Research Article International Ayurvedi c Medical Journal ISSN:2320 5091 A HISTOPATHOLOGICAL STUDY ON LEECH APPLICATION IN THE MANAGEMENT OF VICARCIKA (ECZEMA) Shankar Pratap K. M.1 Rao Dattatreya 2 Sai Prasad 3 1Dept. of Shalya Tantra , Santhigiri Ayurvedic College , Palakkad, Kerala, India 2Dept. of Shalya Tantra, S.V. Ayurvedic College, Tirupati , Andhra Pradesh , India 3Dept. of Pathology, S. V. Medical College, Tirupati, Andhra Pradesh, India ABSTRACT To assess the efficacy of Leech application in the management of Vicarcik a (Eczema) with Histopathological study, the present study with 10 patients having the classical symptoms of Vicarcika, were randomly selected as per the inclusion and exclusion criteria from O.P.D. & I.P.D. sections of Shalya department, S.V. Ayurvedic Hospital, Tirupati. Minimum 4 sittings of Leech application was carried out with seven days interval. Total duration of treatment was 6 weeks. Biopsy samples were collected from the lesion site before and after treatment. Histopathological examination was done by the pathologist. In eczema (dermatitis) the leech application therapy gives excellent response by reducing the inflammatory component, hyperkeratosis, spongiosis, irregular acanthosis and by evoking a granulation tissue response in the dermis and in most of the cases with complete recovery from the lesion. Most of the cases in the study were chronic dermatitis and sebhoric keratosis, almost all local/focal pigmented lesion is totally relieved by leech therapy especially in cases of sebhoric keratos is. In the present study it was found that, leech application evokes significant changes at histological level specifically in reduction of inflammatory component, hyperkeratosis, spongiosis and irregular acanthosis. It was also found that there was a considerable formation of granulation tissue, which helps in formation of healthy new tissues. Keywords: Eczema, leech application, hyperkeratosis, spongiosis, acanthosis INTRODUCTION quality of life, including physical, emotional Skin is an extraordinary structure. It and financial consequences. is frequently damaged because it is directly Eczema or dermatitis is a pattern of in the 'firing line' and, for this reason, skin inflammatory respons e of the skin , which is diseases are very common. There are more characterized by erythema, edema, than 3000 known diseases of the vesiculation, exudation and crust skin.1Although most of the chronic skin formation. 2Acute eczema presents with conditions, such as eczema, psoriasis, weeping, crusting and vesicle formation and vitiligo and leg ulcers, are not immediately sub acute or chronic with dryness, scaling, life-threatening, they are recognized as a fissurin g and lichenification. considera ble burden on health status and Histologically, dermatitis is characterized by inflammation of the Pratap Shankar et. al: Histopathological Study on Leech Application in the Management of Vicarcika epidermis i.e. perivascular lymphohistocytic bloodletting, leech application was selected infiltrate. The hallmark of acute dermatitis is as it is specifically indicated for Tvak dosha spongiosis (intraepidermal vesicles) and (skin disease) 9 and biochemicals released exocytosis of lymphocytes. In sub acute from leech saliva have antinflammatory, dermatitis, apart from the features of acute antibiotic, thrombolytic actions etc., further dermatitis, parakeratosis (increase in leeches can be easily administered with less thickness of stratum corneum) and complication and are cost effective. Many acanthosis (thickened epidermis) are clinical studies have already proved the prominent. As eczema becomes more efficacy of leech application in skin diseases chronic, there is tendency for it to become especially in eczema, but still effect of leech more acanthotic and less spongiotic 3 application on histological level was not accompanied by T-helper lymphocytic explored. Hence this study was designed to infiltration in the upper dermis.4 prove the efficacy of leech application in Management of eczema involves eczema at the tissue level through topical applications like emollients, Histopathological examinations. antipuritic lotions, steroids, coal tar and zinc MATERIALS AND METHODS paste etc, oral antibiotics, sedative Selection of Patients: antihistamines, corticosteroids and Ten patients having the classical immunosuppressive agents.5Even after their symptoms of Eczema were randomly use relapses, recurrences and other selected from O.P.D. & I.P.D. sections of complications are very common. Dept. of Shalya , S.V. Ayurvedic Hospital, Indiscriminate use of these drugs can cause Tirupati. The inclusion criteria included vomiting, diarrhea, stomach upset, allergic patients of age group 16 to 70 yrs (as reaction, peptic ulcer, neuropsychiatric bloodletting is indicated for this age reactions, diabetes, diminution of libido, group). 