted exudates with pustules or vesicles, common on face and extremities

Staphylococci or streptococci

Commonly seen in preschool-aged children; associated with poor hygiene, humid or warm temperatures

Stevens, DL, Bisno, AL, Chambers, HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014.

Moderate: SIRS

Severe: septic, failed treatment, immunocompromised, deep involvement

Daum, RS. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007; 357:380-90.

Empiric Oral Treatment against MRSA

Antibiotics : PENICILLIN Antifungal Medications steroids I & D AND Dressing care Nutrition Improve Immunity

Treatment plan of SSTIs

What about resistant ??Recent data has shown us:Emerging resistance

Community acquired (CA)- Methicillin-resistant Staphylococcus aureus (MRSA) greatest concern ??

Better understanding of mechanisms of antimicrobial resistance. - e.g.selective pressure

Better understanding of risk factors predisposing to CA-MRSA infection

Future :

Molecular testing for resistance organisms Newer antimicrobials ? Adopt immunomodulator medicines for

treatment

What we have to do ?

Building a better mouse trap ?

ROLE OF RASAYANA : Ayurveda is aimed for the maintenance of dhatusamya . It is basically achived by preservation of health. Concept of rasayana is designed for both condition that is

health as well as disease. Rasayana works at various levels in the body and overall

result in absolute state of vyadhikshamatva . Here more emphasis is given on the improvement of internal

invironment rather than cure and destruction of disease agent . Rasayan chikitsa is capable to full fill this aim.

Results of various studies on rasayan shows that it works as a immunomodulator in both conditions that is health and disease.

Dhatu or Body Tissue

Medicinal Plants

1.    Rasa Guduchi, Neem, 2.    Rakta Haridra, Punarnava,

Neem3.    Mansa Aswagandha4.    Meda Pippali5.    Asthi Aswagandha, Guduchi6.    Majja Guduchi7.    Shukra Aswagandha

“SEVEN DHATUS- Rasayan karma”

AshwagandhaPunarnava

PIPPALI

HaridraGuduchi

Tulsi,Neem

IMMUNITY COMPONENTS ENHANCERS

With Imunocin Host Defense mechanism prevails, eradicating microbes

HERBAL INGREDIENTS TO

IMPROVE IMMUNITY

HERBS & IMMUNITY

Improves phagocytic activity of the polymorphonuclear cells.

Enhances immunoglobulin synthesis. Increases the chemotaxis of polymorphs at

the site of infection. Possesses antibacterial, anti-inflammatory

and wound healing properties.

Exhibits potent antioxidant activity.

1.ASHWAGANDHA (Withania somnifera)

Withania somnifera or Indian winter cherry Ashwagandha is a stimulant of immune system. It increases concentration of red blood cell counts and white blood cell counts & enhances the function of T cells & B cells.

Ashwagandha Possess great healing properties therefore has great effects in healing wounds and injuries.

Ashwagandha Works as a rasayan i.e. a substance that helps in preventing early aging (antioxidant properties ) and rejuvenates whole body to provide youth.

Ashwagandha extracts, has strong pleiotropic biological effects related to immune health and stress reduction.

These include increasing cytokine levels and phagocytosis, as well as reducing corticosterone levels.

North American Journal of Medical Sciences 2011 July, Volume 3. No. 7. Immune enhancing effects of WB365, a novel

combination of Ashwagandha (Withania somnifera) and Maitake (Grifola frondosa) extractsVaclav Vetvicka, Jana Vetvickova Department of Pathology, University of Louisville, Louisville, KY, USA

2:GUDUCHI (Tinospora cordifolia)

Guduchi helps to increase the effectiveness & functioning of protective WBC(Innate & Adaptive) and builds up the body's own defense mechanism .(immune system)

Guduchi inhibits growth of bacteria and enhances the buildup of Surface Barriers .

Research suggests that Guduchi possesses antibacterial, anti-inflammatory, anti-rheumatic, and anti-allergic properties.

