Introduction

Psoriasis, known as Kitibha in Ayurvedic medicine, is a chronic, non-communicable disease characterized by red patches and flaky, silver-white scales on skin. The global prevalence of psoriasis varies, affecting about 2-3% of population, with geographic and ethnic variations influencing these figures.^[1] It is a multifactorial disease influenced by genetic predispositions and environmental factors, and is commonly associated with comorbidities such as psoriatic arthritis, cardiovascular diseases and metabolic syndrome.^[2,3]

Psoriasis manifests as well-demarcated erythematous plaques covered with silvery scales, primarily appearing on scalp, elbows and knees. The disease is cyclic, with patients often experiencing flare-ups followed by periods of remission. The impact of psoriasis extends beyond physical symptoms, as it can lead to significant psychological distress and diminished quality of life.^[4]

In Ayurveda, psoriasis is correlated with Kitibha, described in classical texts as a type of Kshudra Kushtha (minor skin disease). The Ayurvedic approach to treat Kitibha includes purification (Shodhana) through Panchakarma, and administration of ayurvedic formulations. Previous studies and traditional Ayurvedic practitioners have emphasized the role of diet, lifestyle modifications and stress management in managing the symptoms and preventing exacerbations of Kitibha.^[5,6]

Psoriasis as an immune-mediated disease, primarily involving the dysregulation of T cells and increased activity of inflammatory pathways, particularly IL-23/Th17 axis. Current treatments focus on controlling symptoms and preventing complications through topical agents, phototherapy and systemic treatments including biologics targeting specific immune pathways.^[7]

According to Ayurveda, the pathogenesis (Samprapti) of Kitibha involves the vitiation of Vata and Kapha Doshas, along with the involvement of Raktadhatu (blood tissue). The vitiated Doshas lead to the production of Ama (toxins) which accumulates in the skin tissues, manifesting as the characteristic plaques and scales of psoriasis. Ayurvedic treatment focuses on detoxification to eliminate Ama, restoration of Doshic balance and rejuvenation of skin tissues.^[8]

Disease Progression & Lifestyle Considerations: With regard to lifestyle, no detailed records have been noted about his diet, exercise or daily routines, which could potentially influence management & progression of psoriasis & asthma. Chronic stress, alco. consumption, smoking habits & other lifestyle factors significantly impact both conditions & have not been sufficiently documented. Continuous progre. of psoriasis over 25 years & onset of asthma 20 years ago, coupled with inadequate control over asthma symptoms, su-ggests possibly interconnected pathoph. influenced by immune response & inflammatory processes. PASI Score of patient was 16.2 during initial visit.

Vital Parameters

• Body Mass Index (BMI): The patient presents with a BMI of approximately 24.8 kg/m².
• Blood Pressure: 118/78 mmHg
• Heart Rate: Regular, at 80 beats per minute.

Systemic Examination

1. Cardiovascular System: No murmurs, rubs, or gallops noted; regular rate and rhythm.
2. Respiratory System: Clear breath sounds bilaterally; no wheezes, rales, or rhonchi observed.
3. Gastrointestinal System: Abdomen soft, non-tender; no hepatosplenomegaly or masses detected.
4. Neurological System: Alert and oriented; cranial nerves intact, normal muscle strength and tone throughout.
5. Musculoskeletal System: No joint swelling or tenderness; normal range of motion in all joints.
6. Integumentary System: Multiple well-demarcated erythematous plaques with silvery scales noted, primarily on bilateral lower limbs and right upper limb (Palm).

Ayurvedic Examination

Table 1: Ashtavidha Pariksha (Eight-fold Examination)

• 2: Episodes last from 5–30 minutes.
• 3: Episodes last >30 minutes.

4. Impact on Daily Activities

Assesses how pruritus interferes with personal, social, or work life:

• 0: No interference.
• 1: Mild interference (minimal disruption).
• 2: Moderate interference (requires temporary adjustments in activities).
• 3: Severe interference (unable to complete routine activities).

5. Impact on Sleep

Evaluates how itching affects sleep quality and continuity:

• 0: No impact on sleep.
• 1: Occasional disruption (once or twice a week).
• 2: Frequent disruption (3–5 times a week).
• 3: Persistent disruption (6 or more nights a week).

Total Score Interpretation

• 0–3: Mild pruritus.
• 4–7: Moderate pruritus.
• 8–12: Severe pruritus.
• 13–15: Very severe pruritus.

B. The Psoriasis Area and Severity Index (PASI) score is a widely used quantitative rating system for measuring the severity and extent of psoriasis. It assesses the severity of lesions, and the area affected and combines these values into a single score ranging from 0 (no disease) to 72 (maximal disease). To calculate the PASI score, both the extent of body surface area affected and the severity of the plaques in terms of redness, thickness and scaling are evaluated across four body regions: the head and neck, upper extremities, trunk and lower extremities.

Calculation of PASI Score:

1. Area Assessment: The body is divided into four sections:

• Head and neck (10% of a person’s skin)
• Upper limbs (20%)
• Trunk (30%)

Therapeutic Intervention

A. Diet Plan:^[9]

Dietary guidelines provided by Jeena Sikho Lifecare Limited Hospital included follo. key commendations:

A) Foods to be avoided:

• Do not consume wheat, refined food, milk and milk products, coffee and tea and packed food.
• Avoid eating after 8 PM.
• During solid consume as small bite and chew 32 times.

