Psoriasis is an autoimmune disorder where the immune system mistakenly attacks healthy skin cells, triggering excessive production of new skin cells. The normal maturation and shedding of skin cells takes 28–30 days, but in Psoriasis, this process can occur as quickly as 3–5 days, resulting in thick, scaly, and inflammatory patches.

Key immune players in Psoriasis include:

• T cells(especially Th 1 And Th17 Cells): It releases inflammatory cytokines.
• Cytokines(TNF-a, IL17, IL-23, IL-12): Leads to inflammation and keratinocyte proliferation.
• Dendritic cells: Activate T cells and amplify the immune response.

In Ayurveda, Sidhma Kushta is classified under the type of Kushta Roga(skin disorder). It is considered a type of Kshudra Roga (minor skin disease) and is often compared to Psoriasis.

CAUSES(NIDANA):

a)Mithya Ahaara(Improper food habits):

• Virudhahara(Incompatible food habits): Consuming food with opposite qualities(e.g.: fish with milk, hot and cold foods together).
• Ati Madhura and Guru Ahaara(Delightful and heavy foods): It can lead to kapha accumulation.
• Atibhojana(Overeating) and Ajirna(Indigestion): It can lead to improper digestion and accumulation of Ama.
• Pitta gets aggravated by spicy, salty, sour foods, fermented foods, etc.
• Kapha gets aggravated by foods like dairy, oily, heavy foods, and excess sugar.

b)Mithya Vihara(Improper lifestyle):

• Divaswapna: Daytime sleep.
• Getting exposed to a cold and damp environment.
• Lack of any physical activity.

c)Mandagni(Weak digestion and metabolism):

• It leads to the building up of toxins in the body.

d) Rasa Dhatu dushti:

• It leads to improper nutrition of skin tissues.

e)Beeja dosha(Genetic predisposition):

• Certain Kushta Rogas have genetic connections.

SAMPRAPTI(PATHOGENESIS):

The disease occurs due to:

1.Dosha Dushti(Imbalance of Doshas):

• Kapha: It causes thickening, scaling, and discoloration of the skin.
• Pitta:It causes inflammation, redness, and a burning sensation.
• Vata(in chronic conditions): It causes dryness, cracking, and roughness.

2.Dhatu Dushti(Impairment of body tissues):

• Rasa Dhatu(plasma and lymph): It leads to proper nourishment of the skin.
• Rakta Dhatu(Blood tissue): It causes discoloration, itching, and irritation.

3.Srotorodha(Obstruction of microchannels):

• Once the toxins get blocked in skin pores, it leads to the formation of dry, scaly patches.

4.Udbhava Sthana(origin site):

• It arises in the stomach due to agni mandya(weak digestion).

5. Vyakthi Sthana(Manifestation site):

• Symptoms appear on the trunk, arms, scalps, etc.

LAKSHANAS OF SIDHMA KUSHTA(SYMPTOMS):

• Mandala Utpatti(Circular, patchy lesions): White or reddish patches.
• Rukshatha(dryness and scaling): Skin becomes flaky and scaly.
• Shwetha Varna(Whitish discoloration): In some cases, patches may be slightly lighter than the normal skin.
• Kandu(Itching): It can be a mild to severe itching sensation.
• Daaha(Burning sensation): When it is associated with aggravated pitta.
• Sparshanaasahatwa(loss of skin sensitivity in chronic cases): The skin might feel numb.
• Snigdha Manda Roma Harsha(weakening of hair follicles): Hair may thin out or fall from the affected area.

CLINICAL SYMPTOMS OF PSORIASIS:

I)Skin Symptoms:

a)Red, inflamed, and scaly patches(plaques):

• The primary sign of the most prevalent type of psoriasis is plaque psoriasis.
• Excessive keratinocyte production causes the skin to seem thicker, redder, and higher.
• Covered in greyish or silvery-white scales (dead skin accumulation).
• Typical sites include the lower back, buttocks, knees, elbows, and scalp.

b)Itching, burning or soreness:

• Skin damage or scratching can result from minor to severe itching.
• Plaque cracking and inflammation result in burning or soreness.
• Inverse psoriasis(with skin folds) can be extremely sensitive and painful.

c)Dry, cracked skin that may bleed:

• Rapid skin cell turnover causes the skin to be dehydrated.
• Cracks form, particularly where there is movement (joints, palms, soles),
• Severe occurrences might result in bleeding and painful cracks.

d)Thickened, pitted, or discolored nails(nail psoriasis):

About 50% of psoriasis patients experience nail involvement.

