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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 42-45

Ayurvedic cosmetic reconstruction for aural keloid of ear piercing


Department of Shalakya Tantra, Ayurveda College, Coimbatore, Tamil Nadu, India

Date of Web Publication1-Nov-2017

Correspondence Address:
P Pundareekaksha Rao
Department of Shalakya Tantra, Ayurveda College, Coimbatore - 641 402, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijny.ijoyppp_6_17

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  Abstract 

Aural keloid is a development of growth in the ear which developed after ear piercing. It can present unilaterally or bilaterally with a raised and irregular border. The present report deals with a case of “aural keloid” diagnosed as “unmantha” according to Ayurveda. Efficacy of treatment was assessed on the photography. The main objectives of the treatment were to provide relief in signs and symptoms of “aural keloid” and also to prevent reoccurrences. Total four assessments were done, before treatment and after follow-up. Shastra karma is done followed by kshara karma and internal Ayurvedic medicines with dietary restrictions along with the lifestyle changes. In the present case, the patient got “clinical cure” with good improvement in itching, redness/inflammation, and also in discomfort after the procedure. With the Ayurvedic treatment procedures followed by internal medicines seem to prevent recurrence/relapse with high cure rate with no adverse effects.

Keywords: Aural keloid, kshara karma, shastra karma, unmantha


How to cite this article:
Rao P P. Ayurvedic cosmetic reconstruction for aural keloid of ear piercing. Int J Yoga - Philosop Psychol Parapsychol 2016;4:42-5

How to cite this URL:
Rao P P. Ayurvedic cosmetic reconstruction for aural keloid of ear piercing. Int J Yoga - Philosop Psychol Parapsychol [serial online] 2016 [cited 2017 Nov 21];4:42-5. Available from: http://www.ijoyppp.org/text.asp?2016/4/2/42/217479


  Introduction Top


Aural keloid is a development of growth in the ear which developed after ear piercing. It can present unilaterally or bilaterally with a raised and irregular border. Topical anti-inflammatory drugs, oral anti-inflammatory drugs, and topical systemic corticosteroids are used to treat “aural keloid.” There was no sufficient data regarding the efficacy of Ayurveda in the management of “aural keloid.” The present case report deals with a patient of “aural keloid,” not getting satisfactory relief (with recurrence) with modern medicines opt Ayurvedic treatment for sustained relief. “Aural keloid” can be correlated with “unmantha.” Keloids are benign skin lesions arising from the exuberant proliferation of collagen substance during the healing phase of wound.[1] The first description of abnormal scar formation in the form of keloids was recorded in the Smith Papyrus regarding surgical techniques in Egypt around 1700 B. C.[2] Although there are many theories about keloid formation, their etiology is still unknown. Abdalla Osman et al. claim that an autoimmune response to sebum trapped deep in the dermis may lead to keloid formation.[3] A disorder of the hormone that stimulates melanocyte is one of the factors that is accused of causing keloid formation.[4] Of all types of keloid, lobular keloid occurs has the highest incidence.


  Case Report Top


A 22-year-old female patient came to Shalakya outpatient department with the complaints of progressive lesion located on the right pinna which is painful and itchy. The patient has been suffering for 2 years. She noticed slight elevation was there at ear piercing, slowly it became nodular mass. The patient was diagnosed as having “aural keloid” and took anti-inflammatory agents and topical corticosteroids but did not get sustained relief. On examination, the lesion is expanding in nature. There was no vesiculation or oozing. There was no history of discharge from the mass. The patient was not having any addictions and she was nondiabetic. His vital signs were stable, and on systemic examination, there was nothing abnormal. The mass was superficial firm and hard in consistency, elevated with irregular borders, shiny, tender while pressing, mobile, and 7 mm × 7 mm × 5 mm in size at back of the right ear pinna. The adjacent skin around the lesion was indurated, but rest of the skin was normal. The anterior surface of the ear was within normal limit. There was no lymphadenopathy. Routine hematological and biochemical investigations were within normal limits. The patient was diagnosed as having “unmantha” is made clinically based on the history and clinical findings. Total four assessments were carried out before starting Ayurvedic treatment and after completion of follow-up. Written informed consent was obtained from the patient for the publication of the present case report. It was suspected as benign mass hence full-thickness excision of mass along with healthy tissue was done under local anesthesia, and apamarga kshara was applied on the lesion.


