1.

Kapalakushta (vataja) (Tuberculoid eczema , Nummular Eczema ) When the lesion appears blackish-red,like an earthen pot (The skin lesions are scattered throughout the body and are raised having the appearance of multiple scattered pieces of a broken earthen pot) as is found in lepra reaction and is dry,coarse and thin with marked pricking pain is known as kappalakustha;this is difficult to treat. Tuberculoid leprosy Tuberculoid leprosy is a skin condition characterized by solitary skin lesions that are asymmetrically distributed CLINICAL FEATURES IN TUBERCULOID LEPROSY :(1) Lesions generally are on the face, lateral aspect of extremities and the buttocks (2) Skin lesions may be single or few (3) Lesions are asymmetrical DESCRIPTION OF SKIN LESIONS:(1) Lesions are slightly or well infiltrated (2) Patches may be hypopigmented or erythematous (3) Margins of the patch are well defined (4) Margins of the patch may be raised (5) Patch may indicate a central area which is healing, but dry and rough (6) Patch has a sensory deficit - often totally anaesthetic (7) Patch may be small or large (8) Patch is warm due to loss of sweating (9) Hair may be absent or spare in lesions.

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DESCRIPTION OF NERVE LESIONS:(1) The cutaneous nerve supplying the lesion is usually palpable (2) Trunk nerves (one or two) supplying the lesion may be tender and enlarged (3) The related main peripheral nerve trunks may show thickening, tenderness, abcess formation and occasionally calcification. A begin, stable, and resistant form of leprosy in which the lepromin reaction is strongly positive but which shows little or no Mycobacterium leprae present in the tissues, and in which the lesions are inflamed, red, well-defined plaques that infiltrate the nervous tissue causing a loss of skin sensation as well as sensorimotor damage to nerves serving the area. Also called cutaneous leprosy, nodular leprosy. Nummular eczema Nummular eczema is an allergy-related disorder in which itchy, coin-shaped spots or patches appear on the skin. Causes The cause of nummular eczema is unknown, but there usually is a personal or family history of:

Allergies Asthma Atopic dermatitis

It is relatively uncommon, and most often occurs in elderly men. Several things may make the condition worse, including

Dry skin Environmental irritants Stress

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Temperature changes

Symptoms

Coin-shaped skin lesions On the arms and legs May spread to middle of body Ooze and become crusty Itching Scaly or raw skin Skin redness or inflammation

Exams and Tests. A skin biopsy may be needed to rule out other similar conditions. Experts do not recommend taking frequent baths - excess bathing and soaps can cause dry skin, which often makes the condition worse. Outlook (Prognosis) Nummular eczema is a chronic condition. Medical treatment and avoiding irritants can help reduce symptoms. Possible Complications A secondary infection of the skin may develop. 2.Audumbara kustha( Allergic Vasculitis)

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Audumbara kustha lesion is associated with pain redness,a burning and an itching sensation,is surrounded by tawny haris,and appears(red) like a (ripe) udumbara(Ficus racemosa linn(syn.F.Glomerata roxb)(fam uricaceae) fruit.

Allergic vasculitis Allergic vasculitis is an extreme reaction to a drug, infection, or foreign substance that leads to inflammation and damage to the blood vessels of the skin. Causes Allergic vasculitis is caused by an allergic reaction to a drug or other foreign substance. Most patients are older than 15 years. Even with a thorough history, the cause of this condition cannot be identified. Symptoms

Purple-colored spots and patches, which get pale when pressure is placed on them (purpura) Skin lesions usually located on the legs, buttocks, or trunk Blisters on the skin Hives (urticaria), may last longer than 24 hours Open sores with dead tissue (necrotic ulcers)

Exams and Tests The diagnosis is based on the symptoms and how the skin looks after the intake of certain medicine or are exposed to a foreign substance (antigen).
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Results : ESR test may be high. Skin biopsy shows inflammation of the blood vessels. Outlook (Prognosis) Allergic vasculitis usually goes away over time. On occasion, people will have repeated episodes.

