Scabies is a contagious skin disease caused by infestation with itch mite (Sarcoptes scabiei). It spreads by skin-to-skin contact with a person who carries the mite. Less commonly, scabies can spread through sharing of clothes and bedding. Scabies is most common among household members and sexual partners of affected individuals. It is also common in congested areas such as hostels, dormitories, army camps, prisons, nursing homes and hospitals. In people with compromised immune systems and malnutrition, scabies can be an extensive disease of skin thickening and a scaly rash; and the syndrome called crusted scabies or Norwegian scabies.

The scabies mite cannot live more than three days without a human host, but it can survive up to a month when living on a human being and lays eggs on human skin, which hatch and grow into adult mites. The initial phase of infestation is asymptomatic. Subsequently, the disease manifests with intense itching especially at night or while taking a hot water bath. The itching is due to allergic reaction to the mites and their excreta or deposit in skin burrows. The skin lesion includes red rashes and raised spots. Due to scratching the skin may become crusty or scaly as the infection progresses. Early scabies rash may show little red bumps like hives, pimples and tiny bites. Scabies usually begins in the body’s folds and crevices such as arm pits, around the nipples of women, on the penis of men, belt line, between the fingers, buttocks, elbows, inner thighs, wrist, and skin under rings, bracelets or watch bands. Except in infants and small children; the face, scalp, neck, palm and scalp are usually spared.

The child may also have irritability, sleeplessness and tiredness due to itching. Secondary bacterial infection may occur over the scabies lesions and in many cases children are treated because of infected skin lesions rather than for the scabies itself. Secondary skin infection with Streptococcus bacteria can sometimes lead to acute glomerulonephritis which is a serious complication of scabies. Curing scabies needs several precautions and effort. A local application made from Gandhaka described in classical texts of Ayurveda can check the infection and reduce the spread of scabies.

Gandhaka ointment (ointment of sulphur)

Gandhaka ointment is an effective preparation made form Gandhaka (sulphur), Tila oil (sesame oil) and Siktha (bee wax). Both internal and external use of purified Gandhaka is mentioned in Ayurvedic classics as well as the Ayurvedic Formulary of India. External use of sulphur possesses parasiticidal and fungicidal property attributed to the formation of hydrogen sulphide and pentatonic acid. Tila consists of dried seeds of Sesamum indicum Linn. a herb extensively cultivated throughout the plains of India. Tila oil extracted from sesame seeds is used in skin diseases such as erysipelas, vitiligo, haemorrhoids, gout, gonorrhea, alopecia, dental disease, burn, etc. Bee wax is obtained from the honey comb of the bees. In pharmaceuticals, it is an ingredient of paraffin ointment. Dermatological and cosmetic applications are probably the most common uses for bee wax and its extracts. Its effects on tissue regeneration and renovation have been well studied. Together with its bactericidal and fungicidal properties bee wax provides many benefits in various applications in cosmetics.

In plastic surgery too bee wax extracts are used for improved wound healing and reduced scar tissue development.

Composition

Gandhaka ointment comprises of Gandhaka, Tila oil and Siktha.

Name	English Name	Latin Name	Family
Gandhaka	Sulphur	–	–
Siktha	Bee Wax	Obtained from bees Apis mellifera	Apidae
Tila oil	Sesame oil	Sesamum indicum Linn.	Pedaliaceae

Main chemical constituents:

• (a) Gandhaka: Sulphur (S2).
• (b) Tila Taila: Fixed oil, natural lipids, glycolipids, phospholipids.
• (c) Siktha: Myricin, free cerotic acid, small quantity of melissic acid and aromatic substance cerolin.

