A successful case study on Ayurvedic management of Dadrukustha w.s.r. to Tinea Infection

Nikhil Joglekar; Arati Datye

A successful case study on Ayurvedic management of Dadrukustha w.s.r. to Tinea Infection

Joglekar N.^1*, Datye A.²

DOI:

^1* Nikhil Joglekar, Assistant Professor, Department of Kayachiktsa, D Y Patil Deemed to be University, School Of Ayurveda, Nerul, Navi Mumbai, Maharashtra, India.

² Arati Datye, Assistant Professor, Department of Kayachiktsa, R A Podar Medical College (Ayu) Worli, Mumbai, Maharashtra, India.

In the current era of civilization, there has been a considerable increase in the incidence of skin disease due to unhygienic condition, poverty, certain types of infection, faulty food habits, etc. Out of the all skin diseases fungal infection is very common. This is opportunistic fungal infection caused by dermatophytes species of fungi. This fungal infection is very common at hot and humid environment In Ayurveda majority of all Twak Vikaras classified under broad term “Kushtha Vikara” Symptoms of fungal infection closely resembles with Dadru Kustha. It has been observed in nowadays that there is increased resistance to antifungal drugs, tinea infection don’t respond to routine antifungal medicines. For few days’ symptoms of tinea infection regresses but again it has tendency to flare up. So there is scope of intervention of Ayurvedic medicine which can control and irradicate tinea infection and prevents relapses. So in this article we are going to discuss a case study of Dadru Kushtha successfully treated with Ayurvedic principles

Keywords: Tinea infection, Dadru Kustha, Ayurvedic Lepa Chikitsa, Nimbadi Yoga Lepam, Ayurveda

Corresponding Author	How to Cite this Article	To Browse
Nikhil Joglekar, Assistant Professor, Department of Kayachiktsa, D Y Patil Deemed to be University, School Of Ayurveda, Nerul, Navi Mumbai, Maharashtra, India. Email:	Nikhil Joglekar, Arati Datye, A successful case study on Ayurvedic management of Dadrukustha w.s.r. to Tinea Infection. J Ayu Int Med Sci. 2022;7(2):120-124. Available From https://jaims.in/jaims/article/view/1765

Introduction

Tinea infection also called as dermatophytosis. The commonest of all fungal infections dermatophytosis is caused by dermatophytes, a group of fungi that survive by living on keratin. These may spread from human to human (By sharing of clothes, and personal articles), animal to human (By close contact with pets) and from soil to human (Contact with soil). Dermatophytosis is extremely common in our country due to tropical climate.

According to site of affection dermatophytosis is classified into tinea corporis, tinea barbae, tinea cruris etc. Pruritus is extremely common to all types of dermatophytosis except tinea incognito, tinea unguium and some cases of non-inflammatory tinea pedis and manuum.

Adults, young and middle aged are typically affected. Obesity, diabetes mellitus, sweating tendency, high temperatures at work place (like near boilers, furnaces), wearing damp or non-absorbent or thick clothing or footwear in a humid atmosphere, sharing personal articles like towels, all predisposes to these infections. Sharing caps, combs, and shaving blades may lead to tinea capitis and tinea barbae respectively.

Tinea Corporis – a typical case has erythematous papules, tiny vesicles, and pustules at the margin of a scaly variably pigmented patch. Secondary changes in this active margin may result in crusting, scaling and erosions. Initial lesions are grouped reddish papules with thin scale. Lesions subside centrally and progress peripherally to produce a ringlike annular lesion hence the name ringworm. Tinea corporis affects waistline, axillae buttocks other part of trunk and extremities excluding palms and soles.

Tinea barbae: grouped erythematous papules and pustules in the beard region. Lesions may heal with loss of hair.

Tinea capitis: Includes a scaly patch of partial alopecia over scalp.

Tinea manuum & tines pedis: affection of hands and feet respectively.

Tinea Unguium: Asymmetric nail involvement. Involved nail may become thick fragile, yellowish, or grayish brown in colour and develop subungal hyperkeratosis.

Tinea Cruris: Use to indicate involvement of upper inner thighs, below scrotum.

In Ayurvedic perspective view skin diseases are narrated under heading of Kustha. In Charak Samhita description of Dadru Kustha has given in Kshudra Kustha. Charak Acharya classified Kustha in 2 parts – Kshudra Kushtha and Maha Kushtha which are of 11 & 7 types respectively.

