Molluscum contagiosum: A novel Ayurvedic approach.

SUMMARY: Three cases of molluscum contagiosum (MC) approached our outpatient Department of Dermatology complaining of umbilicated, skin-colored, firm, painless papules over the neck and face. All of them were immune competent. The medical, social, and family history was insignificant. The lesions were, numerous and recurrent. However, MC in healthy people is a self-limiting disease, but it will take about 18 months to resolve by its own. Hence, the treatment becomes necessary to accelerate the healing process, preventing its spread and for cosmetic reasons. Most of the contemporary treatment methods such as cryotherapy, curettage, and topical application of caustic agents are effective but produce local side-effects such as erythema, tenderness, itching, burning sensation, and pain. The present study reports the efficacy of external application of Pratisaraṇīya Kṇāra (the type of Alkali used for smearing over the affected area) and Bilvādi Agada tablet orally in three cases, which yielded encouraging results.

INTRODUCTION

Molluscum contagiosum (MC) is a self-limiting viral skin infection most commonly seen in children and is an epidermal papular condition caused by a large deoxyribonucleic acid poxvirus with the prevalence of 8-12%, respectively.[1] The typical clinical presentation consists of small, umbilicated, skin-colored, pearly papules with a predilection of the trunk, axillae, antecubital, and popliteal fossae and genital area. Incidence first peaks in preschool children.[2] The average incubation period ranges from 2 to 7 weeks. The diagnosis of MC is typically made by its clinical presentation and can be confirmed by histological demonstration of the cytoplasmic eosinophilic inclusions or molluscum bodies that are characteristic of poxvirus replication.[3] The lesions are cosmetically unattractive, numerous and recurrent. However, MC in healthy people is a self-limiting disease, but it will take about 18 months to resolve by its own. Even though it is self-limiting, it is spreading nature, for cosmetic reasons and to accelerate healing, treatment is called for.

Ajagallikā is described in the context of kṣudraroga (Kṣudra = trivial; Roga = disease, the diseases which have less or no symptoms, with less pain or without pain) in the classics which is presented as snigdha (unctuous), savarṇa (of the same color), grathita (firm), niruja (painless) and mudga sannibha pīḍakas (papules resembling green gram)[4] which analogs with MC. No specific etiology and details regarding the disease are mentioned.

Few reported cases demonstrated significant improvement with biomedicine, but side-effects were also noticed. Here, we report three cases of MC cured without any recurrences, local side-effects and scarring.

CASE REPORTS

Three different cases approached our outpatient Department of Dermatology with similar complaints.

Case 1

A 5-year-old female child presented about 15 umbilicated, skin-colored, firm, painless papules over the neck, and face which appeared 15 days prior to presentation [Figure 1].

Figure 1

Case 1

Case 2

A 9-year-old female child approached our outpatient department complaining nine lesions over right side of the neck, which appeared a month before the presentation. The lesions resembled characteristics of MC [Figure 2].

Figure 2

(a) Before treatment (b) After treatment

Case 3

A male adult of 24 years showed three similar papules over the forehead and one papule close to left eye since 1 month. The patient experienced neither pain nor burning sensation nor itching [Figure 3].

Figure 3

Case 3 -(a) Before treatment (b) application of Kshara (c) after treatment

The pertinent medical, social, and family history was noncontributory in all. All of them were immune competent. No obvious sexual transmission was evaluated. They were clinically diagnosed as MC [Figure 1].

In the first visit, Apāmarga Kṣāra[4] (Alkali, prepared according to the classical method) was applied to all the lesions for 1 min in first two cases as they were pediatric and 2 min in the adult patient and then it was washed with lemon juice and then ghee was applied. Care was taken to restrict the application only to the lesions. Bilvādi Agada,[56] a polyherbal tablet, was prescribed orally for 10 days at the dose of 500 mg BD for the first two, as they were pediatric cases and 1 g BD for an adult patient.

Outcome and follow-up

Slight color change in the lesions was observed on the 2nd day of the treatment. In 10 days, almost all the lesions had disappeared leaving no scar behind. Bilvādi Agada was prescribed to be continued for a fortnight as prophylaxis.

DISCUSSION

Contemporary treatments for MC include cryotherapy, curettage, and topical application of caustic agents. Commonly chosen treatment method of MC is “wait and see,” which usually resolves spontaneously after several months to years, but it is the great source of embarrassment, often limiting social activity.[7] Therapy becomes obligatory, because children may scratch the lesions and infection may spread to other parts or to other people.[8] Curettage is associated with a high risk of relapse, scarring and most frightening to children if performed repeatedly, owing to pain and fear.[9]

Seo SH et al.[1] in their comparative clinical trial between 10% KOH solution and 5% imiquimod cream reported that both are effective and safe but about 40% of patients experienced a local irritation and few patients, however, discontinued the treatment due to the local irritation. No systemic adverse effects were observed.[1] Ahmed et al.[10] in their open label study of treatment of MC with 5% imiquimod cream over 54 MC patients, demonstrated that the treatment to be safe but which produced local side effects which included erythema, tenderness, itching, burning sensations, and pain.

Consequently, we tried the Ayurvedic treatment in this condition which has yielded good response. Apāmarga Kṣāra[4] is an alkaline paste, prepared from the herb Apāmarga (Achyranthes aspera Linn.) which is directly indicated in Ajagallikā and conditions like Carmakīla (skin tags/warts/papules). After retaining the paste at lesions for about 1-2 min, it was washed with lemon juice (acidic), which neutralizes the Kṣāra and hence prevents its further infiltration. Ghee was applied to relieve the slight burning sensation, which is classically asserted.

The kṣāra (Alkali), possesses tīkṣṇa (penetrating) and uṣṇa (hot) properties. These properties make it capable of infiltrating deep into papules, destroy the pathologic cells and viruses and hence preventing recurrence. It acts as chemical cauterizing agent. Only one application is sufficient, if the papules don’t show any change, then it can be repeated after a week. However, Pittaja conditions are contraindicated for Kṣārakarma.

Bilvādi Agada (BA)[6] is an antitoxic medicine (viṣaghna aushadhi), indicated in all animate and inanimate poisoning (Sarpaviṣa, Lootāviṣa, etc., Dūṣiviṣha and Garaviṣa) and is mentioned as Bhūtaghna (perhaps considered as antiviral). It possesses uṣṇa vīrya (hot potency), Kaṭurasa (pungent taste), kaphavātahara (Mitigating Kapha and Vāta), Shūlaghna (Analgesic), Dāhashamana (calms down burning sensation), Shophaghna (anti-inflammatory), Vraṇāropaka (Wound healing), and Granthināśaka (papule resolving) properties. Ajagallikā is a kaphavātaja, Māmsapradoṣaja vyādhi hence prescribed. Studies have shown that BA and its ingredients are proven for their antiviral, hepatoprotective, antimicrobial, antioxidant, immunomodulatory, and anti-inflammatory activities.[511]

CONCLUSION

Three patients of MC have shown encouraging results when treated with Pratisaraṇīya Kṣāra and Bilvādi Agada. The results exhibit patient compliant, single sitting, and cost-effective management for MC or Ajagallikā without any local or systemic side-effects.

The combination of Pratisaraṇīya Kṣāra along with Bilvādi Agada (antitoxic oral medicine) when used in Kaphavāaja skin conditions like Ajagallikā give beneficial results.