Psoriasis is a chronic dermatosis characterised by an unpredictable course of remissionn & relapse. It is an non-infectious skin disaease chracterised by scaly, silvery patches mainly on the scalp and extensior surface of the body. Its exact cause is unkown. In ayurveda, it is closely resembles with ekakushta. The features of ekakushta explains in ayurveda classics resembles with the symptoms of psoriasis. Psoriasis is the challenge for modern science. There is no definite treatment for psoriasis in modern science till today. The drug available in the market use to treat psoriasis are not very effective and have local and systemic effects.

In ayurveda, vata pitta and kapha dosha is the main contributory factor for the disease. Due to vitiation of three dosha, the disease manifest and main line of treatment for psoriasis is panchkarma and internal medicine. It is considering the best approach for skin disorder in ayurveda. A case report of 42-year old male, presented with well demarcated red scaly, silvery patches mainly on both legs, hands, scalp, chest and back with itching, and also nail and joint involvement has been presented in this article.

Etiology of Psoriasis: 

Unknown but many factors have been associated-

Genetic: may be autosomal dominant

Triggers: physical trauma ,infection and drugs.

Biochemical change: like increase level of arachidonic acid and Cgmp.

Immunological factors: helper T cells PLAY A KEY ROLE.

Epidemiology: 

Roughly, 1% of population is affected. Can occur at any age and affected both sex. Most patients as worse in winters.around 7 million people are affected in developed country.

Histopathogenesis:

Increased epidermal cell proliferation.

Retention of nuclei in stratum corneum.

Proliferation of fibroblast.

Dilated and tortous capillary loops.

Shortened epidermal turnover time from normal of 60 to 10 days.

Clinical features: Usually chronic indolent lesions which persist for month. Lesions are mildly papule or plaque.erthematous plaque lesions with characteristic slivery, large, loose scales. The patients of psoriasis may also suffer from depression and low self-esteem.

In a patients with psoriasis always check for nail and joint involvement.

Nail: 10 to 15% of the patients have nail involvement. Pitting, nail plate thickening, subungual debris, discolouration of nail plate and oil spot seen in the nails.

Joints: 10% patients have joint involvement.

Sites: Scalp, pressor points & extensor. Sometimes generalised.

Chronic recurrent psoriasis is difficult to treat. Modern science treat with PUVA and corticosteroids but these drugs having local and systemic side effects like liver and kidney failure etc. So, it is the time to find out the effective and safe treatment for Psoriasis. Medicines which are used in ayurveda are safe and practised since many years. A huge numbers of drugs are prescribed in ayurveda for the treatment of kushta.

Case details: A 42-year old male patient, hindu brahman by religion, presented on 10 april 2016 with well demarcated raised red scaly, silvery patches on chest, back and both legs and hands. He complained of itching all over the body and on scraping, white powder like substances fall down and leaves a bleedy surface. On history, patients had complaints since 20 years and diagnosis of psoriasis by allopathic physician. Since 20 years he has been taking allopathy and homoepathy patients from various practioners of U.P and delhi. He is brahman and lives in well known temple of delhi and visit homes of peoples for religious ceremony. He is afraid that if the disease is spreading continously, then he is unable to work as priest because people neglect him due to disease. The disease is spreading all over his body and also involves nail and joint. Destruction of nail plates of hand and legs was also developed. For this, patients took allopathic treatment for such a long time but do not get relief.

The patients visit our clinic for the first time. He told use that his problem not solves since 20 years and spreading continuously. So, he is unable to trust us. So, we first give him counselling because reassurance and emotional support are invaluable. Physical and mental rest enhance the effects of the treatment. It is also important to tell him that the disease is not contagious and is benign.

SYMPTOMS OF THE PATIENTS :

Itching all over body

Silvery patches, especially, on legs ,chest ,back but now spreading in his hand and scalp.

Destruction on nail plates

Swelling and pain in left middle fingers and flexor deformity in proximal interphalangeal joint

Swelling in right middle metatarso phangeal joint and pain

Some blood test of the patients were done like CBC, LFT, KFT, SR, URIC ACID to assess outcome.

