E-ISSN:2456-3110

Review Article

Dadru Kushta

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

Conceptual study on the etiopathogenesis of Dadru Kushta w.s.r. to Tinea Infection

Mahendrakar S.1*, Timmapur R.2, Mahima S.3
DOI:

1* Sachin Mahendrakar, Post Graduate Scholar, Dept. of Roganidana evam Vikruti Vignyana, Ayurveda Mahavidyalaya, Hubbali, Karnataka, India.

2 RY Timmapur, Guide, Professor & HOD, Dept. of Roganidana evam Vikruti Vignyana, Ayurveda Mahavidyalaya, Hubbali, Karnataka, India.

3 SB Mahima, Co-Guide, Assistant Professor, Dept. of Roganidana evam Vikruti Vignyana, Ayurveda Mahavidyalaya, Hubbali, Karnataka, India.

Ayurveda has given importance to skin diseases since the era of Veda. Dadru is a disease affecting the Twak with symptoms of Kandu, Mandala and Pidaka. It is a Kaphapitta Pradhana, where the symptom closely resembles with symptoms of Tinea infection. Dadru Kushta is due to consumption of Ati Amlalavana Sevana, Ati Snigdha and Ati Drava Ahara Sevana and subjects who are taking Dadhi and Matsya with Kshira which leads to aggravation of Pitta and Kapha Doshas which causes derangement on the skin. North Karnataka is well known for its hot and humid conditions making its population at risk of many Dermatophytic infections. Most common are Tinea Corporis and Tinea Cruris. With this an effort is made to understand the Etiopathogenesis of Dadru Kushta w.s.r. to Tinea Infection.

Keywords: Dadru Kushta, Pitta Dosha, Kapha Dosha, KOH

Corresponding Author How to Cite this Article To Browse
Sachin Mahendrakar, Post Graduate Scholar, Dept. of Roganidana evam Vikruti Vignyana, Ayurveda Mahavidyalaya, Hubbali, Karnataka, India.
Email: 		Sachin Mahendrakar, RY Timmapur, SB Mahima, Conceptual study on the etiopathogenesis of Dadru Kushta w.s.r. to Tinea Infection. J Ayu Int Med Sci. 2022;7(9):139-146.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-24 2022-08-26 2022-09-02 2022-09-09 2022-09-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Sachin Mahendrakar, RY Timmapur, SB Mahimaand 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

Skin is a mirror that reflects external and internal pathology there by helps in diagnosis of disease. It is first organ of the body interacting with environmental stimuli and natural ability of body. Skin diseases accounts for prevalence rate 10-20% of all consultation in general practice.

Skin diseases have been comprehended under the heading of Kushta in Ayurveda and we find a vivid description of Dadru Kushta, since Samhita period. Acharya Charaka[1] as mentioned 18 types of Kushta which are further sub divided into Maha Kushta and Kshudra Kushta. Dadru Kushta has been mentioned in Chikitsa Sthana.

Acharya Vriddha Vagbhatta[2] has mentioned 18 types of Kushta and mentions that Dadru Kushta is Kaphapittaja variety of Kushta. Acharya Laghuvagbhatta has followed the same classification as that of Acharya Susrutha. Bhela Samhita has mentioned 18 types of Kushta.

Dadru is a type of Kushta and analogues with Dermatophytoses or fungal infection or Tinea (ring worm) infection in contemporary science. Dermatophytoses has become a significant health problem affecting children, adolescents and adults worldwide. In India 5 out of 1000 people suffer from Tinea infections. Ringworm is a common superficial fungal infection of the skin, hair, and nails. It can cause an itchy, red, circular rash. Ringworm is also called “Tinea” or “Dermatophytosis”.

The different types of ringworm are usually named based on location of the infection on the body. Potassium hydroxide (KOH) microscopy aids in visualizing hyphae and confirming the diagnosis of Tinea\Dermatophyte infection.

The separate Nidana and Samprapti of Dadru Kushta were not explained. Hence Here is an effort to find Nidana Panchaka of Dadru Kushta, by considering Samanya Nidana and Samprapti of Kushta.

