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TITLE OF CASE

Standalone Ayurvedic management of Plaque psoriasis - A case report.

Dr Partap Chauhan

ABSTRACT

A 50-year-old male patient, presented with dry skin patches with itching all over the body for 20 years associated with hyperacidity for 10 years. He took allopathic treatment from 2003 to 2013, Homeopathic treatment from 2013 to 2018, followed again by Allopathic treatment from 2018 to 2023. He got temporary relief, but on stopping the medications, there was a relapse and more severe. Hence, he opted for Ayurvedic treatments. He consulted Dr Partap Chauhan for better management. Based on the clinical evaluation, the biomedical diagnosis was made as Plaque psoriasis and the Ayurvedic diagnosis as Ekakushta. The line of treatment followed was vata shamaka, vatanulomaka, pittashamaka, srotoshodhaka, dipana - pacana, tvak prasadaka cikitsa are advocated. After 5 months of Ayurvedic treatment, the patient was completely relieved from the symptoms.  The PASI score assessed in the first follow up was 9.6 which was repeatedly scored in further follow ups. At endpoint, the PASI score was recorded as 1.8 indicating mild severity of psoriasis. This case report demonstrates the successful standalone ayurvedic management of plaque psoriasis in a patient suffering from this condition since 20 years and was not getting complete relief even with alternative medicines. 

KEYWORDS

Plaque Psoriasis, Eka kushta, skin, Ayurveda, case report

INTRODUCTION

Plaque psoriasis also called psoriasis vulgaris is a long-lasting autoimmune disease that causes your cells to reproduce very quickly. It’s a type of psoriasis that causes thick, scaly patches called plaques on your skin. It most commonly affects elbows, back, knees, and scalp. In severe cases of plaque psoriasis, the face, feet, genitals (penis, vagina, vulva), hands and legs also may be affected.

Symptoms:

Raised, discoloured (red, brown, grey or purple) plaques with a white or silvery surface.

Cracks (fissures).

Bleeding.

Itchiness.

Irritation or pain.

Diagnostic criteria: Medical history and clinical evaluation are the basic diagnostic criteria used. Apart from this allergy tests, biopsy and blood tests to rule out infections are also done.

Treatment: The treatments given in Plaque psoriasis are Injections, oral medicines, and photo therapy.

Prognosis: There is no cure for Plaque psoriasis. There are flare-ups and remissions, and only temporary relief is predicted.

PATIENT INFORMATION

A 50-year-old male patient, presented with dry skin patches with itching all over the body for 20 years associated with hyperacidity for 10 years. He took allopathic treatment from 2003 to 2013, Homeopathic treatment from 2013 to 2018, followed again by Allopathic treatment from 2018 to 2023. He got temporary relief, but on stopping the medications, there was a relapse and more severe. Hence, he opted for Ayurvedic treatments. He consulted Dr Partap Chauhan for better management. 

Patient is a known case of hypertension since 3 years and diabetes since 10 years. The symptoms started developing as dry skin patches at lower limbs that later on spread to the whole body in 20 years. The symptoms mitigates during summer. Patient tried alternative care for 20 years. The condition aggravates on discontinuing treatments. Hence he opted for Ayurvedic management. 

CLINICAL FINDINGS

General examinations done. 

Dry skin patches all over the body with itching                                                    

BP- 158/100 mm/ Hg                                                          

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; The biomedical diagnosis was confirmed as Plaque psoriasis by the treating physician based on the clinical evaluation.

Ayurvedic Assessment was done based on the presenting complaints and clinical evaluation. The treating physician made the Ayurvedic diagnosis as Ekakushta. 

Differential Diagnosis- The different conditions are as follows

DADRU    - Ruled out as  Pidaka, Daha were absent

SIDDHMA - Ruled out as the twak tanuta was absent

The physician diagnosed the case as Ekakushta based on the clinical examination and presenting complaints . 

Prognosis- Plaque psoriasis is an unpredictable disorder. There is no cure, for this condition and also it is difficult to know who will relapse, how long the active disease will last or how frequently the patient will have remissions. In addition, all treatments have major adverse effects including skin cancers, liver damage and susceptibility to infections. In this case report, the patient is having the persistent symptoms since 20 years inspite of undergoing alternative treatments. After 5 months of Ayurvedic treatment, the patient was completely relieved from the symptoms and PASI Score indicated the disease was mild. 

THERAPEUTIC INTERVENTION

Refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

The patient had 4 follow ups in total. The images were taken throughout the treatment and the PASI Score was also done.

Clinician-based assessment; After 5 months of Ayurvedic treatment, the patient was completely relieved from the symptoms.  The PASI score in the first follow up was 9.6 which was repeatedly documented in the further follow ups. At endpoint, the PASI score dropped to 1.8, which indicates mild severity of plaque psoriasis. 

Image 2. Images of  the right hand with PASI Score

Image 3. Images of  the left hand with PASI Score

Image 4. Images of  the right leg with PASI Score

Image 5. Images of  the left leg with PASI Score

Image 6. Images of  the back with PASI Score

Image 7. PASI Score at endpoint dated 14.9.2023

Patient-assessed; Not relevant

Intervention adherence and tolerability– The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- Images were taken before and after treatment. 

Adverse and unanticipated events; None reported

DISCUSSION ; 

The patient had been suffering from the skin complaints past 20 years. He had tried allopathy and homeopathy treatments over a period of 20 years. Though he got temporary relief, the symptoms would relapse and used to be more severe. The Ayurvedic diagnosis was made as Ekakushta and the line of treatment adopted was vata shamaka, vatanulomaka, pittashamaka, srotoshodhaka, dipana - pacana, tvak prasadaka cikitsa are advocated. At the endpoint, the patient got complete relief from all the symptoms. 

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case report highlights the efficacy of Ayurveda in successfully treating a chronic case of plaque psoriasis where the patient had been trying alternative standard of care over a period of 20 years, but did not get relief. 

INFORMED CONSENT

Written consent obtained from patient for publishing the case report. 

ACKNOWLEDGEMENTS

None

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. Taken from - https://my.clevelandclinic.org/health/diseases/22842-plaque-psoriasis
2. Caraka Samhita. Cikitsa Sthana. Chapter 7. Kushtha Cikitsadhyayam