Symptoms include:

• Small flaws or depressions in nails are called pitting.
• Discoloration (spots of yellow, brown, or white).
• Onycholysis: the detachment of the nail from the nail bed.
• Fragile or thick nails that could break off.

2.Joint Symptoms(Psoriatic Arthritis-PsA):

About 30% of psoriasis patients develop psoriatic arthritis(PsA).

Its symptoms include:

• Joint pain, stiffness, and edema, particularly in the spine, knees, toes, and fingers.
• Morning stiffness that persists for about half an hour.
• Enthesitis is an inflammation of ligaments and tendons.
• Sausage digits, or dactylitis, in which the fingers or toes swell.

3.Systemic Symptoms(In severe psoriasis):

a)Fatigue and malaise:

• Experiencing fatigue, weakness, and low energy levels can result from chronic inflammation.
• It is more prevalent in people with psoriatic arthritis.

b)Fever and chills(Erythrodermic psoriasis):

In erythrodermic psoriasis, widespread inflammation causes:

• Severe scaling and redness over the majority of the body.
• Extreme pain, burning, and itching.
• Dehydration, chills, and fever (a potentially fatal condition).

4. Psychological and emotional symptoms:

• Due to its visible form, psoriasis can lead to tension, worry, sadness, and low self-esteem.
• Embarrassment or stigma might lead to social isolation.

TYPES OF PSORIASIS:

1.Plaque Psoriasis(Psoriasis Vulgaris):

Most Common Type(80%-90% of cases):

Symptoms:

• Raised, inflamed, red lesions covered with silvery white scales.
• It typically appears on the scalp, elbows, knees, and lower back.
• Skin can become cracked and bleed. It may be associated with nail psoriasis.

Causes and triggers:

• Genetics.
• Immune system dysfunction.
• Stress, infections, skin injuries.
• Medications(beta blockers, lithium, etc).

2. Guttate psoriasis:

• It is common in children and young adults.

Symptoms:

• Small,pinkish-red, drop-like lesions.
• Appears mainly on the torso, arms, and legs.
• It may develop suddenly after a bacterial infection(like strep throat).

Causes and triggers:

• Streptococcal throat infection.
• Stress, skin injuries, or certain medications.
• It is more common in people with a family history of psoriasis.

3.Inverse Psoriasis(Flexural psoriasis):

• Usually seen in skin folds.

Symptoms:

• Smooth, shiny, red patches in skin folds(armpits, groin, under breasts).
• No visible scaling.
• It may worsen with sweat and friction.

Causes and triggers:

• Fungal infections.
• Obesity(skin folds rubbing together).
• Heat, sweating, and friction.

4.Pustular Psoriasis:

• It is a severe but rare type.

Symptoms:

• White pustules(blister with pus), surrounded by red skin.
• It can be localized(hands, feet) or widespread.
• It may be accompanied by fever, chills, and fatigue.

Types of Pustular psoriasis:

• Localized(palmoplantar pustulosis): Only on hands and feet.
• Generalized pustular psoriasis: More severe, affects the whole body.

Causes and triggers:

• Sudden withdrawal of corticosteroids.
• Infections, pregnancy, stress.
• Overexposure to UV light.

5. Erythrodermic Psoriasis:

• It is most severe and life-threatening.

Symptoms:

• Widespread redness, inflammation, and peeling of the skin.
• Severe itching, burning sensation, and pain.
• Loss of skin in sheets(like severe burns).
• It can lead to dehydration and infection. 

Causes and triggers:

• Severe sunburn.
• Infection, stress, or withdrawal from systemic psoriasis medications.
• Uncontrolled plaque psoriasis.

6. Nail psoriasis:

• Affects fingernails and toenails.

Symptoms:

• Pitting(tiny dents in nails).
• Discoloration(yellowish nails).
• Thickened or brittle nails. Nails may separate from the nail bed(onycholysis).

