An Ayurvedic insight into managing Multi-Drug-Resistant Tinea w.s.r. to Dadru - A Case Series

Anupam Biswas; Swadha Tiwari; Shomya Tiwari; Nabanita Chakraborty; Tapas Bhaduri

doi:10.21760/jaims.10.3.65

E-ISSN:2456-3110

Case Report

Multi-Drug-Resistant

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 3 MARCH

Publisher

www.maharshicharaka.in

An Ayurvedic insight into managing Multi-Drug-Resistant Tinea w.s.r. to Dadru - A Case Series

Biswas A^1*, Tiwari S², Tiwari S³, Chakraborty N⁴, Bhaduri T⁵

DOI:10.21760/jaims.10.3.65

^1* Anupam Biswas, Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India.

² Swadha Tiwari, Post Graduate Scholar, Department of Panchakarma, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India.

³ Shomya Tiwari, Post Graduate Scholar, Department of Roga Nidan Evam Vikriti Vijnana, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India.

⁴ Nabanita Chakraborty, Lecturer, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India.

⁵ Tapas Bhaduri, Reader and HOD, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India.

Skin, the largest organ of human body acts as a shield for external agent. But in today’s modern world, a remarkable increase in the prevalence of skin is witnessed with dermatophytes infection alone accounting for 20-25% of world population. Dermatophytes are fungi that invade and multiply within keratinised tissues (skin, hair and nails) causing infection. Inappropriate, inadequate and overuse of tropical antifungal and corticosteroids drugs results in altered clinical presentation with extensive lesions, ultimately giving rise to a condition unresponsive to conventional treatment and thereby developing resistance. Multi-drug-resistant tinea, over past few years, has become a major health concern, especially in India. To address this need, Ayurveda is looked upon as a safe and effective treatment option. Dadru Kustha, on the basis of clinical presentation shows significant similarities with Tinea infection. In this context, 5 patients of multi-drug-resistant tinea infection with extensive lesions and history of reoccurrence were selected from the OPD of Kaya Chikitsa. Classical Virechan Karma with Trivrit Avaleha followed by Shaman Aushadhi (Aragvadhadi Kashayam, Gandhak Rasayan and Panchatiktaghrita Guggulu Vati), External application (Siddharthak Snan Churna and Brihat Marichyadi Taila with Tankan Churna) and Lifestyle modification were prescribed. After completion of treatment, significant improvement was noted in Subjective criteria {Kandu (itching), Raga (erythema), Pidika (eruptions) & Utsanna Mandala (elevated circular lesion)} and pictorial representation with no signs of reoccurrence during the 1-month follow-up. Panchakarma therapy and Samana Aushadhi (both external and internal) along with lifestyle modification provides a safe and effective treatment option for multi-drug-resistance tinea, highlighting the potential of Ayurvedic interventions in dermatology.

Keywords: Dadru, Dermatophytes, Multi-drug-resistant tinea, Ayurveda

Corresponding Author	How to Cite this Article	To Browse
Anupam Biswas, Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India. Email:	Biswas A, Tiwari S, Tiwari S, Chakraborty N, Bhaduri T, An Ayurvedic insight into managing Multi-Drug-Resistant Tinea w.s.r. to Dadru - A Case Series. J Ayu Int Med Sci. 2025;10(3):417-424. Available From https://jaims.in/jaims/article/view/4075/

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2025-02-10	2025-02-25	2025-03-05	2025-03-15	2025-03-25
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None	Nil	Not required	11.77

© 2025 by Biswas A, Tiwari S, Tiwari S, Chakraborty N, Bhaduri T and 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].

J Ayu Int Med Sci 2025;10(3)417

Download PDF Back To Article Introduction Materials and Methods Observations and Results Discussion Conclusion References

Anupam B et al. Multi-Drug-Resistant Tinea w.s.r. to Dadru

Introduction

The human skin is the biggest organ in the body. It is vulnerable to a wide range of illnesses due to its size and external position. Skin diseases are seen to be a serious health issue for all.

In tropical and developing nations like India, the prevalence of skin disorders has significantly increased recently for a variety of reasons, including pollution, inadequate sanitation, poverty, and unclean living conditions. According to Ayurveda, all skin diseases fall under the general category of Kustha, which are separated into Kshudra Kustha and Maha Kustha.

Acharya Charaka has described Dadru as a Kshudra Kustha^[1] whereas Acharya Sushruta & Vagbhatta has described Dadru as a Maha Kustha.^[2,3] Tinea or Ringworm infections are group of highly contagious segmented fungal infections, characterized by circular lesions which are usually having sharp margins with raised edges, where related fungi are dermatophytes.

