E-ISSN:2456-3110

Review Article

Dadrukushta

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 5 May
Publisherwww.maharshicharaka.in

A scientific review on Dadrukushta with special reference to Dermatophytosis and its management through Ayurveda

S. Kanvimath S.1*, S Mathapati I.2, Dharmannavar G.3
DOI: http://dx.doi.org/10.21760/jaims.8.5.7

1* Shreeshailaswamy S. Kanvimath, Post Graduate Scholar, Department of P.G. Studies in Kayachikitsa, Shri Shivayogeeshwara Rural Ayurvedic Medical College, Hospital & Post Graduate Research Centre, Inchal, Belgaum, Karnataka, India.

2 I. S Mathapati, Professor, Department of P.G. Studies in Kayachikitsa, Shri Shivayogeeshwara Rural Ayurvedic Medical College, Hospital & Post Graduate Research Centre, Inchal, Belgaum, Karnataka, India.

3 Girish Dharmannavar, Assistant Professor, Department of P.G. Studies in Kayachikitsa, Shri Shivayogeeshwara Rural Ayurvedic Medical College, Hospital & Post Graduate Research Centre, Inchal, Belgaum, Karnataka, India.

Skin is the largest organ of the body and skin diseases has a high prevalence throughout the world and fungal infection of skin is one of them. In the high populated countries like India and China the incidence of skin diseases is considerably increased in recent years due to predisposing factors like warm, humid climate, crowded living conditions, hygiene and poor nutrition. In Ayurveda all the skin related diseases are explained under main heading of Kushta and skin fungal infections termed as Dadrukushta (Dermatophytosis). Ayurveda has a versatile approach towards skin disorders depending on the requirement of the patient. The present article is aimed at understanding the disease Dadrukushta with special reference to Dermatophytosis and its management through Ayurveda.

Keywords: Kushta, Dadrukushta, Dermatophytosis, Ayurveda, Skin, Fungal

Corresponding Author How to Cite this Article To Browse
Shreeshailaswamy S. Kanvimath, Post Graduate Scholar, Department of P.G. Studies in Kayachikitsa, Shri Shivayogeeshwara Rural Ayurvedic Medical College, Hospital & Post Graduate Research Centre, Inchal, Belgaum, Karnataka, India.
Email: 		Shreeshailaswamy S. Kanvimath, I. S Mathapati, Girish Dharmannavar, A scientific review on Dadrukushta with special reference to Dermatophytosis and its management through Ayurveda . J Ayu Int Med Sci. 2023;8(5):41-48.
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https://jaims.in/jaims/article/view/2397

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-03-25 2023-03-27 2023-04-03 2023-04-10 2023-04-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Shreeshailaswamy S. Kanvimath, I. S Mathapati, Girish Dharmannavarand 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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Kanvimath S et al: Dadrukushta with Dermatophytosis and its management

Introduction

Acharya Sushruta explained Dadrukushta as Sankramika or Aupasargika Roga. Dadru spreads person to person by Krimi through Sweda Mala. It can be diagnosed by the symptoms like Raga, Pidaka, Mandala in the Adhishtana that is Twak.[3]

Dadrukushta is mentioned under Kshudra Kushta by Acharya Charaka[2] and Acharya Sushruta under Mahakushta.[1] Dadrukushta is Pitta-Khapaja Vyadhi as per Acharya Charaka[4] and Acharya Vaghbhata.[5]

On the other hand Khaphaja Vyadhi as per Acharya Sushruta.[6]

Causative factors for all skin disorders according to Ayurveda are as follows

  • Mithyahara Vihara (Improper and irregular diet habits)
  • Dosha Vaishamya (Vitiation of the Biological forces)
  • Srotavarodha (Obstruction of the channels)
  • Vegadharana (Suppression of natural urges)
  • Viruddhahara (Incompatible diet)
  • Krimi (Infections)
  • Manovikaras (Emotional stress factor)