10 The exclusion criteria included, Cushing’s syndrome etc. patients having secondary infections, In maximum cases, failure of bleeding disorders, Diabetes Mellitus, Heart contemporary medicine in the treatment of diseases, Tuberculosis, Leprosy and eczema push them to chronic state and Generalized eczema. A specific case sheet hence report to Ayurvedic system in the later was prepared and the patients of the present stage. Vicarcika has been mentioned in study were examined in detail as per case Ayurvedic classics under Kshudra Kustha 6 sheet. Routine hematological investigations and also under Kshudra roga .7 According to and urine examinations were carried out Ayurveda, Rakta dushti (vitiation of blood) before and after treatment to rule out the is one of the prime causes of skin diseases, other associated pathology. The patients among the Shodhana karma (purificatory were included for study after taking written treatments); bloodletting is considered as the consent for ethical clearance. best treatment for skin diseases. According Treatment: Minimum 4 sittings of leech to Sushruta , if a person regularly undergoes application therapy were carried out with bloodletting, he can develop resistance seven days interval. Number of leeches against all types of skin diseases.8 In the applied was decided on the basis of the size present study, among the various methods of 2 www.iamj.in IAMJ: Volume 1; Issue 4 ; July – Aug 2013 Pratap Shankar et. al: Histopathological Study on Leech Application in the Management of Vicarcika of lesion. Procedure of leech application was separate pot containing pure water and used under taken in the following stage: for the same patient after a gap of 7 days. Pre operative procedure : Non poisonous The frequency of leech application will vary Leeches were identified and collected from according to the severity of disease. fresh water sources; they were stored in mud Generally leeches should be applied once in pots. On the day of application, the patient a week up to 4-6 sittings. Leeches should be was placed on proper position according to reserved for a particular patient to avoid the site of lesion. Leeches (no. as required) cross infection. were kept in turmeric water to make them Contra indication of leech therapy active, increase appetite and free from 1. Blood clotting disorder. natural urges, after keeping the leeches for 2. Severe anemia. 45 minutes they were put in fresh water. 3. Allergic reaction to active substances Operative procedure: Lesion is cleaned by of the leech such as hirudin, water and dried with cotton. After this, hyaluronidase, egline, apyrase, rubbing of skin was done as per need. For destabilase, etc. this purpose, either sterilized cotton bandage 4. Human with weak constitution. pad or thick thread of jute was used. The 5. Pregnancy. activated leeches were applied over the Precautions during leech application lesion site. Leeches become elevated like a 1. Bleeding and clotting time of the horse shoe or raised in arched position from patient should be normal. its neck which indicates that they are 2. Gentle handling of the leech. sucking the blood vigorously or strength 3. Cover the leech with wet cotton. fully. After catching the site, leeches were Histopathological analysis covered by wet cotton pad and regularly Skin biopsy (Incisional biopsy) was sprinkled with cold water. The leeches taken from the lesion site before and after usually detach from the site after sucking the the treatment. Sample was transported to the vitiated blood or have to be removed by pathology lab in a fixative (10% formalin sprinkling salt over it when the patient solution). For the histological examinations, complains pain or itching. paraffin-embedded tissue sections of the Post operative procedure : After skin (5 µm) were stained with hematoxylin- detachment of leeches, wound was cleaned eosin (HE). The tissue samples were then with anti septic solution and after that tight examined and photographed under a light bandage was applied for prevention of microscope (Olympus CX31, Olympus, secondary hemorrhage. After falling off, the Japan), for observation. The leeches were dusted with rice powder and Histopathological parameters were fixed as turmeric powder was applied on the mouth follows: Acute dermatitis – Spongiosis and to make it vomit the sucked blood exocytosis of lymphocytes; Sub acute (otherwise it may cause death of leeches). dermatitis – Parakeratosis, acanthosis, Leeches after vomiting were put in fresh Spongiosis and exocytosis of lymphocytes; water and when they move freely without Chronic dermatitis - Irregular acanthosis, sinking down were considered as