Nidana: Specific Nidana of Dadru Kushta is not mentioned in Ayurvedic classic, Hence, Nidanas of Kushta can be considered as Nidanas for Dadru Kushta. These are categorized under following headings.


Aharaja and Viharaja Nidana: Acharya Charaka and Acharya Vagbhata mentioned the Nidanas for Kushta are Adhyashana, Vishamasana, Atyashana, intake of food during Ajeerna, Satata and Atisevana of Madhu, Phanita, Matsya, Lakucha, Mulaka, Kakamachi excessive Snehana, Vidahi Ahara excessive intake of Amla and Lavana Ahara Rasa, Navanna, Dadhi, Masha, Mulaka , Pishtanna, Kshira, Guda, excessive Drava and Snigdha Ahara and Guru Ahara are the Aharaja Nidanas. Diwaswapna, Chardhi Vegadharana, drinking cold water after coming from sunlight, Ativyayama, Ati Santapa Sevana.Acharya Sushruta added Dushivisha. Acharya Harita added Dushita Jala as the etilogical factor for Kushta. Acharya Bhavamishra added excessive intake of Gramya, Anupa, Audaka Mamsa to the above said Nidanas.

Achara Nidana: Diseases are coming by birth so it is considered as Karmaja Vyadhi. After even the best and last treatment if patient not achieved any satisfactory results are considered as Papakarmaja Vyadhi which are one of the causative factor of Kushtha.

Manasika Nidana: Ati Bhaya, Ati Shoka and Ati Chinta are explained as Hetu that causes Kushta. Any imbalance in the mind affects the skin appearance and any abnormalities of the skin affect the mind, which forms a vicious cycle.

Beeja Dosha Nidana: Kushtha is Adibala Pravrutta Vyadhi[3] Dushita Shukra or Shonita results in the birth of Kushthita Shishu. All these indicate the role of physical and psychological behavior as well as hereditary predisposition in causation of Kushtha.

Aupasargika Nidana: A very important factor about Kushtha has been mentioned by Acharya Sushruta.[4] Kushtha can be spread to the healthy person through the contact of diseased person called infectious or contagious disease. A Kushta spreads from one person to another by Nishwasat (Inhalation of fungal spores in infected environment directly), Gatrasamsparsha (by contact and touch), Sahashayyasana (by sharing beds), Vastra (sharing clothes, fomites etc). The mode of spread of Dadru Kushta is similar to these; hence Dadru Kushta is an Aupasargika Vyadhi. In modern literature explains the similar causes as sharing food, clothes, fomites, beds, soaps etc. articles which are infected by the fungal spores. Here Acharyas have explained the contagious nature of Kushta.



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Krimija Nidana: Kushtaja Krimi is a type of Rakthaja Krimi[5] which causes Kushta according to Acharya Sushruta. Dhathwagnimandya may precipitate Malaroopa Kapha in excretory materials like sweat. Thus, vitiated Doshas and Malabhavas may find lodgment upon the skin in due course, making the skin, deficient in resistance. Thus forms a nest over the skin for the fungus to reside and it forms Dadru Kushta.

Chikitsa Vibhramsha Janya: Sthambhana treatment in initial stage or Amavastha of disease may lead to Tiryak Gati of Dosha and thus causes Kushtha e.g., Raktharsha[6], Rakthapitta, Amatisara etc. Not following Panchakarma procedures in correct way and not following Pathya-Apathya or Peyadi Karma doing after Panchakarma or doing Panchakarma without guidance of Vaidya undergo Tridosha Dushti along with Raktha Dushti it leads to Dadru Kushta.

Samprapti: Samprapthi forms the essence of Nidana Panchaka and Vikrithi Vijnana. According to Acharya Vagbhata’s definition, knowledge of Samprapthi should give the idea about nature and manner of vitiation of doshas, associated factors, their spread and nature of lodgment.

Deficient transformation in Dhatu Level (Dhathwagnimandya) may precipitate redundant materials inside the internal atmosphere which may hamper the functions of Bhrajaka Pitta. Improper actions of Bhrajaka Pitta may alter the structural firmness of skin.