Modern view

In modern science there are three genera of superficial dermatophytosis as Trichophyton Microsporum and Epidermophyton. They are grouped according to their natural habitat as geophilic (soil), zoophilic (animals), and anthrophilic (humans).[7] Transmission may be indirect or direct bodily contact. Clinically, these fungal infections are labeled according to the region involved. These are as follows:[13]

1. Tinea capitis occurring on the scalp, especially in children.

2. Tinea barbae affecting the region of beard in adult males.

3. Tinea corporis involving the body surface at all ages.

4. Tinea cruris occurs most frequently in the region of groin in obese men, especially in hot weather.

5. Tinea pedis or ‘athlete foot’ is located in the web places between the toes.

6. Onchyomycosis shows disintegration of the nail substance.

7. Tinea vesicolor caused by Malassezia furfur generally affects the upper trunk.

Predisposing factors

Warm, humid climate, poor nutrition and hygiene, obesity, diabetes mellitus and debilating illness.[7]

Symptoms

Common symptom is pruritus in all types of dermatophytosis.[7] Other clinical features are intense itching, annular erythematous scaly lesions, the active border consists of papulovesicular lesions, and in advancing stage the lesions spread peripherally with central clearing and pigmentation.[8]

Clinical features of Dadrukushta and Dermatophytosis (Mycoses / Tinea / Ringworm) are similar with each other so the co-relation between Dadrukushta and Dermatophytosis is done on the basis of similarities of clinical features in both Ayurveda and Modern medicine.

Prevalence rate

The prevalence rate of this infection is 2% among young adults and increases to 20% among individuals of 40-60 years age.[11] 39% of the world population is suffering from Tinea infections. In India also, 5 out of 1000 people are suffering from Tinea infections.[12]

Nidana for Dadrukushta

There is no separate Nidana for Dadrukushta. Dadrukushta spreads from person to person by Malaja Krimi through Sweda (contact with the infected person and contact with the wearables of the infected person etc.)[14]

Due to the sharing of towels, bed sheets, soap, hand kerchief etc. of infected person causes the spreading of micro - organism from one person to another person.[15]

Dadrukushta is likely similar to fungal infection of the skin in which the fungal spores has been transferred from a diseased person to a healthy person by above explained modes.



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Samprapti of Dadrukushta

Sharing the wearables of infected person (contagious/Sankramika)

↓

Sankramika of Krimi from Purusha to Purusha (Malaja - Bahya Krimi)

↓

Krimi enters into Twak through Sweda and vitiates Tridosha, Twak, Rakta and Lasika

↓

Dadrukushta (Kandu, Pidika, Raaga, Mandala, Visarpini)

Table 1: Secondary causes for Dadrukushta (Dermatophytosis) as per Ayurveda.

Mithyahara Ch.S [16] Su.S [17] B.S [18] H.S [19] M.N [20]
Adhyashana + + - + +
Vishamashana + + - - -
Atyashana + + - - -
Intake of food during indigestion + + - - +
Continuous and excessive use of Madhu, Fanita, Matsya, Lakucha, Mulaka, Kakamachi, and intake of above substances while having Ajirna + - - - -
Excessive Snehana - - - - -
Vidahi Ahara without emesis of undigested food + - + + -
Rasataha
Excessive intake of Amla and Lavana Rasa + - - - +
Dravyataha
Excessive intake of Gramya, Anupa, Audaka, Mamsa - - + - -
Navanna, Dadhi, Masa, Matsya, Mulaka, Tila, Pishtanna, Kshira, Guda + - - - +
Dushivisha - + - - -
Dushita Jala - - - + -
Excessive Dravya, Snigdha Ahara + - - + +
Guru Ahara + + - - +

Abbreviations: Ch.S - Charak Samhita, Su.S - Sushrut Samhita, B.S - Bhel Samhita, H.S - Harit Samhita, M.N - Madhav Nidan

Table 2: Dosha Dushya Sankalpana.

