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PSORIASIS

CFAAR

INTRODUCTION

Psoriasis is a chronic inflammatory disease of the skin characterized by hyperproliferation of keratocytes. The basic pathology is that the skin cells grow abnormally faster. The normal course is that new cell replaces dead cells when they shed off. The rapid growth of new skin cells leads to accumulation before the dead skin cells shed, resulting in thick patches of dry skin with itching. It is not contagious and has a fluctuating course with remissions and relapses.

CAUSES

The exact cause is unclear and it is considered to be a disorder of the immune system with genetic association. The major triggering factors of psoriasis are:

  • Stress and anxiety
  • Climatic changes (especially cold season)
  • Skin injury (Koebner phenomenon)
  • Chronic infections ( Streptococcal throat infection, HIV)
  • Certain medications (β blockers, antimalarials, lithium)
  • Alcohol abuse and smoking

GENERAL FEATURES

  • Itching of skin
  • Erythematous plaques with silvery scale on the skin usually scalp and extensor surfaces of knee, elbow.
  • Raised red patches on skin
  • Skin dryness
  • Thickening and pitting of nails
  • Seronegative arthritis may develop in some (psoriatic arthritis)

Features vary depending upon the type of psoriasis.

TYPES

Stable plaque psoriasis:

Most common type
Raised red patches of skin with pain and itching
Silvery white scaling can be seen
Areas mostly affected are scalp, knees, elbows and lower back.

Guttate psoriasis:

Commonly seen in children and adolescents
May follow a streptococcal sore throat infection
Leisons are small and dot-like

Pustular psoriasis:

Small, non infectious pustules erupt on a red base.
It can be either generalized which is more serious or localized affecting only the palms and soles.
Fever may also be associated in the generalized form.

Erythrodermic psoriasis:

Found in the entire body
There is widespread redness, pain and severe itching
It is a rare but severe type.
Hypothermia or hyperthermia may develop.

Inverse psoriasis:

Characterized by red lesions which are smooth and shiny.
Found in body folds (armpits, groins, under breasts)

DIAGNOSIS

  • Proper examination and history taking are the keys to diagnosis since the patches and silvery scaling are by itself diagnostic.
  • It is sometimes difficult to diagnose since it mimics many other skin diseases.
  • There are no specific blood tests to diagnose psoriasis. To rule out other conditions, a skin biopsy can be done.

AYURVEDIC PROSPECTIVE

Skin diseases come under the broad heading of Kushta roga. The condition psoriasis in Ayurvedic view is considered to be a Vata Kaphaja Kushta roga.Vata dosha is responsible for the severe dryness and scaling of skin whereas Kapha dosha is responsible for itching.

MANAGEMENT

The principle of management circles around the condition of both the roga (disease) and the rogi (patient). Thus a proper history taking to assess the probable causes of disease, triggering factors, emotional state of the patient, medical records, family history, dietary habits, locality where he or she lives etc are necessary. Patient should be given proper clarification, reassurance and directions since this is a chronic skin disease condition with unpredicted remissions and relapses.

The treatment is broadly classified as:

  • Sodhana chikitsa (Elimination therapy)
  • Samana chikitsa (Pacifying therapy)

Sodhana chikitsa is required if the disease has an extensive spread and longer duration of onset which indicates much vitiation of doshas. These vitiated doshas must be expelled out of the body. Depending upon the dosha that is vitiated more, the type of sodhana required is selected.

  • Vamana (expulsion ofdoshas through mouth) is indicated if Kapha dosha is predominantly vitiated.
  • Virechana(expulsion through rectal route after administration of medicine orally) is indicated if pitta and raktha are excessively vitiated which is not usual here, but generally virechana is highly effective for skin diseases.
  • Vasthi(administration of medicine via the rectal route and elimination also through the same) is indicated if Vata dosha is greatly vitiated.
  • Raktha moksha(bloodletting) is an excellent therapy generally for all skin diseases and it mitigates vitiated raktha.

Samana chikitsa aims at stabilizing the immune system of body, maintaining proper digestive capacity and can be done using the wide range of medications like Kashaya, Arishta, Asava, Avaleha, Ghrita, Gutika etc along with psychological support.

ROLE OF MEDICATED GHEE (GHRITA)

Apart from medicinal properties of ghee, the medicinal qualities of herbs with which it is processed, helps to mitigate the disease especially the dryness. Usually the treatment begins with administration of ghee.

The dose of medicated ghee to be taken depends upon the intensity and stage of disease. If expulsion of vitiated doshas is required (sodhana), a larger dose is administered for a period of 5 to 7 days. If only pacifying the doshas is needed (samana), a smaller dose is given for a longer duration.

ROLE OF PATHYA

Pathya is the proper regimen of diet which will help resolve the pathogenesis of the disease better. Since food is the basic requirement for the proper functioning of body, a wise planning of diet that will help push down the disease is necessary along with suitable medications.

USE OF RASAYANA

They are medications that can rejuvenate the body tissues and maintain their proper health. Thus the irregularity in the skin cycle occurring in psoriasis can be corrected with use of Rasayanas.

A wise combination of the above treatments can bring significant restoration of health in psoriatic patients.

 

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