E-ISSN:2456-3110

Case Report

Scalp Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 9 SEPTEMBER
Publisherwww.maharshicharaka.in

Effective management of Kitibha Kushta (Scalp Psoriasis) through Ayurveda: A Case Report

Nagur R1*, Kalyani SS2, Honawad CR3
DOI:10.21760/jaims.9.9.47

1* Rohin Nagur, Post Graduate Scholar, Dept of PG Studies in Kayachikitsa, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.

2 Shivaleela S Kalyani, Professor, Dept of PG Studies in Kayachikitsa, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.

3 Chandrashekhar R Honawad, Professor, Dept of PG studies in Rasashastra and Bhaishajya Kalpana, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.

Introduction: In today’s era where the lifestyle scenario became more sedentary, including improper habit of eating food, lack of physical exercise, unhygienic conditions which leads to risk of many skin diseases like psoriasis. Psoriasis is a long term auto-immune dermatological condition in which there is itching all over the body, dryness & redness of skin and scaling appears on the affected site. In Ayurveda psoriasis can be correlated with Kitibha Kushta is a type of Kshudra Kushta exhibiting in the form of lesions with Shyava Varnata, Kina-Khara Sparsha, Parushata etc.

Methodology: A 48 years old female patient came with the chief complaints of flaky skin lesions over the scalp, ears and eyebrows since 2-3 years, associated with severe itching on the lesions. The case was diagnosed as Kitibha Kushta and managed with Samshodhana and Samshamana Chiktsa successfully.

Result: The patient reported a significant improvement in the complaints.

Conclusion: Kitibha Kushta is a Vata- Kapha Pradhana Tridosaja Vyadhi Classical Vamana Karma was done with Madanaphala, Indrayava, Yastimadhu, Patola, Nimba. Classical Vamana karma is very effective in Kitibha Kushta due to its Sodhana property.

Keywords: Kshudrakushta, Kitibhakushta, psoriasis, Kandu, Vamana, Case report

Corresponding Author How to Cite this Article To Browse
Rohin Nagur, Post Graduate Scholar, Dept of PG Studies in Kayachikitsa, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.
Email: 		Nagur R, Kalyani SS, Honawad CR, Effective management of Kitibha Kushta (Scalp Psoriasis) through Ayurveda: A Case Report. J Ayu Int Med Sci. 2024;9(9):294-299.
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https://jaims.in/jaims/article/view/3664

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-08-13 2024-08-23 2024-09-03 2024-09-09 2024-09-24
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© 2024by Nagur R, Kalyani SS, Honawad CRand 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

The skin is the largest organ of the body; it is a barrier that separates body’s internal and external environment. The skin protects the body from the effects of temperature and chemical and microbial attack. It has a great cosmetic importance also. The disorders of skin greatly affect the mental and physical state of a human being. Skin diseases are the most frequently occurring health problem which affects people of all ages due to altered life style, lack of physical exercise, unhygienic, mental stress, etc.[1]

Psoriasis is a common chronic recurrent auto immune disease of the skin which is characterized by scaly patches with erythematous base over the skin. It can have a significant negative impact on the physical, emotional and psychosocial wellbeing of affected patients. Psoriasis affects people of all ages and in all countries ranging between 0.09% and 11.43%, thus making it a serious global problem, with a prevalence of 0.44 - 2.8% in India.[2] There is a peak incidence during the teenage and early adult years and a second peak during fifties or sixties. In Ayurveda, all skin disorders come under the category of Kushtaroga. Kushta is considered as one of the Ashta Mahagada. There are 18 types of Kushta, of which 7 are Maha Kushta and 11 are Kushdra Kushta. Kitibha Kushta is one among the 11 varieties of Kushdra Kushta which resembles Psoriasis clinically.[3]

