Ayurvedic management for Epidermolysis bullosa - A case report

Epidermolysis bullosa (EB) is an inherited or auto-immunity-mediated, heterogeneous group of rare genetic dermatoses characterized by fragile skin and mucosae with blister formation induced by minimal trauma. Junctional Epidermolysis Bullosa (JEB) is an autosomal recessive inherited subtype of EB with higher chances of malnutrition and nail involvement. Considering the key factors such as genetic disposition, chronicity, pathology, involvement of deeper tissues, and complexities, EB may be considered as Kustha (spectrum of diseases of the integumentary system) from an Ayurvedic perspective. A 34-year-old male patient diagnosed with JEB presented with a history of persistent non-healing ulcers, recurrent blisters, and bullae, usually occurring after minor trauma since the age of three months. The ulcers, scars, and lesions were widespread, covering approximately two-thirds of the body. After a thorough understanding of the Ayurvedic pathology of the disease, Shamana (pacifying therapy) and Shodhana (purificatory therapy) procedures were administered. Later, raktamoshana (Blood-letting through venesection and jalaukavacharana) was also employed. During the treatment and follow-up period, the episodes of new blister formations drastically reduced, and the ulcer formed from occasional blisters healed quickly without crusting. There was a considerable reduction in wound surface area. The patient's personal and social interactions improved. Quality of Life assessed through the Dermatology Life Quality Index (DLQI) showed improvement. The present case of JEB was effectively managed using various Ayurvedic treatment modalities. Understanding the Ayurvedic pathology and tailoring treatment strategies can yield better results in chronic, debilitating autoimmune dermatological conditions such as EB.