SHEETAPITTA, UDARDA AND KOTHA

SHEETAPITTA, UDARDA AND KOTHA – LAKSHANA, SAMPRAPTI AND DIFFERENTIAL DIAGNOSIS

Skin disorders are extensively discussed in Ayurvedic classics. Among them, Sheetapitta, Udarda and Kotha are Tridoshaja Kshudrarogas which manifest as hypersensitivity-type conditions. These are predominantly caused by deranged Vāta and Kapha with Pitta involvement. Modern correlation includes conditions like Urticaria, Angioedema, and Allergic Dermatitis.

SHEETAPITTA – SAMPRAPTI (PATHOGENESIS)

• The causative factors vitiate primarily Vāta and Kapha doshas along with Pitta.

• Due to exposure to cold wind, incompatible food, sudden changes in temperature, or suppression of natural urges, the vitiated doshas move towards the skin and blood channels.

• These doshas obstruct the normal flow of Rakta and Sveda, resulting in symptoms resembling wheals and itching.

• Due to Pitta association, there is burning sensation and redness.

Sanskrit Reference (Aṣṭāṅgahṛdaya Nidāna Sthāna 13/29):
"vātaḥ kaphaśca pittaṃ ca śītavātāt prasūryataḥ |
kupyanti śītapittasya hetavaḥ syuḥ pṛthak pṛthak ||"

SHEETAPITTA – LAKSHANA (CLINICAL FEATURES)

• Sudden appearance of reddish or pinkish raised patches (similar to urticaria)

• Intense itching (kandu)

• Burning sensation (dāha)

• Cold sensation (śīta sparśa)

• These patches may disappear and reappear in different parts of the body

• Associated symptoms like headache, fever, and weakness may also be present

Sanskrit Reference (Aṣṭāṅgahṛdaya Nidāna Sthāna 13/30):
"śītaṃ pittodbhavaṃ rūkṣaṃ pittaṃ śleṣmānvitaṃ ca yat |
sphurantamiva kampantamivātaṅkāni ca dāruṇāni ca ||"

UDARDA – LAKSHANA (CLINICAL FEATURES)

• Raised eruptions or bumps over the skin resembling urticaria but less severe

• Mild itching compared to Sheetapitta

• Skin is cold to touch and pale in color

• Recurrent and temporary

• Caused due to aggravated Vāta and Kapha, suppressing Rakta and Sveda

Sanskrit Reference (Aṣṭāṅgahṛdaya Nidāna Sthāna 13/32):
"udardaḥ śītapittācca saṃjñāto vaidyasaṃmataḥ |
kaṇḍūśītaspṛśaḥ śvetaḥ saṅkṣobhaṃ janayedbahiḥ ||"

KOTHA – LAKSHANA (CLINICAL FEATURES)

• Sudden swelling (śotha) and painful eruptions

• Burning sensation (dāha) more prominent

• Skin appears red or coppery (raktāruṇa varṇa)

• Vesicular or blister-type eruptions may be seen

• Associated with acute allergic or infective etiology

Sanskrit Reference (Suśruta Samhitā Nidāna Sthāna 13/37):
"kotho raktaprakopaśca daṃṣṭrīviṣavipātajaḥ |
sadāhāḥ sphoṭakānvitto raktaruṇaḥ kṛśānalaḥ ||"

DIFFERENTIAL DIAGNOSIS – SHEETAPITTA VS UDARDA

MODERN CORRELATION AND PATHOLOGY

• Sheetapitta is closely related to Urticaria in modern medicine.

  • It is a Type I hypersensitivity reaction mediated by IgE antibodies.

  • Mast cells release histamines causing vasodilation, edema, and wheals.

  • Triggers: Foods (nuts, shellfish), drugs (NSAIDs, penicillin), cold exposure, insect bites, infections.

• Udarda can be related to dermographic urticaria or cold urticaria, which present with localized skin eruptions due to non-immune triggers.

• Kotha corresponds to angioedema or toxic skin eruptions, where deep dermal layers swell with burning and pain.

Histopathological Features (Modern View):

• Edema of the superficial dermis

• Dilated capillaries and lymphatics

• Perivascular infiltration with eosinophils and mast cells

• Normal epidermis

MODERN MANAGEMENT PERSPECTIVE

• Antihistamines (H1 blockers – Cetirizine, Loratadine)

• Corticosteroids in severe cases

• Avoidance of triggers (foods, drugs, physical stimuli)

• Immunotherapy in chronic idiopathic urticaria

• Emergency treatment with adrenaline in anaphylaxis

AYURVEDIC MANAGEMENT OVERVIEW

• Snehana and Swedana (in chronic cases)

• Vamana and Virechana in dosha dominance

• Use of drugs like:

  • Haridra Khanda

  • Mahatiktaka Ghṛita

  • Gandhaka Rasayana

  • Arogyavardhini Vati

  • Triphala decoction

• Local applications with:

  • Chandana paste

  • Aloe vera gel

  • Lepa with Yashtimadhu, Daruharidra