Ayurvedic management of Psoriasis (Kitibha) - A Case Report

Anand R Jalawadi; Dija T Lawrence; K J Girish; Tapas Brata Tripaty

doi:http://dx.doi.org/10.21760/jaims.8.6.42

Ayurvedic management of Psoriasis (Kitibha) - A Case Report

R Jalawadi A.^1*, T Lawrence D.², Girish K.³, Brata Tripaty T.⁴

DOI: http://dx.doi.org/10.21760/jaims.8.6.42

^1* Anand R Jalawadi, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

² Dija T Lawrence, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

³ K J Girish, Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

⁴ Tapas Brata Tripaty, Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Psoriasis is a chronic disorder which is commonly encountered in day-to-day clinical practice. It is a chronic non-communicable proliferative autoimmune skin disease which affects 2-3% of worldwide population. Psoriasis is a disorder of hyperkeratinisation characterized by sharply defined erythemato-squamous lesions. WHO considers skin diseases as Psycho-cutaneous diseases. Psoriasis has resemblance with Kitibha Kushta in Ayurveda. Kitibha Kushta is one of the Kshudra Kushta, characterized by skin manifestation having the symptoms Shyava Varna (blackish brown discoloration), Kinakhara Sparsha (rough in touch), Parushatva (hard) and Kandu (itching). Due to Bahudosha involvement, Shodhana (purifying therapy) followed by Shamana (palliative therapy) plays an important role in the management of Kushta. Case Summary: A 35 years old male patient approached with the complaints of diffuse scaly lesions over scalp, bilateral upper and lower limbs, abdomen and back associated with itching and powdery appearance since 8 years. He was diagnosis with Psoriasis (Kitibha) on the basis of signs and symptoms. The patient was given with Deepana, Pachana, Virechana, Kushtahara Shamana Aushadis (Oral medications) and Kumarabharana Rasa as line of management. Significant improvement was observed after 1 month of treatment in terms of PASI Score.

Keywords: Ayurveda, Psoriasis, Kitibha, Virechana, Shamana

Corresponding Author	How to Cite this Article	To Browse
Anand R Jalawadi, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India. Email:	Anand R Jalawadi, Dija T Lawrence, K J Girish, Tapas Brata Tripaty, Ayurvedic management of Psoriasis (Kitibha) - A Case Report. J Ayu Int Med Sci. 2023;8(6):262-266. Available From https://jaims.in/jaims/article/view/2468

Introduction

Psoriasis is a chronic inflammatory skin disease that affects 2-3% of the world population.^[1] It is considered as a genetic, immunological and systemic disorder. The prevalence of psoriasis in India varies from 0.5–1.5%.^[2] It is characterized by the presence of well-defined, erythematous, scaly papules and plaques that occur especially over the scalp, ears, genitalia, and skin over bony prominences. The most common type of psoriasis is plaque psoriasis. The typical lesion is a raised, well-demarcated erythematous plaque of variable size. In untreated disease, silver/white scale is evident with positive Auspitz sign. The most common sites are the extensor surfaces, notably elbows and knees, and the lower back.^[3] Moreover, Psoriasis affects mental health and people suffering from the disease experience social stigma.^[4]

Psoriasis (Kitibha) is one among the Kshudra Kushta (skin disorder), the signs and symptoms of which are similar to Plaque psoriasis. It is one of the Rakta Pradoshaja Vikara caused by vitiation of Vata and Kapha Dosha predominantly and is characterized by Shyava Varna (blackish brown discoloration), Kinakhara Sparsha (rough in touch), Parushatva (hard), Rukshata (dry),^[5] Ugra Kandu (itching).^[6]Kushta manifests due to vitiation of Sapta Dushya viz. Tridosha, Twak, Rakta, Mamsa and Lasika. The treatment is to be carried out according to the predominance of Dosha based on Roga and Rogi Bala (Strength of disease and patient). In Kushtha repeated Shodhana is indicated due to Bahu Doshavastha in order to eliminate the aggravated Dosha.

