E-ISSN:2456-3110

Research Article

Tinea corporis

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 7 August
Publisherwww.maharshicharaka.in

An observational clinico etiological study of Kushta with specific reference to Tinea corporis

Abhitha A.1*, Arunkumar M.2, Nagaraj S.3, Kumar Shetty S.4
DOI: http://dx.doi.org/10.21760/jaims.7.7.9

1* A Abhitha, Post Graduate Scholar, Department of PG and PhD studies in Roga Nidana Evum Vikruti Vigyan, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Udupi, Karnataka, India.

2 M Arunkumar, Associate Professor, Department of PG and PhD studies in Roga Nidana Evum Vikruti Vigyan, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Udupi, Karnataka, India.

3 S Nagaraj, Professor & HOD, Department of PG and PhD studies in Roga Nidana Evum Vikruti Vigyan, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Udupi, Karnataka, India.

4 Sandesh Kumar Shetty, Associate Professor, Department of PG and PhD studies in Swasthavrittam, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Udupi, Karnataka, India.

Background: Skin diseases are among the most common health problems worldwide and are associated with considerable burden. In Ayurveda classics, skin disorders are termed in general as Kushta and are caused with involvement of Vata, Pitta, Shleshma and Krimi. Among the diversified etiological factors Krimi has a great importance. So, here an attempt is made to evaluate the clinical types, to isolate the common fungal species, etiological factors and to identify probable risk factors of Krimijanya Kushta in the present population. Objectives: To evaluate the clinical types, etiological factors and to identify probable risk factors of Krimijanya Kushta with special reference to Tinea Corporis and to isolate the prevalent causative fungal species. Materials and Methods: A total of 30 patients clinically diagnosed with tinea corporis and fulfilling the inclusion criteria were taken for the study. Results: Among 31 patients studied percentage of growth of different species of dermatophytes in culture study are given as follows, 48.4% are Trichophyton, 6.5% were Trichosporon, 3.2% were Microsporum Gypseum, 19.4% were Epidermophyton,16.1% were Candida, 3.2% were Aspergillus, 3.2% were found no growth. Conclusion: Aharaja and Viharaja Nidana mentioned in Kushta Nidana as well as Krimi Nidana were found to have Madhura, Amla, Lavana Rasa, Guru Guna, Vidahi, and Kledakaraka property which cause Swedaavarodha and is crucial for Kushta Utpathi as well as Krimi Utpatti. The prevalent causative fungal species found in the study were Trichophyton, Epidermophyton, Aspergillus, Trichosporon, Microsporum gypseum. Clinically to approach Kushta, better to be done through culture study.

Keywords: Tinea corporis, Krimi, Kushta, Kleda

Corresponding Author How to Cite this Article To Browse
A Abhitha, Post Graduate Scholar, Department of PG and PhD studies in Roga Nidana Evum Vikruti Vigyan, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Udupi, Karnataka, India.
Email: 		A Abhitha, M Arunkumar, S Nagaraj, Sandesh Kumar Shetty, An observational clinico etiological study of Kushta with specific reference to Tinea corporis. J Ayu Int Med Sci. 2022;7(7):65-72.
Available From
https://jaims.in/jaims/article/view/1932

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-06-23 2022-06-25 2022-07-02 2022-07-09 2022-07-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by A Abhitha, M Arunkumar, S Nagaraj, Sandesh Kumar Shettyand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Kushta one among the Ashtamahagada classification denotes for all the skin diseases.[1] Madhavakara describes the disease in which vitiated Dosha destroys the Dhatu, Upadhatu produces discoloration and putrefaction forming Kotha is called Kushta.[2]

In medical science the skin diseases have gained their magnitude as a multidimensional concept which encompasses psychological, social and financial consequences of the skin disease on the patients, their families and on society. The study of Indian literature reveals that skin diseases were considered as one of the major propositions; speaking, any affection of skin was considered as a serious problem which is evident from its extensive description under the heading of Kustha. Aharaja as well as Viharaja Nidana of along with Krimi Nidana can cause Tridosha Prakopa along with Twak Rakta Mamsa and Lasika causes Kushta.[3] Acharya Susrutha mentioned Krimi as Nidana and Upadrava of Kushta. Acharya Sushruta has categorised under Kushta are contagious or transmitted due to touching, sharing the bed, eating in same vessel, wearing same clothes, or through exhalation of air, common use of garlands, physical contact, sexual intercourse, are the media of transmission of disease from one person to other. The description of Krimijanya Kushta closely resembles the features of tinea corporis. Tinea corporis is the common fungal infection of skin presents as erythematous centrifugally growing annular lesion with a peripheral scale. The lesions of tinea corporis is usually annular or polycyclic, its borders looks like erythematous and vesicular on scaly, with the central clearing.[4] The clinical diagnosis of this infections can be established by typical manifestations and distributions of lesions.

