Ayurvedic management of Ekakushtha (Chronic Plaque Psoriasis) –

A Case Report

 

Almas M. Shaikh1*, Digambar G. Dipankar2, Priyanka K. Yadav3, Sreelakshmi S.4

1PG Scholar Kayachikitsa Department, Dr. D. Y. Patil College of Ayurved and Research Centre,

Pimpri, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University).

2Professor and Guide, Kayachikitsa Department, Dr. D. Y. Patil College of Ayurved and Research Centre, Pimpri, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University).

3PG Scholar Kayachikitsa Department, Dr. D. Y. Patil College of Ayurved and Research Centre,

Pimpri, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University).

4PG Scholar Kayachikitsa Department, Dr. D. Y. Patil College of Ayurved and Research Centre,

Pimpri, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University).

*Corresponding Author E-mail: dralmasyaserkhan@gmail.com

 

ABSTRACT:

Psoriasis is one of the common skin diseases encountered in world population which is characterized by sharply demarcated erythematous papules and plaques. Prevalence of psoriasis is 0.1 to 3 per cent worldwide. Psoriasis occurs equally in both genders, most commonly in second to fourth decade of life. In this paper, a case report of patient with (Ekakushtha) Chronic Plaque Psoriasis is discussed with successful Ayurvedic treatment. A 25-year-old female patient came with complaints of reddish lesions over arms, forearms, legs, thighs and trunk region; itching and burning sensation over lesion and scalp; scaling over scalp region since five years. The condition was diagnosed as Ekakushtha according to Ayurved and the treatment was planned accordingly. The patient was treated with Ayurvedic oral medications, local applications and Pathya (wholesome diet) regimen without any Panchakarma therapy. Ayurvedic management has given her better results within 45 days from commencement of treatment.

 

KEYWORDS: Ekakushtha, Chronic Plaque Psoriasis, Ayurvedic oral medications, local applications, Pathya (wholesome diet).

 

 


1. INTRODUCTION:

Psoriasis is one of the common dermatologic diseases found in upto 2% world’s population.1 It is an autoimmune disease which is characterized by sharply demarcated erythematous papules and plaques covered by silvery scale.2,3,4 On skin scraping, capillaries at the tips of elongated papillae are torn leading to multiple bleeding points (Auspitz sign). Clinical variants of Psoriasis include Guttate psoriasis, Chronic Plaque Psoriasis, Palmoplantar Psoriasis, Flexural Psoriasis, Nail Psoriasis, Exfoliative Psoriasis and Pustular Psoriasis.

 

Amongst which Chronic Plaque Psoriasis is a Stable Psoriasis where bilateral symmetrical well-defined coin-sized to large palm-sized erythematous plaques are seen all over the body. The Modern treatment aims to control the symptoms, to improve quality of life, rather than to cure it which includes topical therapy and systemic therapy. Topical therapy comprises of use of emollients, strong topical steroids, occlusion therapy, intralesional injections, non-steroidal expensive topical options such as topical Calcipotriol.5 Systemic therapy includes use of oral retinoids, methotrexate, UVB Phototherapy and PUVA Therapy with resultant remissions and exacerbations in signs and symptoms.6,7

 

In Ayurved all skin diseases are described under Kushtha. According to Ayurveda, Psoriasis can be considered as Ekakushtha which is one of the types of Kshudra Kustha (Minor Diseases). It is a Vata-Kapha Dosha predominant skin disorder. The classical symptoms of Ekakushtha described in Ayurveda resembles with Psoriasis. Aswedanam (absence of perspiration over site of lesion), Mahavastu (big size widespread lesion), Matsyashakalopamam (scaling resembling that of fish scales) are the features of Ekakushtha.8

 

According to Ayurved, the etiotiological factors can be subdivide into three categories

1)    Unwholesome diet- foods which are incompatible.

2)    Unwholesome behavior- insulting saints, concurring others property or money or any kind of belongings, bad deeds done in previous life.

3)    Improper Panchakarma procedures.