Possible Complications

Permanent damage to the blood vessels or skin with scarring Inflammation of the blood vessels affects the internal organs

3.Mandala kustha(kaphaja) ( Tinea variant, chronic stage with secondary infection ) When blood red,fixed,sudden ,glossy and raised circular patches connected with each other are known as mandala kusthas;these are difficult to treat. Tinea Tinea is the name of a group of diseases caused by a fungus. Types of tinea include ringworm, athlete's foot and jock itch. These infections are usually not serious, but they can be uncomfortable. Tines can spread by touching an infected person, from damp surfaces such as shower floors, or even from a pet. Symptoms depend on the affected area of the body:

Ringworm is a red skin rash that forms a ring around normal-looking skin. A worm doesn't cause it. Scalp ringworm causes itchy, red patches on the head. It can leave bald spots. It usually affects children.

Athlete's foot causes itching, burning and cracked skin between the toes.

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Jock itch causes an itchy, burning rash in the groin area

4.Rsyajihva kustha(vata pittaja)( Melanoma - Skin cancer) A painful lesion which is hard and rough red at the margins and blackish in the middle and looks like the tongue of a rsya( while footed male antelope) is called rsyajihva kustha.

Melanoma Melanoma is the most serious type of skin cancer. Often the first sign of melanoma is a change in the size, shape, color or feel of a mole. Most melanomas have a black or black-blue area. Melanoma may also appear as a new mole. It may be black, abnormal or "ugly looking." Thinking of "ABCD" can help you remember what to watch for:

Asymmetry - the shape of one half does not match the other Border - the edges are ragged, blurred or irregular Colour - the colour in uneven and may include shades of black, brown and tan Diameter - there is a change in size, usually an increase Melanoma can be cured if it is diagnosed and treated early. If melanoma is not

removed in its early stages, cancer cells may grow downward from the skin surface and invade healthy tissue. If it spreads to other parts of the body it can be difficult to control 5.Pundarika kustha(Pitta kaphaja) (Eczema Craquele / Discoid Lupus Erythematosis ) That lesion which is whitish with reddish margins like the petals of a pundarika lotus,is raised and inflamed is called a pundarika kustha.
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Discoid lupus erythematosus (DLE) Discoid lupus erythematosus is a chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp and at times on other body areas. These lesions develop as a red, inflamed patch with a scaling and crusty appearance. The center areas may appear lighter in color with a rim darker than the normal skin. When lesions occur in hairy areas such as the beard or scalp, permanent scarring and hair loss can occur. A small percentage of patients with discoid lupus can develop disease of the internal organs, which can make the person sick. Children and people with many spots are usually at more risk of this. A skin biopsyis to be done to confirm the diagnosis because other conditions can look like discoid lupus erythematosus. If the skin biopsy shows discoid lupus erythematosus, then further blood testing may be indicated. The exact cause is unknown, but it is thought to be autoimmune with the body's immune system incorrectly attacking normal skin. This condition tends to run in families. Females outnumber males with this condition 3 to 1. In some patients with discoid lupus erythematosus, sunlight and cigarette smoking may make the lesions come out. 6.Sidhma kustha(Vata kaphaja) (Psoriasis ) A thin whitish or coppery lesion,usually situated on the chest from which(whitish)scales like the flowers of a gourd fall on rubbing is called a sidhma kustha. (Psoriasis - Mentioned at the end) 7.Kakana kustha(Tridosaja) ( Toxic epidermal necrolysis/ cutaneous manifestation of Primary septicemia )
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When a suppurative and excessively painful lesion of the colour of a kakanantika(seeds of gunja(abrus precatorius linn:Fam Leguminosae)The seeds are bright red with a black spot at one end;the suppurative/discharging part of the lesion appears blackish while the rest of it is bright red)is associated with the features of (vitiation of all)the three dosas it is called a kakana kustha;it is not curable. as infections of the bone (osteomyelitis), central nervous system (meningitis), heart (endocarditis), or other tissues. Symptoms Septicemia can begin with spiking fevers, chills, rapid breathing, and rapid heart Septicemia Septicemia is the invasion of the bloodstream by virulent bacteria that multiply and discharge their toxic products. The disorder, which is serious and sometimes fatal, is commonly known as blood poisoning. The invasive organisms are usually streptococci or staphylococci but may be any type of bacteria. Septicemia occurs most often in older people who have underlying disease that makes them more susceptible to the infection. The primary causes of septicemia are infection within the walls of the blood vessels, rapidly progressing tissue infections (osteomyelitis, cellulitis), virulent systemic disease (meningitis, typhoid), and local infections (abscess, carbuncle) that the defense mechanisms of the body are unable to contain. The microorganisms usually spread to other organs, such as the lungs, liver, and brain. Symptoms of septicemia are fever (usually quite high), chills, low blood pressure, confusion, and rash; it often results in multiple organ failure if not treated promptly with antibiotics. The diagnosis can be confirmed with blood cultures for the organism or with blood tests for antibodies or high levels of white blood cells. Septicemia is the presence of bacteria in the blood (bacteremia) and is often associated with severe infections.
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Causes Septicemia is a serious, life-threatening infection that gets worse very quickly. It can arise from infections throughout the body, including infections in the lungs, abdomen, and urinary tract. It may come before or at the same time rate. The person looks very ill. The symptoms rapidly progress to shock with fever or decreased body temperature (hypothermia), falling blood pressure, confusion or other changes in mental status, and blood clotting problems that lead to a specific type of red spots on the skin (petechiae and ecchymosis). There may be decreased or no urine output. Exams and Tests A physical examination may show:

