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Case Report

Palmoplantar Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 7 JULY
Publisherwww.maharshicharaka.in

A Case Study of Ayurvedic management for Vipadika (Palmoplantar Psoriasis)

Pundir M1*, Lajurkar P2, Singh C3, Purvia RP4, Adlakha MK5
DOI:10.21760/jaims.10.7.53

1* Manisha Pundir, Assistant Professor, Department of Dravyaguna, Krishna Ayurvedic Medical College and Hospital, Bijnor, Uttar Pradesh, India.

2 Pragati Lajurkar, Post Graduate Scholar, Department of Dravya Guna, Dr Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

3 Chandan Singh, Professor and HOD, Department of Dravya Guna, Dr Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

4 Rajendra Prasad Purvia, Associate Professor, Department of Dravya Guna, Dr Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

5 Manoj Kumar Adlakha, Associate Professor, Department of Dravya Guna, Dr Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

Kushta (Skin Diseases) is the general term used in Ayurveda to refer to all skin conditions. Acharya Charaka has listed eighteen different kinds of Kustha (skin diseases). Eleven of them are Kshudra Kushta, while rest of them are Maha Kustha. Vipadika is the one among in Kshudra Kustha which is compared with Palmoplantar Psoriasis. It is a chronic, multifactorial, inflammatory, complicated illness characterised by an increase in the turnover rate of epidermal cells and hyperproliferation of keratinocytes in the epidermis. This skin disease hampers day-to-day activity of patient due to associated symptoms and depresses patients because of cosmetic issues. This case concerned a 27-year-old woman who was experiencing itching on the plantar aspect of Right foot, cracks across the soles, and pain while walking. No prior history of any systemic disease was present. No surgery had been performed on the patient. The symptoms like burning and pain subsided in the initial visit. With subsequent follow-ups, the cracks, itching, and pain during walking decreased. One session of Laghu Virechana and a single session of Raktmokshan were scheduled. The entire course of treatment lasted roughly ten months. During treatment patient was irregular on initial visits though, the patient experienced relief from major parameters with the given treatment regimen.

Keywords: Vipadika, Plantar Psoriasis, Kshudra Kushtha, Virechan, Raktmokshan

Corresponding Author How to Cite this Article To Browse
Manisha Pundir, Assistant Professor, Department of Dravyaguna, Krishna Ayurvedic Medical College and Hospital, Bijnor, Uttar Pradesh, India.
Email: 		Pundir M, Lajurkar P, Singh C, Purvia RP, Adlakha MK, A Case Study of Ayurvedic management for Vipadika (Palmoplantar Psoriasis). J Ayu Int Med Sci. 2025;10(7):341-346.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-05-17 2025-05-27 2025-06-07 2025-06-17 2025-06-27
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© 2025 by Pundir M, Lajurkar P, Singh C, Purvia RP, Adlakha MK 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(7)341
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Manisha P et al. A Case Study of Ayurvedic Management for Vipadika

Introduction

Skin conditions are categorised as non-serious, although they are not cause of death, but patient’s mental health is impacted by cosmetic problem. Kushtha is general term used in Ayurveda for all skin conditions. The Ayurvedic Samhitas describe eighteen different varieties of Kushta. Eleven of them are Kshudra Kushtha, while the remaining ones are Mahakushtha. Vipadika is mentioned in Kshudra Kushthas and indications, symptoms of Vipadika have been presented differently by different Acharyas in Ayurveda. Vipadika is compared with Palmoplantar psoriasis which most frequently appears in skin of elbows, knees, scalp, lumbosacral regions, intergluteal clefts, and glans penis. It is a non-infectious, chronic inflammatory disease of skin, characterized by well-defined erythematous plaques with a silvery-white scale with a predilection for extensor surface and scalp, and a chronic fluctuating course. The primary abnormality is enhanced epidermal proliferation brought on by an overabundance of basal layer cell multiplication. Keratinocyte transit time is shortened, and epidermal turnover is decreased from 28–30 days to 5–6 days.[1,2] Although exact cause is uncertain, immunopathological, biochemical, and genetic factors are seemed to be involved in disease. The condition may worsen due to precipitating factors such as trauma, infections, sunlight, certain medications, and stress/emotions. The Major Symptoms described in Ayurvedic Classics and conventional system of Medicine are given below:

Symptoms of Vipadika mentioned by different Acharyas

  • Ashtang Hridaya states that the symptoms of Vipadika include Sarambha Pidika (red-colored macule), Manda Kandu (mild itching), Tivra Vedana (severe pain), and Panipadsputana (cracks over the palms and soles).
  • According to Acharya Charak crack and Vedana (severe pain) and Kandu (mild itching), are the symptoms of Vipadika.
  • According to Acharya Sushtruta Itching (mild itching), Daha (burning sensation), Vedana (Pain) present especially on pada (sole) are the symptoms of Vipadika. He also mentioned that in Vipadika there is involvement of Tridosha (V, P, K) but Vata is predominantly vitiated.

