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 is a disorder which is characterized by rapid multiplication of skin cells on the skin s surface. These extra skin cells develop into silvery scales, which are often dry and itchy. It may also lead to formation of painful red patches on the skin. This disorder might produce symptoms, which flare up and reduce periodically. There is no cure for psoriasis; treatments however can make the symptoms manageable. 


Symptoms
The symptoms of psoriasis include red patches on the skin and scaly and dry skin. The red patches might be itchy and one might often experience a burning sensation around the area. The joints in your body may also become stiff and swollen. 


Causes
The exact cause of psoriasis has not been ascertained. The accepted theory is that psoriasis occurs when the immune system attacks the healthy skin cells. There is a type of white blood cell called the  T cell , whose function is to combat harmful virus or bacteria in the body. With Psoriasis or any other autoimmune disorder, these T cells start attacking the healthy (skin) cells. 


Overactive  T Cells  may trigger other responses in the body, thus, leading to excess production of skin cells and white blood cells. The excess cells move to the skin surface and end up causing the red painful patches.


Treatment options to manage psoriasis
Although there s no cure for psoriasis as such, the symptoms can be controlled. The treatment options for psoriasis are:
1. Topical treatments: Topical treatments involve application of creams and lotions. They have been mentioned below:
I. Corticosteroids: Corticosteroid creams or lotions reduce the excess skin cell production, thus, reducing inflammation. They are generally not used as a long term treatment as they cause skin thinning.
II. Vitamin D analogues: A synthetic form of Vitamin D, it helps in slowing down skin cell growth. 
III. Salicylic acid: This treatment is used to reduce scaling on the skin, caused due to psoriasis. It is usually administered along with other medications.


2. Light therapy: Light therapy involves using sunlight or artificial light to reduce inflammation and scaling. It helps in reducing the activity of T cells in the body. 


3. Oral medications
In case of severe symptoms, oral medications are prescribed. Medications such methotrexate helps in reducing the excess production of skin cells. Cyclosporine is a drug that is used to suppress the erroneous immune system response. 

Psoriasis - 3 Easy Ways You Can Get them Treated

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?

It is a chronic autoimmune skin disease, in which the skin cells form a mass of scales. Usually, these patches of skin, which are dry, red and itchy, occur on the skin of the back, scalp, palms, knees, elbows and around the fingernails and toenails. But some people have the patches all over the body. The patches may also crack, flake and bleed. While there is no definite cure, the symptoms can be managed and treated.

Symptoms of Psoriasis

The symptoms of psoriasis may vary from patient to patient. However, if more than two of the following signs are seen, it is likely that psoriasis is the causative condition:

1. A sharp and localized pain in the joints accompanied by stiffness
2. Soreness in the throat
3. Tiny depressions in the nails or large brown patches under the nails
4. The diseased patches of skin can crack, peel and bleed
5. Swelling and tenderness of the limbs
6. Dental plaque
7. Muscle pain due to the swollen bands of connective tissue
8. A whitish and silvery mass of scales surrounded by red patches of stinging, itchy skin
9. The appearance of blisters or rashes on the dry scaly skin and also along the nails
10. Bumps on the folded skin like back of the knees, armpits etc.

Causes of Psoriasis

HIV
Human Immuno-deficiency Virus adversely affects the immune system and increases susceptibility of all kinds of infections and diseases. HIV-positive individuals have been found to have an increased risk of psoriasis than HIV-negative people.

Medication
Anti-malarial, anti-inflammatory and blood pressure medicines can cause psoriasis as a side effect. The disease is also an effect of withdrawal from topical steroid creams and other steroid-based medication.

Genetics
More than 32% of the cases of psoriasis have been linked to genes. In case of identical twins, if one twin has the disease,the other has a 70% chance of getting it too. There are several genes associated with the disease- most of these genes are related to the immune system. T cells (lymphocytes which affect cell specific immunity) can also cause psoriasis.

Other diseases
Diseases like strep throat, chronic infections, skin infections and stress may be responsible for the condition. Other factors like obesity, alcoholism, skin dryness and smoking can also lead to psoriasis.

Psoriasis: Symptoms and Causes

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

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