title: Integrating modern dermatology and Ayurveda in the treatment of vitiligo and lymphedema in India.
abstract: BACKGROUND
  Globally, governments have recognized the growing popularity of Complementary and Alternative Medicines and the possibility of their combined use with biomedicine. Decisions within the Government of India have led to a conducive environment for conducting clinical studies, to achieve integration of more than one system of medicine, so that their combined benefits can be brought to bear on chronic, difficult-to-treat conditions.
  
  
  OBJECTIVE
  To develop integrative dermatology treatment protocols for patients with long-standing skin diseases who have received treatment from many centers.
  
  
  METHODS
  A team of doctors from modern dermatology, Ayurveda, yoga therapy, and homeopathy studied recruited patients to develop mutual orientation on each therapeutic system and a working knowledge of approach to their clinical diagnosis. Six-hundred thirty-eight patients affected by lower limb lymphedema requiring skin care as a major part of treatment were treated integrating modern dermatology and Ayurveda. Three-hundred eighty-one vitiligo patients were examined and treated to understand the clinical presentations and treatment options in Ayurveda.
  
  
  RESULTS
  A two-step cluster analysis performed by SPSS Version 16 showed average volume reductions of 13.3% and 23% on day 14, 19.7% and 31.1% on day 45, and 23.4% and 39.7% on day 90 of treatment in small and large lymphedematous limbs. Inflammatory episodes before the onset on this treatment was reported by 79.5% of our lymphedema patients, and 9.4% reported this at the end of three months after our treatment. Among vitiligo patients, we found that 39.6% of patients had kapha, 39.8% pitta, 10.8% had vatha and 0.52% has tridoshaja presentation. There are over 100 treatment options available in Ayurveda to treat vitiligo.
  
  
  CONCLUSIONS
  Each system of medicine recognizes the same disease albeit with minor difference in description. Skin care procedures like washing and emollients restore the barrier function and skin health. We have converged Ayurvedic skin care with that of dermatology with an aim of achieving patient management that is better than that achievable by a single system alone. Overload of the lymphatic system due to loss of epidermal barrier function and consequent inflammation from bacteria and soil irritants is responsive to selected Ayurvedic herbal preparations.
  
  
  CONCLUSIONS
  It is evident that integration at the therapeutic level is possible, although the pathological basis is interpreted differently. Irrespective of background understanding of the given disease, a mutually oriented multisystem therapeutic team was able to effectively use medicines from more than one system of medicine and to develop guidelines for their prescription and a patient care algorithm.
authors.affiliation: Department of Integrative Dermatology, Institute of Applied Dermatology, Kasaragod, India. srnarahari@satyam.net.in
authors.forename: Saravu R
authors.initials: SR
authors.lastname: Narahari
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Ryan
authors.forename: Kuthaje S
authors.initials: KS
authors.lastname: Bose
authors.forename: Kodimoole S
authors.initials: KS
authors.lastname: Prasanna
authors.forename: Guruprasad M
authors.initials: GM
authors.lastname: Aggithaya
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000458:organization & administration; D003880:Dermatology / Q000379:methods* / Q000458:organization & administration; D019317:Evidence-Based Medicine / Q000379:methods / Q000458:organization & administration; D006801:Humans; D007194:India; D008209:Lymphedema / Q000628:therapy*; D008515:Medicine, Ayurvedic; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D014820:Vitiligo / Q000628:therapy*; D015013:Yoga