Skin is one of the structural forms of Rasadhatu. So, this can be considered as a part of Rasavaha Srothas. Causes of longer duration may destruct the structural firmness of skin in different degrees, creating the ‘Srothovaigunya’. Due to etiological factors, which can vitiate the Kapha, Pitta Doshas form the main cause of the disease. Dhathwagnimandya may precipitate Malaroopa Kapha in excretory materials like sweat. Thus, vitiated Doshas and Malabhavas may find lodgment upon the skin in due course, making the skin, deficient in resistance. Thus forms a nest over the skin for the fungus to reside. Then the toxic materials secreted by these fungi derange the properties of Doshas located on skin which disturb the structural equilibrium, initiating Kandu, Daha, Ruksha, Raga etc. are seen. Behind each symptom produced, there will be an altered dosha as precipitating factor.

Samprapti Ghataka

Dosha - Kaphapitta Pradhna Tridoshaja

Vata - Vyana Vata

Kapha - Tarpaka Kapha

Pitta - Bhrajaka Pitta

Dushya - Twak,Raktha, Mamsa And Lasika

Srotas - Rasava, Rakthavaha, Mamsavaha and Lasika Srotas

Srotodushti - Sanga and Vimargagamana

Agni - Jatargnijanya Mandya

Ama - Agnijanya Mandya

Udbhava Sthana - Amashaya

Sanchara Sthana - Rasayani

Adhisthana - Twacha

Roga Marga - Bahyarogamarga

Vyadhi Svabhava - Chirakari

Purvarupa[7]

Ayurvedic classics have not described Purvarupa of Dadru Kushta, still the Purvarupa of Kushta can be considered as the Poorvaroopa of Dadru Kushta.

Poorvaroopa of Kushta in general is considered as mentioned in different texts. Asweda, Atisweda, Athi Slakshanata or Parushyam. Ati Vedana, Vaivarnyam, Kandurudhira Krishnata, Toda, Suptatha, Paridaha, Lomaharsha, Kharatwa, Ushmayanam, Shyavathu Visarpagamana, Pakwadagha, Bhaghna, Kshatopa, Skalitheshu Atimatra Vadana, Sheeghrothpatti and Chirasthithi, Dourbalya, Rookshatwa, Pidakas, Raga, Pipaasa, Kota Utpatti, Shrama and Klama.

Though these can be considered as Purvarupa of Dadru Kushta, practically, we hardly found some of them existing in the form of prodromal symptoms. Many times, not a single symptom is present as Purvarupa.

Rupa

Lakshanas of Dadru Kushta which are fully manifested in Vyaktavastha of Kriyakala. Those Lakshanas are Kandu, Daha, Durvavat Deergha Pratana. Ruksha, Raga, Pidaka, Utsanna Mandalas, Srava, Atasipushpa Varnani, Tamra Varnani, Anushangini, Visarpani and Chirrottama.


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The above mentioned Lakshanas are explained by different Acharyas,

The Laxanas of Dadru Kushta are explained in detail as below:

Kandu (Itching sensation): Acharya Sushruta and Acharya Vagbhata mentioned the Lakshana of Kandu. Kandu (Itching) is one of the most common and predominant features observed in Dadru. As Dadru is a Kapha Pradhana and Kleda Pradhana Vyadhi even Kandu is the manifestation due to Kapha vitiation there is a Utpatti of Kandu.

Daha (Burning sensation): It is the Paittika Lakshana of Pitta as a result of Pitta Prakopa. Due to Ushna, Tikshna Guna of Pitta subject feel burning sensation in Twacha.

Durvavat Deergha Pratana (Large spreaded area): Acharya Vagbhata said that, the skin lesions which will be Deerghapratana (elongated), due to Vata Vruddhi along with Pitta and Kapha. Deergha Pratana may indicate towards the spore forming nature of the fungus on getting favourable environment may restart spreading.

Ruksha (Dryness): Due to Vata Vruddhi along with Pitta and Kapha vitiation the Mandala appears like Ruksha.

Raga (Redness): Acharya Charaka mentioned the Raga Lakshana of the Dadru Kushta. When the vitiated Pitta gets accumulated in Twacha and Raktha creates Raga or redness. Erythema is redness of the skin due to congestion of the capillaries.