Skin diseases can place a heavy emotional and psychological burden on patients that may be far worse than the physical impact. Hence, it’s important to constantly review the causative agents and its distribution to avoid resistant, recurrent dermatophytoses. In view of that critical understanding of the Krimi in dermatological manifestation is needed. This calls for the study of various etiological factors, clinical presentation of Krimijanya Kushta with features resembling Tinea Corporis.

Methodology

This was an observational descriptive, cross-sectional, hospital based study on minimum of 30 patients clinically diagnosed cases of dermatophytosis of age groups between 16-70 year of both gender registered from O.P.D and I.P.D of S.D.M Hospital, Udupi. The written informed consents were taken from the subjects. This study was approved by the ethical committee of the institution. Data collection was done by a pre-formed case proforma. Subjects fulfilled diagnostic criteria such as dermatological lesions on body or limbs i.e., round or annular skin lesions and scaling with well marginated patches. KOH positive skin scrapings were included. Patients under antifungal treatment for more than 4 weeks, non-dermatophytic fungal infections, uncontrolled diabetes mellitus, Pregnant and lactating women and those who diagnosed with other immune compromised conditions were excluded from the study. Assessment criteria for the present study included identification of fungal Species etiological factors for Krimi, etiological factors and clinical types of Kushta.

Collection of sample: A total of 31 patients clinically diagnosed with tinea corporis and fulfilling the inclusion criteria were taken for the study. A detailed clinical history was taken and physical examination done in all the cases, and the data will be entered in a pre-formed proforma. The infected skin lesions were scraped to obtain specimens confirming the presence of fungal infection by microscopic examination and culture. The lesions were thoroughly cleaned free of any debris by using 70% alcohol to reduce bacterial contamination. The area was allowed to dry thoroughly. Scrapings of the skin were taken with a no. 15 sterile surgical blade held vertically to the skin from the edge of the lesions. Scrapings collected were directly placed onto the slide for KOH-microscopy. For KOH microscopy, a drop of 10% KOH was added to the sample collected on the slide. A cover slip is applied with gentle pressure to drain away excess KOH. The slides were kept at room temperature for 20 min for clearing of the keratin. Slides are then examined microscopically at 400× magnification. The test is considered positive when long, branching, septate, hyaline hyphae were present. Positive sample scrapings then transferred into a glass container, for transport to the microbiology lab for culture. 



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Statistical analysis: Microsoft Word and Microsoft Excel 2019 were used to process manuscript and tables. Results were analysed using descriptive statistical methods like mean and percentages.

Results

The frequency of each Nidana was assessed through a Likert-type scale.

Table 1: Likert-type scale

Frequency Likert like scale No of days/ week
Never 0% chance Never
Rarely 10% and above chance I would have 1-2 times/ semester
Sometime 50% and above chances I would have used 1-2 times/month
Often Frequently about 70% of chances I would have 1-3 times/week
Almost In about 90% and above of chances I could have 3+times/week

In the present study data analysis showed that among 31 patients included 58.1% were female patients, 41.9% of male patients. Infections were more common in age group of 40-50 years (29%).

Majority of the subjects belongs to middle class (71%). 19 (61.3%) patients had Mandagini. Among 16 patients (51.6%) were having Krura Koshta.

Table 2: Aharaja Nidana of Kushta in Tinea corporis patients.

Nidana[5] Never% Rarely% Sometime% Often% Almost%
Cold water/juice/beverages during warm meals 6.5 54.8 38.7   0   0
Lavana Atisevana 6.5 32.3 29.0 32.3 0
Milk with sour substances 12.9 51.6  22.6 12.9 0
Chilichimamatsya with Payas 74.2 25.8 0 0 0
Aquatic fish/domestic meat in combination with honey/jaggarey/ sesame seeds/ radish/ blackgram 74.2   25.8   0    0   0 
Amlatisevana 3.2 61.3 12.9 22.6 0
Atisneha 25.8 58.1 12.9 3.2 0
Intake of Santarpana and Apatarpana diet without sequences 0 3.2 54.8 35.5 6.5
Intake of freshly harvested grains 0 6.5 58.1 35.5 0
Madhu, Phanita, Matsya, Lakucha, Mulaka, Kakamachi 3.2 41.9 48.4 6.5 0
Excessive intake of Patrasaaka 0 32.3 41.9 22.6 3.2
Excessive intake of jaggery 6.5 54.8 25.8 9.7 3.2


Table 3: Viharaja Nidana of Kushta in Tinea corporis patients.

