Photodermatitis – Ayurvedic Treatment, Diet, Exercises, Research Papers, Yoga & Pranayama

Introduction

            Photodermatitis is an allergic skin reaction mostly reactive to light, especially sunlight containing UV rays. It is a form of allergic contact dermatitis. The allergen on the skin is to be activated by light to start the allergic response due to sensitization. It usually starts with a skin rash but can lead to further complications like systemic problems if the exposure is continued. Photodermatitis is termed especially when the skin rash due to light exposure is eczematous in nature.

Signs & symptoms

Reddish to black skin discolouration

Itchy bumps, blisters or raised areas

Outbreaks in exposed skin

Pain, redness and swelling

Headache

Chills, fever, and nausea

Causes

Diseases such as lupus or eczema

Genetic causes

Metabolic conditions like pellagra and scurvy

Reactions to chemicals and medications

Allergic reactions

Pathophysiology

Photodermatitis is a phototoxic reaction entirely independent of the immune system. In other words, photodermatitis can occur in any individual, and prior sensitization or an intact immune system is not required. The ingredients needed to produce photodermatitis include temporal exposure to sunlight, especially ultraviolet radiation. In reaction to UV rays, certain chemicals, and drugs can cause sunburn, an eczema type reaction or hives. It may be related with an allergy like phytophotodermatitis where the trigger comes from plants.

Furocoumarins are photosensitizing chemical components produced by certain plants and consist of psoralens, 5-methoxypsoralens, 8-methoxypsoralens, angelicin, bergaptol, and xanthotal.

The natural sunlight emission spectrum reaching the earth ranges from approximately 270-5000 nm. This electromagnetic radiation consists of photons with a reciprocal relationship between the wavelength and the energy of the photons. Only light that is absorbed into the skin can cause a photochemical reaction. Within the light spectra, UV-A (320-400 nm) is responsible for the vast majority of photoreactions resulting in phytophotodermatitis.

The wavelengths of ultraviolet light that most efficiently produce phytophotodermatitis lie within the UV-A range and have peak activity at 335 nm. When a photon with the appropriate wavelength strikes a furocoumarin, the energy is absorbed, raising this chemical to a triple excited state from the ground state. Upon return to the ground state, energy is released in the form of heat, fluorescence, and/or phosphorescence, and a photoproduct may form.

Two distinct photochemical reactions have been described in phytophotodermatitis, which occur independently from each other. A type I reaction occurs in the absence of oxygen, whereas a type II reaction occurs in the presence of oxygen. These photochemical reactions damage cell membranes and DNA and result in DNA interstrand cross-linking between the psoralen furan ring and the thymines or the cytosines of DNA. During the type I oxygen-independent reaction, the RNA and nuclear DNA become fastened to the exposed ultraviolet-activated furocoumarins. Likewise, the oxygen-dependent reactions result in cell membrane damage and edema from activated furocoumarins. This results in activation of arachidonic acid metabolic pathways and in cell death (sunburn cells and apoptotic keratinocytes). Clinically, erythema, blistering, epidermal necrosis, and eventual epidermal desquamation occur. See the image below.

A post inflammatory pigment alteration may follow the acute phase of this phototoxic reaction. This alteration occurs primarily by 2 mechanisms. First, melanin, which is normally found in the epidermis, “falls” into the dermis and is ingested by melanophages. Secondly, an increased number of functional melanocytes and melanosomes are distributed in the epidermis following phytophotodermatitis and also account for the hyperpigmentation. This hyperpigmentation may serve as a protective mechanism against further UV injury. Clinically, this corresponds with irregular hyperpigmentation (or occasionally hypopigmentation resulting in dyschromia) seen as the end stage of the phototoxic reaction.

Diagnosis

Usually, a direct physical examination is only needed for a confirmation. In rare cases, skin biopsy may be needed.

Treatments

Prevention is the best cure in the cases of photodermatitis. Once you know you have the condition you can:

  • Limit the sun exposure
    • Use sunscreen with high SPF which is PABA free
    • Cover up maximum with long sleeves, pants, hat etc.

In acute conditions, cool and wet dressings are applied externally. In extreme sensitivity cases, immunosuppressive drugs like azathioprine are used.