Patient Information

A 35-year-old male patient approached Kayachikitsa outpatient department of SDM Ayurveda Hospital, Hassan with complaints of diffuse dry scaly lesions over scalp, bilateral upper and lower limbs, abdomen and back associated with moderate itching and powdery appearance since 8 years, aggravated since 1 month. Clinical signs and symptoms like Shyaava (Blackish brown colour), Kina Khara Sparsha (rough in touch), Parusha (hard) and Kandu (itching) were present. He underwent allopathic treatment from which he got symptomatic relief. But on discontinuing the medication, symptoms re-occurred and he came for further management.

Associated complaints: He had disturbed sleep occasionally due to itching.

Personal history

Habits: taking curd, spicy, oily food, and more non-veg.

Timeline

Table 1: Timeline of the Case

Date	Relevant medical history
May 2015	Acute onset of well-defined, elevated skin margin with scales over B/L legs associated with itching
May 2015	Gradual development of skin lesions over other body parts
August 2015	Lesions over scalp, dryness and scales on scratching
September 2015	Disturbed sleep due to itching and lesions
October 2015	Started allopathic treatment (corticosteroids and ointment)
February 2023	Symptoms reappeared after discontinuing medication. Consulted in outpatient department of SDM Hospital and admission advised.
April 2023	Admitted in SDM Ayurvedic Hospital

Clinical findings: On general examination a male patient with moderately nourished having normal vital signs. Other parameters like pallor, icterus, central cyanosis, oedema, digital clubbing and local lymphadenopathy were absent. On Integumentary system examination, distribution of the skin lesion was over scalp, bilateral upper limb and lower limb, abdomen and back. Type of lesion was secondary scaly lesions with diffused distribution. The colour was blackish brown associated with rough surface and itching. Tests like Candle grease and Auspitz sign were positive.

Laboratory parameters

Hb: 13.4 gm%, E.S.R: 20 mm/hr, and other parameters within normal limit.

Diagnostic Assessment: Raktavaha Srotas (Channels involved in blood circulation) involved with symptoms like Vyanga (pigmentation), Kushta (Skin lesion).^[7]

Psoriasis - Skin lesions are erythematous, sharply demarcated papules and rounded plaques covered by silvery micaceous scale and are variably pruritic.^[4] The lakshanas (symptoms) are Shyava (Blackish brown colour), Kina Khara Sparsha (rough in touch), Parusha (hard) and Kandu (Itching).^[6,7]

Diagnosis - Plaque psoriasis (Kitibha)

Therapeutic intervention

Table 2: Timeline of intervention

Date	Intervention	Dose
23/4/23 to 25/4/23	Sarvanga Udwartana followed by Dhanyamla Parisheka Jeeraka Kashaya	OD 50ml-0-50ml after food
26/4/23 to 28/4/23	Snehapana with Murchita Gritha	Day 1 - 50 ml at 7AM Day 2 - 100 ml at 7AM Day 3 - 180 ml at 7AM
29/4/23 and 30/4/23	Sarvanga Abhyanga with Marichadi Taila followed by Dhanyamla and Dashamoola Qwatha Parisheka.	OD
1/5/23	Sarvanga Abhyanga with Marichadi Taila followed by Dhanyamla and Dashamoola Qwatha Parisheka. Virechana with Trivrit Lehya - Triphala Kashaya -	OD 80gms 100ml

Total Virechana Vegas were 18. Samsarjana Krama, Pathya Apathya and Nidana Parivarjana was advised.

Table 3: Shamana (Discharge Medicine)

3/5/23	1. Panchatikta Guggulu Gritha	20 ml morning Before food with warm water
	2. Kumarabharana Rasa with honey	1-0-0 after food
	3. Marichadi Taila	External application

Outcomes

Improvements were observed in Lakshanas of Kitibha and PASI Score after Shodhana and Shamana Chikitsa.

Table 4: Outcomes

Parameter	Before Treatment	After Shodhana	1 month after treatment
Shyava	Present	Reduced	Reduced
Kinakhara Sparsha	Absent	Reduced	Reduced
Parusha	Present	Reduced	Absent
Ugra Kandu	Present	Absent	Absent
PASI Score	27.1	11.7	3.9

Figure 1 (a&b): Picture showing before the intervention of case

Figure 2 (c&d): Picture showing after the intervention of case

Discussion

Psoriasis is an immune-mediated disease, where treatment depends on the type, location, and extent of disease. Most cases of localized, plaque-type psoriasis can be managed with midpotency topical glucocorticoids. Kitibha is Raktapradoshaja vikara which is caused by the vitiation of Vata Kapha Doshas, Twak, Lasika, Rakta and Mamsa. Samshodhana needs to be performed as Kushta is Bahudoshavstha Vyadhi. Acharya Vagbhata highlighted the significance of Samshodhana in Kushtha by citing Virechana once in a month, Vamana once in every 15 days, Raktamokshana once in every 6 months and Nasya once in every 3 days. Virechana Karma is chosen among the Shodhana due to the involvement of Vata and Kapha Dosha.