Nidana Never% Rarely% Sometime% Often% Almost%
Cold bath when afflicted with fear, exhaustion and grief 35.5 45.2 19.4 0 0
Immersing in cold water after exposure to sunlight 3.2 51.6 14.5 14.5 16.1
Hard work causing fatigue 29.0 48.4 22.6 0 0
Excessive exercise 29.0 45.2 25.8 0 0
Indulgence in sex after intake of food 6.45 22.55 12.9 12.9 45.2
Day sleep 16.1 16.1 19.4 25.8 22.6

Table 4: Krimi Nidana in Tinea corporis patients.

Nidana[6] Never% Rarely% Sometime% Often% Almost%
Intake of food during indigestion 3.2 9.7 35.5 16.1 35.5
Excessive sweet items 0 12.9 38.7 16.1 32.3
Excessive sour items 3.5 19.4 25.8 3.2 48.1
Drava Priya 6.5 3.2 25.8 22.6 41.9
Pishtanna 9.7 0 32.3 16.1 41.9
Gudabhokta 3.2 9.7 16.1 35.5 35.5
Vyayama Varji 0 6.5 51.6 12.9 29.0
Divaswapna 0 12.9 22.6 16.1 48.4

Table 5: Upasargaja Nidana in Tinea corporis patients.

Nidana[7] Never% Rarely% Sometime% Often% Almost%
Sharing clothes 3.2 6.5 3.2 16.1 38.7
Sharing bed 3.2 6.5 3.2 16.1 38.7
Eating in same vessel 6.5 9.7 45.2 22.5 16.1
Sharing ornaments 16.1 22.5 38.7 16.1 6.6
Sharing unguents 25.8 32.3 23.5 15.3 3.1
Sexual intercourse 74.2 22.7 3.1 0 0
Physical contact 6.5 3.1 6.5 38.7 45.2

Table 6: Dermatophyte species found in different clinical type.

Culture N=31 Percent%
Trichophyton 15 48.4
Trichosporon 2 6.5
Microsporum Gypseum 1 3.2
Epidermophyton 6 19.4
Aspergillus 5 16.1
Candida 1 3.2
No growth 1 3.2




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Table 7: Doshaja Kushta Lakshana in Tinea corporis patients.

Vatajakushta Lakshana[8] Present/Absent N = 31 Percent %
Twak Samkocha Present 15 48.4
Absent 16 51.6
Supti Present 0 0
Absent 31 100
Sweda Present 8 25.8
Absent 23 74.2
Bheda Present 8 25.8
Absent 23 74.2
Shobha Present 2 6.5
Absent 29 93.5
Kaunya Present 0 0
Absent 31 100
Swaropaghata Present 0 0
Absent 31 100
Kaphaja Kushta Lakshanas[9] Gourava Present 0 0
Absent 31 100
Kandu Present 10 31
Absent 21 69
Bheda Present 8 25.8
Absent 23 74.2
Shobha Present 2 6.5
Absent 29 93.5
Raga Present 31 100
Absent 0 0
Srava Present 2 6.5
Absent 29 93.5

Table 8: Dhatu Gata Kushta Lakshana in Tinea corporis patients/

Twak Gata Kushta Lakshanas[10] Present/Absent %
Sparsha Hani Present 0
Absent 100
Twak Vaivarnya Present 100
Absent 0
Swedasyatipravarthi Present 67.7
Absent 32.3
Ishat Kandu Present 100
Absent 0
Twak Swapa Present 0
Absent 100
Rooksha Bhava Present 83.2
Absent 16.2
Rakta Dhatu Gata Kushta Lakshanas[11] Kandu Present 100
Absent 0
Vipooyaka   Present 58.1
Absent 41.9
Twak Swapa Present 0
Absent 100
Romaharsha Present 45.2
Absent 54.8
Svedasya Atipravarti Present 67.7
Absent 32.3

Table 9: Samanya Krimi lakshanas in Tinea corporis patients.

Samanya Krimi Lakshanas[12] Present/Absent N=31 %
Jwara Present   0
Absent   100
Vivarnata Present   100
Absent   0
Shoola Present   25.8
Absent   74.2
Hridroga Present   0
Absent   100
Sadana Present   22.6
Absent   77.4
Bhrama Present    0
Absent   100
Atisara Present   0
Absent   100
Bhaktadvesha Present   25.8
Absent   74.2
Bahya Krimi Lakshana[13] Kota Present   74.2
Absent   25.8
Pidaka Present   38.7
Absent   61.3
Kandu Present   100
Absent   0
Gandaan Present   22.6
Absent   77.4

Table 10: Dadru Kushta Lakshana in Tinea corporis patients.