The direct drug treatment to J774A cells showed activation as assessed by biochemical assays.

Enhanced secretion of lysozyme by macrophage cell line J774A on treatment with Tinospora cordifolia and lipopolysacharide was observed, suggesting activated state of macrophages.

The enhanced inhibitory effects of T. cordifolia (direct effect) and T.

cordifolia treated cell supernatant (indirect effect) on the bacteria (E. coli) indicates the susceptibility of bacteria. This study is an attempt to check the potential significance of the T. cordifolia to be used as immunomodulator for activation of macrophages.

Int Immunopharmacol. 2004 Jun;4(6):841-9.Immune response modulation to DPT vaccine by aqueous extract of Withania somnifera in experimental system.Gautam M, Diwanay SS, Gairola S, Shinde YS, Jadhav SS, Patwardhan BK.

Source :Bioprospecting Laboratory, Interdisciplinary School of Health Sciences, University of Pune, Pune 411007, Maharastra, India. gautam_monty@hotmail.com

Abstract :The immunostimulation was evaluated using serological and hematological parameters. Treatment of immunized animals with test material (100 mg/kg/day) for 15 days resulted in significant increase of antibody titers to B. pertussis (P=0.000007). Immunized animals (treated and untreated) were challenged with B. pertussis 18,323 strain and the animals were observed for 14 days. Results indicate that the treated animals did show significant increase in antibody titers as compared to untreated animals after challenge (P=0.000003). Immuno protection against intracerebral challenge of live B. pertussis cells was evaluated based on degree of sickness, paralysis and subsequent death. Reduced mortality accompanied with overall improved health status was observed in treated animals after intracerebral challenge of B. pertussis indicating development of protective immune response. Copyright 2004 Elsevier B.V.

Indian J Pharmacol. 2008 Jun;40(3):107-10.Immunomodulatory effect of Tinospora cordifolia extract in human

immuno-deficiency virus positive patients.Kalikar MV, Thawani VR, Varadpande UK, Sontakke SD, Singh RP,

Khiyani RK.

CONCLUSION:

Tinospora cordifolia extract, a plant derived immunostimulant, significantly affected the symptoms of HIV. This was validated by

clinical evaluation. However not all of the objective parameters studied by us, Tinospora cordifolia could be used as an adjunct to HIV/AIDS

management.

3.NEEM (Azadirachta indica) :

Neem enhances immune system by boosting both the lymphocytic and Leukocytes systems, including "Killer T”, “B Cells”, “Neutrophils”, “Macrophages”.

Compounds of Neem helps to control fungi that can causes athlete's foot, ringworm and candida.

It having anti fungal as well as antibacterial property.

4.PUNARNAVA (Boerhaavia diffusa) :

Punarnava produces significant leucocytosis.

Studies have revealed that punarnava is an excellent diuretic, anti-inflammatory, mild laxative and is a heart tonic.

Punarnava is also used in treating obesity, improving appetite, jaundice, and general fever.

5.TULSI (Ocimum sanctum) : Tulsi is an immuno-modulator is an agent that

balances and improves the immune response of the body in fighting antigens & exhibits anti–microbial property.

Tulsi is rich in antioxidants and is recommended to guard against free radicals and protect body cells.

Tulsi is an adaptogen that helps the body adapt more efficiently to stress & reduce the intensity and negative impact of the stress.

6.HARIDRA (Curcuma longa) :

Haridra is nature’s own antiseptic and antimicrobial which helps to fight against recurrent infections.

Haridra possesses powerful antioxidant properties and has been prescribed in the treatment of inflammatory, biliary, and respiratory disorders..

Haridra has anti-hepatotoxic (liver-supporting) properties.

7.PIPPALI (Piper longum) :

Pipali is most commonly used to treat respiratory infections, bronchitis, diseases of spleen, tumor, cough and asthma.

Pippali acts as an anti-allergic and hepatoprotective.

Non healing ulcers :

Non healing ulcers :

Cellulitis :

Eczema :

Psoriasis :

THANK YOU……………………