  Discussion Top


The term keloid is derived from the Greek word cheloides, meaning “crab's claw,” because of its lateral extensions, resembling the legs of a crab, growing into normal tissue.[5] Dark races and Asian people are more likely to develop keloid than Caucasians, the incidence varying from 5:1 to 15:1.[6] Lobular keloid has been reported to occur as a secondary inflammatory response in patients who have undergone ear piercing at nonmedical institutions such as jewelry shop, at home, or school with a piercing gun, needle, and earrings. The lobular keloid appears as smooth, globular, and shinning swellings having the same color as that of the surrounding skin and may occur in one or both ears. Besides cosmetic complaints, others include pain, numbness, and itching.[7],[8],[9] There are no established methods for effectively predicting or preventing recurrence of the lobular keloid.[10] Prevention or treatment methods for lobular keloid include intralesional steroid injection, radiotherapy, compression therapy, surgical excision, silicone sheet application, laser therapy, cryotherapy, interferon-α injection, and pharmacological treatments.[1],[11],[12],[13] Surgical excision of keloids alone has a poor success with a high recurrence rate of 55%.[14] Lee et al. propose a new surgical technique to treat keloid without adjuvant therapy after surgery and called it keloid core extirpation. They found this technique to be excellent in preventing keloid recurrence.[15] In a recent study, it is reported that cyclooxygenase (COX) 2 enzyme gene expression is absent in abnormal scar-derived fibroblasts and may contribute to the development of fibrotic scars, and that COX gene expression could be modulated by hexose sugars and sucrose, especially in normal granulation tissue fibroblasts (about 90% decrease at maximum) and hypertrophic scar fibroblasts (almost sevenfold increase).[16]

Auricle keloid closely resembles with unmantha. Same colored painless swelling of pinna arising from vata and kapha and having itching is known as unmantha or galliri.[17] The Ayurvedic line of treatment for “karnaroga” consists of Shodhana and Shamana. In unmantha, the pinna should anoint with prepared with talapatra, ashwagandha, arka, fruits of bakuchi and saindhava, and muscle fat of godha and karka. Navana nasya should be done with surana and langali, tikshna dravya, and siddha taila.[18]

In the present case, virechana was done after snehapana (internal administration of pure cow's ghee) for eliminating the preaccumulated dosa. After attaining samyak snigdha lakshana (signs and symptoms to assess proper snehapana) medicine was given for virechana purpose. About 5 g of Avipathi churnam along with 10 ml of “eranda tailam” is prescribed at early morning on empty stomach. The patient got 6 vega's without any discomfort. After virechana, Samsarjana krama (posttherapeutic diet regimen) was observed for 3 days. There was a good improvement noticed immediately after shastra and kshara karma in signs and symptoms. Itching, redness/inflammation, and pain during pressing got reduced. The lesion was reduced in size and also the intensity. Before starting treatment, the size of lesion was 7 mm × 7 mm × 5 mm, which is reduced to 3 mm (width) during follow-up assessment. Kanchanara guggulu and triphala ghrita (for local application on affected areas) were prescribed after the procedure. Along with internal medication, pathya and apathya (diet protocol suitable to the patient and disease) and personal hygiene were advised to the patient to prevent recurrence. Dressing was conducted daily. Scar mark measured after 15 days as 6 mm × 6 mm × 1 mm (width). No adverse effects were reported by the patient [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6].
Figure 1: Before the treatment

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Figure 2: Before treatment lateral view