Pidaka (Pustule/Vesicle): Acharya Sushruta mentioned that, when the vitiated Pitta gets accumulated in Twacha and Raktha creates Ragayukta Shopha i.e., inflammation and redness then it is known as Pidaka or pustule.

The vitiated Pitta after vitiating Twacha and Raktha rests over them and presents with Ragayukta Shopha and hence called as Pidaka.

Utsanna Mandalas (Elevated circular patches): Acharya Vagbhata used the word Utsanna Mandala while Acharya Charaka used the word Mandala, It is the result of Tridosha and four Dhatu Raktha, Mamsa, Meda and Lasika.

Srava: Acharya Bhela mentioned that, the vitiated Pitta, Kapha and Lasika produces Srava.


Atasi Pushpavat Pidaka: Acharya Sushruta mentioned that, the skin lesion resembles like Atasi Pushpa which is purple colored round flower. The skin lesion is Annular Erythematic purple colored plaques as mentioned in modern texts closely resemble with above features.

Tamra Varna Pidaka: Acharya Sushruta describes the color of the lesions in Dadru more specifically like that of Tamra (copper). Due to Pitta involvement the Pidaka or lesion looks Tamra Varna.

Anushangini, Visarpani and Chirottam: Acharya Vagbhata and Harita explained these Lakshanas as spreadings nature (Visarpanshila) but slow in progress or chronic in nature (chirrottham) may indicate towards the spore forming nature of the fungus on getting favorable environment may restart spreading. So, its described as Anushangini, Visrpani and Chirottam.

Sadhyasadhyata: As Dadru is a Kapha Pitta Pradhana Tridoshaja Vyadhi, Acharya Charaka has mentioned it under Kshudra Kushta whereas Acharya Sushruta mentioned it under Maha Kushta, Charakacharya mentioned it as Kruchrasadhya.[8]

Chakrapani has mentioned Sitha and Asitha Dadru. Sitha is Sadhya Vyadhi whereas Asitha Dadru is Asadhya.[9]

While Acharya Vagbhata says it as Anushangi that is remains for longer period (Deergha Kaala Anubandha Vyadhi) explains about the adaptability of the Fungi in the body for longer period and also explains about its recurrence.

Upashaya

Ahara: Shali (Oriza sativa), Shastik Shali (Oriza sativa), Yava (Barly), Godhuma (Wheat), Koradoosha (Paspalum scrobiculatum), Shyamaka (Echinochlova frumentacea), Uddalaka (wild variety of Paspalum scrobiculatum. The above-mentioned grains should be one year old and matured flesh of Jangala animals devoid of fatty matter.

Vihara: To be sincere and to be dutiful to God, Teachers, Gurus, to offer prayers, perform Yagna, Homas, give donation to poor and needy.

Anupashaya

Ahara: Mamsa (Flesh of birds), Vasa (Oily part of flesh), Dugdha (Milk), Dadhi (Curd), Tila Taila (Seasame oil), Kulatta (Dolichos biflorus),


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Masha (Phaseolus mungo), Nishpav (Dolichos lablab), Preparations of sugar and Jaggery, Pistiamla (Articles having sour taste), Viruddha Ahara (incompatible food), Vidahi (Food which can cause obstruction to channels), Vidagda (food which cause acidic eructation’s).

Vihara: Diva Swapna, Vegadharana, Ativyayama, Ativyavaya, Abusing elders, Gurus, teachers.

Concept of Dermatophytosis / Tinea Infection[10]

Dermatophytosis comes under fungal infections category. The fungal diseases of the skin can be divided into superficial mycoses & the deep mycoses. Dermatophytosis comes under superficial fungal infections of the skin. Superficial infection involving keratinized tissue is called as dermatophytosis. The infection is commonly designated as ringworm or tenia. The term literally means insects’ larva. The father of modern mycology Raymonds aboraudin 1910 classified dermatophytosis as tenia crusis, corporis and so on depending on the part affected. These infections are restricted to invasion of horny structures like the stratum concern, the nails & the hair. Ringworm infection is commonly found in stratum corneum of skin, hair and nail. They are also referred as Dermatophytosis or tenia. Ringworm is caused by twenty species of Dermatophytes fungi which are grouped into three genera: Trichophyton, Microsporum, and Epidermophyton.