 

These factors increases Vatadi Doshas which moves in different directions inside the body; invades the channels present everywhere inside; thereby causing vitiation of skin, lymph, blood and muscles makes them fragile manifesting signs and symptoms of Kushta.9 The function of Jatharagni (digestive fire) is Ayu (life span), Bala (strength), Swasthya (health), Utsaha (enthusiasm), Upachaya (corpulance), Prabha (Luster), Oja (immunity) and Teja (complexion). Its proper maintenance helps a person to live a long life, and its impairment gives rise to disease.10  The treatment of Kushtha is carried out according to the predominance of the Doshas, the aggravated Doshas should be treated first followed by treating other Doshas.11,12  In Vata predominant Kushtha roga oral intake of medicated ghee is indicated, in Kapha predominant Kushtha Vaman therapy (medicated emesis) should be done and in Pitta predominant Kushtha Raktamokshana (blood-letting therapy) and Virechan therapy (medicated purgation) are indicated.13  In case of Kshudra Kushtha (Minor disease) Prachchan (Incisional blood-letting therapy) is indicated while in case of Mahakushtha (Major skin diseases) Siravedha or Raktamokshan (blood-letting therapy)  is indicated. Other treatment modalities include Basti (medicated enema), Nasya (medicated nasal instillations), Dhoomapana (medicated inhalation therapy), Lepa (thin external application), Pradeha (thick external application), and use of internal medications.14,15 For this paper, a case report of 25 years female patient having signs symptoms of Ekakushtha (Psoriasis) since last 5 years is discussed. The patient was treated with Shamana (pacification) with Ayurvedic oral medications, external applications and Pathya (wholesome diet) regimen. Ayurvedic management has given her better results. Patient started feeling better within 45 days with complete relief after 4 months of treatment.

 

2. MATERIAL AND METHODS:

It is a single case report. Informed consent was taken in patient’s language before commencement of treatment.

 

Patient information and clinical findings:

A 25 years old female patient from new sangvi, pune came to Dr. D. Y. Patil Ayurved hospital OPD on 16 September 2019 with complaints of Reddish lesions over arms, forearms, legs, thighs and trunk region; itching and burning sensation over lesion and scalp, scaling over scalp region since 5 years i.e. 2014. Patient was alright before five years then she started suffering from appearance of erythematous well demarcated lesions gradually over trunk region followed by upper limb and lower limb lesions along with scaling over scalp region which gradually increased day by day with itching and burning sensation over the lesion site. Patient had no previous associated illness. She approached higher Medical Centre for treatment for four consecutive years where she was diagnosed as chronic plaque psoriasis. Patient had no history of DM / HTN / IHD / Surgical history / Family history. Patient was second Gravida with 1male 1 female child of 2 and 4 years of age respectively FTND with normal menstruation. On examination, her built and nourishment were moderate with normal vitals. Patient had normal appetite, thirst, micturition with irregular unsatisfactory motions since 2 months with absent perspiration at the site of lesion.  On general examination of patient erythematous sharply demarcated un-indurated lesions were observed over upper and lower limbs, trunk along with scaly lesions over scalp (Fig 1). Ashtavidha pariksha (Eight-fold Examination) revealed medium built, irregular unsatisfactory bowel along with normal pulse, urine, tongue, speech, touch and eyes. Systemic examinations and vitals were normal. Basic investigations were done which was normal. Because of recurrent remissions she opted to take Ayurvedic treatment. Local examination revealed Erythematous scaly lesions over arms, forearm, trunk, legs and thigh region along with silvery scaly lesion over scalp as seen below.

 

 

Fig 1: Date 16 September 2019 before treatment: Erythematous scaly lesions over arms, forearm, trunk, legs and thigh region

·       Investigations:

Patient had already done routine investigations CBC with ESR, Urine routine microscopic, BSL Random along with RA factor, uric acid and C-Reactive protein which were found to be within normal limits.

·       Differential Diagnosis:

Contact Eczema

Lichen Planus

Seborrhoec Dermatitis

Reactive Arthritis

 

3. Diagnosis: Ekakushtha (Chronic Plaque Psoriasis):

On the basis of signs and symptoms (Table 1 and 2) and etiopathogenesis (Table 3) of the disease, the patient was diagnosed as Ekakushtha (Chronic Plaque Psoriasis).

 

Table 1: Signs and symptoms chart

Sr. No.

Sign and symptoms

Gradations

1.

Twak Daran (Scaling at the site of lesion)

4

2.

Rukshata (Dryness at the site of lesion)

3

3.

Raga (Redness)

3

4.

Kandu (Itching)

2

5.

Auspitz sign

2

6.

PASI score16

56.5

 

Table 2: Gradation of assessment of Signs and Symptoms of Psoriasis.17

Sr.No.

 

SCORE

1. TWAKDARAN (SCALING AT THE SITE OF LESION)

1.

No scaling

0

2.

Mild scaling by rubbing/ itching

1

3.

Moderate scaling by rubbing/ itching

2

4.

Severe scaling by rubbing/ itching

3

5.

Scaling without rubbing/ itching

4

2. RAGA (REDNESS AT THE LESION SITE)

1.

Normal skin

0

2.

Faint or near to normal

1

3.

