Narfarsi (Eczema) Tanzeel - PowerPoint Presentation

Slide1

Narfarsi (Eczema)

Tanzeel

Ahmad

Department of

Moalejat

Slide2

Introduction

‘

Eczein

’ is the

Greek

word from which the word ‘Eczema’ is derived which means to boil out

20

. In classical literatures of

Unani

Eczema is described under the heading of “

Narfarsi

”

which means the fire of

Faras

(Persia). It is so called because it is more prevalent in Persia or the person first diseased was from Persia. This disease is synonymously known as “

Chajan

” or “

Akota

”.

Slide3

Introduction

According to

Jalinoos

(129AD-200 AD)

the eruptions appear on body when

Dam

(Sanguineous matter) becomes hot even

Safra

(Bilious matter)

Ibn

Sina

(

980-1037

)- These are the Eruptions burning like fire and contain corrosive matter, burning and

irritative

that may be caused when Hot humour (Bilious matter) is mixed in dry

khilt

that is

Saudavi

madda

(Melancholic matter)

Slide4

Definition

M.H.Quamri

described ‘

Narfarsi

’ a

s a type of Itch related to very severe non bearable burning, it occurs in some organs with

vesiculation

and the vesicles are filled with dilute liquid. It is due to increase of

hiddat

in

khilte

Dam

because of

safra

.

Slide5

Dawood

Antaqi

(1541-1599AD)

quoted that the term

Narfarsi

is given to this disease because it is more prevalent in Persia, and there is intense itching and burning in lesion

.

Akbar

Arzani

(1722 AD)

also described

Narfarsi

in his book

Tibb

e

akbar

as a skin disease associated with vesicle formation, itching and burning

Slide6

Mohammad Tabri described that,

Narfarsi

is characterised by large vesicles associated with severe burning and pain.

Slide7

Recent concept: Narfarsi is

synonimous

with Eczema /Eczematous

Dermatoses

.

The term Eczema is a clinical and histological pattern of

inflammation

of the skin seen in a variety of

Dermatoses

with widely diverse aetiologies and characterized by variable intensity of itching and soreness, inconsistent grade of signs and symptoms including dryness,

erythema

, excoriation, exudation,

fissuring

, hyperkeratosis,

lichenification

, scaling and

vesiculation

.

Slide8

Commonest form of Eczema is Atopic Dermatitis a chronic relapsing form of skin disorder characterized by pruritus

,

erythema

, and scaly patches that often become

lichenified

and commonly involve the flexural areas of the neck and extremities. It is usually found with family history of asthma, hay fever, allergic rhinitis.

Slide9

Eczema is an inflammatory condition of skin that commonly begins in infancy and childhood and then extends into adults .

Slide10

Pathogenesis

Usually

Lateef

Safravi

Mavad

are eliminated through the skin. When there is excess of these or if there is any problem in eliminating these morbid substances; the

Ghaleez

Mavad

accumulated beneath the skin which is responsible for itching, burning and appear in the form of vesicles and oozing.

Slide11

Etiology:

Ibn

Sina

(980-1037 AD),

-

Narfarsi

results from

haad

Akhlat

mixed with

khilt

e

raqeeq

(

Safra

).

The

etiology

of Atopic Dermatitis is unknown. Previously it was considered that

IgE

-mediated immediate and late –phase reactions play a major role in the development of Atopic Dermatitis. Recent studies reveal that an variance involving two subsets of T helper cells, Th1 and Th2, may cause the pathogenesis of Atopic Dermatitis including the overproduction of

IgE

.

Slide12

Allergy, debility, age, familial predisposition, and psychological factors are important in Eczema. It occurs in infancy, puberty, and old

age.Patient

with Eczema usually presents with a history of allergy in the form of asthma, hay fever and allergic rhinitis due to familial

sensitiveness.Extreme

conditions of environment like heat, Dampness and severe cold cause Eczema. Some

local factors like varicose veins, hypostasis,

Ichthyosis

,

xeroderma

, a greasy skin,

hyperhydrosis

, predispose to Eczema. Exciting factors that are chemicals, plants, clothing, medicaments, infections, drugs, diet, sepsis and all factors impose or only auto sensitization of

integumentory

system alone

Slide13

Epidemiology and Prevalence:

From last decade the collective incidence of Atopic Eczema had risen from 13.2% to 19.7%. The reason for this steady rise in the prevalence of Atopic diseases is not clear, but there are a number of possible environmental

factors

.