Low blood pressure Low body temperature or fever Signs of associated disease (such as meningitis, epiglottitis, pneumonia, or cellulitis)

Tests that can confirm infection include:

Blood culture Blood gases CBC Clotting studies PT PTT

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Fibrinogen levels CSF culture Culture of any suspect skin lesion Platelet count Urine culture

Outlook (Prognosis) What to expect depends on the organism involved and how quickly the patient is hospitalized and treatment begins. The death rate is high -- more than 50% for some organisms. Possible Complications Septicemia can rapidly lead to adult respiratory distress syndrome (ARDS), septic shock, and death. Septicemia associated with meningococci can lead to shock or adrenal collapse ( Waterhouse-Friderichsen syndrome). 8.Ekakustha and carmakushta( Ichthyosis and lichen planus) Ekakushta is that lesion which is brad based looks like the scales of a fish and is associated with anhidrosis. Ichthyosis vulgaris Ichthyosis vulgaris is a common skin disorder passed down through families that leads to dry, scaly skin. Causes

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Ichthyosis vulgaris is one of the most common of the inherited skin disorders. It may begin in early childhood, before age 4. The condition is inherited in an autosomal dominant pattern. The condition is often more noticeable in the winter. It may occur along with atopic dermatitis, keratosis pilaris (small bumps on the back of the arms), or other skin disorders. Symptoms

Dry skin, severe Scaly skin ( scales) Possible skin thickening Mild itching of the skin

The dry, scaly skin is usually most severe over the legs but may also involve the arms, hands, and middle of the body. Persons with this condition may also have many fine lines over the palm of the hand.

Outlook (Prognosis) Ichthyosis vulgaris can be a nuisance, but it rarely affects your overall health. The condition usually disappears during adulthood, but may return years later. Possible Complications A bacterial skin infection may develop if scratching causes openings in the skin. Carma (kustha lesion)(Dry eczema) is thick like the skin of an elephant. Lichen Planus
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Lichen planus is a disease in which there is an itchy rash on the skin or in the mouth. Causes The exact cause of lichen planus is unknown. However, it is likely to be related to an allergic or immune reaction. Risks include:

Exposure to medications, dyes, and other chemical substances (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines, and diuretics)

Disorders such as hepatitis C

Lichen planus generally affects middle-aged adults. It is less common in children. Symptoms

Mouth lesions Tender or painful (mild cases may have no discomfort) Located on the sides of the tongue or the inside of the cheek Sometimes located on the gums Area of blue-white spots or "pimples" Lines of lesions that form a lacy-looking network Gradual increase in size of the affected area Lesions sometimes form painful ulcers

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Skin lesions:

Ekakustha and carmakustha

Usually located on the inner wrist, legs, torso, or genitals Itchy Even on both sides (symmetrical) Single lesion or clusters of lesions, often at sites of skin injury Papule 2 - 4 cm in size Papules clustered into a large, flat-topped lesion Lesions have distinct, sharp borders Possibly covered with fine white streaks or scratch marks called Wickham's striae