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Figure 3: Shastra karma

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Figure 4: Kshara karma

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Figure 5: After procedure

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Figure 6: After treatment

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  Conclusion Top


Long-term follow-up is essential since it has high rate of recurrence and distant metastasis. The patient got clinically meaningful improvement by shastra karma and followed by kshara karma along with internal medicines and dietary restrictions. With the Ayurvedic treatment procedures followed by internal medicines seem to prevent recurrence/relapse with high cure rate with no adverse effects. The present study findings cannot be generalized, and further long-term follow-up studies with large sample are required to substantiate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kelly AP. Medical and surgical therapies for keloids. Dermatol Ther 2004;17:212-8.  Back to cited text no. 1
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2.
Tanaydin V, Colla C, Piatkowski A, Beugels J, Hendrix N, den Kerckhove EV, et al. Management of ear keloids using custom-molded pressure clips: A preliminary study. Eur J Plast Surg 2014;37:259-66.  Back to cited text no. 2
    
3.
Abdalla Osman AA, Gumma KA, Satir AA. Highlights on the etiology of keloid. Int Surg 1978;63:33-7.  Back to cited text no. 3
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4.
Koonin AJ. The aetiology of keloids: A review of the literature and a new hypothesis. S Afr Med J 1964;38:913-6.  Back to cited text no. 4
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5.
Addison T. On the keloid of Alibert, and on true keloid. Med Chir Trans 1854;37:27-47.  Back to cited text no. 5
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6.
Blackburn WR, Cosman B. Histologic basis of keloid and hypertrophic scar differentiation. Clinicopathologic correlation. Arch Pathol 1966;82:65-71.  Back to cited text no. 6
[PUBMED]    
7.
Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: A meta-analysis and review of the literature. Arch Facial Plast Surg 2006;8:362-8.  Back to cited text no. 7
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8.
Butler PD, Longaker MT, Yang GP. Current progress in keloid research and treatment. J Am Coll Surg 2008;206:731-41.  Back to cited text no. 8
[PUBMED]    
9.
Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, et al. Areview of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 2007;33:1291-302.  Back to cited text no. 9
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10.
Mutalik S. Treatment of keloids and hypertrophic scars. Indian J Dermatol Venereol Leprol 2005;71:3-8.  Back to cited text no. 10
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11.
Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP. Keloid pathogenesis and treatment. Plast Reconstr Surg 2006;117:286-300.  Back to cited text no. 11
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12.
Park CH, Hong SJ, Chang KH, Jung KN, Kwon TK, Lee JH. Combination therapy of earlobe keloids. Korean J Otolaryngol Head Neck Surg 2006;49:968-72.  Back to cited text no. 12
    
13.
Contin LA, Bastazini I, Alves CJ, do Nascimento DB. Keloids in the ears: Follow-up of 41 patients who had surgery and intralesional corticosteroid injections. Surg Cosmet Dermatol 2011;3:109-11.  Back to cited text no. 13
    
14.
Cosman B, Wolff M. Correlation of keloid recurrence with completeness of local excision. A negative report. Plast Reconstr Surg 1972;50:163-6.  Back to cited text no. 14
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15.
Lee Y, Minn KW, Baek RM, Hong JJ. A new surgical treatment of keloid: Keloid core excision. Ann Plast Surg 2001;46:135-40.  Back to cited text no. 15
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16.
Kössi J, Peltonen J, Uotila P, Laato M. Differential effects of hexoses and sucrose, and platelet-derived growth factor isoforms on cyclooxygenase-1 and -2 mRNA expression in keloid, hypertrophic scar and granulation tissue fibroblasts. Arch Dermatol Res 2001;293:126-32.  Back to cited text no. 16
    
17.
Tripathi B. Astanga Hrudaya Uttarastana, 17/22-23. Delhi: Chaukhamba Sanskrit Pratishthan; 2009.  Back to cited text no. 17
    
18.
Tripathi B. Astanga Hrudaya Uttarastana, 18/45-46. Delhi: Chaukhamba Sanskrit Pratishthan; 2009.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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