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2 CASE REPORT Impact Factor (2014) by International Scientific Indexing (ISI) UAE EFFECT OF AYURVEDIC SHAMAN TREATMENT IN PLANTAR PSORIASIS (KITIBHA KUSHTHA)- A Case Study Sumit Sunil Kadam 1*, Jayant J. Phadke 2, Tushar S. Khairnar 3, Priyanka V. Gaikwad 4 1. M.D. Scholar, Dept. of Agadtantra Vyavhar Ayurved Avum Vidhivaidyak, College Of Ayurved & Research Center, Nigdi, Pune , Maharashtra, Contact No , - sumitkadam18@gmail.com 2. Prof. & HOD, Dept. of Agadtantra Vyavhar Ayurved Avum Vidhivaidyak, College Of Ayurved and Research Center, Nigdi, Pune, Contact No Reader, Dept. of Agadtantra Vyavhar Ayurved Avum Vidhivaidyak, College Of Ayurved and Research Center, Nigdi, Pune, Contact No M.D. Scholar, Dept. of Dravyaguna, College of Ayurved and Research Center, Nigdi, Pune, Contact No Article Received on - 12 th Oct 2015 Article Revised on - 16 th Dec 2015 Article Accepted on - 28 th Dec 2015 All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non commercial purpose (see copyright notice below). (Full Text Page IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3 CASE REPORT EFFECT OF AYURVEDIC SHAMAN TREATMENT IN PLANTAR PSORIASIS (KITIBHA KUSHTHA) - A Case Study *Corresponding Author Sumit Sunil Kadam M.D. Scholar, Dept. of Agadtantra Vyavhar Ayurved Avum Vidhivaidyak, College Of Ayurved and Research Center, Nigdi, Pune , Contact No , - sumitkadam18@gmail.com ABSTRACT: A case of recurrent plantar psoriasis that is not responding to modern medicines is a challenge to treat. Plantar Psoriasis can be correlated with Kitibha kushtha according to Ayurveda. Such condition can be treated successfully, if Ayurvedic principles mentioned in treatment of Kushtha are followed. This case of plantar psoriasis was diagnosed as a case of Kitibha Kushtha. According to severity of disease, internally Anantmoola vati was given. For external application Jivantyadi Yamakam and Topisal3% lotion was given, showed good results. Ayurvedic treatment can show good results in severe form of psoriasis, which turns PASI score from 7.2 to 0.4 in this case study. QR Code IJAAM Key Words: Plantar psoriasis, Anantamoola Vati, Jivantyadi Yamakam, Panchatikta ghrita guggula, Kitibha Kushtha DIDS: INTRODUCTION Plantar Psoriasis is characterized by chronic inflammation of skin, clinically characterized by severe itching, greyish white lesions [1]. It is correlated mainly with three conditions described in Ayurveda namely Mandala kushtha, Kitibha kushtha and Ekakushtha. Ayurveda has advocated use of shamana treatment. Further discussed patient was diagnosed as a case of plantar psoriasis. As regards to Ayurveda principles, the nature of skin lesions, and other associated symptoms, patient was diagnosed as a case of Kitibha kushtha, and was given treatment accordingly. Patient was started on internal Ayurvedic Shamana treatment along with Ayurvedic & Allopathic medicines for external application. After 28 days of treatment, marked decrease in the raised grayish white lesions and shedding of deceased skin was seen. Body ache and burning, itching sensation at the site of lesions were also less. Dryness and scaling were considerably reduced. Thus, the chronic and recurring nature of the disease hampers the quality of life to a great extent. As a result of Ayurvedic Shamana chikitsa along with Ayurvedic & Allopathic External application of lotion shows that Psoriasis may be controlled by Ayurvedic medicines; which turns PASI score from 7.2 to 0.4 in this patient. CASE REPORT A 28 years old male presented in outpatient department of Ayurveda Rugnalayaand Sterling Multispecialty Hospital with complaints of raised, inflamed, greyish white lesions or plaques covering the entire plantar surface of feet