Shiny or scaly appearance Dark colored -- reddish-purple (skin) or gray-white (mouth) Possibility of developing blisters or ulcers

Other symptoms include:

Dry mouth Hair loss Metallic taste in the mouth Ridges in the nails (nail abnormalities)

Exams and Tests The health care provider may make the diagnosis based on the appearance of the skin or mouth lesions.
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A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis. Blood tests may be done to rule out hepatitis 9.Kitibha kustha( Atopic dermatitis with keratanization ) Kitibha kustha(Atopic dermatitis)is blackish,feels rough like a wart . Atopic dermatitis Atopic dermatitis is a very common, often chronic (long-lasting) skin disease that affects a large percentage of the world's population. It is also called eczema, dermatitis, or atopy. Most commonly, it may be thought of as a type of skin allergy or sensitivity. The atopic dermatitis triad includes asthma, allergies (hay fever), and eczema. There is a known hereditary component of the disease, and it is seen more in some families. The hallmarks of the disease include skin rashes and itching. The word "dermatitis" means inflammation of the skin. "Atopic" refers to diseases that are hereditary, tend to run in families, and often occur together. In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling. Dry skin is a very common complaint and an underlying cause of some of the typical rash symptoms. Although atopic dermatitis can occur in any age, most often it affects infants and young children. In some instances, it may persist into adulthood or actually first show up later in life. A large number of patients tend to have a long-term course with various ups and downs. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin may remain somewhat dry and easily irritated.

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Multiple factors can trigger or worsen atopic dermatitis, including dry skin, seasonal allergies, exposure to harsh soaps and detergents, new skin products or creams, and cold weather. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait. Difference between atopic dermatitis and eczema Eczema is used as a general term for many types of skin inflammation (dermatitis) and allergic-type skin rashes. There are different types of eczema, like allergic, contact, irritant, and nummular eczema. Several other forms have very similar symptoms. The diverse types of eczema are listed and briefly described below. Atopic dermatitis is typically a more specific set of three associated conditions occurring in the same person including eczema, allergies, and asthma. Not every component has to be present at the same time, but usually these patients are prone to all of these three related conditions 10.Vaipadika kustha (Palmoplantar Psoriasis or Traumatic Dermatitis ) Vaipadika(kustha lesion)has cracks(Rhagadaes) in the palms and the soles and is severely painful.

Palmoplantar Psoriasis Palmoplantar psoriasis is a chronic, recurring condition that affects the palms of hands and soles of feet. It looks similar to other types of skin conditions, such as hand dermatitis, but the appearance of psoriasis lesions elsewhere on the body is an indicator of psoriasis. It varies in severity, and may limit a person s ability to complete their daily activities. It most often affects adults, and is sometimes hereditary. Palmoplantar psoriasis is characterized by a few different symptoms:

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The appearance of red patches of skin topped with scales typical of psoriasis on the palms and elsewhere on the body Thickening and scaling of the skin accompanied with the formation of deep, painful fissures on the palms and soles

Palmoplantar pustulosis - the appearance of deep, yellowish pustules.

Symptoms and Signs of Palmoplantar Psoriasis The "fleshy" areas of the hands and feet (base of thumb and/or sides of heels) develop large, yellowish pustules - about the size of a pencil eraser, or .5 centimeters. These Pustules have a studded pattern over reddened patches of skin, and contain non-infectious pus (white blood cells). Throughout the next 7 to 14 days, the Pustule will become smaller, lose it's yellowish color, and become topped with a brown scale of skin. Usually, the disease becomes much less active for a time after peeling. Palmoplantar pustulosis had been found to occur more frequently in people who smoke or used to some tobacco. The causes of flare-ups are not known, but pressure and rubbing will make it worse. The effects on overall health are small, but it can be very uncomfortable and painful. 11.Alasaka kustha (allergic dermatitis) It is studded with itching and red nodules. Allergic contact dermatitis Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating or allergy-causing substance (irritant or allergen). Reactions may vary in the same person over time. A history of any type of allergies increases the risk for this condition.