Blanching + red color

2

4.

No blanching + red color

3

3. RUKSHATA ( DRYNESS)

1.

No line on scrubbing with nail

 

2.

Faint line on scrubbing by nail

 

3.

Lining and even words can be written on scrubbing by nail

 

4.

Excessive dryness leading to itching

 

5.

Dryness leading to crack formation

 

4. KANDU (ITCHING)

1.

No itching

0

2.

Mild or occasional itching

1

3.

Moderate (tolerable) in frequency

2

4.

Very severe itching

3

5. AUSPITZ SIGN

1.

Absent

0

2.

Improvement

1

3.

Present

2

6. PASI SCORE

1.

Score before treatment

 

2.

Score after treatment

 

 

Table 3: Samprapti ghatak (Etiopathogenesis) of Ekakushtha

1.

Doshaj Prakruti

Vata predominant Pitta

2.

Manas prakruti

Rajas

3.

Aaharaj hetu

Improper diet habits, stale food

4.

Viharaj hetu

Excess anger, Day sleep, Physical stress

5.

Dosha

Vata predominant Pitta Dosha

6.

Dushya

Skin, lymph, blood and muscle

7.

Agni

Jatharagni, Dhatvagni (digestive fires)

8.

Srotodushti prakara

Vimargagamana (Doshas moving in different directions)

9.

Udhbhava sthana

Twak (skin)

10.

Adhishtan

Twak, mamsa

11.

Rogamarga

Shakhagata rogamarga

 

4. Treatment Advised:

Considering the Samprapti (etiopathogenesis) of Disease in this patient, following treatment plan was prescribed. The treatment was provided in the form of Shaman Chikitsa (Ayurvedic oral medications and external applications) shown in Tables 4 and Pathya (wholesome diet).

 

Contents of Raktashodhak decoction:

It is the combination of some of the ingredients of Kandughna Mahakashaya and Kushthaghna Mahakashaya mentioned in Charak Samhita in Shadvirechanshatashritiya Adhyaya.18 Ingredients of Raktashodhak decoction are Nimba (Azadirachta indica), Amlaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitak (Terminalia belerica), Daruharidra (Berberris aristata), Manjishtha (Rubia cordifolia), Sariva (Hemidesmus indicus) and Yashtimadhu (Glycirrhiza glabra).

 

Patient was asked to follow proper diet regimen for 4 consecutive months. Patient was advised to take Pathya (wholesome) diet regimen which included Shalishashti (Rice), Koradoosh (Rice), Yavagu (Rice Gruel), Godhuma (Wheat), Koradoosh (Rice), Mudga Yusha (Green Gram Soup) and all such food which are easily digestible. Patient was asked to avoid Apathya (unwholesome) diet regimen such as Mamsa (Meat), Milk, Curd, Amla (Sour) Substances, Fatty food and all other Improper Diet Habits.19

 


 

Table 4: Shaman chikitsa (Ayurvedic oral medications and external applications)

Sr. No.

Drugs

Dose

Time of administration

Medium

Duration

1.

Raktashodhak decoction*

40ml BD

before meals

-

4 months

2.

Arogyavardhini tablet

125 mg BD

before meals

warm water

4 months

3.

Gandhak rasayan tablet

250 mg BD

before meals

warm water

4 months

4.

Khadir, Nimba, Daruharidra powder

Each 5 gm

dry massage half hour before bath

-

4 months

5.

Nimba Ghana tablet

250 mg BD

before meals

warm water

4 months

6.

777 Oil

LA

every evening

-

4 months

(BD- Twice a day, gm- gram, LA- Local application)

Table 5: Assessment of Patient:

SR.NO.

Type of assessment

0 Day (16/09/19)

30th Day (14/10/19)

60th Day (11/11/19)

120th Day (07/01/20)

1.

Twak Daran (Scaling at the site of lesion)

4

3

1

0

2.

Rukshata (Dryness)

3

2

1

0

3.

Raga (Redness)

3

2

1

0

4.

Kandu (Itching)

2

1

0

0

5.

Auspitz sign

2

1

1

0

6.

PASI score

56.5

50.4

24.5

6.8

 

 

Fig 2: Date 07/01/2020 After treatment: Reduced erythematous scaly lesions over arms, forearm, trunk, legs and thigh region

 


5. OBSERVATION AND RESULT:

After taking Ayurvedic therapy (Shaman Chikitsa and Pathya), the patient experienced significant relief in signs and symptoms. The lesions disappeared gradually over trunk and hand region as seen in Fig 2. All other lesions also reduced significantly. Assessment of patient was done on 0, 30th, 60th and 120th day which are shown in Table 5. Thus this study has shown that Ayurvedic therapy proves to be fruitful and effective in psoriasis patient along with relief in all signs and symptoms.

