Introduction:

Keloid is result of frequent physical trauma on certain part of the body. Now days ear piercing is most knowingly fashion.keloid of ear pinna is the complication of ear piercing.keloid expands in claw-like growths over normal skin. They have the capability to hurt with a needle like pain or to itch without warning.

Keloids were described by Egyptian surgeons around 1700 BC. Baron Jean-Louis Alibert (1768–1837) identified the keloid as an entity in 1806. He called them cancroïde, later changing the name to chéloïde to avoid confusion with cancer. The word is derived from the Greek chele, meaning " hoof ", here in the sense of "crab pincers ", and the suffix -oid , meaning "like".

The causes of keloid are piercing, pimple, acne, chickenpox, insect bite, infection, repeated trauma. As per ear pinna keloid excessive and repeated ear piercing is main cause which is gift of modern style. Such trauma developed circular, painless, irregular swelling and hard in consistence and devoid of tenderness.

The frequency of occurrence is 15 times higher in highly pigmented people.

Accoding to ayurvedic samhita it’s described as arbuda of karna pali.  According to ayurvdic literature, keloid of ear pinna can be correlated with arbuda. Arbuda is mansa dhatupradoshak vhyadhi.

Sushruta charya describe shastra karma treatment inmansadhatupradoshak vhyadhi.

As comparing to modern surgery kshrasutra is best surgery in such disease

Ksharasutra has controlled chemical cauterizing action on living tissue. Its action is a simultaneous combination of incision, excision. Debridement, scrapping along with haemostatic, antiseptic and healing. Ayurvedic management for such case gives best result and avoid relapse and provide complete cure.

A case report as follow:

A 32 year old Female patient came to us with chief compliant of

Over growth of the fibrous tissue on Right ear lobe: -since last 3 years.
H/Osurgery of Right ear pinna keloid – Two year ago
No H/o Dm / HTN, Asthma

History of personal illness: The patient was normal 3 years back. Patient has hobby of ear piercings. Ultimately its result in Right ear pinna keloid. As beauty precaution so she done excision of ear pinna keloid from ENT surgeon. Butit’s occurringagain and again. To stop its recurrence she came toward Ayurveda - our hospital – Seth Sakharam Nemchand Jain AyurvedicRugnalaya in shalya-chikitsa department opd.

Personal History: Occupation: House wife. O/E: Nadi (pulse) = 74/min. Mala (stool) = Prakruta (Normal). Mutra (urine) = Prakruta (Normal). Jeeva (tounge) = Eshatha saam. Agni = Prakruta(Normal). Shabda (speech) = Prakruta (Normal). Sparsha (skin) = Prakruta (Normal). Druka (eyes) = Prakruta (Normal). Akruti = Madhyama. Bala = Madhyama. Raktadaaba (B.P) = 100/70 mm/Hg.

Material and Method: Material - ksharasutra ligation (on every 3rd days )

Method - Center of study : S.S.N.J.AyurvedicRugnalaya, Solapur. Simple random single case study.

Preparation of ksharasutra : ksharasutra was prepared as per classical method. Surgical Barbour thread no 20 was used for preparation of ksharasutra. 11 layers of shuhi ksheer (latex of Euphoria) and7 layer haridara (curcuma longa) powders were applied on the thread and were allowed to get dry. Another 3 layers of the combination was applied, similarly and was dried. This procedure containing total 21 alternate coating. This thread, now called as ksharasutra. This ksharasutra is kept in UV chamber for maintain its sterility.

Surgical protocol : Under all aseptic precaution local anethesic lignocaine 2% with adrenaline (1:1000) was administered by infiltration in superficial skin around the base of the keloid. A superficial skin incision was taken around the base of keloid. A sterile ksharasutra was applied and legated tightly on the incision site. After ligation dressing with povidone iodine was done. The patient was observed for pain, inflammation, discolouration, and necrosis. The same ksharasutra kept for three days. On the fourth day after removal of first ksharasutra a fresh sterile ksharasutra was ligated. The new ksharasutra was kept for next three days. This cycle continues till keloid get fall off completely. Dressing with pividone-iodine was done after ligation of ksharasutra. Patient was asking to visit on day the keloid fell off completely.

Discussion: According to Ayurvdic literature, keloid of ear pinna can be correlated with Arbuda of karna pali.Arbudais mansa dhatupradoshak vhyadhi. Application of kshrasutra is best in such disease. Action of drug: Shnuhi ksheer (latex of Euphoria nerifolia)is strong alkaline in nature which cause chemical cauterization. Its action on tissue begins with severe irritation and subsequent inflammation of local tissue causing local tissue necrosis. This debris of necroses tissue is cleared out giving way for fresh budding granulation tissue over the wound. Haridra (curcuma longa) is anti-inflammatory, antiseptic and antibacterial having wound healing activity which prevents infection and facilities tissue growth thereby promoting healing. Ksharasutra has controlled chemical cauterizing action on living tissue. Its action is a simultaneous combination of incision, excision.debridement, scrapping along with haemostatic,antiseptic and healing. This lead to removal keloid mass without producing any other injury.

Sanprapti Ghatak: Dosh : Vata, kapha Dushya : Rakta,Mansa. Adhishtana : Left ear pinna. Hetu–Ear piercing.

Result: The study shows that ear pinna keloid can be successfully removed by ksharasutra and there is significance risk reduction in recurrence of earpinna keoid.

Conclusion: Since the even after surgery ofear pinna keloidthere is chances of recurrence, Ayurvedic management with ksharsutracan be effective therapy in recurrent ear pinna keoid.

References:

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