Vol. 2, Issue 2, Part A (2025)

Background: Atopic dermatitis (AD) is a chronic, relapsing, pruritic dermatosis that substantially impairs quality of life and imposes a considerable economic burden in children, particularly in low- and middle-income countries. Long-term dependence on topical corticosteroids, concerns about adverse effects and access barriers to newer systemic or biologic agents often prompt families to seek complementary systems of medicine, including Ayurveda, where AD is largely correlated with Vicharchika/Charmaroga and managed using multi-modal protocols.

Objectives: To evaluate the clinical efficacy and short-term safety of a standardized, child-friendly Ayurvedic protocol in children with mild to moderate AD (Charmaroga/Vicharchika), with particular reference to changes in disease severity (SCORAD), pruritus and sleep disturbance, health-related quality of life and requirement for rescue topical corticosteroids.

Materials and Methods: This prospective, open-label, single-arm clinical study was conducted in paediatric units of an Ayurvedic teaching hospital. Children aged 2-14 years with clinically diagnosed AD, fulfilling predefined inclusion criteria and having mild to moderate baseline SCORAD, received a standardized Ayurvedic treatment package for 8 weeks, followed by a 4-week post-treatment observation period. The protocol comprised internal ghrita-based polyherbal formulations, external applications (medicated ointment/oil) and pathya-apathya (diet and lifestyle) counselling. Primary outcome was mean change in SCORAD from baseline to week 8; secondary outcomes included change in pruritus and sleep visual analogue scale scores, Children’s Dermatology Life Quality Index (CDLQI), documented flare frequency, days of rescue low-potency topical corticosteroid use and safety parameters on clinical and laboratory evaluation.

Results: Forty children were enrolled and 36 completed the 8-week intervention and 4-week follow-up. Mean baseline SCORAD was 45.2±8.6, which decreased to 18.3±7.4 at week 8 (mean change −26.9±9.1; p<0.001), with sustained benefit at week 12. SCORAD-50 and SCORAD-75 responses at week 8 were observed in 77.8% and 38.9% of participants, respectively. Pruritus and sleep disturbance scores showed parallel, statistically significant reductions, and mean CDLQI improved from 12.5±4.2 to 4.1±2.3 (p<0.001), indicating a shift from moderate to mild/minimal quality-of-life impairment. Mean days of rescue topical corticosteroid use per 4 weeks declined from 12.3±5.7 in the pre-study recall period to 4.8±3.2 during the intervention, and the proportion of children requiring any topical steroid fell from 86.1% to 38.9%. No serious adverse events occurred; mild, transient gastrointestinal discomfort and early aggravation of itching were noted in a small number of children and resolved without discontinuation of therapy, and no clinically significant laboratory abnormalities were detected.

Conclusion: Within the limitations of an open-label, single-arm design, this prospective paediatric study suggests that a standardized Ayurvedic protocol for Charmaroga/Vicharchika can achieve clinically meaningful and sustained improvements in AD severity, symptoms and health-related quality of life, while substantially reducing reliance on rescue topical corticosteroids and demonstrating an acceptable short-term safety profile. These findings support further controlled, multicentric trials and implementation research to define the role of well-standardized Ayurvedic regimens as steroid-sparing, integrative options in the long-term management of paediatric AD.