His general health was good and both physical and all blood test were within the normal limts.we advise patients for panchkarma and oral medication but patients refuse for panchkarma so we start his oral or internal medication. 

Investigation Done :

CBC(Complete Blood Count)

LFT(Liver Function Test)

KFT(Kidney function Test)

Sr. Uric Acid

Investigation was done to rule out any other pathology. Investigation were within normal limit.

Internal Medication :

Medication are given into two phase. In First Phase, we are given panchsakara churna - one spoon two times daily for anulomana and pachan, Panchnimba churna- one spoon two times daily with luke water, panchtikta ghrita gugulu - two tab two times daily, and one oil for local application containing jyotishmati,bakuchi, and chakramad for five days. We told patient to apply the oil firstly only on legs for 5 days. Patient taking the same for 5 days and come on 5th day, we see the fabulous result, the rashes which are developed within 4 to 5 months just disappear and other rashes are also subsiding.

After 5 days, in second phase, we continue the same treatment and also added haridra khand - one spoon two times daily, gugulu tiktam kashaya - three spoon two times daily (one hour before food for 15 days). The patient came back on 20th day, with great result, the rashes were almost 60 % subsiding and pain and swelling in finger and ankle also reduce to great extent. Now, patient is not taking any pain killer for pain. Patient also get improvement in nails of legs.

We prescribe the same medicine for one month that time and ask him to do some physiotherapy additional for finger deformity. After that patient came with 70 to 75 % relief in symptoms and patients also tell that during the treatment, he will not develop any additional rashes.

During the treatment, we also told the patients to follow some dietary changes and live according to the rules of Ayurveda.

Result: Psoriasis is a disease with unkown etiology and triggered by many factors. In modern science, treatment of psoriasis is a challenge. They do not have any safe and proper medicine for psoriasis. But, ayurveda treatment gives satisfactory results as well as the quality life to the patients. Ayurveda removes toxin out of the body and corrects the formation of aama. Ayurveda gives the prevention as well as the treatment. So, by following the dietary and lifestyle change we prevent the reoccurrence of the disease.

Ayurveda For Psoriasis 

Psoriasis, in general, is a persistent autoimmune condition that causes the speedy development of skin cell. This increase in the number of cells causes unhealthy scales on the surface of the skin.

Symptoms of nail psoriasis
Symptoms to watch out for are the nails cracking right from the nail bed. This, in medicinal term, is known as onycholysis and it creates space that can get contaminated by germs. Soreness or a sponge like feeling beneath the nails, pitting, warping and hardening of the nails, discoloration, painful chalk like build up beneath the cuticles which causes the nail to move upwards, are common symptoms as well. This is known as subungual hyperkeratosis. As a rule, almost everybody who is affected by general psoriasis, suffer from nail psoriasis.

Sometimes nail psoriasis may be accompanied by fungal infections. A parting amid the nail and nail bed is the perfect environment for the fungi to grow. If the symptoms you are experiencing are extremely moderate, treatment may not be required. If the discoloration, nail hardening or chipping of the nails is severe, it is probably a good time to make an appointment with a dermatologist.

Causes
A diet deficient in Calcium, Vitamin C or B12 can lead to this condition. Unhygienic habits can aggravate the condition. Psoriasis, in most cases, is acquired genetically. A weak immune system can also be a marker. Certain steps can be taken to keep the nails healthy. Keeping the nails clipped short and clean helps. Wearing gloves while working in the kitchen, during gardening or washing is another preventive measure you can always take.

Treatment
It may be hard to treat nail psoriasis; while topical medicines are prescribed, they usually don t work that well. Oral D3 supplements can be taken. D3 ointments, light or photo therapy and finally corticosteroid injections directly aimed to the nail bed may ease the situation. In very severe cases, nails may need to be removed with the help of surgery, so as to help new nails to grow back. Patience is the key word.

