Ayurvedic Management in a Case of Plaque Psoriasis
WJ03-WJ04
Correspondence
Khushhali Balpande,
Postgraduate Scholar, Department of Kayachikitsa (Medicine), Mahatama Gandhi College of Ayurvedic Science and Research Hospital, Salod, Sawangi, Wardha-442001, Maharashtra, India.
E-mail: balpandekhushhali@gmail.com
Psoriasis is a papulosquamous skin disorder characterised by erythematous squamous lesions that are clearly defined and have reddish scaly regions on the skin. In classical texts, all forms of skin conditions are mentioned under the Kushtha topic, and in this condition, it is mainly correlated with Ekakushtha, which is one among the Kshudrakushtha (1).
A 45-year-old male patient came with the main complaint of reddish erythematous plaques over both upper and lower limbs with dryness and itching for the past three years. He had previously consulted an allopathic dermatologist and was clinically diagnosed with plaque psoriasis. He was prescribed immunosuppressive agents, systemic and topical corticosteroids, which he took for two years. However, there was no relief, so he came to an Ayurvedic hospital for treatment. No significant family history was present regarding any dermatological disorders or major illnesses such as hypertension, diabetes, and bronchial asthma. This condition can be differentially diagnosed with dry eczema due to dry blackish-brown patches associated with itching and oozing, as well as Tinea corporis with circular ring patches, dryness, and itching (2). In the present case, the blackish-brown patch was widespread over a larger surface area, associated with itching, dryness, and white powdery discharge, which is specific to plaque psoriasis (Table/Fig 1), (Table/Fig 2). Plaque psoriasis was diagnosed based on the clinical appearance of silvery-white scales and the Auspitz sign, which exhibits pinpoint bleeding patches.
In ayurvedic literature, all skin conditions are categorised into seven Mahakushthas and 11 Kshudrakushthas, discussed under the Kushtharogaadhikar. Ekakushtha is one of the 11 Kshudrakushthas. Symptoms observed in Ekakushtha include Mahavastu (spread over a larger surface area), Matsayashakalopama (resembling fish skin), and Kandu (itching) (3). It is considered a Tridoshajvyadhi with Vata kapha Pradhan. The Samprapti (pathogenesis) involves the involvement of Rasa (plasma), Rakta (blood), Mamsa (muscle), and Lasika (lymph) leading to Dosha-Dushya Samurchana in the Twak (skin), resulting in Ekakushtha. The literature describes both Shodhan (purification treatment) and Shaman Chikitsa (palliative care) for the treatment of Ekakushtha (4). In this case, purification treatment such as Vaman (emesis) is administered along with palliative care and topical application (Table/Fig 3).
Purification Procedure-Vaman (emesis): In the pre-procedure (Purvakarma), Tab Chitrakadi is given, which acts as a digestant and appetizer. Internal oleation with Mahatiktaghritam is administered to alleviate the vitiated Vata in the body. Marichyadi Tail (external oleation) improves blood circulation, reduces dryness and itching, and provides moisture to the body. Hot fomentation with Dashmool decoction is given to liquefy the vitiated Doshas from Shakha (tissues) to Koshtha (Gastrointestinal tract) and remove Srotorodha (obstruction in blood vessels). Vaman (emesis) eliminates vitiated Kapha and Pitta from the Gastrointestinal (GI) tract. The properties of Vamanopaga Dravyas, such as being hot, penetrating, diffusing, and dispersing, help enhance absorption and remove toxins from the upper GI tract (5). Excessive elimination of Doshas leads to a decrease in digestive strength, so a light diet is initiated, progressing to a semi-solid diet in a sequential pattern to gradually increase the patient’s digestive strength (6).
Palliative care: Tab Arogyavardhini contains Katuki (Picrorhizia kurroa) as the main ingredient, which has antioxidant and anti-pruritic properties and promotes tissue nourishment. It pacifies all the Tridoshas, acts as an appetiser, and aids digestion (7). Tab Gandhak rasayan includes refined sulfur, which is used to treat many skin conditions (8). It has antimicrobial, antiviral, and antibacterial properties that help reduce the signs and symptoms of psoriasis. Syp Patolkaturohinyadi contains Chandan (sandalwood), Patol (Trichosanthes dioica), Guduchi (Tinospora cordifolia), and Murva (Marsdenia tenacissima), which possess Tridosha-shamak (balancing) properties. Hence, it is useful in treating Kapha Pradhanta (predominant Kapha) skin disorders such as Ekakustha (9).
Topical application: Vetapallai lubricant and Psoralin ointment have antibacterial, antiviral, anti-inflammatory, antifungal, antioxidant, anti-psoriatic, anti-pruritic, and antimicrobial properties. All the ingredients are Twachya (skin-friendly) and Tridosha-shamak (balancing). They moisturise and soothe the skin (10). Thus, the purification procedure, palliative care, and topical applications help reduce itching, dryness, and erythematous lesions on the lower and upper limbs [Table/Fig- 4,5] by pacifying the vitiated Vata and Kapha Doshas.
Hence, it can be concluded that psoriasis (Ekakustha) can be successfully managed with Ayurvedic modalities.