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Irritant dermatitis, the most common type of contact dermatitis, involves inflammation resulting from contact with acids, alkaline materials such as soaps and detergents, solvents, or other chemicals. The reaction usually resembles a burn. Allergic contact dermatitis, the second most common type of contact dermatitis, is caused by exposure to a substance or material to which the person has become extra sensitive or allergic. The allergic reaction is often delayed, with the rash appearing 24 - 48 hours after exposure. The skin inflammation varies from mild irritation and redness to open sores, depending on the type of irritant, the body part affected, and sensitivity. Overtreatment dermatitis is a form of contact dermatitis that occurs when treatment for another skin disorder causes irritation. Common allergens associated with contact dermatitis include:

Poison ivy, poison oak, poison sumac Other plants Nickel or other metals Medications Antibiotics, especially those applied to the surface of the skin (topical) Topical anesthetics Other medications Rubber or latex Cosmetics Fabrics and clothing Detergents

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Solvents Adhesives Fragrances, perfumes Other chemicals and substances

Contact dermatitis may involve a reaction to a substance that are exposed to, or use repeatedly. Although there may be no initial reaction, regular use (for example, nail polish remover, preservatives in contact lens solutions, or repeated contact with metals in earring posts and the metal backs of watches) can eventually cause cause sensitivity and reaction to the product. Some products cause a reaction only when they contact the skin and are exposed to sunlight (photosensitivity). These include shaving lotions, sunscreens, sulfa ointments, some perfumes, coal tar products, and oil from the skin of a lime. A few airborne allergens, such as ragweed or insecticide spray, can cause contact dermatitis. Symptoms

Itching (pruritus) of the skin in exposed areas Skin redness or inflammation in the exposed area Tenderness of the skin in the exposed area Localized swelling of the skin Warmth of the exposed area (may occur) Skin lesion or rash at the site of exposure

Lesions of any type:

redness, rash, papules (pimple-like), vesicles, and bullae (blisters) May involve oozing, draining, or crusting

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May become scaly, raw, or thickened

Exams and Tests The diagnosis is primarily based on the skin appearance and a history of exposure to an irritant or an allergen. According to the American Academy of Allergy, Asthma, and Immunology, "patch testing is the gold standard for contact allergen identification." Allergy testing with skin patches may isolate the suspected allergen that is causing the reaction. Patch testing is used for patients who have chronic, recurring contact dermatitis. It requires three office visits and must be done by a clinician with detailed experience in the procedures and interpretation of results. On the first visit, small patches of potential allergens are applied to the skin. These patches are removed 48 hours later to see if a reaction has occurred. A third visit approximately 2 days later is to evaluate for any delayed reaction. The person should bring suspected materials , especially if have already tested those materials on a small area of your skin and noticed a reaction. Other tests may be used to rule out other possible causes, including skin lesion biopsy or culture of the skin lesion (see skin or mucosal biopsy culture). Outlook (Prognosis) Contact dermatitis usually clears up without complications within 2 or 3 weeks, but may return if the substance or material that caused it cannot be identified or avoided. A change of occupation or occupational habits may be necessary if the disorder is caused by occupational exposure. Possible Complications Secondary bacterial skin infections may occur. 12.Dadru kustha (Tinea skin lesion)
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Dadru kustha(ringworm)is an elevated ring shaped plaque associated with an itching sensation and reddish nodule Tinea Tinea is the name of a group of diseases caused by a fungus. Types of tinea include ringworm, athlete's foot and jock itch. These infections are usually not serious, but they can be uncomfortable. Tines can spread by touching an infected person, from damp surfaces such as shower floors, or even from a pet. Symptoms depend on the affected area of the body:

Ringworm is a red skin rash that forms a ring around normal-looking skin. A worm doesn't cause it. Scalp ringworm causes itchy, red patches on the head. It can leave bald spots. It usually affects children.

Athlete's foot causes itching, burning and cracked skin between the toes. Jock itch causes an itchy, burning rash in the groin area

13.Carmadala kustha( chronic lichen simplex) The red,painful and itching lesion in which there may also be putrefaction and which is associated with blisters and is intolerant to touch(Hyperaesthesia) is known as a carmadala kustha(pemphigus). chronic lichen simplex This disorder may occur in people who have:

Eczema (atopic dermatitis) Psoriasis Nervousness, anxiety, depression, and other psychologic disorders

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It is common in children, who cannot stop scratching insect bites and other itchy skin conditions. It can also be common in children who have chronic repetitive movements. Symptoms This skin disorder leads to a scratch-itch cycle:

It may begin with something that rubs, irritates, or scratches the skin, such as clothing. This causes the person to rub or scratch the affected area. Constant scratching causes the skin to thicken.