Nail Psoriasis - How To Know If You Are Suffering From It?

The term  skin disorders  is used to describe different skin problems- from widespread rashes to red small bumps on certain portions of the skin. While some conditions can be harmless but unsightly, others may be infectious and even life-threatening in rare cases.

Some skin conditions have a genetic component, while others may result from allergic reactions. Allergic skin problems occur when certain allergens stimulate an immune response such as itching or redness. Bacteria, fungi, viruses can also lead to skin problems. The most common types of skin problems are psoriasis, eczema, acne, rosacea, warts etc. Let s take a closer look at these disorders-

Psoriasis- This is an autoimmune chronic skin condition which causes a rapid increase in the number of skin cells. Due to this rapid accumulation of cells, the surface of your skin becomes dry and flaky. The white scales are usually seen in the joints of your knees and elbows. You will most likely notice redness and inflammation around the scales.
Eczema- Eczema is a medical condition that causes your skin to turn red and become inflamed and itchy. Eczema occurs in many forms, the most common among which is Atopic dermatitis. This condition begins usually in childhood, and gradually fades away or becomes milder as you age.
Acne- This is perhaps the most common skin problem particularly prevalent between the ages of 15 and 35. Almost every other person develops small raised bumps known as acne breakouts due to infected or blocked hair follicles. When the skin pores become clogged due to excess oil secretion or accumulation of dirt and dead skin cells, acne can appear anywhere in the skin. Most commonly, these are noticed on the face- cheeks, chin or the nose.
Rosacea- Rosacea is often mistaken as acne because it induces acne-like inflammatory symptoms. But this particular skin condition can occur due to a combination of genetic and environmental factors. Rosacea produces red, pus-filled small bumps on the skin, and usually affects fair-skinned middle-aged women. Visibly broken blood vessels, swollen skin, itchy dry eyes, rough patches on the skin- all these signs indicate you may have rosacea.
Warts- These are slightly raised bumps or patches on the upper layer of your skin caused by the Human Papillomavirus (HPV) infection. Warts come in different shapes and sizes and can occur in any part of your body- hands, palms, feet, knees, or face.
Role of Ayurveda in curing skin disorders-
The Ayurveda school of treatment aims to restore your body s doshic balance- kapha, vata and pitta. Treatment methods include self-care practices such as a balanced lifestyle, healthy diet, exercise and meditation. There are several Ayurvedic therapies including Abhyanga and Panchakarma that are designed to promote healthy skin.

The Panchakarma vidhi uses medicated herbs, natural ingredients like rice, sand, medicated powder on your body to soothe your senses and flush out the toxins from your body. Once your body is detoxified, your skin feels rejuvenated and nourished.
Essential rosemary oil and olive oil act as excellent moisturizers, especially for dry flaky skin resulting from psoriasis.
Ashwagandha, one of the most essential, powerful herbs packed with anti-inflammatory properties, helps remove rosacea puss. To fetch best results, apply or drink extracts of this wonder herb every alternate day.
Fenugreek seeds, or what is more commonly known as  methi , are rich in essential vitamins like C and K, folic acid and iron. This medicinal plant helps remove dry red patches on the skin. It also prevents the formation of rosacea puss and helps reduce itching.
Skin problems can be mild or severe. Sometimes a conventional treatment method that may work for one condition, may not work well for the other. Ayurveda is a holistic approach to treatment and uses natural ingredients to cure the root cause behind the apparent condition.

Psoriasis And Skin Disorders - What All Should You Know

An often persistent and long-lasting condition, psoriasis interferes with the life cycle of skin cells and causes them to increase rapidly on the surface of the skin. These generally appear as dry, itchy and red patches of skin having thick, silvery scales.