Diagnosis of the disease in Conventional system of Medicine is mainly based on clinical symptoms that are

  • Erythematous sharply defined plaques, covered with silvery-white scales.
  • Extensor surfaces primarily involved such as the knees and elbows.
  • Koebner’s phenomenon is present in the active phase of the disease.
  • Wornoff’s ring is often present in the healing phase of the disease.
  • Auspitz sign and Candle grease sign are other classic features of the disease.

Case Report

Patient information: A 27-year-old Female student came to OPD complaining of cracks and itching on the sole of right foot from last 5 months along with complain of burning sensation for last 3 months.

History of present illness: The patient came to OPD with all the mentioned symptoms. She did not have any history of systemic diseases or, any family history. The patient was relatively healthy before the occurrence of disease; she noticed itching and scaling on the right foot which gradually increased and spread over the heel. She took allopathic medicine containing Steroids and antifungal Medicines for 2 months experiencing only symptomatic relief during this period. Despite continuous use, the underlying condition persisted, masked by the temporary alleviation of symptoms. Each time the patient discontinued the use of the local steroid ointment, the disease re-emerged. So, she came to our OPD for further treatment.

Mental status: Mild depressed.

Clinical findings: The patient was examined based on Dashvidh Pariksha (Ten examinations), Which includes Nadi (Pulse), Mala (Stool), Mutra (Urine), Jivha (Tongue), Shabda (Speech), Sparsha (Skin), Drik (Eyes), Akruti (Built), Agni (Digestion) and Bala (Power). [Table No.1]

Subjective criteria: The patient was tested on subjective criteria, which includes Vedana (Pain), Kandu (Itching), and Daha (Burning sensation), and Paadtwak Daran (cracks/ Scaling) are observed. [Table No.2]


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Manisha P et al. A Case Study of Ayurvedic Management for Vipadika

Table 1: Dashvidh Pariksha

SNExaminationResult
1. Nadi (Pulse)84/m (Vaat-Pitta Saam)
2. Mala (Stool)1-2 times/ Day (Constipated)
3. Mutra (Urine)Normal (Frequency / consistency)
4. Jihva (Tongue)Coated (Saam)
5. Shabda (Speech)Normal/ Spasht
6. Sparsha (Skin)Anushna/ Ruksha
7. Drik (Eyes)Samyak
8. Akruti (Built)Madhyam
9. Agni (Digestion)Visham
10.Bala (Power)Madhyam

Table 2: Subjective Criteria

SNCriteriaGradeSymptoms
1. Paadtwak Daran (Scaling)0No scaling: Skin is smooth and intact
1Mild scaling: Slight flaking or roughness
2Moderate Scaling: Nnoticeable flaking and roughness
3Severe scaling: extensive flaking and thickened skin
2. Kandu (Itching)0No itching; skin feels completely comfortable
1Mild itching: occasional and not bothersome
2Moderate itching: frequent and somewhat bothersome
3Severe itching: constant and disrupts sleep
3. Daha (Burning sensation)0No burning sensation: skin feels completely normal
1Mild burning: occasional and not overly bothersome
2Moderate burning: frequent and somewhat uncomfortable
3Severe burning: constant and significantly uncomfortable or painful
4. Vedana (Pain)0No pain: Completely comfortable
1Mild pain: Occasional and not significantly bothersome
2Moderate pain: Frequent and increases on touch
3Severe pain: Constant and significantly impacts daily activities and quality of life

Samprapti Ghatak

  • Saptako Dravya Sangrah: The seven Dushya (Vata, Pitta, Kapha, Twak, Rakta, Mamsa, Lasika) are given in Charak Samhita in Kushtha Roga.[3] Majorly Twak, Rakta, Mamsa were seen involved in the above disease.
  • Dosha: Pitta-Vata Saam
  • Dushya: Rasa, Rakta, Mansa
  • Srotas: Rasavaha, Raktavaha, Mansavaha
  • Rogmarga: Bahya
  • Udhbhav Sthana: Amashaya
  • Vyakt Sthan: Pad-tal Twak
  • Sadhyaasadhyatva: Kashtsadhya