with severe itching, burning sensation, dryness, generalized weakness, heaviness, body ache since six months [Photograph 1]. Patient shows symptoms like greyish white elevated patches along with inching, erythema, etc. symptoms was suggested as a case of plantar Psoriasis. PASI score was 7.2. Diagnosis: In view of modern science, considering the nature of lesions it was clearly a case of plantar-psoriasis. Researchers have compared psoriasis with various skin diseases mentioned in Ayurvedic classics namely Mandal kushtha, Kitibha kushtha and Eka kushtha [2]. Mandal kushtha is seen due to dominance of Kapha while Kitibha kushtha and Eka kushtha are seen due to Vata and Kapha dominance. Lesions seen in this patient were well defined, grayish white in color, rough, having excessive itching; these symptoms are seen as it is in Kitibha Kushtha [2,3]. Treatment: Patient received Anantmoola Vati [Chaitanya Pharmaceuticals] orally 2 tablets (500mg) twice a day after food with warm water, Panchatiktaghrita Guggula[ref. Ashtangahridaya] 2 tablets twice a day after food with warm water. Initially for a period of 21 days combination of Jivantyadi Page327

4 Yamakam [Arya Vaidya Sala, Kottakkal. Ashtangarhidaya ref.] & Topisal 3% lotion, 4: 1 concentration was used for Local application, followed by only Jivantyadi Yamakam alone for local application for two months. Treatment outcome: Patient started to show improvement after 14 days of this treatment; decrease in symptoms like itching, erythema, body ache. After 28 days of treatment, marked decrease in the raised grayish white lesions and shedding of deceased skin was seen. Significant reduction in symptoms like itching was seen. Body ache and burning sensation at the site of lesions were also less. Skin now showed whitish but less inflamed small patches [Photograph 2]. Dryness and scaling were reduced after 42 days of treatment. Skin showed reddish, less inflamed patches. Scaling was minimal. After75 days only a few lesions, remained on lower side of toe, but there was noitching, scaling or dryness. Skin was almost normal [Photograph 3]. No new skin lesion was seen. Reduction in PASI scores-from 7.5 to 0.4was seen after 90 days of treatment. Patient continued the treatment for next two months and he has better effect. DISCUSSION Global prevalence of psoriasis varies considerably from 0.91% to 8.5% with variation in geographical regions, age [4]. Prevalence of psoriasis in India ranges between 0.44 and 2.8% [5]. Chronic psoriasis is a lifelong disease with a substantial impact on the physical well-being and quality of a patient s life. Characterized by periods of spontaneous remission and relapse, the course of psoriasis is variable and often unpredictable. To maintain control of their disease, patient typically requires long- term therapy. However, long- term treatment in patients with moderate to severe psoriasis is limited by the potential for toxic effects on organs such as kidney, liver, bones, in addition to teratogenicity and malignancy associated with the traditional systemic therapies. Kushtha is mentioned in Ashto mahagad (octa-ominous disorder) in Ayurveda [6]. Kushtha can be correlated with Psoriasis. In Ayurveda all skin diseases are described under the common disease Kushtha. It is named as a Rakta Pradoshaja Vyadhi because Rakta vitiation is found as a common pathology in this disorder [7]. Local application in psoriasis is the main part of treatment along with internal medicines. In this patient Jivantyadi Yamakam is used along with Topisal3% cream in 4:1 proportion for local application. Topical 3% cream given for first 21 days achieved good healing. Later on only Jivantyadi Yamakam given for local application for next two months. Contents of Jivantyadi