7.Psoriatic Arthritis(PsA):

• It mainly affects joints and skin.

Symptoms:

• Joint pain, stiffness, and swelling.
• Fatigue and difficulty in movement.
• It may develop years after skin symptoms.

Causes and triggers:

• Autoimmune reaction.
• Genetic predisposition.

DIAGNOSIS OF PSORIASIS:

Diagnostic criteria include clinical evaluation, medical history, and laboratory tests to rule out other skin conditions.

1. Clinical Examination:

Signs that must be observed are:

Plaques: These are well-demarcated red patches covered with silvery white scales(most common in plaque psoriasis).

• Koebner phenomenon: New psoriasis lesions appearing at sites of skin injury.
• Auspitz sign: Tiny pinpoint bleeding when scales are scrapped off.
• Nail changes: Pitting, thickening, or yellowish discoloration of nails.
• Scalp involvement: Flaky and thickened skin in the scalp area.

2. Medical History Assessment:

Check for;

• Onset and duration of symptoms.
• Family history of psoriasis or other autoimmune disorders.
• Trigger factors(stress, infections, medications, trauma, climate changes).
• Associated symptoms include(itching, pain, joint stiffness).
• Previous treatments and their effectiveness.

3. Differential diagnosis:

Psoriasis can resemble other skin conditions such as:

• Eczema(Atopic dermatitis): More itchy, less well-defined borders.
• Fungal infections(Tinea corporis, Tinea capitis): Can mimic psoriasis but respond to antifungal treatment.
• Seborrheic dermatitis: Greasier scales, especially on the scalp and face.
• Lichen planus: Purple, flat-topped papules with a different distribution.

4. Skin Biopsy:

If the diagnosis is unclear, a skin biopsy may be performed. A small piece of affected skin is removed and examined under a microscope.

• Parakeratosis:Retained nuclei in the stratum corneum.
• Hyperkeratosis: Thickened outer skin layer.
• Acanthosis: Thickening of the epidermis.
• Dilated Capillaries: Causing pinpoint bleeding when scraped(Auspitz sign).

5.Blood Tests(Not Always Required):

While psoriasis is mainly diagnosed clinically, blood tests may help rule out other conditions.

• Rheumatoid factor(RF): To differentiate psoriatic arthritis and rheumatoid arthritis.
• C-reactive protein(CRP) and ESR: To assess inflammation levels.
• Vitamin D levels: Deficiency is common in psoriasis.

6.Assessing Psoriatic Arthritis(PsA):

Since 30% of psoriasis patients develop arthritis, check for:

• Joint pain, stiffness, swelling(especially in the morning).
• Enthesis(pain at tendon insertion sites).
• Dactylitis(swelling of fingers or toes).
• X-ray/MRI(For joint damage in advanced PsA).

7. Severity Assessment:

To determine the severity of psoriasis, doctors use:

1.PASI Score(Psoriasis Area and Severity index):

• Evaluate redness, thickness, and scaling of plaques over different body areas.

2.BSA(Body Surface AREA):

• Measures the percentage of skin affected .eg:>10%=severe psoriasis).

3.DLQI(Dermatology Life Quality Index):

• Assess the impact of psoriasis on daily life.

TREATMENT OF PSORIASIS IN MAURYA  AYURVEDA HOSPITAL:

INTERNAL MEDICATIONS GIVEN ARE:

• Patolakadurohinyadi Kashayam.
• Patoladi gana Kashaym.
• Tikthakam Kashaym.
• Guggulu Tikathkam Kashyam.
• Nishothamadi kashayam.
• Manjishtadi kashayam.
• Aragwadhadi kashayam.
• Mahatikthakam Kashaym.
• Avipathi Choornam.
• Triphala Choornam.
• Kaisora guggulu.
• Vilwadi Gulika.
• Triphala Guggulu.
• Trivruth lehyam.
• Dasamoolahareethaki.
• Manibadhragulam.
• Guggulutiktam Grtham.
• Aragwadha Mahatikthaka Ghrtham.
• Nimbamritasavam.
• Amrutharishtam.
• Abhayarishtam.
• Haridrakhandam.
• Kalyanaka Kashyam.
• Kalyanaka Avaleha.