Differential Diagnosis

Eczema, Taenia and Contact Dermatitis are diseases that present with similar symptoms in patients & become confused when receiving therapy. Unders-tanding distinctions b/W these illnesses is crucial for treatment. Morphology of Palmoplantar Psoriasis is well defined & mostly has indurated plagues, while in Eczema it is red inflamed, with swelling & crusting, In Taenia it is in form of ring which is usually unclear, In Contact dermatitis it is red, puffy with edges which are poorly defined. Scaling is silvery with plagues in Palmoplantar Psoriasis, thin whitish flaky in Eczema, Flaky dry in taenia, & Cracked & flaky in Contact Dermatitis. Auspitz sign is only positive in Palmoplantar Psoriasis.

Final diagnosis: Palmoplantar Psoriasis.

Timeline and Therapeutic Intervention

Written consent was taken from patient before starting treatment. Following ayurvedic treatment was given with mentioned timeline to patient.

Table 3: Showing timeline and Therapeutic Interventions

Deepana Pachana Karma
19/07/2024Aampachak Vati Patol + Indrayava + Kutki Yoga[4]
Shodhana Karma (Virechan karma)No. of Vega
Sneha Paan
22/07/2024
23/07/2024
24/07/2024		Panchtikta Ghrit
30 ml
60 ml
90 ml		-
Dravya Paan
(25/07/2024)		1. Triphala Kwath - 150ml + Erand Sneha- 25 ml
2. Trivruta Avleha - 20 gm		10 (Uttam Suddhi as per Laghu Virechan)
Sansarjana Krama
3 Ahara Kaal
(26-28/07/2024)		1. Peya
2. Vilepi
3. Mudga Yusha

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Shamana Chikitsa
DateManagementImprovement
29/07/241. Mamsa Pachaka Arogyavardhini Vati (250mg)3 g BD with Lukewarm water after mealUpshayanugami,
Improvement in Discoloration, Itching and Scaling decreases.
2. Gandhaka Rasayana500 mg BD with Lukewarm water after meal
3. Sarivadi Churna- 3g Kamdughda Rasa -500mg + Trivanga Bhasma- 200mg3 g BD with Lukewarm water after meal
4. Avipattikar Churna5 g HS with Lukewarm water at Bed time
5. Gandhak MalharLocal application
14/08/241. CST
03/09/241. Mamsa Pachaka Churna
Arogyavardhini Vati		3 g BD with Lukewarm water after mealMild itching
Mild Discoloration
2. Rasayana Churna
Guduchi + Amlaki + Gokshur		3 g BD with Lukewarm water after meal
3. Sarivadi Churna
Saariva + Usheer + Shatavari + Shweta Chandana + Kamdughda Rasa + Trivanga Bhasma - 200mg		3 g BD with Lukewarm water after meal
4. Avipattikar Churna5 g HS with Lukewarm water at Bed time
5. Gandhak MalharLocal application
18/09/24CSTNo itching
Mild Discoloration
15/02/25Follow up-No visible symptoms of recurrence

Follow-up and Outcomes

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Patient underwent treatment of ten months of int-ernal medicine, which included one session of Laghu Virechan and one session of Raktmokshan. Internal medicines primarily used were Katu, Tikta, Rakta shodhaka & Pitta Shamaka Dravyas, such as Mams-apachaka Churna, Arogyavardhini Vati, Gandhaka Rasayana, Rasayana Churna, and Sarivadi Churna.

For local application, Gandhak Malhar was prescribed. This treatment yielded good results for the patient. Upon follow-up after 15 days of completing the treatment, no visible symptoms of recurrence were observed.

Discussion

The outcome was noted on each visit as well as before and after therapy after the subjective standards of the patient, following 10 months of full treatment, the patient's condition at each visit was improved. The use of various treatment methods and preparations mentioned above are used accordingly, each method and preparation has been carefully selected to address specific medical conditions and improve patient outcomes. This case of Vipadika is treated with Arogyavardhini Vati, two Shashtrokt mentioned compound formulations, Avipattikar Churna and Gandhaka Malhar for local application.

Arogyavardhini Vati

मंडलं सेविता हयैषा हन्ति कुष्ठानि शेषतः।। [5]

The drugs used in Arogyvardhini Vati are Vata-Kaphanashak, Pachak (Digestive), Deepak (Appetizer), Vishaghna (Antitoxic), Jwaraghna (Antipyretic), Malashuddhikara (Detoxify), and has Medovinashana effect and is mentioned as the best medicine for skin diseases.