In today’s modern world, a remarkable increase in the prevalence of skin is witnessed with dermatophytes infection alone accounting for 20-25% of world population. The prevalence of tinea infections in India is considered very high, range from 36.6-78.4% of population affected by dermatophytosis, where tinea corporis being the most common presentation.

This high prevalence is likely due to warm and humid climate in most parts of the country, contributing to favourable conditions for the fungal growth.^[4]

The Kushta having the Lakshanas of Kandu (itching), Raga (erythema), Pidaka (eruption) and Utsanna Mandala (elevated circular lesion) is called as Dadru. Mainly Kapha & Pitta Dosha predominant.

Materials and Methods

Case Reports

5 patients with chief complaints of severe itchy hyper pigmented round skin lesions over different parts of their bodies and having history of reoccurrence after intake and external application of contemporary medicine were selected from the Kayachikitsa OPD of I.P.G.A.E&R, Kolkata.

Table 1: Inclusion and exclusion Criteria

Inclusive criteria	Exclusive criteria
Age between 18 to 70 years	Age <18 years and >70 years
Subjects presenting with classical features of Dadru Kustha	Immune-compromised patients – HIV, HBV
Both male and female	Diabetes mellitus, Congestive cardiac failure, chronic kidney disease
History less than 3 years of origin	Pregnant and Lactating mother

Patient’s information

Table 2: Showing Patient’s information of all 5 cases

	Case 1		Case 2	Case 3	Case 4	Case 5
OPD No.	5924		6286	6743	7009	7528
Name	SK		BS	GP	HR	NK
Age	53 yr		57 yr	23 yr	56 yr	46 yr
Sex	Male		Male	Male	Male	Female
Religion	Islam		Hinduism	Hinduism	Islam	Islam
Occupation	Businessman		Shopkeeper	Student	Businessman	Housewife
Socio-economic status	Middle		Middle	Lower middle	Lower middle	Lower middle
Marital status	Married		Married	Unmarried	Married	Married
Past History
Medical		HTN	N.S	N.S	N.S	N.S
Surgical		N.S	N.S	N.S	N.S	N.S
Family		N.S	N.S	N.S	N.S	N.S

Personal history

Table 3: Showing Personal history of all 5 cases

	Case 1		Case 2	Case 3	Case 4	Case 5
Appetite	Poor		Poor	Normal	Normal	Poor
Bowel	Constipated		Constipated	Unsatisfactory	Normal	Constipated
Bladder	Normal		Normal	Normal	Normal	Normal
Sleep	Disturbed		Disturbed	Normal	Disturbed	Disturbed
Addiction	No such		Tobacco	No such	No such	No such
Dietary	Mix		Mix	Mix	Mix	Vegetarian
Rasa	Amla, Lavan, Katu	Amla, Lavan		Amla, Lavan	Amla, Katu	Amla, Lavan
Guna	Ushna, Snigdha	Snigdha		Snigdha	Ushna	Ushna, Snigdha
Agni	Mandagni		Vishamagni	Vishamagni	Mandagni	Mandagni
Kostha	Krura		Krura	Madhyam	Mridu	Krura

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Local Examination

Table 4: Showing Local Examination of 5 cases

Patches	Case 1	Case 2	Case 3	Case 4	Case 5
Location	Chest	Groin, Leg	Back	Axilla	Buttock
Shape	Circular	Ovoid	Circular	Ovoid	Circular, ovoid
Number	1	5-6	1	2	2
Colour	Erythematous	Erythematous	Blackish	Erythematous	Blackish
Border	Well demarcated	Well demarcated	Well demarcated	Well demarcated	Well demarcated
Texture	Elevated, Rough	Elevated, Rough	Elevated, Rough	Elevated, Rough	Elevated, Rough
Distribution	Symmetrical	Symmetrical	Symmetrical	Symmetrical	Symmetrical

Assessment criteria of Subjective parameters as per PARGOTRA et al. 2011

SN	Parameters	Findings	Arbitrary score
1.	Kandu (Itching)	Absent	0
		Mild occasional itching	1
		Moderate itching	2
		Severe itching	3
2.	Raga (erythema)	Absent	0
		Mild redness	1
		Moderate redness	2
		Deep red coloration	3
3.	Pidika (eruptions)	Absent	0
		1 to 3 in number	1
		4 to 7 in number	2
		> 7 in number	3
4.	Utsanna mandala (elevated circular lesion)	Absent	0
		Mild elevated	1
		Moderate elevated	2
		Severe elevated	3

