What is Urticarial Vasculitis? – Causes, Symptoms and Ayurvedic Treatment
ABSTRACT
Urticarial Vasculitis is a rare autoimmune disorder, also known as chronic urticaria. Autoimmune disorders can cause abnormally low activity of the immune system. When there is overactivity the body attacks and damages its own tissues. And its deficiency decreases to fight against infections. An unknown trigger begins to produce antibodies which instead of fighting it attacks its own tissues. Inflammation is the essential part of the body, and in the process of healing. If the inflammation continues it may lead to chronic inflammation. If inflammation is in the immune system it affects the various arteries, veins and many small arteries. When inflammation weakens it leads to aneurysms. When blood vessels get narrow it causes occlusions. When the immune system gets overactive, it attacks parts of the body and causes allergic reactions which are known as antigens. Vasculitis can affect small blood vessels (capillaries), medium size blood vessels and large blood vessels (aorta). When these rashes appear which leaves behind dusky hyperpigmentation. Usually this disease is idiopathic but is linked to many drugs, infections and many autoimmune connective diseases. In this article we are going to study about its causes, signs and its ayurvedic management further in detail.
INTRODUCTION
Urticarial vasculitis is the rare disease of the inflammation of the blood vessels, which can restrict the flow of blood which damages the organs and various tissues. It has histological evidence of leukocytoclastic vasculitis. It forms primarily the small vessels on the skin, causing various patches and hives which cause itching, burn and leave the skin discolouration. Hives are the sudden pale blue, red lumps on the skin which results in allergic reactions. It ranges in size from 1mm to each centimeter which is known as giant urticaria which is often itchy. It is characterized by chronic and recurrent episodes of lesions which show characteristic of leukocytoclastic vasculitis which is limited to skin and on various organs such as renal, pulmonary, ocular system. It can be seen in skin diseases such as EGPA (Churg- Strauss), IgG4 related diseases. Sometimes it is triggered by disease such as infection, cancer. Some are associated with the blood complement system in the blood. It usually affects people of all ages, commonly seen in adults between 30-40 years of age. Women are more prone to get this disease.
FACTS
- Urticarial vasculitis can be a feature of any other disease or a disease of its own.
- It can be limited to skin or may have systemic manifestation
- There are complement abnormalities in blood, so the term hypocomplementemic is used.
- Treatment follows the same principles and drugs in other vasculitis too.
TYPES
There are generally two types of urticarial vasculitis for complement proteins in the blood which plays an important role in the immune system.
- Normocomplementemic Urticarial Vasculitis- It mainly refers to normal level of complement proteins which is less severe and has little effect on organs involvement.
- Hypocomplementemic Urticarial Vasculitis- It refers to the low level of complement which affects the joints, lungs, kidneys and other tract.
MECHANISM
Antibodies are raised against foregin proteins as they are replicated by certain viruses. These antibodies get stuck to highlight the other cells of the immune system. Antibodies against self proteins known as autoantibodies which are not found in any healthy individuals. They only detect various diseases,
C1q– It is the integral component of a complicated pathway of protein, seen in hypocomplementemic urticarial vasculitis, in low level.
Impaired classical complement pathway- It includes further subsets pathway such as lectin and mannose pathway. This pathway culminates in the production of C3 convertase and catalyzes the other parts. The inhibition of C1 inhibitor leads to overactivation of the complement pathway, which builds up the protein which results in the excess water being built up under the skin.
CAUSES
- Inflammatory connective disorders such in SLE and Sjogren Syndrome
- Leukemia and other cancer
- Viral disease such as Hepatitis B, Hepatitis C and Glandular fever
- Immunoglobulin disorders such as immunoglobulin A, M monoclonal gammopathies.
- Drug induced conditions such as ACE inhibitors, sulfonamides and thiazides.
SYMPTOMS
It usually begins with an eruption of the skin lesions (wheals), Hives (urticaria) which causes itching, pain and burning sensations. These patches have a red rim with a white center and many petechiae, also red purple spots under the skin. It is present for more than 24 hour and heals by leaving bruises like discoloration as they heal.