As there is no specific Hetu and Samprapti of Dadru Kustha available in text hence Hetu and Samprapti of Kustha is considered as of the same for Dadru Kustha.

Acharya Sushruta has described Kushtha Nidana and Chikitsa. Aacharya Sushruta clearly described Anuvanshika (Hereditary) and Krimija (infectious) Nidana as a causative factor for Kushtha. Kushtha has been also included in list of Aupasargika Roga, which may spread from one person to another.

In Nidana Sthana, Acharya Sushruta has explained the Dhatugatatva or Uttarottara Dhatu Pravesha of Kushtha Roga. The unique concept is also found in Sushruta by giving the two chapters of treatment (Chikitsa) i.e. Kushtha Chikitsa & Maha Kushtha Chikitsa.

So, Dadru is a Tridoshaj Twakvikara with Pitta-Kapha predominance. It involves clinical features like Kandu, Raga, Pidika, and Mandala.

These symptoms are very much similar with the features of Tinea or fungal infection like pruritus, moist erythematous patches, vesicles, tiny superficial pustules spreading all over the body. It occurs mostly at the certain part of the body like folds and mucosa.

It is very common skin disease in India with prevalence rate of almost 20-22%. According to modern science, management of Tinea infections carried out with topical as well as systemic antifungal drugs. But it has been observed in nowadays that there is increased resistance to antifungal drugs, tinea infection don’t respond to routine antifungal medicines.

For few days’ symptoms of tinea infection regresses but again it has tendency to flare up.

So, there is scope of intervention of ayurvedic medicine which can control and irradicate tinea infection and prevents relapses.

Comparative symptoms of tinea infection and Dadru.

SN	Symptoms of Tinea	Symptoms of Dadru Kushta
1.	Erythema	Raga
2.	Itching	Kandu
3.	Granular surface	Pidka
4.	Circular elevation of skin	Utsanna Mandal

Case Report

30 year old male patient presented in Dr. D Y Patil Ayurvedic Hospital Kayachikitsa OPD with complaints of erythematous patch with papules and pustules at the margin over buttock and right arm region. Lesions were with crusting, scaling and erosions. Patient was having severe itching. He was working as auto rickshaw driver since last 5 years. He was not having any major medical and surgical illness.

Previously he was taking allopathic treatment but could able to get temporary result and after discontinuation of the treatment again there was flaring of the symptoms.

So, patient approached for the ayurvedic treatment.

Materials and Methods

Assessment Criteria - Subjective Criteria

Symptoms of Dadru mentioned in text and practically observed will be assessed at each follow-up.

All the observed symptoms will be categorized in 4 grades.

Kandu (Itching)

Grade	Symptoms
0	No itching
1	Relieve spontaneously
2	Relieve by itching
3	Disturbing routine

Vaivarnya (Discoloration)

Grade	Symptoms
0	Absent
1	Reddish
2	Dark Red
3	Reddish black

Treatment Given

Nimbadi Yoga Lepam for local application.

Contents of the drug: Nimba, Chakramarda, Triphala, Musta, Khadir ,Vidang, Haridra, – All drugs are in equal quantity.

Preparation of Lepa

Dry Sookshma Churna of all drugs are taken in equal quantity, mixed thoroughly. 2 tsp approx 10-15 gms powder is taken, it is mixed with the sufficient amount of water in it. Prepare the drug in the form of Lepa. Then apply this Lepa on lesions twice daily. Lepa will be of ½ cm thick. Lepa will be applied till it becomes dry. After drying wash it out with warm water.

Route of Administration: Topical (External Application) Local application covering the entire lesion. Twice daily.

Duration: 4 weeks.

Aahar: regular as per patients previous schedule avoiding Ushna (Too Spicy) or oily food stuff, Ati Madhur, Ati Amla, Ati Lavan Rasa Yukta, Street food, fast food, fermented and processed food products, Dugdhajanya Vikruti.

Vihar: Maintain Proper hygiene, avoid tight clothing, and wear loose cotton clothes.

With the above mentioned treatment patient got satisfactory relief from the symptoms of tinea (Dadru Kustha). It can be well appreciated on the photographs, documented before and after treatment.

Kandu (Itching)		Vaivarnya (Discoloration)
BT	AT	BT	AT
3	0	3	1

Before treatment

Lesion over buttocks

Lesion Over Right Arm

After Treatment

Lesion Over Buttock

Lesion Over Right Arm

Discussion

In above case study patient got satisfactory relief from symptoms of Tinea Infection (Dadru Kustha). In this case study Nimbadi Yoga Lepa Chikitsa showed good results. Nimbadi Yoga Lepa Chikitsa helps to continuous removal of pathogen along with dead skin debris stimulating

basal layer to proliferate well replacing them new healthy skin cells.