Dadru Kushta Lakshana[14] Present % Absent %
Kandu 100 0
Udgata Mandala 74.2 25.8
Pidaka 38.7 61.3
Vivarnata 100 0
Dirghapratanata 77.4 22.6

Discussion

The Aharaja, Viharaja Nidana of Kushta as well as Krimi along with Upasargaja Nidana which causes Dosha Dushti and produce Vyadhi.

Samuthana Vishesha

Ahara

Virudha Ahara, Atiamla Atilavana Rasa Pradhana Ahara are described as Nidana for Kushta. Intake of excessive Lavana and Amla Rasa produce excessive Kledada to the body which favours the Krimi Uthpatti.


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The mode of action of Viruddha Ahara tend to vitiate Rakta and may also lead to many Dhatupradoshaka Vikaras such as Kustha. These Aharadi Nidanas act as a Viprakrushta Hetu for Vyadhi manifestation.

Divaswapna

Divaswapna causes Tridosha Dushti, and is observed in study subjects. Divaswapna causes Kapha Prakopaka and also Kledakaraka.

Sheeta Jalapana after Vyayama

Sheethoshna Vyatyasa Nidana is one of the prime causes for Swedovaha Srotodushti. Vasodilatation is observed in individuals after exercise or heavy work. Immediate intake of Sheetala Jala may result in vasoconstriction. This sudden change for a long time might have ended up in the dysfunction of skin barrier thereby allowing the entry of microbes inside the epidermis ensuing inflammatory processes. This can be considered as a Viprakrushta Nidana of the Vyadhi.

Upasargaja Nidana: Aupasargika Vyadhi spreads from persons by Krimi through Sweda. As tinea corporis is contagious disease it spreads by skin-to-skin contact or by touching contaminated surface or fomites. In the present study there is Upasaragaja Nidana plays a major role in manifesting Vyadhi. This acts as Sannikrushta Nidana for the Vyadhi.

Manasika Nidana: Manasika Nidanas in Ayurveda were categorised into that causes Pitta Prakopaka and Vata Prakopaka. Krodha causes Pitta Prakopa which directly vitiates Rakta Dushti and causes Kushta.

Krimi Nidana: Krimi Nidana which produce Kledata to the Twak and favours Krimi Utpatti leads to Kushta. In the assessment of Adhishtanantarani, Kustha vitiates the three Dosas and creates Saithilya in the Dushyas as same as in Bahya Krimi which spreads persons to person through Upasargaja Nidanas.

Discussion on involvement of Dosha and Dhatu

Even though in Kushta there is Tridosha become agitated and bring looseness in Twagadi Dhatus. In Krimi Janya Kushta the Vata and Kapha Pradhana Tridosha was noted more in the study affecting only the Utthana Dhatus like Twak and Rakta. A large sample size is needed to check the involvement of Tridoshas.

Also Virudha is found to act at the level of Rasaadi Dhatus, Tridoshas or directly culminate into Shonita Dushti because most of the Viruddhas act either abruptly as that of Visha.

Conclusion

To summarise, Kushta Aharaja, Viharaja as well as Krimija and Upasargaja Nidana were predominantly found. Involvement of Pitta Dosha (comparatively less) and Mamsa Dhatu were observed in some cases. In the assessment of Samutthana Vishesha, all the Saptavidha Vyadhi classification along with Upasargaja Nidana are found to be more or less significant in explaining this type of Kushta. Both literary analysis and clinical findings reveals the role of Tridosha Dushti, Twak, Rakta, Mamsa in genesis of Kushta with Krimi involvement. 75% which was statistically highly significant follows Kushta Aharaja and Viharaja Nidana, 73% of them follows Krimija Nidana. This Nidana might have caused Swedaavarodha resulting in Kledabahulatha. This is crucial factor for Kusthotpatti. Different categories of Kushta having pathological presentation of tinea corporis such as Vataja Kushta Lakshanas , Kaphaja Kushta Lakshanas, Dadru Kushta, Mandala Kushta, Twak Gata Kushta, Rakta Gata Kushta, Mamsa Gata Kushta (fewer Lakshanas). Different species of dermatophytes found in culture study are as follows, 48.4% were Trichophyton, 6.5% were Trichosporon, 3.2% were Microsporum Gypseum, 19.4% were Epidermophyton,16.1% were Candida, 3.2% were Aspergillus, 3.2% were found no growth. This Observation study concluded that there is a need of culture study to detect the organism present in the lesion as the lesions of superficial infections mimics with the opportunistic fungal infections. Oppurtunistic mycosis were seen in immunocompromised host, including species of fungi like Trichosporon, Candida and Aspergillus as there is immune system impairment and thus increase the risk of invasive fungal infections. Ojas as well as Vyadhikshamatva also plays a role in manifestation of dermatophytes. Hence, to reach a diagnosis and for the successful course of treatment fungal culture is crucial.

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