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TITLE OF CASE

Standalone Ayurvedic management of plaque psoriasis- a case report

Dr Partap Chauhan

ABSTRACT

A 25-year-old female patient presented with dry skin patches with itching and redness over the scalp, right knee, right hand and chest region associated with irregular menstruation and excessive weight gain since 3 years. There was a temporary relief in the itching, but the patches kept on increasing in size over time despite taking alternative treatments, and hence she opted for Ayurvedic management. She approached Dr Partap Chauhan for better management. Based on the clinical evaluation, the biomedical diagnosis was made as Plaque psoriasis and Ayurvedic diagnosis as Eka kushta. The line of treatment followed was tridosa shamana, rakta shodhana and prasadana, sroto shodhana and shothaghna cikitsa. After 6 months of ayurvedic treatment, there was a significant reduction in symptoms, and in 7 months, she was completely relieved from all the associated symptoms. PASI documented as 4.4 at midpoint was recorded as 0.1 at endpoint. This case report demonstrates the successful ayurvedic management of a chronic case of plaque psoriasis in a patient who was not getting relief with conventional medicines. 

KEYWORDS

Plaque Psoriasis, psoriasis, eka kushta, kushta, scalp, case report, PASI

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 25-year-old female patient presented with dry skin patches with itching and redness over the scalp, right knee, right hand and chest region associated with irregular menstruation and excessive weight gain since 3 years. There was a temporary relief in the itching, but the patches kept on increasing in size over time despite taking alternative treatments, and hence she opted for Ayurvedic management. She approached Dr Partap Chauhan for better management. Based on the clinical evaluation, the biomedical diagnosis was made as Plaque psoriasis and Ayurvedic diagnosis as Eka kushta.

CLINICAL FINDINGS

General and systemic examinations were done. 

Vitals- Normal
Body weight- 61.6 Kg
Physical examination- Dry skin rashes with severe scaling and redness.
Itching +++++
Body weight- 61.6 Kg                                                  

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.

Table 1. Symptoms tabulated at Baseline

 

Chief complaints	Feb/ 23
Itching	+++++
Scaling	+++++
Redness	++++
Patches	+++++

 

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 Eka kushta based on the clinical examination and presenting complaints . 

Prognosis- 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 suffering from the persisting symptoms even with medications. Hence she opted for Ayurvedic management. After 7 months of Ayurvedic treatment, the patient got complete relief from all the symptoms.

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 treatment, itching reduced, scaling and redness- absent.  Skin patches have reduced. In 6 months, there was a significant reduction in all the symptoms, and in 7 months she got complete relief from all the symptoms. She had a regular menstrual cycle and had a weight loss of 6.4 kg. In further follow-up done after 1 month, the patient had no specific symptoms. PASI score was 4.4 during the first follow-up after 5 months of treatment, which dropped to 0.1 after 7 months.

Image 2. Images of  the lesions in the back of the head with the PASI score

Image 3. Images of  the lesions in the right knee with the PASI Score

Image 4. Online PASI Score calculator at endpoint

 

Patient-assessed; Not relevant

Table 2. Symptoms charted throughout treatment

 

Chief complaints	Feb/ 23	March/23	April/ 23	May/23	June/ 23	July/23	Aug/ 23	Sep /23
Itching	+++++	++++	+++	++	+	Rarely	Absent	Absent
Scaling	+++++	++++	+++	++	+	Absent	Absent	Absent
Redness	++++	+++	+++	++	+	Absent	Absent	Absent
Patches	+++++	+++++	++++	+++	++	+	+	Absent

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 3 years. She tried allopathic and homeopathic medicines, but the skin patch was continuously increasing in size. The Ayurvedic diagnosis was Eka kushta, and the line of treatment followed was tridosa shamana, rakta shodhana and prasadana, sroto shodhana and shothaghna cikitsa. She got complete relief from all the symptoms in 7 months. 

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 3 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