The thickened skin itches, causing more scratching, which causes more thickening.

The skin may become leathery and brownish in the affected area.

Symptoms include:

Itching of the skin

May be long-term (chronic) May be intense Increases with nervous tension, stress

Skin lesion, patch, or plaque

Commonly located on the ankle, wrist, neck, rectum/anal area, forearms, thighs, lower leg, back of the knee, inner elbow

Exaggerated skin lines over the lesion Distinct borders to the lesion Becomes leathery in texture (lichenification)

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Darkened (hyperpigmented) or reddened skin Raw areas Scratch marks Scaling

Exams and Tests The diagnosis is primarily based on the appearance of the skin and a history of chronic itching and scratching. A skin lesion biopsy may be needed to confirm the diagnosis. Outlook (Prognosis) One can control lichen simplex chronicus by reducing stress and scratching less. The condition may return or change sites.

Possible Complications

Bacterial skin infection Permanent changes in skin color Permanent scar

14.Pama and kacchu kustha( scabies) Numerous tiny discharging boils associated with an itching and a burning sensation are known as pama kustha(scabies). These very lesions,when severe,present in both hands and buttocks and associated with blisters having an excessive burning sensation are known as kacchu(severe from of scabies).
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Scabies Scabies is an itchy skin condition caused by the microscopic mite Sarcoptes scabei. It is common all over the world, and it affects people of all races and social classes. Scabies spreads quickly in crowded conditions where there is frequent skin-toskin contact between people. Hospitals, child-care centers and nursing homes are examples. Scabies can easily infect sex partners and other household members. Sharing clothes, towels, and bedding can also spread scabies.One cannot get scabies from a pet. Pets get a different mite infection called mange. Symptoms are

Pimple-like irritations or a rash Intense itching, especially at night Sores caused by scratching

Several lotions are available to treat scabies. The infected person's clothes, bedding and towels should be washed in hot water and dried in a hot dryer

15.Visphota kustha ( Folliculitis ) Visphota (kustha lesion) his blackish or reddish blisters with a thin(covering)skin. Folliculitis Folliculitis is inflammation of one or more hair follicles. It can occur anywhere on the skin. Causes

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Folliculitis starts when hair follicles are damaged by friction from clothing, blockage of the follicle, or shaving. In most cases of folliculitis, the damaged follicles are then infected with the bacteria Staphylococcus (staph). Barber's itch is a staph infection of the hair follicles in the beard area of the face, usually the upper lip. Shaving makes it worse. Tinea barbae is similar to barber's itch, but the infection is caused by a fungus. Pseudofolliculitis barbae is a disorder that occurs mainly in black men. If curly beard hairs are cut too short, they may curve back into the skin and cause inflammation. Symptoms Common symptoms include a rash, itching, and pimples or pustules near a hair follicle in the neck, groin, or genital area. The pimples may crust over. Exams and Tests A diagnosis is primarily based on how the skin looks. Lab tests may show which bacteria or fungus is causing the infection. Folliculitis usually responds well to treatment, but may come back. Possible Complications

Folliculitis may return Infection may spread to other body areas.

16.Sataru kustha( Pyoderma gangrinosum) Sataru(kustha)(A form of eczema very commonly found in children)has multiple red or blackish ulcerative lesions associated with burning sensation and pain. Pyoderma gangrenosum
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Pyoderma gangrenosum is a condition that causes large, painful sores (ulcers) on the skin, most often on your legs It's not certain what causes pyoderma gangrenosum, but it may be related to a disorder of the immune system. About half the people with pyoderma gangrenosum have an underlying chronic health condition. Pyoderma gangrenosum is rare. Effective treatment for pyoderma gangrenosum is available, but in some cases, the ulcers may leave scars. Early diagnosis and therapy reduce your risk of scarring. In some cases, pyoderma gangrenosum may recur.