B) Hydration:

• During water intake, take sip by sip and drink slowly to ensure the amount of water intake each time.
• Drink about 2-3 liters of alkaline water in 3 to 4 times throughout the day.
• Include Herbal tea, living water and turmeric-infused water part of daily routine.
• Boil 4 liters water & reduce up to 2 liters and consume.

C) Millet Intake:

• Incorporate five types of millet into your diet: Foxtail (Setaria italica), Barnyard (Echinochloa esculenta), Little (Panicum sumatrense), Kodo (Paspalum scrobiculatum) and Browntop (Urochloa ramose).
• Use only steel cook wares for preparing millets
• Cook the millets only using mustard oil.

D) Meal Timing and Structure:

1. Early Morning (5:45 AM): Herbal tea, curry leaves (1 leaf-1 min/5 leaves-5 min) along with raw ginger and turmeric.

The changes in the subjective parameters that was observed are-

Table 6: Outcomes - Subjective Parameters

Before Treatment - Image 1 and 2

Discussion

This case report shows promising approach to using Ayurvedic treatment for managing chronic psoriasis, disease that presents significant challenges in both diagnosis & long-term management when using conventional medical treatments alone. Patient, 56-year-old male with long-standing psoriasis poorly controlled by allopathic medications, exhibited significant improvement in both objective & subjective measures through Ayurvedic intervention. Psoriasis, in western medical framework, is seen as an autoimmune condition characterized by an accelerated growth cycle of skin cells, leading to thick, scaly plaques. These manifestations are both physically & psychologically distressing & can severely impact quality of life.^[10]

Nature of disease, with its intermittent flares & remissions, calls for innovative & effective management strategies. In Ayurveda, psoriasis is described as Kitibha, involving an imbalance of Vata & Kapha Doshas, along with an accumulation of ama (toxins). Samprapti Vighatana involves therapeutic interventions aimed at detoxifying body & restoring balance to these Doshas. Panchakarma, an Ayurvedic detoxification procedure, plays pivotal role in this treatment by systemically removing build-up of toxins from body, which is essential for treating chronic conditions like psoriasis.^[11] Medicines used to break Samprapti in this disease were - Psoro Cap, Tab Skin Cure, Syp Raktaprasadhan & Psoro Oil - embody compre-hensive approach to treat psoriasis by targeting different aspects of disease through blend of several potent Ayurvedic herbs & natural compounds.

Psoro Cap combines Neem (Azadirachta indica), renowned for its antimicrobial and anti-inflammatory properties, with Pawad Beej (Cassia tora), which is useful in skin diseases due to its laxative and purgative action that aids in detoxification. Ushba (Smilax ornata) and Manjistha (Rubia cordifolia) acts as blood purifiers, helps eliminate toxins that exacerbate skin issues. Bakuchi (Psoralea corylifolia) is specifically used in the treatment of skin disorders, playing a crucial role in reducing white scaly patches. Gandhak Rasayan, a processed form of sulphur, is traditionally used in Ayurveda for its rejuvenative and antimicrobial effects, improving skin health and reducing itching and scaling.

Additionally, a randomized, double-blind, placebo-controlled trial by Uebelhack et al. on the efficacy and tolerability of Mahonia aquifolium extract - a herb commonly used in Ayurvedic medicine - for psoriasis treatment emphasized the potential of ayurvedic extracts in managing this skin condition.^[14]

Furthermore, Laddha et al. explored the role of Ayurveda in managing psoriasis through diet, lifestyle changes and Ayurvedic medicine, offering comprehensive insights into holistic care approaches.^[15] Kumar et al. also published results from a clinical trial evaluating the efficacy of a specific Ayurvedic compound against a placebo, demonstrating notable improvements in skin disease severity and symptoms.^[16]

Lastly, research by Balakrishnan, though primarily focused on vitiligo, underscored the potential applicability of findings to related dermatological conditions like psoriasis due to similar underlying Doshik imbalances, highlighting the versatility of Ayurvedic treatments in managing complex skin diseases.^[17]

The case report and supporting references from various studies emphasize the potential of Ayurvedic medicine to provide effective and sustainable solutions, particularly for the patients seeking alternatives or complementary options to conventional therapies. This approach aligns with the growing paradigm shift towards integrating traditional medicinal systems with modern healthcare practices to enhance patient outcomes and well-being. As we continue to explore these integrative methods, it is crucial to conduct further research and controlled clinical trials to robustly establish the efficacy, safety and mechanisms of Ayurvedic treatments in dermatological care and beyond.

Need for further research

While the therapeutic potential of Ayurvedic medicine in treating psoriasis is promising, continued and rigorous scientific investigation is needed to further validate its efficacy and safety. This entails conducting structured clinical trials with larger patient cohorts, standardizing treatment protocols and employing modern research methodologies to elucidate the biochemical mechanisms underlying the therapeutic effects of Ayurvedic practices.