Gandhak Rasayana

कंडूम च कुष्ठं विषदोषमोग्रं मासद्वेयेनेह जयेत प्रयोग: ।।[6]


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The main area of use for Gandhak is in treating skin Diseases and Rakta Dhatu. It contains Shuddha Gandhak, or pure sulphur, Triphala, Chaturjat, Brungaraj, Sunthi, and Guduchi. These contain antitoxin properties (Vishaghna), antioxidant properties (Rasayan), antimicrobial properties (Jatughna), fights skin illnesses (Kushtaghna), and Yogvahi (increases the action of medicine) in action.

Mamsa Pachaka[7]: Patola + Triphala + Nimba Twak + Musta + Indrayava + Arogyavardhini Vati

These drugs are mainly used for Mansagwat Jwara, and Anyedushka Jwara. In Psoriasis, the “Dosha” are believed to be mainly vitiated in Mansagat Srotasa, therefore, this preparation is used for Dosha Pachan (Eliminating the Toxins) mainly from Mansagata Srotasa.

Sarivadi Churna: Saariva + Usheer + Shatavari + Shweta Chandana + Kamdughda Rasa + Trivanga Bhasma

Sariva is considered as Raktshodhak (Blood purifier), Shothahara (Anti-inflammatory), Kushth-aghna (Skin diseases) & Dahaprashamana (Burning sensation).[8]

Usheer is Tikta in Rasa and hence act as Raktaprasadaka and Doshapachak. Being Sheeta Veerya it acts as Daha Prashamana, Mutrala (Elimination of Dosha from Urinary tract) and, Twakdoshahara (Skin Diseases).[9]

Chandana is Tikta in Rasa and has Sheeta Veerya thus acts as Dahaprashamana, Varnya (Complexion), Raktshodhaka and, Kushthaghna.[10]

Shatavari being Madhura, Tikta in Rasa acts as Pachaka (Ignites digestive fire), Raktpitta Shamaka (Bleeding Disorders), Balya and Rasayana (Good for Overall health).[11]

Avipattikara Churna[12]:

Classic Ayurvedic treatment for Vipadika (Palmoplantar psoriasis) reduces overall symptoms, which include cracking, burning, pain, & itching. Action is mainly on Raktavaha Strotas. In Classical text it is mentioned that to ensure quick drug absorption, Strotas should be cleaned before to beginning treatment. Therefore, first, Srotas were cleansed & then according to disease, Shaman Aus-hadi was administered, which showed positive res-ults. Raktmokshan was done which improved condi-tion bec. of involvement of Rakta & Pitta doshas.

Gandhak Malhar: This is specifically used for local application in skin diseases like eczema (Pama) and itching (Kandu).[13]

Raktamokshan

Due to Prabhutdosha Nirharan by Siravedha and Raktashudhhi, Sharirlaghvta, symptoms such as Vedana Shanti, Twakvaivarnta, Kandu, and Daha were decreased, because of the Bahudosha Avastha, Acharya Charak and Acharya Sushruta say that Shodhan is required for the same. It is possible to administer Siravedha Karma (Bloodletting) since Kushtha is Tridoshaj Condition. Toxic substances can be effectively absorbed by the Siravedha technique, allowing for their easy removal from the body. Besides eliminating Pitta and Kapha Doshas, the main seat of Vata is also purified thereby making Siravedha Karma a truly Tridoshahar procedure.

Conclusion

Kushtha in overall is considered as Krichsadhya Vyadhi. The line of treatment was modified according to the patient and it showed good results in cracks, burning sensation, pain, and itching and gave relief within 10 months of treatment with no side effect. Mainly Tikta Rasa, Sheet Veerya, Aampachaka and Vaivarnyakara Aushadhis are given along with Shodhan and Raktmokshan. Stress is both a secondary cause and an effect of the disease, it affects a patient’s social life and his/her mental health. Even after allopathic treatment, the patient experienced recurrence. However, after the treatment provided, there was no recurrence observed even during the follow-up, five months after stopping the medication. So, with the above given treatment, we advised the patient to do meditation and decrease the stress factors. By carefully understanding the patient's constitution (Prakriti), we made a treatment plan that delivered a 100% effective results. This approach emphasizes the importance of thoroughly examining each patient and providing personalized care, this can further be used in future for treatment.

References

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