Ayurvedic Management of Refractory Childhood Plaque Psoriasis (Ekakushtha): A Case Report
Keywords:
Ayurveda, Childhood Psoriasis, Ekakushta, Shamana, ShodhanaAbstract
Introduction: Psoriasis is a chronic, non-communicable, painful, disfiguring, and disabling disease for which there is no cure and with great negative impact on patients’ quality of life (QOL). Psoriasis causes great physical, emotional, and social burden. Both internal and environmental causes, including minor trauma, sunburn, infections, systemic medicines, and stress, can cause psoriasis. In the Ayurveda, all the skin disease has been described under Kustha. Ekakushtha is one of the Kshudra-Kustha described in Ayurvedic text. Ekakustha is a Vata-Kaphaj predominance disease. According to symptom of Ekakushtha, it can be compared to Psoriasis.
Methods: A 14-year-old female child came to Kaumarbhritya outpatient department, with the chief complaint of crusted skin rashes with oozing, itching and pain over lips, face, and all over body. The patient was first administered Deepana-Pachana drugs along with Srotoshodhana Chikitsa for 15 days. Shamana Aushadhi along with immunomodulatory drugs was then given for a period of 3 months. After 3 months, immunomodulatory drugs along with Rasayana drugs were administered for 1 month.
Results: At the end of Ayurveda therapy, complete remissions of symptoms were observed and photographs taken before and after treatment evidenced it. Furthermore, there were significant decreases in Psoriasis Area Severity Index score and Adolescent Psoriasis QOL score.
Conclusion: The treatment given for Ekakushtha was Deepana, Pachana, Srotoshodhak, Vatanulomna, Rasayana, and Tridoshahara; so above treatment helped to relieve symptoms of disease and also an attempt to provide safe and effective treatment to the patient.
References
1. Harden JL, Krueger JG, Bowcock AM. The immunogenetics of psoriasis: A comprehensive review. J Autoimmun. 2015;64:66-73. doi: 10.1016/j.jaut.2015.07.008
2. Boehncke WH, Schön MP. Psoriasis. Lancet. 2015;386(9997):983- 94. doi: 10.1016/S0140-6736(14)61909-7
3. Kimball AB, Jacobson C, Weiss S, Vreeland MG, Wu Y. The psychosocial burden of psoriasis. Am J Clin Dermatol. 2005;6(6):383- 92. doi: 10.2165/00128071-200506060-00005
4. De Korte J, Sprangers MA, Mombers FM, Bos JD. Quality of life in patients with psoriasis: A systematic literature review. J Investig Dermatol Symp Proc. 2004;9(2):140-7. doi: 10.1046/j.1087- 0024.2003.09110.x
5. Augustin M, Krüger K, Radtke MA, Schwippl I, Reich K. Disease severity, quality of life and health care in plaque-type psoriasis: A multicenter cross-sectional study in Germany. Dermatology. 2008;216(4):366-72.
6. Sampogna F, Tabolli S, Abeni D, IDI Multipurpose Psoriasis Research on Vital Experiences (IMPROVE) Investigators. Living with psoriasis: Prevalence of shame, anger, worry, and problems in daily activities and social life. Acta Derm Venereol. 2012;92(3):299-303. doi: 10.2340/00015555-1273
7. Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol. 1995;61(4):202-5.
8. Pariser D, Schenkel B, Carter C, Farahi K, Brown TM, Ellis CN, Psoriasis Patient Interview Study Group. A multicenter, noninterventional study to evaluate patient-reported experiences of living with psoriasis. J Dermatolog Treat. 2016;27(1):19-26. doi: 10.3109/09546634.2015.1044492
9. Reich K, Krüger K, Mössner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: A prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol. 2009;160(5):1040-7. doi: 10.1111/j.1365-2133.2008.09023.x 10. Augustin M, Radtke MA, Glaeske G, Reich K, Christophers E, Schaefer I, Jacobi A. Epidemiology and comorbidity in children with psoriasis and atopic eczema. Dermatology. 2015;231(1):35-40. doi: 10.1159/000381913
11. Merola JF, Qureshi A, Husni ME. Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther. 2018;31(3):e12589. doi:10.1111/dth.12589
12. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20(6):1475. doi: 10.3390/ijms20061475
13. Tripathi B, editor. Chikitsa sthana. In: Charaka samhita. Ch. 7. Varanasi, India: Chaukhamba Surbharati Prakashan; 2009.
14. Tripathi B, editor. Chikitsa sthana 7/21-2. In: Charaka samhita. Varanasi, India: Chaukhamba Surbharati Prakashan; 2009. p. 305.
15. Tripathi B, editor. Chikitsa sthana 7/29. In: Charaka samhita. Varanasi, India: Chaukhamba Surbharati Prakashan; 2009. p. 306.
16. Rwigema JM, Choi J, Lee NY, Heron DE, Chen AM. Re-irradiation therapy for locally recurrent head and neck cancer: A national survey of practice patterns. Cancer Invest. 2017;35(6):393-402. doi: 10.1080/07357907.2017.1310222
17. Kassahun Gebremeskel A, Wijerathne TD, Kim JH, Kim MJ, Seo CS, Shin HK, Lee KP. Psoralea corylifolia extract induces vasodilation in rat arteries through both endothelium-dependent and -independent mechanisms involving inhibition of TRPC3 channel activity and elaboration of prostaglandin. Pharm Biol. 2017;55(1):2136-44. doi: 10.1080/13880209.2017.1383484
18. Raut A, Dhami-Shah H, Phadke A, Shindikar A, Udipi S, Joshi J, Vaidya R, Vaidya AD. Picrorhiza kurroa, Royle ex Benth: Traditional uses, phytopharmacology, and translational potential in therapy of fatty liver disease. J Ayurveda Integr Med. 2023;14(1):100558. doi: 10.1016/j.jaim.2022.100558
19. Pandey BL, Das PK. Immunopharmacological studies on Picrorhiza kurroa Royle-ex-Benth. Part IV: Cellular mechanisms of antiinflammatory action. Indian J Physiol Pharmacol. 1989;33(1):28-30.