Quality standards

Quality of Gandhaka and sesame oil is determined on the basis of following parameters:

1. Gandhaka

Parameters	Impure Gandhaka	Pure Gandhaka
Carbon disulphide extract % w/w	100.00	95.7
Successive extract with % w/w
1. Carbon disulfide	92.93	81.37
2. Chloroform	4.93	9.02
3. Hexane	2.69	5.36

2. Sesame oil

Foreign matter	Not more than 2%
Total ash	Not more than 9%
Acid-insoluble ash	Not more than 1.5%
Alcohol-soluble extractives	Not less than 20%
Water-soluble extractives	Not less than 4%
Fixed oil	Not less than 35%

Preparation of Gandhaka ointment

Step 1: Method of purification of Gandhaka

• (1) Take fine powder of Gandhaka in a ladle, add a little amount of clarified butter or ghee, melt it and pour into the vessel which contains cow’s milk.
• (2) This process is repeated seven times.
• (3) Collect the purified Gandhaka on cooling to room temperature and wash with plenty of luke-warm water.
• (4) After drying, prepare the fine powder of purified Gandhaka and preserve it for further use.

Step 2: Take the ingredients in following proportion.

No.	Ingredient	Quantity	Proportion
1.	Gandhaka powder	25 grams	1/4th part
2.	Siktha (bee wax)	100 grams	1 part
3.	Tila oil	500 grams	5 parts

Apparatus required for preparing ointment comprises mortar and pestle, steel vessel, spoon, gas stove or heating plate, weighing balance, and thermometer. The procedure is as follows:

• (1) Tila oil is taken in a steel vessel and heated up to 130 °C and then cooled to 70° C.
• (2) Dissolve small pieces of Siktha (bee wax) into the oil with continuous stirring till a homogenous mixture called siktha taila is obtained.
• (3) Siktha taila is taken in mortar and triturated with pestle adding Gandhaka powder till ointment-like consistency is achieved.

Precautions

• (1) Over-heating of the oil should be avoided.
• (2) The trituration should be firm enough to avoid formation of gritty particles.

Dosage form

The preparation has ointment-like consistency with light-yellow colour and a peculiar strong smell.

Therapeutic properties

Gandhaka ointment has parasiticidal, fungicidal, and antiseptic properties.

Indications and uses

Gandhaka ointment is useful in fungal infections of skin, scabies, eczema, and for application over chronic infective lesions.

Dose and mode of administration

• (1) Gandhaka ointment is applied externally on the affected parts of the body once or twice daily and left on the lesions for an hour or so.
• (2) Thereafter, the lesions should be cleaned with warm water.
• (3) Repeat the procedure daily for 7 to 10 days or till all the lesions disappear.

Precautions and safety aspects

• (1) Gandhaka should not be used in formulations without subjecting it to purification.
• (2) Persons sensitive to sulphur should not use this application.
• (3) If the skin lesions do not heal within a few days of application, proper medical guidance should be sought.
• (4) Gandhaka ointment should not be used on open wounds and lesions.
• (5) Persons with scabies having secondary bacterial infection should avoid the use of Gandhaka ointment.
• (6) Persons known to have scabies should avoid having close skinto-skin contact until they have been cured.
• (7) If a member of a family has scabies, all other household members, sexual partners and close contacts should be treated simultaneously.
• (8) Use gloves and gowns when treating others with a suspicious rash and itching.
• (9) Wash all clothing, towels and bed linens that were used in the last three days by the affected person, with hot water.
• (10) Use the dryer at high heat rather than air drying. Since the mites cannot survive on nonliving objects for several days, therefore place the objects that are not machine-washable such as coats and stuffed toys into a bag and store for a week.
• (11) Cut nails and clean them thoroughly to remove any mites or eggs.
• (12) Try to avoid scratching and keep all open sores clean and aseptic.

References

• (1) India, Ministry of Health and Family Welfare. The Ayurvedic formulary of India. Part I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2003. p. 217-219.
• (2) Tripathi KD. Essentials of medical pharmacology, 6th ed. Delhi: Jaypee Brothers Publishers, 2008.
• (3) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. 4. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2004. p.145.
• (4) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. New Delhi: Central Council for Research in Ayurveda & Siddha, 2002. Vol. 5. p. 419.

Further reading

• (1) Shastri Ambikadatta. Rasaratna samuchya. Chapter 3. Varanasi: Chaukhambha Amarbharati Prakashana Publishers, 9th edition, 1995.

Source: Traditional Herbal Remedies for Primary Health Care - WHO