The Most Common Symptoms Are
- Fever
- Abdominal pain
- Inflammation in eyes
- Joint pain
- Shortness of breath
- Cardiac involvement
- Inflammation in kidney
- Ecchymoses and hyperpigmentation during healing
- Swollen lymph nodes
- Photosensitivity
DIAGNOSIS
- Skin Biopsy
- Blood test
- Kidney test
- Chest X Ray
- CRP
- ESR
DIFFERENTIAL DIAGNOSIS
- Chronic idiopathic urticaria
- Schmitzler’s syndrome
- Well’s syndrome
- Tumid lupus erythematosus
- Erythema migrans
TREATMENT
Patients suffering from normocomplementemic urticarial vasculitis causes no systemic involvement so can resolve on their own. So the treatment is based on the systemic effects and its extent of involvement.
- Antihistamines
- Non steroidal anti inflammatory drugs (NSAIDS) are used to relieve the symptoms.
- Corticosteroids (such as oral prednisone)
- Hydroxychloroquine
- Other immunosuppressive agents such as Cyclosporine, azathioprine.
Other therapies that are effective include high dose Iv immunoglobulin, Plasma exchange and rituximab.
SIDE EFFECTS
- Lower immunity fight against infection
- Osteoporosis
AYURVEDIC MANAGEMENT
In ayurveda urticarial vasculitis is co related with Agni visarpa (vata pitta visarpa). Agneya visarpa is blisters as if burnt by fire which occurs with high levels of inflammation and is usually vitiated by vata and pitta which is associated by fever, vomiting, joint pain and many more. These visarpas closely resemble herpes, blisters due to cutaneous radiation syndrome.
CAUSES OF VISARPA ROGAS
- Nij Hetu-
- Excessive consumption of salt, sour and hot food.
- Over use of curd, beer and vinegar
- Increased and regular intake of heavy food items such as lasun (garlic), Kulthi (Macrotyloma uniflorum) and flour of grains
- Suppressing the urge of vomit
- Atibhojan, divaswapna and ajiran (indigestion), adhyasahan.
- Avoid use of oily junk food, stale food and unfavorable foods.
- Aagantuj Hetu-
- Over exposure of sunlight and wind
- Falling from height
- Exposure to contaminated wind and environment
SYMPTOMS OF VISARPA
- Fever
- Burn like blisters
- Reddish and bluish color discoloration in the region where disease is progressing
- Episodes of hiccups, anxiety and sometimes death
- Reduced sleep
- Burning sensation in the whole body.
SADHYA- ASDHYATA
- The visarpa roga which is limited to skin only is easily treatable
- When the condition is present in body tissues (antarmarg gatt) that is difficult to treat.
- If this disease is neglected then it can kill a person like a poisonous snake.
TREATMENT
It includes
- Nidana parivarjana
- Shodana chikitsa
- Shaman chikitsa
- Pathya- Apathya
- Nidana Pravanjan- It is the avoidance of the causative factors and risk factors.
- Shodana Chikitsa- This is used in detoxification of the body and various body tissues-
- Virechana (therapeutic purgation)- With medicated ghee
- Raktamokshana (bloodletting therapy)- It is beneficial in early stages when the disease is limited to the skin
- Vamana (therapeutic emesis)- It is the best procedure for skin disorders.
- Basti (medicated enema)- It is the best procedure for vataj disorders.
- Shaman Chikitsa- It includes various formulations which includes for oral administration and for local applications such as Parlep (dashang lepa) and various medicated oils which usually contain drugs such as Karanj, Sunthi etc.
VARIOUS HERBS USEFUL FOR URTICARIAL VASCULITIS
1. GILOY
Giloy (Tinospora cordifolia) is a famous ayurvedic herb used extensively in the treatment of fever , diabetes and in many autoimmune disorders. It is very helpful in treating vata imbalance disorders, helps to balance tridoshas, is light to digest and has madhura vipaka. It works as a rejuvenative and is used in malabsorption syndrome which helps to relieve indigestion and burning sensation.