According to the study of WHO the prevalence rate of psoriasis at world level is in between 0.09% to 11.43% and 0.44% to 2.8% in Indian population. In Ayurveda, the psoriasis can be correlated with the kitibhakushta. Kushta is caused by the vitiation of Doshas in the person due to daily consumption of Apathya Ahara-Vihara. Management of Psoriasis as per contemporary treatment modalities includes use of corticosteroids, phototherapy, topical therapy, etc. Most of these are having their own limitations. According to Ayurveda, Acharyas have emphasized on Shodhana therapy in the treatment of Kushta which eliminates the vitiated Doshas. Ayurveda through its holistic approach particularly by Samshodhana Chikitsa which aims at correcting the basic causative factor is the first line of treatment advised for all types Kushta. Kitibha Kushta being Kapha-Vata dominant condition, so Vamana Karma is selected.

Comparison between Psoriasis and Kithibha Kushta[4]

Kitibha Kushta can be closely correlated with Psoriasis based on the findings like in Kitibha Kushta there is Shyava/Krishna Varna, Kharatvam, Parushatvam, Rukshatvam and Kandu whereas in psoriasis there is erythematous lesion turned to black in chronic cases, scaling / roughness, abnormal hardening, hyperkeratosis, dryness, itching.

Patient information

A 48 years old female patient visited the OPD of Kayachikitsa with the chief complaints of flaky skin lesion over the scalp, ears and eyebrows since 2-3 years, with no erythema associated with severe itching on the lesions along with other body surface. She consulted an allopathic physician and was advised with antibiotics, anti-histamines and topical steroids. But there was no considerable relief. Later she consulted to our hospital OPD for treatment. She is working woman belonging to middle-class Hindu family background. She had no past history of DM, HTN, or any metabolic disorders and no any Family history.

Personal History

  • Diet : Excessive Guru, Katu, Amla Ahara, Dadhi, Mamsa Sevana, Viruddha Ahara.
  • Appetite : decreased appetite
  • Bowel : Constipated
  • Micturition : 4-5 times per day
  • Sleep : Disturbed
  • Habits : Nil

General examination

  • Built : Moderate
  • Nourishment : Well nourished
  • Pallor : Absent
  • Icterus : Absent
  • Cyanosis : Absent
  • Clubbing : Absent
  • Lymphadenopathy : Not palpable
  • Edema : Absent
  • Pulse : 78/min
  • RR : 22cpm

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Shivaleela SK et al. Effective management of Kitibha Kushta (Scalp Psoriasis)
  • BP : 110/80mmHg
  • Temperature : Afebrile

Dashavidha Pariksha

  • Prakruti : Vata-Pittaja
  • Vikruti : Vata-Kaphaja
  • Sara : Madhyama
  • Samhanana : Madhyama
  • Satwa : Madhyama
  • Satmya : Sarvarasa Satmya
  • Pramana : Madhyama
  • Ahara Shakti : Madhyama
  • Vyayama Shakti : Madhyama
  • Vaya : Madhyama (48yrs)

Systemic examination

CNS : Conscious, well oriented
CVS : S1, S2 heard
RS : AEBE, NVBS

Clinical findings

Skin Examination:

Inspection

  • Lesions : Well defined erythematous papules and plaques with silvery white scales Surface: dry/rough
  • Discharge : Absent
  • Texture : Dry/rough
  • Exfoliation : Present
  • Temperature : Normal

Signs

  • Auspitz sign : Positive
  • Candle grease sign : Positive
  • Koebner’s phenomenon : Absent

Samprapti Ghataka

  • Dosha: Vata-Kapha Pradhana Tridoshaja
  • Dushya: Rasa, Rakta, Mamsa
  • Agni: Jatharagni-Janya, Dhatwagni-Janya
  • Ama: Jatharagni-Janya Ama
  • Srotas: Rasavaha, Raktavaha Srotas
  • Srotodushti Prakara: Sanga
  • Rogamarga: Bahya
  • Udbhava Sthana: Amashaya
  • Vyaktasthana: Twak
  • Swabhava: Chirakari
  • Sadhya-Asadhyata: Kricchrasadhya