Psoriasis can be subdivided into the following:

    Plaque psoriasis: The most common form, characterized by dry, red skin lesions covered with silvery scales and can be seen anywhere on the body.
    Scalp psoriasis: These appear on the scalp and may extend beyond the hairline.
    Nail psoriasis: These affect the toenails and fingernails.
    Guttate psoriasis: Characterized by blister-like appearances and are stimulated by bacterial infections.
    Inverse psoriasis: Caused by fungal infections.
    Erythrodermic psoriasis: Can cover the entire body with a reddish rash that may peel.
    Pustular psoriasis: Capable of causing chills, fever and diarrhea.

The usual signs and symptoms of psoriasis include:

    Red, sensitive patches of skin
    A silvery, scaly cover
    Dry and cracked skin that may bleed when scratched or agitated
    Tiny scaling spots (witnessed in children)
    Persistent itching, soreness or burning sensation
    Ridged, thickened or pitted nails
    Stiff and swollen joints

Possible causes of psoriasis may include:

    Skin infections or strep throat infections
    Stress
    Skin injuries, like cuts, bites or sunburns
    Smoking
    Cold weather
    Chronic alcoholism
    Certain medications such as high blood pressure medications

Risk factors

The following factors may further increase the risk of developing the disease:

    Fungal and bacterial infections
    Family history
    Obesity
    Stress
    Smoking

Ayurveda and Psoriasis

Although the root cause of the disease is yet to be identified, according to traditional Ayurveda, the vitiation of Vata and Kapha causes psoriasis. As per ayurvedic principles, Vata and Kapha are the two basic energies that uphold the balance of our body equilibrium. Strong genetic predisposition, sun deprivation, and intense streptococcal infection on the upper respiratory tract can badly aggravate psoriasis. As per ayurveda, these conditions are strong enough to create several visible pathological changes that take place are mainly due to the accumulation of dooshi vishas or low potency poisons.

Uneven and unhealthy food habits, consumption of foodstuffs in the wrong combination (Example: dairy products with fish or chicken), too much intake of yogurt, black gram, seafood, sour or salted food stuffs, etc. can trigger the psoriasis inducing pathogenesis. Other catalysts that cause psoriasis includes stress, alcohol, and tobacco consumption

Psoriasis can be effectively treated through panchakarma therapies, which include ayurvedic treatment methods for the complete detoxification of the body, and successful elimination of harmful toxins from the body fluids.

A few health tips for psoriasis patients:

    Maintain safer distance from the possible variables that cause or aggravate psoriasis
    Practice yoga regularly. Yoga can lessen the intensity of psoriasis.
    Avoid pricking, peeling or scratching your skin.
    Make sure to pat your skin dry after washing, and avoid rubbing vigorously with towel or any rough cloth.
    Avoid artificial cleansers and use gram flour (besan flour) instead.
    Use cotton clothes
    Avoid cold water bath or immediate cleaning up right after heavy work-out, long walks, or travel.
    Avoid food stuffs that can cause indigestion.
    Avoid excessive salty and acidic food stuffs, radish, urad dal, sesame, jaggery (gur), curds, fish and other sour food stuffs that can trigger psoriasis.

Psoriasis - How it Effects Your Skin?

Psoriasis is a common autoimmune disorder of the skin that results in the formation of thickened and elevated plaques of cells that remain covered by scales (loose, whitish-silver scales). In psoriasis, the skin cells multiply at an alarming rate resulting in the scaling of the skin. Though non-contagious, psoriasis can be itchy and often painful. Psoriasis mainly affects the scalp, elbow, and knees. In some, the condition may also affect the palms, feet (soles of the feet), and the torso.

As per a survey, psoriasis is known to affect approximately 2.2% of the total adult population. Psoriasis can also affect children (children under the age group of 5-8 years are mostly affected by this inflammatory skin disorder).