Content and action of drug of the Nimbadi Yoga Lepam

Medicine name	Rasa	Veerya	Vipaaka	Guna
Nimba	Tikta Kashay	Sheeta	Katu	Laghu, Ruksha
Chakramaarda	Katu	Ushna	Katu	Laghu, Ruksha
Haritaki	Pancharasatmak (Lavan Rasa Virahit)	Ushna	Madhur	Laghu, Ruksha
Bibhitaki	Kashay	Ushna	Madhur	Laghu, Ruksha
Aamalaki	Pancharasatmak (Lavan Rasa Virahit)	Sheeta	Madhur	Laghu, Ruksha
Vidanga	Katu	Ushna	Katu	Laghu, Ruksha
Haridra	Katu Tikta	Ushna	Katu	Laghu, Ruksha
Musta	Katu Tikta Kashay	Sheeta	Katu	Laghu, Ruksha
Khadir	Tikta Kashay	Sheeta	Katu	Laghu, Ruksha

1. Nimba: is very effective in all types of Twak Vikara. It has sheet Laghu Grahi It has Kledaghna Krumighna Kapha Pittahara properties. So, this medicine is very useful for treatment of Dadru.

2. Chakramarda: Chakramarda has Laghu, Ruksha Gunas and has Ushna Veerya. It has Kledahara Guna, Kandughna, Krumihar It is special drug on Dadru as one of its synonyms is Dadrughna.

3. Triphala: has Kusthghna effect; also, it pacifies Kapha Pitta which is predominant in Dadru Samprapti.

4. Haritaki: is Ruksha Ushna Gunatmak, Pancharasatmak, and also has Kusthghna It has Kashay Rasa predominance which is Kledahar and Kandunashak.

5. Bibhitaki: is Kashay Rasatmak, Ruksha so, it has Kledahar, Krumighna properties and thus effective on Dadru Kustha.

6. Aamalaki: Action of Amalaki is like Haritaki. Amalaki is Raktaprasadak so, it reduces Daha, Kandu, Vaivarnya and thus acts as a Dadrughna.

7. Musta: Musta is Tikta Kashay Rasatmak. Thus, it reduces Kleda. Also, it has Raktaprasadan properties because of its sheet Veerya. Thus, very useful for Dadru Chikitsa.

7. Khadir: It is Shreshtha Kusthghna Dravya according to Acharya Charak. It has Kledaghna and Kanduhar Kapha Pittaghna properties because of Tikta Kashay Rasa thus helps in treatment of Kustha.

9. Vidanga: is Katu Rasatmak, Ushna Veerya. Its Prabhav is Krumighna. So, Vidanga helps in Kruminashan (i.e., destruction of pathogen in this case it is fungi.) also it is Kaphaghna and Kledashoshan Gunatmak.

10. Haridra: very effective in all Twaka Vikara. It has Krumighna Kledahar Kaphapittahar properties thus very useful for Dadru Chikitsa.

Conclusion

In this case study, marked improvement was seen in patient of Dadru Kustha. The treatment so planned was helpful in Kledaharan, Kandushaman, Rakta Prasadan, and Shaman of vitiated Kapha Pitta Dosha. And hence the treatment was found to be effective to relieve the symptoms quite significantly.

Reference

1. Kasthinath Shastri. Charak Samhita of Agnivesha. Chaukhamba Prakashan, Varanasi. 2012 edition, Chikitsasthana, Kushta Chikitsa Adhyaya, Chapter 7.

2. Anant Ram Sharma. Sushrut Samhita. Chaukhamba Prakashan, Varanasi. 2008 edition, Chikitsasthan, Kustha & Mahkustha Chiktsa.

3. Uday Khopkar. Text Book of skin diseases and sexually transmitted infections. 2009, 6th Edition, Cutaneous fungal infections.

4. K C Chunekar, Ganga Sahay Pandey. Bhavprakash Nighantu. Chaukhamba Prakashan, Varanasi. 2010 edition.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-01-31	2022-02-01	2022-02-08	2022-02-15	2022-02-22
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	17%

Case Report

Tinea infection

Journal of Ayurveda and Integrated Medical Sciences