Pyoderma gangrenosum is a disease that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs. When they occur, they can lead to chronic wounds. Ulcers usually initially look like small bug bites or papules, and they progress to larger ulcers. Though the wounds rarely lead to death, they can cause pain and scarring.

It affects approximately 1 person in 100,000 in the population. Though it can affect people of any age, it mostly affects people in their 40s and 50s.

Associations The common conditions associated with pyoderma gangrenosum are:

Inflammatory bowel disease:

Ulcerative colitis Crohn's disease

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Arthritides:

Rheumatoid arthritis Seronegative symmetrical polyarthritis

Haematological disease:

Myelocytic leukemia Hairy cell leukemia Myelofibrosis Myeloid metaplasia Monoclonal gammopathy (IgA)

17.Vicarcika kustha(weeping eczema) The lesion has blackish boils with an excessive discharge and an itching sensation. Vicarcika kustha Vicarcika kustha(Weeping eczema)lesion has blackish boils with an excessive discharge and an itching sensation.

Weeping eczema This shows gradual changes in the condition of the affected skin. The skin can become inflamed and even bleed. It also gradually becomes quite raw and crusty.skin will look and feel rough at this stage. If liquid or blood is oozing out from the patches then this is known as wet eczema. People suffering from this type of eczema feel uncomfortable and embarrassed. This fluid is not good as it can cause the itchy area to spread to other parts of the
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body. However, the condition is not contagious. The patient should be very careful
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about the hygiene. Otherwise,the condition rapidly becomes worse. A linen cloth or gauze compresses are recommended.

Moist compresses are used to treat the affected area until the acute inflammation and weeping stages have considerable subsided. In the weeping stage, loose, humid dressings that allow plenty of evaporation should be used.

Pure cotton clothes are very much more comfortable for the person suffering from weeping eczema. The touch of irritants like cleaning chemicals, detergents and soaps should be avoided. The condition may become worse because of such contact. ************************************ Clinical features due to dosas

in the kustha lesions (The lesion of) kustha with vata predominance is rough,blackish-red ,dry and painful. (The lesion of)kustha with pitta predominance is sodden ,dense ,smooth,along with a itching sensation as if being boiled(As in suppuration) along with redness of coldness and heaviness. Mixed features of (any of these) two types implies combined vitiation of (the respective)two humours,whereas all the features together signify simultaneous vitiation of all the three humours. Clinical features of kustha lesions according to the tissue involved Skin Local discolouration and dryness are produced due to kustha involcing the skin. Blood(Lichenification/Lichen planu) Loss of skin sensation ,horripialtion, excessive sweating, an itching sensation and putrid suppuration are present in a kustha lesion involving rakta.
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Muscles(Dinear of sweat glands) Multiplicity of lesions, dryness of the mouth, roughness, appearance of boils ,pricking pain, blisters and fixity are present in a kustha lesion involving the fleshy tissue.contratures with metabolic fealures. Adipose tissue(Medas) Falling off of the fingers and toes, restricted movements of the limbs, tearing sensation, migratory nature of the lesion along with the features mentioned above are present in the kustha lesion involving the fatty tissue. Bone and bone-marrow(Sle/vasculitis) Falling-off of the nose, congestion of the eyes, production of maggots in the lesion and loss of speech are present in the kustha lesions involving the bones and bone-marrow. Sperms and ovum(Leprosy) Siblings born form the couple having advanced skin disease,with their sperms and ovum afflicted should be known to have an inherent skin disease. Prognosis The kustha located in the skin,blood or muscles or with vata and kapha predominance are curable; those in the fatty tissue or with dual involvement of the dosas are relievable; whereas those located in the bone-marrow and bones, infested with maggots, or associated with thirst, burning sensation and a weak digestive power as also those which are due to all the three dosas should be discarded (from treatment as incurable). Leucoderma(svitram)
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The aetiology of svitra, kilasa and varuna is similar to that of kustha.

Ekakustha and carmakustha

However, these have no discharge their origin is considered to be form the three dosas(vata, pitta and kapha) and their location is in the three dhatus(rakta, mamsa and medas).

Lesions due to vata are dry and reddish those due to pitta are copper coloured like the petals of a lotus, are associated with a burning sensation and loss of hairs; whereas ,those due to kapha are white ,thick and indurated with an itching sensation.