Yamakam are Jivanti (Leptadenia reticulata Retz.), Manjishtha (Rubia cordifolia Linn.), Daruharidra (Barberis aristata DC)- useful in skin disorders having rakta and kapha dosha dushti mainly [8-12] ; Arka ksheera (Calotropis procera Ait.) is useful in Kushtha [13-14] ; Tutthha is mentioned in treatment of Shwitra [15]. Jivantyadi Yamakam is mentioned as Vipadikahar Lepa in Ayurvedic texts. [16] Shaman treatment is core of psoriasis treatment. Tablet Panchatikta ghritaguggula given as 2 tabs twice a day. Panchatikta ghritaguggula is advised for treatment of Kushtha. [17] Contents of Panchatikta ghritaguggula are Nimba (Azadiracta indica A.), Amrita (Tinospora cordifolia Willd.), Vasa (Adhatoda vasica Nees.) are described for Kushtha [18-22] ; Amrita is one of the Rasayana drug mentioned in Ayurvedic texts. Patol (Tricosanthes diocia Roxb.) has wound healing property [23], so this preparation is used to achieve good and early healing of psoriasis. Tablet of Anantamoolais used 2tabs twice daily. Anantamoola (Hemidesmus indicus R. Br.) have property to increase sweating, poly-urination, purifies blood, improve skin texture, rasayana, balya. Chemical constituent of Anantamoolais- P-Methyl Salicylic aldehyde which useful in psoriasis as mentioned in very research articles [24].so this medicine is used in this case. According to Modern sciences various treatments for psoriasis are available such as corticosteroids, retinoid, anthalin, Psoralen and ultraviolet A phototherapy (PUVA), methotrexate etc. But each of the treatment potential side effects which could be resistance to treatment, thinning of skin, immune suppression and also as severe as formation of Melanoma [25]. Contents of Topisal 3% lotion are Clobetasol propionate & Salicylic acid. Clobetasol propionate is a corticosteroid, which stops or lowers irritation and swelling. Corticosteroids exert antiinflammatory, anti- proliferative and immune suppressive actions by affecting gene transcription [26]. In this case, use of combination of Topisal 3% lotion and Jivantyadi Yamakam showed better result as anti-inflammatory, anti- proliferative and immunosuppressive actions by Topisal and wound healing (Ropan) action by Jivantyadi yamakam. The appearance of systemic side-effects following topical treatment with corticosteroids has been reported for several preparations, predominantly for creams and ointments. Although most pronounced at higher doses, adrenal function in some cases also becomes impaired at low doses of Page328

5 VOL 3 INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE Methotrixate is one of the modern medicines which is used now a days for psoriasis. Study shows adverse drug reaction as Liver fibrosis/cirrhosis, pneumonia/alveolitis, bone marrow depression, renal damage, alopecia (reversible), nausea, weariness, vomiting, elevated transaminases, infection, gastrointestinal ulcerations, nephrotoxicity [28-30]. Another medicine used by modern practitioner is Retinoid. Adverse drug reactions are noted in retinoid treatment as Hypervitaminosis A [31]. To overcome from these complications, Ayurvedic medicines are safer to use. This patient didn t show any symptoms of hepatic/renal toxicity or other adverse drug reaction in treatment period. It is only single case study, to see better prognosis it requires further study that how Jivantyadi Yamakam + Topisal 3% lotion can give better effect than using either of them alone. Photograph 1- showing Lesions of psoriasis at planter side of both legs on Day 0 Photograph 2- showing marked decrease in lesions of psoriasis at plantar side of both legs on Day 28 Photograph 3- almost normal skinat planter side of leg on Day 75 REFERENCES Schön Pm, Boehncke Wh. Psoriasis. N Engl J Med 2005; 352: Acharya Yt