Therapeutic intervention and timeline

a) Classical Vamana

  • Deepana-Pachana with Hingwashtaka churna
  • Snehapana with Pancha Tiktaka Ghrita (PTG)
  • Sarvanga Abhyanga with Nimba Taila + 777 oil followed by Bashpasweda
  • Vamanakarma with Madanaphalapippali added with Saindhavalavana, Vacha Churna and Madhu
  • No: of Vegas: 6
  • Shuddhi: Madhyama
  • Peyadisamsarjana Karma was followed after Vamana for next 2 days.

b) Shamana Aushadhis

  • Cap. Tiktamrita
  • Patolakaturohinyadi Kashaya
  • 777 Oil
  • Atrisor ointment
  • Atrisor soap

Table 1: Treatment schedule

DateTreatmentMedicineDosage
20/04/2024Deepana- PachanaHingwashtaka Churna2tsf BD B/F with warm water for 3 days
23/0/2024 to 25/04/2024SnehapanaPTG1st day - 30ml
2nd day - 60ml
3rd day - 90ml
26/04/2024Sarvanga Abhyanga, BashpaswedaNimba Taila + 777 oilQ.S
27/04/2024Vamana § Madanaphala Pippali added with Saindhava Lavana, Vacha Churna and Madhu-half tea spoon each
§ Milk - 4glasses
§ Yashtimadhu Phanta - 11 glasses
§ Saindhava Jala - 6 glasses
§ Total Vegas - 6		80gm
28/04/2024 to 29/04/2024Samsarjana Karma Ganji - for 2 days after Vamana

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Outcome and Follow-up

The patient was under close observation in the In-Patient Department of Kayachikitsa Department, for 7 days and no side effect were reported. The patient noted a good improvement since there was a reduction in the scaling of the skin and itching on her scalp, ears and eyebrows.

Results

Table 2: Changes in signs and symptoms

Assessed using Psoriasis Scalp severity Index (PSSI)[5]

FeaturesScore
BTAT
Erythema00
Induration20
Desquamation20

Table 3: Changes in signs and symptoms before and after treatment

Signs and symptomsBefore treatmentAfter treatment
DrynessPresentAbsent
ItchingPresentAbsent
Scaling of skinPresentAbsent
Excessive sweatingPresentReduced
Discoloration of skinPresentReduced

Discussion

According to Ayurveda all the skin disease come under broad term Kushta. Kushta i.e., Kshudra Kushta under the heading of Kitibha Kustha. Vamana Karma is considered to be best treatment for Kaphaja Vyadhi, combination of Kapha with Pitta or the conditions in which Pitta or Vata invade the site of Kapha. Considering the status of Dosha, Dushya, Agni, Samprapti Vaishistyata and Vyadhi Lakshana a classical Vamana Karma was administered in the present clinical study.

Hingwashtaka Churna:it has 8 ingredients, mainly indicated for Jatharagni Dipana, Pachana and in Agnimandya.

Panchatikta Ghrita:Proper Snehapana is necessary for effectiveness of Vamana Karma. In present study, Panchatiktaka Ghrita has been used for Snehapana. Panchatiktaghrita consist of drugs like Guduchi, Nimba, Kantakari etc. which acts as an agent or a substance that inhibits the manifestation of immediate hypersensitivity.

And help to reduce oxidative stress, by scavenging free radicals. Thus, Shodhana therapy along with Shamanaushadhi completely expels the Doshas out of the body and prevents the relapse of disease.

777 oil: 777 oil contain Wrightia tinctoria have Kushtaghna and Kandughna property. Increases the bio-availability of the active ingredients and balances the micro and macro level of activities. Ideal hydro-lipo quotient reduces xerosis of skin associated itching, and delays cell death.