Etiology: Transmitted from one person to another person or by contaminated objects e.g., Clothes, hats, hairbrushes etc.

Pathogenesis: Following stages are involved in the Pathogenesis

Inoculation in the host skin

Dermatophytes can survive solely on outer cornified layers of the skin. Natural infection is acquired by the deposition of viable arthrospores or hyphae on the surface of the susceptible individual.

Adherence: After the inoculation in the skin suitable condition like humid, warmth (sweat etc.) favors the infection to progress by competing with the normal flora produced by Keratinocytes and the fatty acids produced by the sebaceous glands, the arthroconidia (an infectious element) adhere to the keratinized tissue.

The germination of hyphal growth proceeds in multiple directions. At the skin surface, long and sparse fibrils connect fungal arthroconidia to keratinocytes to each other later large surfaces are involved.

Penetration: Dermatophytes are provided with an arsenal of proteases aimed at digestion of keratin into oligopeptides or amino acids. Once established, spores must germinate and penetrate the stratum corneum at the rate of desquamation. Penetration is accompanied by dermatophytes secreting multiple serine- proteases providing nutrition to the fungi.

Development of host response

Fungal metabolic products diffuse through malphigian layer to cause erythema, vesicle or even pustule formation along with pruritis. Their in vivo activity is restricted to the zone differentiation. Acute dermatophytosis is associated with DTH skin response against them while persistent disease corresponds to IH responses, to high level of IgE antibodies.

Diagnosis: The diagnosis is done on the basis of clinical features and Symptoms


Types Area\Site Caustive Organism Signs & Symptoms
Tinea corporis Body Trycophyton rubrum, Trycophyton mentagrophytes, Epidermophyton floccosum red scaly border with central clearing, centrifugally expanding
Tinea curis Groin Pustules or vesicles seen at border of rash.
Tinea pedis (Athlets Foot’s) Foot Moist scaling, erythema extending onto sole
Tinea manuum Hand Diffuse dry scaling on plantar aspect of hand
Tinea unguium Nails   Subungual hyperkeratosis, crumbling nail plate, white onycholysis
Tinea capitis Scalp Possible patches of hair loss

KOH Mount: It is a quick inexpensive fungal test to differentiate dermatophyte and candida albicans symptoms from other skin disorders like psoriasis and eczema.

Evaluation

1. Dermatophytes are easily recognized under the microscope by their long branch-like tubular structures called hyphae.


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2. Fungi causing ringworm infections produce septate (segmented) hyphae. Some show the presence of spores formed directly from the hyphae (arthroconidia).

3. Under the microscope Tinea vesicolor is recognized by curved hyphae and round yeast forms that give it a spaghetti-and-meatball appearance.

4. Yeast cells appear round or oval and budding forms may be seen.

5. The KOH prep cannot identify the specific organism; the specimen can be submitted for fungal culture to identify the organism.

Discussion

Kushta is a skin ailment. Twak is derived from the Matruja Bhava. It is the Sthana of Sparshanendriya and Upadhatu of Mamsadhatu. Twacha has a direct relation between Dosha- Dhatu- Mala which are known to be the structural and functional unit of the body. In the modern view, skin is described with embryology, macroscopic and microscopic structure and it also has an immunological component i.e. its structure, cells (Langerhans cell, T lymphocytes, mast cells and Keratinocytes), functional system and immunogenetics. Since time immemorial the skin diseases were found in the form of blemishes of skin.

The Nidanas of Dadru Kushta are not separately explained in classics but being one of the eighten types of Kushta, some of the Nidanas may be applicable for Dadru Kushta.

Dadru is a Kapha Pitta Pradhana Tridoshaja Vyadhi. The Nidanas which are aggravating Kapha and Pitta can be taken here. Ati Singdha, Ati Drava Ahara Sevana, Ati Amla-Lavana Sevana,Dadhi Sevana, Matsya with Ksheera Sevana, Adhyashana, Ajeernashana,Ati Guru Ahara Sevana, Jalaja and Gramya Mamsa Sevana, Ati Sevana of Masha, Diwaswapna, Chardhi Vegadharana, drinking cold water after coming from sunlight, Ativyayama, Ati Santapa Sevana and Aupasargika Nidanas like Prasanga , Gatra Samsparsha, Nishwasa, Saha Bhojana, Sahashayya, Sahasana, Vastra and Mala Anulepana etc. are the striking causes for Dadru Kushta.