  Ch.S Su.S A.H A.S M.N
Dosha Pitta - Kapha Kapha Kapha - Pitta Kapha - Pitta Kapha - Pitta
Dushya Twak, Rakta, Mansa, Ambu Twak, Rakta, Mansa, Ambu Twak, Rakta, Mansa, Ambu Twak, Rakta, Mansa, Ambu Twak, Rakta, Lasika, Ambu
Srotas Rasa, Rakta Rasa, Rakta Rasa, Rakta Rasa, Rakta Rasa, Rakta

Abbreviations: Ch.S - Charak Samhita, Su.S - Sushrut Samhita, A.H - Ashtanga Hridaya, A.S - Ashtanga Sangraha, M.N - Madhava Nidana

Table 3: Sign & symptoms of Dadrukushta according to various Acharayas and Modern Science.

SN Signs & Symptoms Charaka Sushruta A.H A.S M.N Y.R Modern
1. Kandu (itching/pruritus) + - + + + + +
2. Raga (redness/erythema) + - + + + + +
3. Atasi Pushpavat Pidika (macular rashes similar to flax flower) - + + - - - -
4. Tamra Varna Pidika (copper coloured macular rashes) - + - - - - -
5. Visarpani Pidika (diffused macular rashes) - + + + - - -
6. Dirgha Pratana (tendril like macular rashes) - - + + - - -
7. Unnata Mandala (raised border ring) - - + + + - -
8. Scaling - - - - - - +
9. Vesiculations - - - - - - +

Abbreviations: A.H - Ashtanga Hridaya, A.S - Ashtanga Sangraha, M.N - Madhava Nidana, Y.R - Yogaratnakara

Clinical examination as per modern medical science[21]

Typical infections have an annular appearance that patients refer to as “ringworm” and following table showing sign and symptoms of Tinea.

SN Type of Tinea Clinical manifestations Prevention
1. Tinea pedis Most common infection of foot, Variable erythema, Edema, Scaling, pruritis, and occasionally vesiculations, Involvement may be widespread or localized but generally involves the web space between the fourth and fifth toes. Prevention strategies include allowing the feet to breathe plenty of air and keeping them clean and dry. Wearing sandals in public showers or in locker rooms is a smart idea.
2. Tinea capitis Infection of the scalp, produce a relatively non-inflammatory infection with mild scale and hair loss that is diffuse or localized One should not share towels, combs, hairbrushes, hats or pillowcases with other family members, friends or visitors. Wash the towels in warm, soapy water after each use.
3. Tinea cruris Mainly involvement of groin region, Scaling, Erythematous eruption sparing the scrotum Basic hygiene can also be of assistance in treating and preventing ringworm. Holding the skin clean and dry may help to prevent infection. Public safety includes wearing sandals in public showers or locker rooms and avoiding shared towels and items.
4. Onchyomycosis Mostly affected nails, Opacified, thickened nails, Sub-ungual debris, Distal-lateral variant is most common, Proximal subungual onychomycosis may be marker for HIV infection Avoiding yeast infections begins with a healthy diet and proper hygiene. Wearing loose-fitting garments made of natural fabrics can also help avoid infection. Washing undergarments in very hot water and adjusting feminine items will also help avoid fungal growth too.

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Differential diagnosis of Dadrukushta (Dermatophytosis).

1. Disease

Vicharchika (Eczema)

Symptoms: Bahusraava Yukta Pidika originate in Vicharchika

jaims_2397_01.JPGDiagram

2. Disease

Pama Kushta (Scabies)

Symptoms: Scattered Pidika with different Varna (white, red, black)

jaims_2397_02.JPGDiagram

3. Disease

Dadrukushta (Dermatophytosis)

Symptoms: Atasi Pushpa like Pidika, Varna with Mandala (round patches)

jaims_2397_03.JPGDiagram

Diagrams of various Fungal Infections

jaims_2397_04.JPGTinea pedis

jaims_2397_05.JPGTinea capitis

jaims_2397_06.JPGTinea cruris


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jaims_2397_07.JPGOnchyomycosis

