17-year-old Sophia has withdrawn over the last few months and no longer really enjoys life. She avoids contact with boys and doesn't go out of the house dressed bare-shouldered, even in the height of summer. After the dermatologist was also unable to provide lasting help and Sophia was unable to tolerate heavy medication, her mother turned to my Ayurvedic practice. Sophia suffers from severe acne.
Acne vulgaris is one of the most common skin diseases and usually manifests itself during puberty and young adulthood with papules and pustules in regions rich in sebaceous glands; in severe cases, painful lumps and abscesses also develop. Incorrect manipulation can lead to scars and cysts.
Read the following case study of Sophia to find out how this physically and psychologically stressful illness can be successfully treated with Ayurvedic therapy.
The recording
On a sunny day, Sophia rings my doorbell and greets me shyly with a „Hello, Sophia R., I have an appointment with you“.
The first sight is frightening: from her forehead to her cheeks and chin to her neck, countless pustules cover the slender teenager's delicate face. The first scars are also visible. Sophia is wearing a high-cut turtleneck shirt, under which I suspect further inflammation.
Sophia is 170 cm tall and weighs 58 kg (BMI 20.1). She wears her thin blonde hair tied up and it looks a little greasy. Her slender nose, small ears, thin lips and delicate fingers anatomically indicate a Vata-dominated constitution.
I ask her to allow me to examine her skin - even if it is unpleasant. The inspection reveals further severe inflammation on her shoulders and décolleté. Increased hair growth on the arms and legs is particularly noticeable. „It's my male hormones being too strong,“ says Sophia, describing her hair.
Her facial skin shows a lot of redness and freckles are visible on her forehead and shoulders. There are several pigment naevi („liver spots“) all over her body. Sophia's sun-sensitive skin can be categorised as phototype 2 according to Fitzpatrick; from an Ayurvedic point of view, she has a Pitta-dominant skin constitution.
Ayurvedic pulse findings
- Increased rate, variable rhythm, moderate amplitude, low volume
- Features: light, mobile, clear
- Evaluation: Vata dominance, Samagni (normal Agni) with Nirama (no Ama)
Ayurvedic tongue findings
- Tongue body pale red medium sized, many red dots (raspberry tongue), rough crack-free surface, thin grey-yellowish coating in the middle and rear third, lower tongue side inconspicuous
- Evaluation: Raktadushti (contaminated blood) with Vata dominance
Acne from a Western and Ayurvedic perspective
Three factors are primarily involved in the clinical picture of acne:
- Increased secretion of the sebaceous glands with increased sensitivity to androgens
- Hyperkeratosis (keratinisation) of the hair follicles
- Bacterial colonisation of „blackheads“ (comedones), which occur when the excretory duct of a sebaceous gland in the skin becomes blocked due to keratinisation
In Ayurveda, acne is recognised as Yauvana („adolescent / pubertal“) Pidika („pimple / pustule“) or Mukha („Face“) Dushika („impurity“) and is one of the minor diseases (Kshudraroga). Vata, Kapha and Rakta (as blood impurities) are primarily involved in the pathogenesis (Samprapti), resulting in a blockage (Srotorodha) of the sebaceous gland ducts. In practice, there is also often a strong involvement of Pitta Dosha.
The most important causes from an Ayurvedic point of view are
- Dietary habits that contaminate the blood: overly fatty, fried or deep-fried food, meaty food, acidic and excessively spicy food, fast food
- Incorrect skin cleansing and care, excessive oiling
- Mental and hormonal imbalances
In the nutritional history Sophia describes herself as a sweet tooth who can't do without her daily chocolate. „It calms me down - and I can afford it as I never get fat anyway,“ she explains her situation.
Sophie's grandparents have run a reputable butcher's shop in the village for decades. She grew up with home-style cooking and still regularly picks up her favourite sausage from Grandad on the way home from school.
Sophia doesn't have a real meal plan: „I eat when I'm hungry and whatever I feel like.“ She particularly enjoys eating chicken with red curry sauce at the Thai takeaway.
Sophia's eating habits are directly linked to her skin condition. From a therapeutic point of view, this is even „pleasing“, as we can expect to see improvements in the appearance of her skin very soon by making a consistent change.
The therapy
Successful Ayurvedic treatment of acne involves a combination of soothing measures (Shamana Chikitsa) and draining procedures (Shodhana Chikitsa).
The most important soothing measures are
- Nutritional correction
- Order therapy including personalised skin care
- Phytotherapy
The following elimination methods are primarily used
- Vamana Karma - therapeutic gastric lavage to eliminate excess Kapha
- Virechana Karma - laxative therapy to eliminate excess Pitta
- Raktamokshana Karma - bloodletting therapy for blood purification
Sophia is only 17 years old, so I decided against a Panchakarma treatment for the time being. We started with outpatient therapy, initially for 3 months.
Nutritional correction
I decided on a big-point strategy for Sophia and gave her 5 key dos and don'ts for the next 4 weeks:
5 Dos
- 3 regular meals at around 9.30 am (during the school break), 2.00 pm (after school) and 7.00 pm - freshly prepared
- Green vegetables at least once a day, e.g. chard, spinach, kohlrabi, broccoli or courgettes with cereals such as rice, spelt or quinoa
- At lunchtime, a side salad made from bitter ingredients such as chicory, rocket and dandelion
- Mainly boiling, stewing and steaming
- Only consume ghee, coconut oil and olive oil mildly heated or at room temperature
5 Don'ts
- No snacks, snacks and sweets, ready meals
- No meat and sausage products
- No acidic and high-fat dairy products such as yoghurt or cheese
- Avoid frying, deep-frying and roasting
- No frying fats of any kind, no sunflower oil
We made a deal: she would try it out consistently for four weeks and then decide whether to keep the changes based on the results. She agreed to this.
Phytotherapy
- To reduce inflammation and heal wounds: Kaishora Guggulu 3x 1g with hot water 15 minutes before meals
- For blood purification: Mahamanjishtadi Kashayam 15ml with equal quantity of water along with Kaishora Guggulu before meals
- For psychodermatological stabilisation: Mandukaparni + Guduchi Churna 3g each in the afternoon separately from meals with warm water
External therapy
- Morning and evening skin cleansing with a medicinal, pH-neutral cleansing milk - followed by application of Vachadi Lepa, consisting of equal parts of the powders of Vacha (Acorus calamus / calamus root), Lodhra (Symplocos racemosa), Sarshapa (Brassica nigra / mustard seed) and rock salt. Sophia mixes the powder with water to form a paste, applies it to the affected skin over a large area against the direction of hair growth and removes it once it has dried out. She then applies a mild, oil-free moisturiser.
- She refrains from any manipulation of her pustules for a month and instead comes to our practice every fortnight for medical cleansing.
The result
After four weeks, we arranged a first follow-up appointment. This time Sophia came dressed in a light top and was visibly delighted - the reddening of her skin had disappeared, the number of pustules was significantly reduced and she seemed happier.
„We'll continue in the same way,“ she began her feedback on the experiences of the first phase of therapy. I explained to her that we were on the right track - but that she still had several months to go before achieving the desired skin appearance.
The treatment of acne vulgaris with Ayurvedic medicine is very successful if the patient's co-operation is guaranteed. It requires patience, but experience has shown that lasting results can be achieved within 3-6 months. Once the desired skin appearance has been achieved, the result can be stabilised through preventive measures.
With best wishes for your health,
Ralph Steuernagel
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