These afflict the rakta, mamsa and medas respectively and according to both the colour(of the lesion) as well as the dosika involvement they are progressively more and more difficult to treat.

Modes of spread of contagious diseases Skin diseases including leprosy, fever, consumption, conjunctivitis and infectious diseases spread from person to person through sexual intercourse bodily contact, exhaled air, eating together, and even sharing the same bed and by common clothings, garlands and consmetics. THE DIAGNOSIS OF SITAPITTA,UDARDA AND KOTHA(ALLERGIC SKIN

MANIFESTATIONS) Aetiopathogenesis Due to an exposure to a cold wind, kapha and vayu become vitiated, and when they combine with pitta and spread, they produce these(allergic) diseases on the external(Skin) as well as the internal(Mucous membranes)surfaces. Prodromal features

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Ekakustha and carmakustha

Their premonitory features are thirst, anorexia, nausea, malaise, a feeling of heaviness of the body and redness in the eyes(Spring catarrh).

When swellings develop externally resembling a wasp bite and are associated with an itching sensation and an excessive feeling of pins and needles, vomiting, fever and heartburn, the condition is called udarda; others diagnose it as sitapitta.

However, sitapitta has a predominance of vata, whereas udarda has a predominance of kapha.

That kaphaja disorder is called udarda which is characterized by raised, reddish and itching circular patches appearing in the winter season.

Kotha Improper emesis, leading to the retention of pitta, slesma, and food matter which were about to be expelled, gives rise to multiple, reddish, circular, itching and raised patches which recur again and again; these are diagnosed as kotha.

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Ekakustha and carmakustha

Urticaria is an allergic reaction in the skin, characterised by itchy weals surrounded by redness. Usually hives (also called urticaria or nettlerash) are the result of an ALLERGY to drugs, certain foods (particularly eggs, shellfish, nuts and fruits), and sometimes insect bites or stings. In most cases it is very diffi-cult to identify the allergen (allergycausing sub-stance). The reaction can develop rapidly after exposure to a small amount of the allergen, and in severe cases the hives may enlarge, join together and progress to ANGlO-OEDEMA, in which the tongue. lips and face also become swollen. Most attacks of hives will subside within a week. Itching can be relieved by applying calamine lotion, or other anti-itch preparations recommended by your doctor or pharmacist. Antihistamines taken by mouth will help to suppress mild reactions; more severe reactions may need corticosteroid treatment. Further attacks can be prevented by trying to avoid the allergen, if known. If hives appear while you are taking any medicine, discontinue the drug and contact your doctor as soon as possible. Urticaria is basically a skin disease typical to youth, but it may occur to the people at any age. Usually intensely itching intradermal vascular reaction (wheals or hives). No epidermal changes such as scaling, papules, or blisters. More often has an unknown, nonspecific etiology, but can be related to medications, foods, and similar vascularstimulating agents. Laboratory studies are not likely to be helpful in evaluation unless there are suggestive findings in the history and physical examination. It is characterized by raised, red skin welts that are more than 5mm in diameter. Hives are extremely itchy, and often have a pale border surrounding the red area. The urticarial rash can be isolated or many, sometimes they join together and form a large area of raised, red rash. Hives can also be caused by stress. Causes of Urticaria The common Causes of Urticaria :

Emotional stress and exercise. Environmental factors (eg, pollens, chemicals, plants, danders, dust, mold). The cause of acute generalized urticaria often is undetermined. Cold urticaria, cryoglobulinemia, cryofibrinogenemia, or syphilis. Urticaria pigmentosa is most often seen in children, but it can occur in adults as well. Diarrhea can also be a cause of urticaria pigmentosa. Skin lesion may lead to the condition of urticaria pigmentosa. .

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Ekakustha and carmakustha

Acute headache may also lead to urticaria pigmentosa.

Symptoms of Urticaria Some common Symptoms of Urticaria :

The headache may be seen in urticaria patient. Lesions may also develop. Emotional Stress may be seen in urticaria pigmentosa patient. Eye drops containing dextan can be seen in this disease. some times these are filled with fluid. Histamine causes hives , itching , and flushing . Redish brown itchy spot. Rubbed area becomes reddened, swollen and itchy.

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Ekakustha and carmakustha