Pathological Examinations

a. Potassium Hydroxide (KOH) Microscopy[9]
Potassium hydroxide (KOH) may be used to diagnose tinea from skin scrapings, nails scrapings, or hair direct microscopic examination.

b. Fungal culture[10]
Skin scrapings should be sent for culture whenever infection of the dermatophytes is suspected. It takes at least two weeks before the fungus grows enough to identify itself. Nail clippings and hair samples should be examined in the same way as skin scrapings.

Modern management of Dermatophytosis

Tinea Pedis: Athlete's foot is often treated with topical antifungal ointments which can be purchased online or over-the-counter. Severe infections can also require supplementary oral medication. The feet will also need to be treated and kept dry in order to help kill the fungus.

Tinea Capitis: Although oral Griseofulvin has been the standard treatment for tinea capitis, newer oral antifungal agents such as terbinafine, itraconazole, and fluconazole are effective, safe, and have shorter treatment courses.

Tinea Curis: Tinea curis is commonly known as Jock itch. Jock itch care typically requires the use of topical antifungal ointments and proper grooming. Over-the-counter medications improve many cases of jock itch, though some require prescription medications. This may also help destroy the infection by washing the infected area and keeping this dry.

Onchyomycosis: Treatment of infections with leasts depends on their severity. Standard treatments include creams, tablets, or suppositories available through prescription, or over-the-counter, or online. Complicated infections can take complex therapies.

Ayurvedic management of Dadrukushta (Dermatophytosis)

The basic principle of treatment as per Ayurveda is Nidana Parivarjana. Hence avoid the causative factors and take special care to protect the skin. Following measures should be taken to reduce the risk of infection with the fungal skin and to prevent of spread.

  • Dry the skin thoroughly after a bath.
  • To remove any fungi, wash socks, clothes and bed linen frequently by soaking them in warm water
  • Wear clean flip - flops or plastic shoes in damp areas, as well as common areas such as showers, saunas and pools.
  • Wear loose fitting clothes made of cotton or material to keep the skin away from moisture.
  • Do not share towels, hair brushes and combs that might carry a fungus. The treatment of Dadru should be done on the basis of their cause.
  • Make sure about the cleanliness of the equipment’s at haircut shops & saloons.

As per Ayurveda treatment of Dadru are

1. Shodhana Chikitsa

2. Shamana Chikitsa

3. Lepana Karma (Local Applications)

1. Shodhana Chikitsa: The excretion of vitiated Doshas from the diseased individual is very important role of Shodhana Chikitsa. To remove vitiated Pitta and Rakta in Dadrukushta Virechana Karma and Raktmokshana should be carried out.

Virechana Karma

Purvakarma

Snehana Karma - Snehana should be done with Mahatiktaka Ghirta daily by increasing manner starting from 50 ml, 150 ml, and 250 ml up to emergence of manifestation of Samyak Snehana in the early morning after the completions of physiological urges.

Swedana Karma - After the completion of the Snehana and before the Virechana Karma, Sarvanga Sweda should be given after Sarvanga Abhyanga.



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Pradhankarma

Virechana Karma - Following Samyak Snehana and Shodhana and patient examination, the planned induce of purgation should be given to patients by giving Trivrit Kwatha early in the morning. Patients should be observed for Samyak Virechana Lakshanas and Samsarjana Karma should be followed as scheduled.

Rakta - Mokshana Karma - Rakta Mokshana should be done by using No.18 bore needle early in the morning and near about 60 ml blood should be withdrawn per sitting.