Swedana: Removes obstruction in Srotas through the process of Srotoshodhana.[6]

Vamana - Mode of action: Vamana Dravya has the properties like Ushna, Tikshna, Sukshma, Vyavayi and Vikasi, reaches to Hridaya by virtue of its Virya then to Dhamani even to the Anusrotas due to Sukshma Guna and throughout the body due to Vyavayi and Vikasi Guna. Later does the Vishyandana of the Dosha by Agneya Guna and Vicchindana by Tikshna Guna. By Agni and Vayu Mahabhuta Pradhanyata and Urdhvabhagahara Prabhava, Dosha are expelled through the Mukha-marga.[7]

Shamana Aushadhis

Cap. Tiktamrita it has ingredients like Amrita, Vasa, Kantakari, Patola, Nimba, Triphala, Shudha Guggulu. Acts as Kapha-Pittahara, Rakta-Shodhaka and mainly indicated in Kandu, Kushta etc.

Patolakaturohinyadi Kashaya[8] it has ingredients like Patola, Katurohini, Chandana, Guduchi, Patha etc. Patola Katurohinyadi Kashayam all drugs are Tikta and Katu Rasa Pradhana and having maximum action on Skin and Liver. Therefore, have Kapha- Pittahara and Tridoshahara Karma.

Before treatment
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jaims_3664_02.JPG

After treatment
jaims_3664_03.JPG
jaims_3664_04.JPG

Conclusion

Due to very wide range of clinical manifestations we have to conclude that no single disease in Ayurveda can be exactly co-related as Psoriasis. According to Symptoms of disease & concepts of Ayurveda to some extend we can consider Kitibha Kustha as Psoriasis. Kitibha Kustha is a Vata-Kapha Pradhana Tridoshaja Vyadhi. Classical Vamana Karma was done with Madanaphala, Indrayava, Yastimadhu, Patola, Nimba. Classical Vamana Karma is very effective in Kitibha Kushta due to its Sodhana property. These drugs also having anti-inflammatory, immune-modulator, analgesic and antioxidant effect.

Patient perspective

The patient expressed great contentment with a treatment that was cost-effective and required less time. Features like scaling, itching have shown marked relief making the patient socially and semantically confident.

Informed consent

Informed written consent was obtained from the patient for disclosure of the name and photographs

References

1. Pravin Kumar Rai, Shikkasharma, Ajay Saxena, Clinical study of Vamana karma and streekutaja oil in the management of Ekakushta vis-à-vis psoriasis, International journal of Ayurveda and altered medicine, 2014.
2. Dogra S, Mahajan R. Psoriasis: Epidemiology, clinical features, co-morbidities, and clinical scoring. Indian Dermatol Online J. 2016 Nov-Dec;7(6):471-480. doi: 10.4103/2229-5178.193906. PMID: 27990381; PMCID: PMC5134160.
3. Pandit Kashinath Sashtri and Dr. Gorakhnath Chaturvedi,Chaukhambha Bharati academy, Varanasi, 2013, Charaka Samhita vol. 1, Chikitsa-sthana 7/13, Page 250.
4. Murthy KRS, Sushruta Samhita Reprint, Nidana Sthana; Kushtha Nidana, Chapter 5, Shloka 14, Varanasi, Chowkhamba Krishnadas Academy, 2010; 496.
5. Leon Kircik MD, Salicylic Acid 6% in an Ammonium Lactate Emollient Foam Vehicle in the Treatment of Mild-to-Moderate Scalp Psoriasis, J Drugs Dermatol. 2011;10(3):270-273.
6. C. Patil, Principles and Practice of Panchakarma, Chaukhambha Publications, New Delhi, 3rd edition, chp 9, Swedana karma, Pg.no 192
7. Singh vijethya, Srivasthava Alok Kumar, Ayurvedic management of Psoriasis (ekakushta) with Panchakarmachikitsa, International journal of Ayurveda and pharma research, 2015
8. K.R. Srikantha Murthy, Astanga Hrdayam, Chowkhamba Krishnadas Academy, Varanasi, 10th edition, 2014, chp 15, verse 15, Pg.no 202


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