Ayurvedic Medicine in Dermatology: Expert Q&A

Withania somnifera, known commonly as ashwaghanda, Indian ginseng, or winter cherry is a plant in the nightshade family. The ashwaghanda plant is a small shrub with yellow flowers that is native to India and North Africa. Ashwaghanda is one of the most important herbs in Ayurveda – ancient Indian natural healing.
Dermatology Advisor interviewed Raja Sivamani, MD, MS, AP, adjunct associate professor of clinical dermatology and director of clinical research at the University of California to discuss the application of ayurvedic medicine in dermatology.

An estimated 30% of adults and 12% of children in the United States use complementary and integrative medicine approaches, and the application of these modalities is increasing in health care settings.1 Accumulating evidence supports the effectiveness of numerous integrative therapies for various conditions, such as mindfulness-based stress reduction, biofeedback, and acupuncture for migraine treatment (See Complementary and Integrative Treatments for Migraine: An Expert Interview). In addition, ongoing studies are investigating the use of integrative approaches for pain management in veterans and military personnel, symptom relief in cancer patients and survivors, and other purposes and in other populations.1

There is a growing interest in integrative medicine — among patients, practitioners, and researchers alike — and one approach that has garnered increasing attention is the ancient Indian practice of Ayurveda. Far from a fleeting health trend, Ayurveda (which means “Science of Life” in Sanskrit) was established more than 5000 years ago and is currently the primary healthcare system in India.2,3

Ayurvedic medicine is relevant to all specialties and is used in the prevention and treatment of a wide range of disorders. To learn more about Ayurveda and its potential applications in dermatology, Dermatology Advisor interviewed Raja Sivamani, MD, MS, AP, adjunct associate professor of clinical dermatology and director of clinical research at the University of California, Davis; medical editor of LearnSkin.com; founder of the Jiva Factory blog and podcast focused on integrative approaches to wellness; and co-chair of the Integrative Dermatology Symposium to be held in October 2019 in San Diego.

Dermatology Advisor: How would you describe Ayurveda to other physicians?

Dr Sivamani: Ayurveda is a medical field that originated out of India and focuses on understanding how the body is out of balance at a given time. It is a holistic system that utilizes the concept of the “dosha” to describe imbalances that can cut across all organ systems as recognized in Western medicine. Much like in Western medicine, where we look for symptoms that allow for a diagnosis and eventually treatment, Ayurveda looks for symptoms that correlate with imbalances that can be treated.

The imbalances are described by the 3 doshas, which represent 3 distinct physiologic energy vectors that can contribute to imbalances. When thinking about treatment, Ayurveda is not only focused on herbs — a frequent misconception — but involves a treatment plan that includes certain foods, mindfulness activities, exercises such as specific forms of yoga, sleep hygiene, and herbs.

Dermatology Advisor: You may be the only dermatologist in the United States who is also an Ayurvedic practitioner. Tell us about that.

Dr Sivamani: When I was in medical training and dermatology training, I realized that I wanted to learn more about how to empower patients to change their lifestyle along with the treatments that I would give them. Ayurveda gave me a language to help connect with my patients at a deeper level. Also, I began to look at different skin conditions through an Ayurvedic lens, which has allowed me to ask clinical research questions that I would not have asked before. For example, we recently completed and published a study on bakuchiol compared with retinol, and I became interested in bakuchiol because it was derived from the Ayurvedic herb Bakuchi (Psoralea corylifolia).4 [Editor’s note: The 12-week randomized, double-blind trial demonstrated that bakuchiol cream (o.5% twice daily) and retinol (o.5% daily) were equally effective in reducing wrinkle surface area and hyperpigmentation, with less scaling and stinging in the bakuchiol group.]

Dermatology Advisor: What are some ways in which you apply Ayurveda in your practice?

Dr Sivamani: Ayurveda has expanded my ability to have mind-body, nutrition, and skincare-related conversations. One example is a patient with seborrheic dermatitis who was using topical steroids for control on the face and scalp but was getting frustrated with the need for frequent steroid use and had been trying coconut oil, which was making her scalp even worse. Ayurveda has a rich knowledge around oils and herbals, so I taught the patient how to make a neem-infused coconut oil. She started applying it to her face and the scalp, which greatly helped to control her condition.

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In general, our conversations around natural oils have focused on just the oil, but herb-infused oils can greatly change the character of the oil. By using a neem-infused coconut oil, the character of the coconut oil was changed, and she was able to get much better control. She still needs steroids occasionally but her steroid use has decreased significantly. Interestingly, she now uses a coconut oil infused with the herb gotu kola for her moisturizer on her body.

Dermatology Advisor: What does the research suggest thus far about the use of Ayurveda in dermatology?