Psoriasis Can of Different Types

Plaque Psoriasis: As the name suggests, this type of psoriasis results in the formation of plaques of cells (thickened and elevated) on the skin surface. One of the most common types of psoriasis, plaque psoriasis affects the scalp, knees, and elbow.
Pustular Psoriasis: Pustular psoriasis mainly affects the hands and the feet of the adults whereby white blisters (pus-filled) appear on the affected area of the skin. The skin also appears red and inflamed.
Guttate Psoriasis: This type of psoriasis usually affects the legs, torso, and arms. Common in children (sometimes young adults), Guttate psoriasis results in the formation of small red spots.
Inverse Psoriasis: In Inverse psoriasis, shiny red (bright red) inflammations or lesions appear on the armpits, groyne, breasts.
Erythrodermic Psoriasis: Though rare, this type of psoriasis is marked by extreme redness of the skin. There is also shedding of the scales (in the form of sheets). The skin more or less appears sun burnt.
Symptoms:
The symptoms associated with psoriasis include

Elevated and inflamed red patches covered by whitish- silver scales (plaques).
The nails appear thick and pitted.
There is a pain in the joints followed by swelling.
At times, the affected skin may crack resulting in bleeding.
Soreness, itching and a burning sensation around the red patches.
In psoriasis of the scalp,

There may be the formation of scales (usually mild).
In severe cases, there may be crusting (the full scalp) which can spread to the forehead, ears (inside and behind), in the beard or even around the nose.
Treatment:
Though there is no definite treatment for psoriasis of the body and the scalp, the following medications may prove to be helpful

Medications like Methotrexate and Cyclosporine (immunosuppressant drugs), Retinoids, and Biologics (injected intravenously) may provide some relief.
Patients may also benefit from light therapy, anthralin, topical corticosteroids as well as vitamin D analogs.
Precaution and care
For psoriasis of the scalp

Before the treatment, it is important to remove (and soften) the scales. Medicated shampoos that contain salicylic acid can be used to remove the scales.
Use of petroleum jelly or medicated oils and ointments (as recommended by the doctor) can be helpful.
For better results, you can keep the scalp covered (preferably with a shower cap) after applying the ointment.
For Psoriasis of the Body

Avoid the skin from getting dry. You can use a medicated lotion or a moisturizer.
Drinking and smoking can worsen the situation. Avoid these vices as much as you can.
Avoid using hot water while bathing. To keep your skin moisturised, you can add oil or salt to the water (bathwater).

Psoriasis - Types, Symptoms, and Treatment

Psoriasis is a durable autoimmune disease defined by patches of irregular skin. These patches of skin are usually scaly, red and itchy. Its symptoms vary greatly in severity, the coverage might be small and focused or it could spread all over the body.

Types
There are mainly five types of psoriasis:
1. Plaque- also called psoriasis vulgaris, is the most common kind of psoriasis (90% of cases). It affects the skin behind the forearms, over the navel, shins and scalp, usually presenting itself in red patches with white- colored scales over it.
2. Guttate- has lesions that are drop-shaped.
3. Inverse- red patches show up in the folds of your skin.
4. Pustular- pus-filled blisters form. They are non-infectious.
5. Erythrodermic- the rash spreads wider. In some people, even fingernails and toenails get affected as pits may form on them or their colour may change.

Causes
Anything from emotional trauma and stress to streptococcal infection can cause psoriasis. Sometimes you might carry predisposition for psoriasis in your genes and stress may aggravate it. Environmental factors may also lead to psoriasis. And then again defects in the immune system may also be the underlying cause. Even after thirty years of research, the exact cause for psoriasis remains a mystery. There is no age limit to psoriasis. It can show up from anywhere between infancy to old age.

Symptoms
Common symptoms include
1. Pink or red scaly bumps that are smaller in size, but become plaques later, show up on the skin. Although these scales can show up anywhere, they are mostly common on sites where there is much friction, abrasion or scratching.
2. Small pinpoint depressions or pits might show up on toenails and fingernails. Distal onycholysis, which refers to large brown/yellow divisions on the nails, shows up as well.
3. Sore throat may follow if it is guttate psoriasis.

Treatment
Psoriasis is not curable. But its symptoms can be managed with steroid creams, ultraviolet creams, vitamin d3 creams and with medicines that act as immunosuppressants. Creams alone can help control symptoms in 75% of patients with psoriasis.

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