Timeline of Therapeutic Intervention

Table 5: Showing timeline of therapeutic intervention

SN	Karma	Drug & Dose	Duration
1.	Deepana and Pachana	Panchakola Churna 5 gm twice daily before meal with luke warm water (L.W.W)	5 days
2.	Snehapana	Mahatikta Ghrita (D1-30ml, D2-60ml, D3-90ml, D4-120ml, D5-150ml)	5 days
3.	Sarvanga Abhyanga	Neem Taila (Q.S)	3 days
4.	Sarvanga Bashpa Swedana	Dasamoola Kwath for 10 minutes	3 days
5.	Virechana Karma	Trivritavaleha 100 gm with L.W.W	1 day
6.	Samsarjana Krama	As per classics	5 days
7.	a. Kwath	Aragwadhadhi Kashaya 20 ml twice daily after meal with L.W.W	30 days
	b. Vati	Gandhak Rasayan 250 mg twice daily after meal with L.W.W	30 days
	b. Vati	Panchatikta Ghrita Guggulu 500 mg twice daily after meal with L.W.W	30 days
	c. External application	Brihat Marichyadi Taila with Tankan Churna twice daily	30 days
	c. External application	Siddharthak Snan Churna once daily	30 days

Pathyapathya

Table 6: Showing Pathya-Apathya of Kustha

Pathya	Apathya
Karvellaka	Amla, Lavan Rasa
Mudga	Dadhi
Nimba Patra	Guda
Nitya Snan	Anupa Mamsa
Mridu Vastra Dharana	Suktha
Vegadharan Varjana	Ati Snigdha Anna
Matravat Asana	Virudhasana

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Precautions

1. Wash clothes & towels in hot water daily.
2. Change socks and wash feet regularly.
3. Do not share towels, soaps, clothes & combs.
4. Do not walk barefoot, especially in wet places.
5. Avoid wearing tight and sweaty innerwear.

Observations and Results

Table 7: Showing number of Virechan Vega 5 cases

	No. of Vega
Case 1	16
Case 2	19
Case 3	18
Case 4	17
Case 5	18

Table 8: Showing BT-AT comparison of Subjective Parameters

Case	Kandu		Raga		Pidika		Utsanna Mandala
Case	BT	AT	BT	AT	BT	AT	BT	AT
Case 1	3	0	3	1	2	0	2	0
Case 2	3	0	3	1	2	0	2	0
Case 3	3	0	2	0	3	0	3	0
Case 4	3	1	3	0	2	0	3	0
Case 5	3	1	3	1	2	0	3	1

Table 9: Showing results of Subjective Parameters

Parameter	n	Mean score		Mean difference	S.D	S.E	t value	% of relief	p value
Parameter	n	BT	AT	Mean difference	S.D	S.E	t value	% of relief	p value
Kandu	5	3	0.40	2.60	0.54	0.24	10.83	73.33	0.001
Raga	5	2.80	0.60	2.20	0.44	0.19	11.57	78.57	0.001
Pidika	5	2.20	0	2.20	0.44	0.19	11.57	100	0.001
Utsanna mandala	5	2.60	0.20	2.40	0.54	0.24	10	92.30	0.001

Picture 1: Pictorial assessment of the study

Graph 1: Showing BT-AT comparison on Subjective parameters in patients

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Graph 2: Showing effect of treatment on Subjective parameters in Patients

Follow Up and Outcome

After completion of treatment there was significant improvement in signs & symptoms i.e., Kandu (itching), Raga (erythema), Pidika (eruption) and Utsanna Mandala (elevated circular lesion) along with Pictorial changes. On follow-up after one-month patients were satisfied with the multi modal Ayurvedic management.

Probable Mode of Action of Treatment Modalities:

