SUCHIMUKHI (PINHOLE OS)

🔺 CASE STUDY: SUCHIMUKHI (सूचिमुखी) – PINHOLE OS

(A minor Kustha / skin lesion with features of follicular papules)

🔺 NIDANA (CAUSES)
As per general Kustha Nidana:

• Ati Snigdha, Guru, Amla, Lavana, Katu Ahara – Excessively unctuous, heavy, sour, salty, pungent food

• Viruddha Ahara – Incompatible food combinations

• Rooksha Anna – Excessively dry foods

• Dadhi, Matsya, Anupa Mamsa Sevana – Excess curd, fish, marshy meat

• Abhishyandi Ahara – Channel-blocking foods

• Asatmya Sevana – Consumption of unsuitable food

• Viharaja Nidana – Pollution, excessive sweating, unclean surroundings

• Manasika Nidana – Anger (Krodha), Grief (Shoka)

🔺 PURVAROOPAM (PRODROMAL SYMPTOMS)

• Kandu – Itching

• Toda – Pricking sensation

• Sphutana – Cracks or scaling

• Daha – Burning

• Vaivarnya – Discoloration

• Sthanik Vedana – Localized pain

🔺 LAKSHANA (SYMPTOMS)

• Sookshma Sphota – Tiny elevated papules

• Sukshma Suchi Tulya – Needle-like projections (hence “Suchimukhi”)

• Shweta Varna – Skin-colored to white lesions

• Snigdha & Sthira – Slightly greasy and firm texture

• Alpa Vedana – Mild pain or irritation

• Common Sites – Face, eyelids, cheeks (areas with hair follicles)

🔺 GENERAL EXAMINATION

• Vital Signs – To rule out systemic illness

• Pallor, Icterus, Cyanosis – Nutritional or systemic disorder indicators

• Lymphadenopathy – If infection or immune involvement

• Edema, Clubbing – For chronic systemic illness

• Nutritional Status – To assess immunity and healing response

🔺 SYSTEMIC EXAMINATION

• Skin Examination –

  • Site, size, shape, surface of lesions

  • Color, distribution, symmetry

  • Presence of discharge, pus, crust

• Hair, Nails, Mucosa – Secondary involvement

• Lymph Nodes – In suspected infection

• Abdomen – Hepatosplenomegaly (if systemic disease)

• Cardiorespiratory/Neurological – If systemic symptoms present

🔺 LABORATORY INVESTIGATIONS

• CBC – WBC (infection), Eosinophils (allergy), Hb (anemia)

• ESR & CRP – Chronic inflammation

• Blood Sugar (FBS/PPBS/HbA1c) – Diabetes rule out

• LFT/RFT – To rule out systemic or drug-induced impact

• Serum IgE – Allergic response

• KOH Mount – To exclude fungal etiology

• Bacterial Culture – In pustular lesions

• Patch Testing – For suspected allergy

• Histopathology – If atypical or chronic lesions

• Viral markers – If viral skin eruptions suspected

🔺 DIFFERENTIAL DIAGNOSIS (DD)

• Folliculitis

• Miliaria (heat rash)

• Contact or allergic dermatitis

• Atopic dermatitis

• Viral exanthems

• Insect bite reaction

• Scabies

• Acneiform eruptions

• Impetigo

🔺 SAMPRAPTI (PATHOGENESIS)

• Dosha Involvement – Kapha (Snigdha, Sthira) and Vata (Sookshma, Rooksha)

• Dushya – Twak, Rakta, Mamsa, Lasika

• Srotodushti – Blockage of Swedavaha and Romakupa Srotas by Kapha

• Rukshata by Vata – Forms papular, firm lesions

• Resulting in micro-papular eruptions resembling a needle tip

🔺 SAMANYA CHIKITSA (GENERAL LINE OF TREATMENT)

Shodhana (Detoxification):

• Vamana – If Kapha dominance (thick, greasy eruptions)

• Virechana – In Pitta dominant involvement (inflammation)

• Raktamokshana – Local bloodletting, if pustular or dushti in Rakta

Shamana (Palliative):

• Deepana & Pachana – Agni improvement

• Tikta, Kashaya, Katu rasa drugs – For skin detox and channel cleansing

• External Lepa – Drying, Kapha-Vata balancing pastes

🔺 UPASHAYA (RELIEVING FACTORS)

• Use of Tikta, Kashaya Lepa

• Gentle exfoliation with Triphala Churna

• Ushna and Ruksha Sweda – Dry fomentation

• Medicated oil application – Nimbadi Taila, Khadira Taila

🔺 ANUPASHAYA (AGGRAVATING FACTORS)

• Snigdha, Guru Ahara – Oily, heavy, fried foods

• Excess curd, cheese, and fish intake

• Use of cosmetics, pore-blocking creams

• Day sleep, sedentary lifestyle

🔺 VISHESHA CHIKITSA (SPECIFIC TREATMENT)

📌 INTERNAL MEDICATIONS:

📌 EXTERNAL APPLICATIONS:

• Nimbadi Lepa – Anti-infective and drying

• Manjishtha Lepa – For pigmentation and healing

• Khadira Churna with honey or rose water – Anti-inflammatory

• Triphala Churna – Gentle rubbing for exfoliation

📌 LOCAL PROCEDURES:

• Pracchana Karma – Controlled lesion scraping (if comedonal)

• Raktamokshana – Especially leech therapy or scarification for Rakta dushti

• Ksharakarna – Local application of mild alkali to open follicular blockage