2. Shamana Chikitsa: Some commonly used classical Ayurvedic formulations in Dadrukushta are as follows:

Table 6: Ayurvedic formulations in Dadrukushta

SN Drug Dose Anupana
1. Arogyavardhini Rasa 500mg twice a day Luke warm Water
2. Gandhaka Rasayana 500mg twice a day Luke warm Water
3. Panchatiktaka Guggulu 250mg twice a day Luke warm Water
4. Kaishor Guggulu 500 mg, twice a day, after food Luke warm Water
5. Panchtikita Ghrita Guggulu 500 mg, twice a day, after food Luke warm Water
6. Aaragvadhadi Kashaya 15 - 20ml twice a day, before food Sambhag Ghrita
7. Nimbadi Kashaya 15 - 20ml twice a day, before food Water
8. Aragwadha Kashaya 15 - 20ml twice a day, before food Water
9. Guduchyadi Kashaya 15 - 20ml twice a day, before food Water
10. Patolakaturohinyadi Kashaya 15 - 20ml twice a day, before food Water
11. Manjisthadi Kashaya 15 - 20ml twice a day, before food Madhu
12. Aragvadhasava 15 - 20ml Water
13. Khadirarishta 15 - 20ml Water
14. Chakramarda (Cassia tora Linn) Swarasa- 10-20 gm Churna-1-6gm Water
15. Panchnimbadi Churna 5gm(3-5 masha) Madhu, Ushna Jala
16. Haridra Khanda Churna 3-5gm Dugdha
17. Gomutra Siddha Haritaki 5gm at night Lukewarm water
18. Hinguliya Manikyarasa 8mg/ml Water

3. Lepana Karma (Local Applications)

Lepa should be applied as per area of skin lesion. Mostly applied in the morning and bedtime.

  • Dashanga Lepa
  • Karanja Taila
  • Durvadi Lepa
  • Aragvadhadi Lepa
  • Edagajadi Lepa
  • Maha Marichyadi Tail
  • Nimba Taila
  • Chakramarda Taila

Pathya - Apathya to be followed in Dadrukushta

  • Maintain daily dietary timings, vegetarian food will be better.
  • Hold very hygienic.
  • Regular exercise based on physical capacity, for at least 1 hour.
  • Get breakfast sprouts, nuts, and vegetable juices or fruit juices.
  • Stop excess salty, spicy, and fatty, candy, drug misuse and fast food.
  • Ksheera and Ghritha are used every day as Rasayana.
  • Body massage (Abhyanga)
  • Minimum 7 - 8 hour sleep is compulsory
  • Avoid late at night awakening (Ratri Jagarana)
  • Follow Yogasanas to alleviate mental stress and release toxins
  • Adopt holistic approach

Practice positive thoughts

Discussion

Dadrukushta is the prevalent disease in developing countries such as India, with the majority of the population living in unhygienic conditions. Dadru has mentioned nearly all the Acharayas along with their management. Thus, Ayurveda is able to cure the disease of the skin like Dadrukushta. As this is one among the relapsing type of skin disease so patient was advised to follow Pathyapthya like Ahara, Vihara, Achara, Vichara.

Repeated Shodhana as per classics in accordance with Dosha, Kala, Agni and Desha etc., should be administered to control the frequency of recurrence and further spread chances of recurrences are more in fungal lesions. Utmost care should be taken for skin protection.



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Conclusion

Dadrukustha is a specific skin condition that is clinically replicated by dermatophytosis or tinea. It can be concluded that the use of Chikitsa Upakramas mentioned in Ayurveda such as Shodhana, Shamana (formulations such as Arogyavardhini Vati, Gandhaka Rasayana etc.) and Bahirparimarjana (Lepa of local application Karanj Taila, Nimba Tail etc.) are effective in the management of Dudrukushta. Clinical features of Dadrukushta and Dermatophytosis (Mycoses / Tinea / Ringworm) are similar with each other so the co-relation between Dadrukushta and Dermatophytosis is done on the basis of similarities of clinical features in both Ayurveda and Modern medicine.

Reference

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12. Ronald Marks. Roxburgh’s Common skin diseases, Chapter – 11; 7th edition, Arnold, London, 2003:3.

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