Multivitamins and minerals intake daily to correct nutritional deficiencies are also recommended in needed cases.

Prognosis

The prognosis is good with identification and avoidance of the offending agent, that is sunlight. Most commonly, photodermatitis is a localized cutaneous phenomenon developing initially in a burning sensation, which may be followed acutely by erythema and blistering. Eventually, the affected sites may desquamate and develop permanent hyperpigmentation or hypopigmentation. However, scarring is rare.

Complications

In rare cases, sun sensitivity can cause severe burns and can be fatal. Long term effects include scarring and an increased risk of skin cancer.

Disease & Ayurveda

            There is not a direct mentioning about allergy to light in Ayurvedic texts. But the skin rashes seen in photodermatitis are eczematous and can be compared with Vicharchika. Also, the body of the person may be predominant with Pitta dosha as it is easier to get heated up and become sensitive to sunlight.

Nidana

        Diet consisting of food items with opposite potency

            Unwholesome diet like chilichima with milk, certain cereals with milk etc.

            Improper physical activities like exercise, sexual intercourse etc

            Suppression of vomiting

            And all other causes of Kushtha roga

Purvaaroopa

        Absence or excess sweating

            Discolouration of skin

            Lack of tactile sensation

Samprapti

        Due to the causative factors like viruddhara, aama is formed and agni becomes manda. The vitiated doshas (mainly kapha) in this condition vitiate eachother and dhatus mainly rasa & rakta, and reaches skin. When exposed to the sunlight, these cause immediate reaction in the skin and develop into the rashes and other discomforts.

Lakshana

        Blisters with pain, itching, red/black colour and exudation

Divisions

            Not mentioned

Prognosis

            Saadhya in new and uncomplicated cases

            Yaapya in chronic cases

Chikithsa

Treatment of kushtha (especially vicharchika) is alleviating the kleda or vitiated Kaphadosha. It should be done accordingly in each case. If the lesions are wet/oily and swelling is present, kaphadoshahara treatment should be done. If there is burning sensation, redness & severe inflammation, Pittadoshahara treatment should be administered. Other factors like body constitution, age, physical and mental strength of patient, digestion, season etc. also should be considered while treating the kushtha.

Samana

kshalana – washing with kashayas like aragwadhadikwatha or triphalakwatha

lepana – applying external medicines like nalparadi lepa, chandanadi lepa, kumaryadi lepa etc.

Sodhana

Vamana with madanaphalakwatha

Virechana with erandatailam, or avipathi choornam

Commonly used medicines

        Aragwadhadi kwatham

Drakshadi kwatham

Mahathikthakam ghrutham

Avipathi choornam

Nimbamruthadi erandam

Brands available

AVS Kottakal

SNA Oushadhasala

Vaidyaratnam oushadhasala

AVP Coimbatore

Home remedies

No home remedy is there to completely cure photodermatitis. Prevention is the best cure in these cases. But herbs that can help reduce the discomforts of the disease includes the following:

Turmeric

Aloe vera

Neem

Applying ice packs can also be beneficial.

Diet

Pathya

Light meals and easily digestible foods

Green gram, soups, buttermilk boiled with ginger, turmeric, curry leaves etc.

Freshly cooked and warm food processed with cumin seeds, ginger, ajwain etc

Apathya

Heavy meals and difficult to digest foods – cause indigestion.

Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine

Carbonated drinks – makes the stomach more acidic and disturbed digestion

Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)

Milk and milk products other than buttermilk- Cause indigestion, increase Kaphadosha, can lead to obstruction in channels and respiratory problems.

Curd – causes vidaaha and thereby many other diseases

Red chilli and other pungent, hot and spicy food items.

Vihaara

Better to avoid exposure to excessive sunlight.

Avoid stress.

Maintain a regular food and sleep schedule.

Avoid sedentary lifestyle as it is one of the main causes of many diseases.

Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.

Yoga

Most of skin diseases, gets worse with stress & lack of proper circulation. A regular exercise routine and yoga therapy is recommended in psoriasis cases for proper destressing & improved circulation.

Salabhasana

vajrasana

Nadisudhi pranayama

Bhujangasana

All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.

Research articles

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063367/

These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.

Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.

Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.

Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.

Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com

Whatsapp – +91 9446918019, +91 8075810816

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