Cosmetic problems are the burning issues in today’s time and lot of attention has made towards such problem in past few years.

Disturbed lifestyle, Dietary habits, underlying various conditions and deteriorated environmental conditions etc. contribute to Kushta Disease. Now a day’s skin disease has become common challenge in general practice. In recent years there has been considerable increase in the incidence of skin problems in the tropical and developing countries like India due to less immunity, unhygienic, living conditions and nutrition. Skin is the most exposed part of the body. Patient who suffers with any skin diseases leads to experience Physical, Emotional and Socioeconomic embarrassment from cosmetic point of view.

Skin is one of the structural forms of Rasadhatu. So, this can be considered as a part of Rasavaha Srothas. Causes of longer duration may destruct the structural firmness of skin in different degrees, creating the ‘Srothovaigunya’. Due to etiological factors, which can vitiate the Kapha, Pitta Doshas forms the main cause of the disease. Dhathwagnimandya may precipitate Malaroopa Kapha in excretory materials like sweat. Thus, vitiated Doshas and Malabhavas may find lodgment upon the skin in due course, making the skin, deficient in resistance. Thus forms a nest over the skin for the fungus to reside. Then the toxic materials secreted by these fungi derange the properties of doshas located on skin which disturb the structural equilibrium, initiating Kandu, Daha, Ruksha, Raga etc are seen. Behind each symptom produced, there will be an altered dosha as precipitating factor.

Dadru can be compared with Tinea Infection. Symptoms include redness, itching, and circular rashes which closely resembles the symptoms of Raga, Kandu and Utsanna Mandala of Twak. Main site of etiopathogenesis are Twak (skin), Rakta (blood and Lymph) and Lasika (sweat gland). Rupa appears during the fifth Kriyakala and this 'Vyakta' stage may be stated to that of the manifestation of the fully developed disease.

Intake of Aharas of Shali, Shastika, Godhuma, Yava, Uddalaka, Koradoosha, Shyamaka, Mudga relieve the symptoms. Intake of these Aharas which gives the mild relief to the subjects. Khadira Kashaya Snaana, Sidharthaka Snaana, to be sincere and to be dutiful to God, Teachers, Gurus, to offer prayers, perform Yagna, Homas, give donation to poor and needy. Mamsa (Flesh of birds), Vasa (Oily part of flesh), Dugdha (Milk), Dadhi (Curd),


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Tila Taila (Seasame oil), Kulatta (Dolichos biflorus), Masha (Phaseolus mungo), Nishpav (Dolichos lablab), Preparations of sugar and Jaggery, Pisti Amla (Articles having sour taste), Viruddha Ahara (incompatible food), Vidahi (Food which can cause obstruction to channels), Vidagda (food which cause acidic eructations).

Vihara: Diva Swapnam, Vegadharana, Ativyayamam, Ativyavayam, Abusing elders, Gurus, teachers.

Conclusion

Dadru Kushta is one of the types of Kushta as in this Pitta and Kapha Doshas plays major role along with Vata as Anubhanda Dosha. Analysis of textual references regarding etiology of Dadru Kushta discloses fact that Pittakara and Kaphakara Nidana plays a significant role in manifestation of Dadru Kushta.It is concluded that any abnormalities in Bhrajaka Pitta, Tarpaka Kapha and Vyana Vata due to different kinds of Nidanas resulting in Dadru Kushta. Lakshanas of Dadru Kushta are Kandu with Mandalas, Raga and Pidakas. These Lakshanas have close resemblance with symptoms of Tinea infection in modern science where Circular patches with severe Itching, redness and pustules are the common complaints.

Reference

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8. POMH Bhaishajya Ratnavali of Sri Govindadasji Bhisagratna commented upon by Shri Ambika Dutta Shastri, English Translation by Dr Kanjiv Lochan, Chaukhambha Sanskrit Bhawan, Varanasi, reprinted edition 2006, Vol. 3rd, Chapter 54, Verse 257- 60, p.82.

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