Table 10: Showing Probable mode of action of treatment modalities

Treatment modality	Drug used	Main ingredients	Mode of action
1. Deepana-Pachana	Panchakola Churna[5]	Pippali, Pippali Mula, Chavya, Chitrak, Nagara	Enhances secretion of digestive enzymes like amylase, lipase and protease facilitating the breakdown and absorption of nutrients. Prevents indigestion and promotes intestinal motility.
2. Snehapana	Mahatikta Ghrita[6]	Chandan, Yastimadhu, Sariba, Khadira, Abhaya, Amlaki, Aragwadha, Saptaparna etc.	Cures diseases like Kustha, Kandu, Visphota, Pidaka due to its Tikta Rasa. It has Raktashodhak and Varnya properties. It also maintains the normal texture of skin due to its lipophilic action.
3. Sarvanga Abhyanga	Neem Taila[7]	Neem	Act on the site of disease manifestation by the virtue of fungicidal, antibacterial, antiviral, insecticidal etc. properties.
4. Sarvanga Baspa Sveda	Dasamoola Kwath[8]	Bilva, Agnimantha, Gambhari, Shyonak, Patala, Brihati, Salaparni, Prisniparni, Kantikari, Gokshura	Has potent anti-inflammatory, anti-microbial, antiseptic, anti-oxidant properties.
5. Virechana Karma	Trivrit Avaleha[9]	Trivrit	Included in Bhedaniya, Vishaghna and Asthapanopaga Mahakasaya. Helps in elimination of toxins due to Adhobhagahara Guna (i.e. elimination of Dosha from lower half of the body)
6. Samsarjana Karma[10]	As per classics	Peya, Vilepi, Yusa, Rasa	Restores the deranged or weakened Agni, normalises the equilibrium of Dosha by gradually normalizing digestive process and digestive fire.
7. Kwath	Aragwadhadi Kashayam[11]	Amlatasa, Neem, Guduchi, Patha, Karanja etc.	Indicated in Kaphavikar, Sodhana of Dusta Vrana. Acts as Raktasodhak, Twak prasadak. Possesses anti-pruritic, anti-microbial, anti-oxidant, anti-inflammatory properties. It enhances re-epithelialization and neo-vascularisation of skin.
8. Vati	i. Gandhak Rasayan[12]	Shuddha Gandhak, Triphala, Trijata, Sunthi etc.	Possesses Agnideepak, Ama Nasak, Vishahara, Soshak and Kriminasak properties.
8. Vati	ii. Pancatikta Ghrita Guggulu[13]	Neem, Guduchi, Vasa, Patola, Nidigdhka, Ghrita, Guggulu	It acts by the virtue of Kledaghna, Kandughna and Vranasodhak properties.

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9. Bahira Parimarjan Chikitsa / Tropical application	i. Brihat Marichyadi Taila[14,15]	Chandan, Haridra, Saptaparna, Khadira, Guduchi, Daruharidra, Sirisha, Katu Taila, Haritala, Manashila, Gomutra etc.	It possesses Kandughna, Vishaghna, Varniya, Dahaprasamana, Kusthaghna properties. Majority of its ingredients are having antiseptic and anti-fungal action. Also, ingredients like Gomutra have Lekhaniya or exfoliating property helping in breaking down dead skin cells, promoting new cell growth.
9. Bahira Parimarjan Chikitsa / Tropical application	ii. Siddhartak Snana Churna[15,16]	Mustak, Madana, Triphala, Karanja, Aragvadha, Daruharidra, Saptaparna etc.	Cures Tvak Vikara by the virtue of Kandughna, Kusthaghna, Krimighna and Lehaniya properties. Majority of the ingredients are having anti-inflammatory, anti-bacterial and anti-fungal effect.

Discussion

Tinea infection is a challenging condition that has become refractory to conventional treatments due to an increase in emergence of multi- drug resistance. Dadru Kustha presenting clinical correlation with Tinea, is a chronic skin condition characterised by intense itching, inflammation, scaling etc. due to predominance of Kapha and Pitta Doshas. In this case series, 5 cases fulfilling the inclusion criteria were randomly selected from the Kayachikitsa OPD. Percentage of relief for Kandu was 73.33%, for Raga 78.57%, for Pidika 100% and for Utsanna Mandala, it was 92.3%. The p values of all the symptoms were 0.001, which shows highly significant results in all the 5 cases. Virechan Karma was chosen as prime Samsodhana (Purificatory) therapy due to its function of eliminating aggravated Pitta Dosha and thereby pacifying vitiated Rakta Dosha. It also aids in moderately eliminating aggravated Kapha Dosha.^[17]