The prevalence of Atopic Dermatitis is estimated to 15–30% in children and 2–10% in adults while the incidence has shown a 2 to 3 fold increase in the past 3 decades in developed countries

Slide14

Classification:

According

to matter present in vesicles:

(I)

Saudavi

(ii)

Safravi

According

to appearance:

(

i

)

Aabledar

(ii)

Yabis

According

to colour:

Siyah

Rasasi

According

to severity:

Haa

,

d

and

Muzmin

Slide15

Endogenous Eczema

Exogenous Eczema

Seborrhoic

Dermatitis

Irritant Contact Dermatitis

Atopic Eczema

Allergic Contact Dermatitis

Nummular Eczema

Photo Dermatitis

Pompholyx

Eczema

Infectious Eczematous Dermatitis

Asteototic

Eczema

Static Dermatitis

Lichen simplex chronics

Slide16

Clinical Features:

Acute Eczema

:

It

represents wet type of Eczema characterized by intense

pruritus

,

erythema

,

edema

, papules, vesicles, oozing, crusting and even blister formation

.

Sub acute

Eczema:

It

is characterized by diffused

erythema

,

edema

and scaling. In this stage oedema,

vesiculation

, and oozing components come down. This lesion starts scaling.

Slide17

Chronic Eczema:

Presented

as severe

pruritus

,

Erythema

,

edema

, hyper

keratosis

and

lichenification

(thickening, hyper-pigmentation and

accentuatuated

skin markings) usually start around the age of 3 months called infantile Eczema as well as at school going age and classically affects the scalp, cheeks, and extensor surfaces of limbs and trunk but relapse occurs by the age of 18 months. In about two thirds of the cases of childhood Eczema is subsided at

puberty

.

Slide18

Hanifin and Rajka’s

Criteria

which states that minimum 3 major and minimum 3 minor criteria must be present

.

Major criteria:

Pruritus

Typical morphology facial and extensor eruptions in infants and children and flexural distribution,

lichenification

in adults.

Chronic Dermatitis (relapsing)

History of personal or familial

Atopy

(asthma, allergic rhinitis, Atopic Dermatitis)

Slide19

Minor criteria:High level serum

IgE

Direct (type I) skin test reaction

Kurtosis

pilaris

, Ichthyoids/palmer hyper linearity

Neurosis

Early age of onset

Impaired cell mediated immunity

Cont.

Slide20

Affinity towards non specific hand or foot Dermatitis

Eczema of nipple

Cheilitis

Recurrent conjunctivitis

Infraorbital

fold of Dannie-Morgan

Anterior sub capsular cataracts

Orbital darkening

Facial

erythema

Cont.

Slide21

Neck foldsItch when sweating

Intolerance to irritant

Periofollicular

stress

Food bigotry

Dryness predisposed by environmental and emotional factors

White

dermographism

, delayed blanch

Slide22

Investigations:

IgE

level in serum:

It is very helpful to measure

IgE

level especially when the typical presentation of Atopic Eczema is not present particularly when the distribution of Eczema is atypical and there are no conditions of other Atopic

illness.

Patch tests:

There are specific antigens for every allergen due to

Atopy

and this test gives specific clue about the antigen.

Cont.

Slide23

Prick test: the indications are same as for specific

IgE

but are less commonly performed .

40, 41

Bacterial and viral swabs for microscopy and culture:

These are beneficial tests in suspecting secondary infection. Skin swab for bacteriological assessment will regularly reveal presence of bacteria.

40, 41

Skin Biopsy:

It reveals

spongiosis

, marked epidermal thickening,

parakeratosis

and an inflammatory cell infiltrate,

edema

and vasodilatation in the dermis.

34

Slide24

Management

Line of Management:

Istifragh

(evacuation) of

fasid

akhlat

after giving

nuz’j

to causative

khilte

:

Nuz’j

must be given before elimination by administering

Munzije

Safra

or

Sauda

as the case needed. After the appearance of features of

Nuzj

in the respective

Khilt

, three “

Mushils

” alternated with three “

Tabrids

” should be given. After

tanqiya

, specific medicines are advised for oral use and local application.

Tarteeb

Mizaj

and

badan

by

hammam

,

ghiza

and rest.

Local applications of

Murakhi

,

Jali

,

Muhallil

and

Mundamile

qurooh

advia

.

Tazaha

bish

shams

for 15 to 30 minutes in the morning.

Slide25

Common prescriptions: Chiraita

, mundi, barge

neem

,

gule

nilofer

,

bisfaij

, sandal

safaid

(04gm each) to be boiled in water to make decoction and 40 ml of it should be taken orally twice a day.

Sufoofe

Qooba

(ingredients:

Phitkiri

birya

,

Suhaga

birya

) mixed in

roghan

kamela

and apply locally

Sufoofe

Hikka

(ingredients: Barge

Hina

,

Maghze

Badam

talkh

,

Kamela

,

Khashkhash

,

Gule

Surkh

, Nar

mushk

,

Sange

jarahat

)

Sufoofe

Zimad

(ingredients:

Suhaga

biryan

)

Marhame

sada

(ingredients: Bees wax ,Coconut oil,

Suhaga

biryan

)

Avoid food like sour, sweet and reddish.