Editor. Charak Samhita Of Agnivesha. Varanasi: Chaukhamba Sanskrit Sansthan; p.451. Dr. Anna Moreswar Kunte Editor. Astangahridaya of Vagbhata. Varanasi: Chaukhamba Sanskrit Sansthan; p.525. Parisi R, Symmons Dpm, Griffiths Cem, Ashcroft Dm Global Epidemiology of Psoriasis: A Systematic Review Of Incidence And Prevelance. Journal of Investigative Dermatology, 2013; 133: Dogra S, Yadavs. Psoriasis In India: Prevelence And Pattern. Indian Journal Of Dermatology, Venerology And Leprology, 2010; 76(6): Acharya Yt Editor. Charak Samhita of Agnivesha. Varanasi: Chaukhamba Sanskrit Sansthan; p.368. Ibid p.179. Prof. Priyavrat Sharma Editor. Dhanvantari Nighantu. Varanasi: Chaukhamba Orientalia; p.41, 99. Page 329 potent steroids [27]. To overcome from these side effects, Jivantyadi Yamakam is used in combination with Topisal3% lotion. Such combination is used in our practice in many cases and is showing better results than that of individual use of either medicine. Effect of such combination needs to be studied in larger clinical trial needs to be evaluated further. eissn

6 9. Prof. Priyavrat Sharma Editor. Dhanvantari Nighantu. Varanasi: Chaukhamba Orientalia; p Pandit Narhari Editor. Rajnighantu. Varanasi: Chaukhamba Krishnadas Academy; p Ibid p Prof. Priyavrat Sharma Editor. Dhanvantari Nighantu. Varanasi: Chaukhamba Orientalia; p Ibid p Pandit Narhari Editor. Rajnighantu. Varanasi: Chaukhamba Krishnadas Academy; p Ibid. p Acharya Yt Editor. Charak Samhita of Agnivesha. Varanasi: Chaukhamba Sanskrit Sansthan; p Shree Govinda Das Editor. Bhaishajya Ratnavali. Varanasi: Chaukhamba Prakashan; p Acharya Yt Editor. Charak Samhita of Agnivesha. Varanasi: Chaukhamba Sanskrit Sansthan; p Kaviraj Dr. Ambikadatta Shastri Editor. Susruta Samhita of Maharshi Susruta. Varanasi: Chaukhamba Sanskrit Sansthan; p Bapalal Vaidya Editor. Nighantu Adarsha I. Varanasi: Chaukhamba Bharati Academy; p Ibid. p Ibid. p Kaviraj Dr. Ambikadatta Shastri Editor. Susruta Samhita Of Maharshi Susruta. Varanasi: Chaukhamba Sanskrit Sansthan; p Lars Hillstorm, Md, Lars Pettersson, Md And Louise Svensson, Md, Department Of Dermatology, District General Hospital, S Gdvle, Sweden Comparision Of Betamethasone Dipropionate Lotion With Salicylic Acid (Diprosalic ) And Clobetasol Propionate Lotion (Dermovate ) In The Treatment Of Psoriasis Of The Scalp. J Int Med Res (1982)10.p Shaikh G, Ali S, Talmale Sy, Surwase Us, Et Al. Alternative Medicine for Psoriasis- Natural Herbal Ayurvedic Treatment- A Review. International Journal of Ayurvedic and Herbal Medicine; (3): Feldman SR. Dellavalle Robert P, Duffin Kristina C. Treatment of Psoriasis. [accessed date 30/08/2015] 27. Hillstorm L., Pettersson L., Svensson L. Comparision of Betamethasone Dipropionate Lotion with Salicylic Acid (Diprosalic ) and Clobetasol Propionate Lotion (Dermovate ) In the Treatment of Psoriasis of the Scalp. J Int Med Res (1982). 10, Nast A., Koop I., Augustin M, Bandit K. B, Boehncke W. H.; German Evidence- Based Guidelines for the Treatment of Psoriasis Vulgaris. Arch Dermatol Res (2007). 299: Haustein U-F and Rytter M. Methotrexate in Psoriasis: 26 Years Experience with Low-Dose Long-Term Treatment. Journal of the European Academy of Dermatology and Venereology (2000); 14: Roenigk H. Jr., Haserick F, John R. and Curtis George H. Methotrexate* For Psoriasis A Preliminary Report. Cleveland Clinic quarterly Gollnick H.P.M. Oral Retinoids Efficacy and Toxicity in Psoriasis. British Journal of Dermatology (1996); 135:6 17. CITE THIS ARTICLE AS Kadam S. S. et.al., Effect of Ayurvedic Shaman Treatment in Plantar Psoriasis (Kitibha Kushtha)- A Case Study, Int. J. Ayu. Alt. Med., Source of Support Nil Conflict of Interest None Declared Page330

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