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Ayurvedic Herbal Treatment of Pemphigus Vulgaris (PV)
Pemphigus vulgaris (PV) involves the formation of blisters on the skin and mucous membranes. Although rare, this disease is quite significant as it is potentially life-threatening with a high mortality rate of 5-15%. Blistering of the skin and mucous membranes is a hallmark of this disease, caused by the presence of circulating antibodies directed against the cell surfaces of keratinocytes in the skin, causing loss of adhesion between cells and breakdown of the skin. the skin. Blisters may appear on normal or inflamed skin; they have different sizes; they are fragile and tear easily; they are painful and heal slowly, usually without scarring. Oral involvement is the most common manifestation; other mucous membranes that may be involved include the conjunctiva, esophagus, labia, vagina, cervix, vulva, penis, urethra, nasal mucosa, and anus.
A skin biopsy from the edge of the blister can help with an accurate diagnosis. Two tests are commonly used: direct immunofluorescence (DIF) on normal-appearing skin surrounding a blister or torn hair sheath; and indirect immunofluorescence (IDIF) using patient serum. Antibody titers correlate well with disease activity and can be detected using ELISA tests. Antibodies to desmoglein 3 indicate mucosal involvement; while antidesmoglein 1 levels help predict the course of the disease. DIF test reversal to negative can be used as an indicator of remission and for monitoring during tapering of medications.
Corticosteroids are used as the main treatment for PV to reduce and stop the inflammatory process; while immunosuppressive drugs are sometimes used early in the course of the disease as steroid-sparing drugs. Susceptibility to infection as well as fluid and electrolyte imbalances contribute to mortality, which is more common in the first 5 years of illness. Morbidity and mortality are related to the severity and extent of disease, the dosage of steroids required to induce remission, as well as the presence of comorbidities, with older patients and patients with extensive disease having a worse prognosis. Long-term use of steroids and immunosuppressants also contributes to overall morbidity and mortality. Steroid-sparing medications include rituximab, sulfasalazine, pentoxifylline, methotrexate, and dapsone. Intravenous immunoglobulin therapy and plasmapheresis have been used with some degree of success in refractory patients.
Ayurvedic herbal medicines play a significant role in the overall long-term treatment and management of PV, considering the high mortality of this disease as well as the contributing toxicity of steroids and immunosuppressive drugs. As with all autoimmune disorders, the treatment protocol for this disease includes a multifaceted approach of detoxification, proper nutrition, rejuvenation of body systems, immune modulation as well as specific treatment for the currently affected systems or organs.
Ayurvedic treatment to strengthen the integrity of the skin and mucous membranes involves the use of drugs that act specifically on the skin and mucous membranes as well as the blood vessels. Immune-modulating herbs that work specifically on the skin and mucous membranes are very helpful in this scenario. Other medications are also required to help the ulcers heal and to prevent secondary infection of the ulcers.
The Ayurvedic detoxification protocol for each patient needs to be tailored according to the severity and chronicity of the PV lesions. While some patients may require only a few additional drugs to enhance kidney and liver function, others may require an elaborate detoxification plan for induced vomiting, induced cleansing, and perfusion. These procedures, known in Ayurveda as Panch-karma, can be used alone or as combined procedures. These detoxification procedures are highly effective and have the potential to provide rapid remission of PV symptoms; however, patients must be carefully selected because most affected PVs are old or have concurrent comorbid diseases.
Ayurvedic herbal medicines may need to be administered for about 6 to 10 months, with more than 80% of patients achieving complete remission. Recurrences can be prevented by gradual reduction of medication, appropriate modification of diet and lifestyle. Aggravating factors such as stress and certain medications should also be avoided. Thus, Ayurvedic herbal treatment can significantly improve PV and significantly reduce the mortality and morbidity caused by this condition.
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