2. HARIDRA
Haridra (Curcuma longa) is one of the famous ayurvedic herbs which helps to remove the blocked guna’s in the blood vessels and makes the circulation easy of the blood and nutrients. It helps to correct the metabolism which enables the free circulation of nutrients and has antioxidant properties and liver restorative properties.
3. NEEM
Neem (Azadirachta indica) has cold potency and has katu vipaka. It helps in absorbing moisture from the intestine and cleans the dried ulcers. Helps to improve digestion, relieves tiredness and usually balances pitta and kapha doshas. It is useful in diabetes and various disorders which are related to the urinary tract. Helpful in various skin disorders, cleanses the wounds quickly.
HERBAL REMEDIES BY PLANET AYURVEDA FOR URTICARIAL VASCULITIS
Planet Ayurveda is an ayurvedic clinic which has been serving humanity for the last 20 years and provides great treatment with great results. All the formulations which are prepared by planet ayurveda are made under the strict guidance of M.D experts. These herbal remedies are free from any resins, colors and from synthetic preservatives. These products are 100% pure made from plant extracts and provide the benefits to patients without causing any side effects.
PRODUCTS LIST
- ALLER G CARE
- GANDHAK RASAYAN
- PITTA BALANCE
- KAMDUDHA RAS
PRODUCTS DESCRIPTION
1. Aller G Care
These are poly herbal capsules prepared by planet ayurveda using ingredients such as Haridra (Curcuma longa), Shirish (Albizia lebbeck), Ashwagandha (Withania somnifera), Neem (Azadirachta indica). These capsules have vish ghan property which helps to remove the excess toxins out of the body and are used in blood related disorders. Aller G Care Capsules has an anti-inflammatory and analgesic property. It helps to enhance the immunity and provides the strength to the body to fight against infections
Dosage– 1-2 capsules twice daily with plain water after meals.
2.Gandhak Rasayan
Gandhak Rasayan are herbal tablets formulated by planet ayurveda using standardized extract of Shuddha Gandhak (Pure Gandhak). These tablets are very helpful against skin disorders, it helps to calm the burning sensation of the blisters. It helps to reduce the itching, scabies and improves the skin complexion. Gandhak Rasayan is beneficial in urinary tract disorders, helps to improve digestion and absorption.
Dosage– 1-2 tablets twice daily with lukewarm water.
3. Pitta Balance
These are polyherbal Capsules prepared using ingredients such as JaharMohra Pishti (Calcium Compound), Akik Pishti (Calcium Compound) and many more. It helps to restore the vata imbalance, improves bone density, and reduces excessive bleeding due to menstruation. Thesee capsules help in piles, decreasing eyesight and in premature graying of hair. Helps to restore the healthy skin and clears complexion ct as a blood cleanser.
Dosage– 1-2 capsules twice daily with plain water after meals.
4. Kamdudha Ras
These are classical ayurvedic formulations made using ingredients such as Amrita Satva (Tinospora cordifolia), Swarna Gairik (Ochre) and many more. These tablets are useful in headache, ulcerative colitis and in peptic ulcers. It is helpful in pitta disorders and in various bleeding disorders. It helps to reduce the Daha and inflammation.
Dosage- 2 tablets twice daily with plain water.
CONCLUSION
Urticarial Vasculitis is a rare autoimmune disorder, also known as chronic urticaria. Autoimmune disorders can cause abnormally low activity of the immune system. It forms primarily the small vessels on the skin, causing various patches and hives which cause itching, burn and leave the skin discolouration. Hives are the sudden pale blue, red lumps on the skin which results in allergic reactions. In ayurveda urticarial vasculitis is co related with Agni visarpa (vata pitta visarpa). Agneya visarpa is blisters as if burnt by fire which occurs with high levels of inflammation and is usually vitiated by vata and pitta. Planet ayurveda provided many herbal remedies which provided great relief to patients without causing any side effects.
Dr. Vikram Chauhan
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