The patient in the current study received Shodhana, Shamana and Bahirparimarjana Chikitsa.

Mode of action of Intervention

Deepana Pachana

Deepana Pachana was done with Jeeraka Kashaya. Jeeraka by its Laghu Guna, Katu Rasa, Katu Vipaka, Ushna Veerya does Kapha Vata hara and does Deepana and Pachana.^[8] Triphala by its property helps in Koshta Shuddhi and Vatanulomana.

Udwartana and Dhanyamla Parisheka

Udwartana pacifies the Kapha Dosha, does Sroto Shodhana, alleviates Kandu (itching)^[9] and gives Twak Prasadana.^[10]

Parisheka Swedana provides Mriduta (Softness), Laghuta (lightness) and Agnideepti (increase of digestive power) of body. The vitiated Vata-Kapha is pacified by Dhanyamla due to its Ushna Guna.^[11]

Snehapana, Sarvanga Abhyanga and Swedana

Doshas can be brought from Shakha to Koshta by Vriddhi and Vishyandana. Snehana and Swedana help in this aspect and bring the Dosha to Koshta before Shodhana. Snehapana is done with Murchita Ghrita.

Sarvanga Abhyanga was done with Marichadi Taila which is indicated in all types of Kushta. Based on the properties of ingredients, Marichadi Taila acts as Kapha Shamaka, Kandughna and Kushtaghna.

Virechana: Kitibha Kushta is Vata Kapha Pradhana Kushta, for which Virechana is suitable treatment. Virechana Dravya possesses Ushna, Teekshna, Sukshma, Vyavayi, Vikasi Guna. Virechana was given with Trivrit Lehya.

Shamana Chikitsa: Panchatiktaka Ghrita is administered in the morning in empty stomach as Kitibha is Vata Kaphaja and Bahudosha Avasta Vyadhi.^[12] It is Deepana, Pachaka, Srotoshodhaka, Raktaprasadaka, Kandughna, Kushtaghna, Varnya. Ghee has anti-inflammatory properties due to components such as linoleic acid, which is helpful in the reduction of inflammation of the skin in psoriasis.^[13]

Kumarabharana Rasa contains Bhasmas of Swarna (Gold), Rajata (Silver), Pravala (Coral) and Churnas of Ashwagandha (Withania somnifera), Amalaki (Emblica officinalis), Shunti (Zingiber officinale), Pippali (Piper longum), Haritaki (Terminalia chebula), Vacha (Acorus calamus) and Yasimadhu (Glycyrrhiza glabra). These drugs exhibit a wide range of biological activities including immunomodulatory, anti-inflammatory activity. The cumulative actions of these drugs are Kaphahara, Lekhana (scraping), Deepana (digestive stimulant), Pachana (digestive), Anulomana (carminative), Balya (nourishing) and Rasayana (rejuvenating) property. Swarna Bhasma promotes immunity through phagocytosis.^[14] Gold is one of the noble metals used in continuity to increase the vitality and immunity.^[15]

Swarna Bhasma helps in rejuvenation and immunomodulation for some chronic diseases.

Conclusion

Psoriasis is a relapsing disease. The prevalence of psoriasis is increasing day by day. Shodhana is of great importance in Bahudosha Avastha.

Shodhana Karma helps to eliminate the Doshas and thus prevents recurrence of the disease. This case study shows significant improvements in terms of skin lesion, roughness, powdery appearance and itching after 1 month of treatment. Hence, it can be concluded that Kitibha Kushtha can be treated with the Shodhana, Shamana, Bahirparimarjana Chikitsa, Nidana Parivarjana and following Pathyaapathya.

Patient Perspective: Patient was satisfied with the treatment in terms of reduced skin lesion, dryness, itching, powdery appearance and improved sleep.