20. Semalty M, Semalty A, Badola A, Joshi GP, Rawat MS. Semecarpus anacardium Linn.: A review. Pharmacogn Rev. 2010;4(7):88-94. doi: 10.4103/0973-7847.65328
21. Kapoor B, Kaur G, Gupta M, Gupta R. Sub-chronic safety evaluation of aqueous extract of Alangium salvifolium (L.f.) Wangerin leaves in rats. J Adv Pharm Technol Res. 2017;8(3):108-13. doi: 10.4103/japtr. JAPTR_69_17
22. Nille GC, Bhuyan M, Gupta LN, Ali M, Tripathi CSP, Nille OS, Mishra SK, Vibhute A, Kamble P, Ranjan H, Singh AK, P-Tiwari A, Chaudhary AK. Characterization and potential novel applications of zinc-based traditional medicine, Yashad Bhasma. J Ayurveda Integr Med. 2025;16(5):101188. doi: 10.1016/j.jaim.2025.101188
23. Singh N, Bhalla M, De Jager P, Gilca M. An overview on ashwagandha: A Rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):208-13. doi: 10.4314/ ajtcam.v8i5S.9
24. Mahajan P, Gnana Oli R, Jachak SM, Bharate SB, Chaudhuri B. Antioxidant and antiproliferative activity of indigocarpan, a pterocarpan from Indigofera aspalathoides. J Pharm Pharmacol. 2016;68(10):1331-9. doi: 10.1111/jphp.12609
25. Balasubramani S, Brindha P, Evaluation of wound healing activity of Indigofera aspalathoides Vahl. Ex Dc.-a traditional Siddha drug, Int J Pharm Pharm Sci. 2012;4(2):40-4.
26. Chandrakala AN, Reddy AH, Nageswari G, Sri Vani DS, Begum SS, Venkatappa B. Anti venom and immunomodulatory functions of Corallocarpus epigaeus L. Int J Pharm Bio Sci. 2013;4(1):654-60.
27. More SK, Lande AA, Jagdale PG, Adkar PP, Ambavade SD. Evaluation of anti-inflammatory activity of Solanum xanthocarpum Schrad and Wendl (Kaṇṭakāri) extract in laboratory animals. Anc Sci Life. 2013;32(4):222-6. doi: 10.4103/0257-7941.131976
28. Kang NJ, Han SC, Yoon SH, Sim JY, Maeng YH, Kang HK, Yoo ES. Cinnamomum camphora leaves alleviate allergic skin inflammatory responses in vitro and in vivo. Toxicol Res. 2019;35(3):279-85. doi: 10.5487/TR.2019.35.3.279
29. Priyavardhini S, Vasantha K, Tresina Soris P, Mohan VR. Efficacy of phytochemical and antibacterial activity of Corallocarpus epigaeus Hook.f. Int J PharmTech Res. 2012;4:35-43.
30. More NB, Sharma N, Pulivendala G, Bale S, Godugu C. Natural product topical therapy in mitigating imiquimod-induced psoriasislike skin inflammation-underscoring the anti-psoriatic potential of Nimbolide. Indian J Pharmacol. 2021;53(4):278-85. doi: 10.4103/ ijp.IJP_591_20
31. Kang MH, Jang GY, Ji YJ, Lee JH, Choi SJ, Hyun TK, Kim HD. Antioxidant and anti-melanogenic activities of heat-treated licorice (wongam, Glycyrrhiza glabra × G. uralensis) extract. Curr Issues Mol Biol. 2021;43(2):1171-87. doi: 10.3390/cimb43020083
32. Ghosh A, Tiwari GJ. Role of nitric oxide-scavenging activity of Karanjin and Pongapin in the treatment of psoriasis. 3 Biotech. 2018;8(8):338. doi: 10.1007/s13205-018-1337-5
33. Atarzadeh F, Kamalinejad M, Dastgheib L, Amin G, Jaladat AM,Nimrouzi M. Cassia fistula: A remedy from traditional Persian medicine for treatment of cutaneous lesions of pemphigus vulgaris. Avicenna J Phytomed. 2017;7(2):107-15.
34. Biswas TK, Pandit S, Chakrabarti S, Banerjee S, Poyra N, Seal T. Evaluation of Cynodon dactylon for wound healing activity. J Ethnopharmacol. 2017;197:128-37. doi: 10.1016/j.jep.2016.07.065
35. Marwat SK, Rehman F, Khan EA, Baloch MS, Sadiq M, Ullah I, Javaria S, Shaheen S. Review - Ricinus cmmunis - ethnomedicinal uses and pharmacological activities. Pak J Pharm Sci. 2017;30(5):1815-27.
36. Varma SR, Sivaprakasam TO, Arumugam I, Dilip N, Raghuraman M, Pavan KB, Rafiq M, Paramesh R. In vitro anti-inflammatory and skin protective properties of Virgin coconut oil. J Tradit Complement Med. 2018;9(1):5-14. doi: 10.1016/j.jtcme.2017.06.012