Deepana-Pachana Karma conducted before Virechan Karma helps in digestion of Ama Dosha, increases the Abhyavaharana and Jarana Sakti, facilitates the separation of Dosha from dhatu and prepares body for Snehapana.^[18]Snehapana was done with Mahatikta Ghrita in ascending dose till appearance of Samyak Snigdha Lakshana. Ghrita is generally Vata- Pitta Samak but it has ability to transform itself so as to incorporate qualities of ingredients (Shown in table no. 10) added to it.^[19] Sneha acts as solvent. It increases Kleda Guna due to an increase in Apya Amsha (watery or moisture content) leading to Utklesha Avastha and promotes Vriddhya, Vishyandana etc. factors which are required for movement of Doshas from Sakha to Kostha.^[20]Sarvanga Abhyanga may help in moistening of Dhatu and Srotas by Snigdha Guna. Sarvanga Baspa Swedana applied after Abhyanga facilitated liquefaction of vitiated Doshas due to its Ushna Guna. It also helped in Srotomukha Vishodhana (clearing of channels of circulation) promoting movement of liquefied Doshas from Sakha to Kostha.^[21]

Thereafter, administration of Virechana Yoga facilitates easy evacuation of aggravated Doshas and toxins by the virtue of its Guna (Ushna, Tikshna, Suksma, Vyavayi, Vikasai), Virya (through which it reaches Hridaya, circulates through micro & macro channels etc.), Prabhav (Adhobhagahara) and predominance of Prithvi and Jala Mahabhuta. It rectified the Rakta Dhusti due to its Ashraya- Ashrayi Bhava with Pitta Dosha. By eliminating the toxins and ensuring balance condition of Dosha and Dhatu, Virechan Karma helped in minimising the presenting symptoms by breaking the pathology of the disease.^[22]Shaman Aushadis administered after Sodhan Karma acted more efficiently upon the involved Doshas and Dhatus due to the absence of Shrota-Rodha. Gandhak Rasayan possesses Rakta Sodhak property. It acts upon the vitiated Kapha Dosha due to its Ushna Virya and Katu-Kashaya Rasa. It is also having Agni Deepana, Pachana and Kledaghna properties which might have helped in reducing symptoms like Kandu, Pidika, Utsanna Mandala etc.^[23]Aragvadhadi Kashayam contains ingredients (Shown in table no.10) promoting Rakta Sodhan and Tvak Prasadana. It also has Kandughna, Vishaghna etc. properties which pacified Kandu, Daha, Utsanna Mandala etc. symptoms of Dadru.^[24]Panchatiktaghrita Guggulu possesses Tikta Rasa which acts on both vitiated Kapha and Pitta dosha. Guggulu acts as Yogavahi, Upshoshak, Vranashodhak and Kledaghna. By these properties it acts upon the pathogenesis of Dadru Kustha.^[25]Along with Shaman Aushadhi, topical application of Brihat Marichyadi Taila and Sidhhartaka Snan Churna were prescribed. Both the drugs are indicated in managing Tvak Vikar due to the presence of their ingredients (Shown in Table no. 10). Siddhartaka Snan Churna was applied in the form of Lepa in the affected region with the aim to pacify the Doshas provoked locally. It also bears Sodhana, Utsadana and Ropana Guna requires for overcoming the clinical presentation of Dadru Kustha.^[26]Siddhartaka Snan Churna tropical application treat fungal infection like Tinea by killing the fungus or stopping it from growing, probably it targets fungal cell membrane causing destruction.

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Lot of articles reviewed the efficacy of Siddhartaka Snan Churna’s antifungal activity.^[27] Topical application of Brihat Marichyadi Taila increases local blood flow and nutrient supply, decreases stagnation of fluid, balances moisture content, removes dead skin, eliminates waste product and fights against Dadru due to its antifungal and antiseptic properties, contributing to microbiological clearance.^[28]

Conclusion

The present case series demonstrates the potential efficacy of multi-modal Ayurvedic intervention in managing multi-drug-resistant Tinea (Clinically correlated with Dadru). The significant improvement in all cases, including reduction in symptoms, skin lesions and fungal load, the combination of Shodhana (Purification) and Shamana (Pacification) therapies along with Bahirparimarjana (External) therapies confirmed the efficacy and safety of Ayurvedic interventions in managing multi-drug-resistant tinea where conventional treatments has failed or did not provide satisfactory effect. Further research is warranted to explore the potential benefits of Ayurvedic interventions in dermatology.

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J Ayu Int Med Sci 2025;10(3)424

Case Report

Multi-Drug-Resistant

Journal of Ayurveda and Integrated Medical Sciences

An Ayurvedic insight into managing Multi-Drug-Resistant Tinea w.s.r. to Dadru - A Case Series

Biswas A1*, Tiwari S2, Tiwari S3, Chakraborty N4, Bhaduri T5

Introduction

Materials and Methods

Observations and Results

Discussion

Conclusion

References

Biswas A^1*, Tiwari S², Tiwari S³, Chakraborty N⁴, Bhaduri T⁵