Patient Consent: Informed consent for publication of this case study has been obtained from the patient.

Reference

1. Neena K, Kumar AS. World clinic series- Dermatology: Psoriasis. 1st edition. New Delhi: Jaypee publications; 2015: p 11-12.

2. Neena K, Tejaswi TR. Step by step Psoriasis Management. 1st edition. New Delhi: Jaypee publications; 2011: p 1- 6.

3. Ibbotson SH. Dermatology. In: Stuart HR, Iran DP, Mark WJ, Richard PH, editors. Davidson’s Principles and Practice of Medicine. 24thed. England: Elsevier publication; 2023: p.1100.

4. Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders. In: Leslie P. Lawley, Calvin O. McCall, Thomas J. Lawley editors. Harrisons, Principle of internal medicine, section 9, 14thed. Singapore: Mecrrwhill publications.1998: vol-2. p.300.

5. Chalapathi RS, Maheswar T, Subhose V, Swamy RK. Critical Evaluation of Kshudra Kustas of Charaka Samhitha: an Ayurvedic Treatise in Light of Modern Medicine. Int JRes Ayurveda Pharm. 2016;7(1):13–9.

6. Sushruta, Sushruta Samhita Nidansthana chapter 14th, sloka 20,1st edition; edited by Indradev Tripatihi and Shrikanth Tripathi, Krishnadas Academy; Varanasi, 1994, P-147.

7. Sharma RK, Dash Bhagwan. English translation on Cakrapani Datta’s Ayurveda Dipika on Agnivesa’s Caraka Samhita, Sutrasthana, Vividha ashitapeethiya adhyaya: Chapter28, Verse11-12, Varanasi: Chowkhamba Sanskrit series office, 2012 :576.

8. Bhavamishra, Purva khanda, Haritakyadi Varga, verse 81-5, In: Mishra B, Sri Vaishya R, editors. Vidyotini, Hindi Commentary, Bhavaprakasha, First Edition, Varanasi Choukambha Sanskrit Santhan, 2020; Vol.I. p.804.

9. Sharma RK, Dash Bhagwan. English translation on Cakrapani Datta’s Ayurveda Dipika on Agnivesa’s Caraka Samhita, Sutrasthana, Matrashitiya Adhyaya: Chapter5, Verse93, Varanasi: Chowkhamba Sanskrit series office,2014 :125.

10. Murty KRS. English translation on Astanga Hrdayam of Vagbhata. Sutra sthana; Dinacharya: Chapter 2, verse 15. Varanasi: Chowkhamba Krishnadas Academy, 2013:42.

11. Sushruta, Dalhana, Sutra sthana, Dravadravyavidhyadhyaya, (chapter 45) verse 215, In: Sharma AR, editor. Sushruta Samhita, 1st edition, Varanasi: Chaukhamba Surbharati Prakashan, 2013; Vol.I. p. 384.

12. Sharangdhara, Prathamakhanda, Bhaishajya akhyana, (chapter 2), verse 3, In: Mishra D editor. Sharangdhara Samhita. Varanasi: Chaukhambha Sanskrut Series Office; 2006. p.13.

13. Ali H, Nawaz H, Saleem M, Nurjis F, Ahmed M. Qualitative analysis of desi ghee, edible oils, and spreads using Raman spectroscopy. J Raman Spectrosc 2016; 47:706-1

14. Singh N, Choudhary A. Suvarna Bhasma and Gold compounds: an innovation of pharmaceutical illumination of therapeutics. IJRAP 2012; 3:1-9

15. Sur TK, Pandit S, Mukherjee R, Debnath PK, Bandhopadhya SK, Bhattacharya D. Effect of Sonachandi Chyawanprash and Chyawanprash Plus, two herbal formulations on Immunomodulation. Nepal Med Coll J 2004; 6:126-8

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2023-04-24	2023-04-26	2023-05-03	2023-05-10	2023-05-17
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

Ayurvedic management of Psoriasis (Kitibha) - A Case Report

R Jalawadi A.1*, T Lawrence D.2, Girish K.3, Brata Tripaty T.4

Introduction

Patient Information

Outcomes

Discussion

Conclusion

Reference

R Jalawadi A.^1*, T Lawrence D.², Girish K.³, Brata Tripaty T.⁴