 

6. DISCUSSION:

This is a single case study of Ekakushtha (Chronic Plaque Psoriasis) where patient got relief without recurrence of signs and symptoms with improved quality of life. Desirable results were achieved with only Ayurvedic oral medications, local applications and Pathya (following wholesome diet regimen). The medications used for treating this case acts as Vata Kaphashamak, Raktashodhak (purifies blood), Vranaropaka (wound healing), Vranashodhak (cleanses wound), Kushthaghna (antibacterial), Anti-inflammatory, Rasayana (rejuvenating effect), Kandughna (anti-itch) and anti-oxidant which are opposite to the etiopathogenesis of Ekakushtha (Psoriasis).20  Mode of action of each medications used is explained below.

 

Mode of action of contents of RaktaShodhak Decoction21,22:

1)    Nimba (Azadirachta indica) being pungent after digestion and cold in potency reduces Kapha and Pitta thus acts as Kandughna (reduces itching), Kushtaghna (used in skin diseases). It is well known for its antibacterial, antifungal and anti-inflammatory actions.

2)    Amlaki (Emblica officinalis) being sweet after digestion and cold in potency reduces all Doshas thus acts as Kushtaghna (used in skin diseases). It is well known for its Rasayan (Rejuvenating effect), immuno- modulatory, antibacterial and anti-oxidant effects.

3)    Haritaki (Terminalia chebula) being sweet after digestion and hot in potency reduces all Doshas thus acts as Kushtaghna (used in skin diseases). It is well known for its Rasayan (Rejuvenating effect).

4)    Bibhitak (Terminalia belerica) being sweet after digestion and hot in potency reduces all Doshas. It also has antihistaminic, antifungal and anti- inflammatory properties.

5)    Daruharidra (Berberris aristata) Pungent after digestion, Hot in potency, Reduces Kapha and Pitta, Vranashodhan-ropan cleanses& heals wound Kandughna (reduces itching) and Kushtaghna (used in skin diseases) Antibacterial.

6)    Manjishtha (Rubia cordifolia) being pungent after digestion and hot in potency reduces Kapha and Vata thus acts as Raktaprasadak (promotes quality of blood) and Kushtaghna (used in skin diseases). It has anti-inflammatory action and promotes complexion.

7)    Sariva (Hemidesmus indicus) being sweet after digestion and cold in potency reduces all Doshas thus acts as Kushtaghna (used in skin diseases) and Raktashodhak (purifies blood).

8)    Yashtimadhu (Glycirrhiza glabra) being sweet after digestion and cold in potency reduces Vata and Pitta Doshas thus acts as Kandughna (reduces itching), Rasayan (Rejuvenating effect) and Varnya (promotes complexion). It has immuno- modulatory and anti-oxidant effect.

 

Mode of action of other medications used:

1)    Arogyavardhini Tablet23 has Kushtaghna (antibacterial) action, Rasayan (rejuvenating) effect and is also used for Malashodhana (laxative effect).

2)    Gandhak Rasayan Tablet24 is Pittashamak (reduces pitta) and thus acts as Kushtaghna (antibacterial) and also has Rasayan (rejuvenating effect). 

3)    Khadir, Nimba, DaruharidraUdvartana (rubbing of these powder paste) over lesion site does Vranaropana (heals wound), Vranashodhan (cleanses wound), Raktashodhana (purifies blood) and acts as Kushtaghna (antibacterial).

4)    Nimba Ghana Tablet is an effective medication for Shothahara (anti-inflammatory), Kushtaghna (antibacterial) and Rasayan (rejuvenating effect).

5)    777 Oil contains Shweta Kutaja (Wrightia tinctoria) which acts as Shothahara (anti-inflammatory), antipruritic, antiulcerogenic, anti-itch and moisturizer.25

 


7. CONCLUSION:

Ayurvedic treatment has given good results to the patient. This is a single case that got complete relief without any recurrence till date. The patient is advised to follow wholesome diet and do seasonal Panchakarma therapies like Vaman (Medicated emesis), Virechan (Medicated purgation) and Basti (Medicated enema) as per necessity. There is further scope for research on this topic.

 

8. CONFLICT OF INTEREST:

The authors declare no conflict of interest.

 

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Received on 04.02.2021           Modified on 20.07.2021

Accepted on 17.09.2021         © RJPT All right reserved

Research J. Pharm. and Tech. 2022; 15(6):2417-2421.

DOI: 10.52711/0974-360X.2022.00402