OILS USED FOR EXTERNAL APPLICATION ARE:

• Eladi Keram.
• Psora oil(Ayyappala Thailam).
• Paranthyadi Thailam.
• Nalpamaradi Thailam.
• Pinda Thailam.

EXTERNAL TREATMENT OF PSORIASIS IN AYURVEDA

DEEPANA PACHANAM:

Deepana and Pachana are essential Ayurvedic treatments for improving digestion and metabolism. Psoriasis is a primarily Kapha Vata dominant condition, where toxins accumulate due to indigestion and poor metabolism. When the toxins along with Rasa(nutrient plasma) and Raktha(Blood tissues), they trigger inflammatory skin conditions. Panchakola Choornam and Ashtachoornam are normally  used for Deepana Pachanam.

Benefits of Deepana Pachana:

• It improves digestion and metabolism.
• It helps in the reduction of Ama.
• It balances dosha like Kapha, Vata, and Pitta.
• It prepares the body for detoxification(PanchaKarma procedures).
• It enhances skin health and immunity.

SNEHAPANAM: 

Snehapanam is a preparatory procedure that involves the oral intake of medicated ghee or oil. It is used as a pre-procedure (Purva karma) in Vamana(therapeutic emesis) and Virechana(therapeutic purgation). This helps in pacifying vitiated Vata and Kapha doshas, which are primarily involved in psoriasis.

Procedure of Snehapana:

1. Patient Selection and Pre-treatment Assessment:

The physician assesses the Prakriti (constitution), Vikruthi(imbalance), severity of psoriasis, and digestive power(Agni) before prescribing Snehapanam. Also, the patient should have a clear digestive system without Ama(toxic undigested material) accumulation.

2.Choice of Sneha(Medicated Ghee or Oil):

The most commonly given Ghrita are;

• Aragvadha Mahatiktaka Ghritam.
• Tiktaka Ghritam.
• Vajraka Ghriitam.
• Sonitamritam Ghritham.
• Gulguluthikthakam Ghritham

3. Dosage and Administration:

• The therapy lasts for 3-7 days, gradually increasing the dose as per the patient’s capacity.
• The initial dose is around 30-50 g and gradually increases based on digestion and tolerance.
• The medicated ghee is administered early in the morning or on an empty stomach.
• The patient is advised to avoid solid food until the ghee is fully digested. Warm water may be given in small sips to aid digestion.
• The physician checks signs of proper digestion(Samyak Snigdha Lakshana), such as soft skin, improved digestion, and proper elimination of stools. 

4. Dietary and Lifestyle Restrictions (Pathya and Apathya):

• During Snehapanam, the patient must follow a strict diet and lifestyle regimen.
• Avoid spicy, salty, and heavy foods.
• Eat light and warm food like rice gruel(Peya) and warm soups after digestion of ghee.
• Maintain mental calmness, avoiding stress, and excessive physical activity.
• Avoid cold and damp environments, which aggravate psoriasis.

5. Completion of Snehapanam:

• Once the Samyak Snighdha Lakshnas(Proper signs of Oleation)appear, Snehapanam is stopped.
• This is followed by Swedana(Sudation therapy) and then Vamana(therapeutic emesis) or Virechana(therapeutic purgation) to expel the toxins.

Benefits of Snehapanam in Psoriasis:

• It prepares the body for further detoxification.
• It detoxifies the body.
• It balances the doshas.
• It improves skin health.
• It enhances digestion and metabolism.
• It boosts immunity. 

VIRECHANAM:

Virechana is one of the five main Pancha karma therapies in Ayurveda. It is a controlled purgation therapy that helps regulate pitta and kapha doshas accumulated in the body. It is especially beneficial for skin disorders like psoriasis, as it eliminates toxins(Ama) and excess Pitta from the body.

The procedure of Virechana in Psoriasis:

1.Purva Karma(Pre-procedure):

• Deepana-Pachana(digestive strengthening).
• Snehapanam(Internal Oleation).
• Abhyanga and swedana(External Oleation and sudation). 

2.Pradhana Karma(Main procedure):

The purgative medicines are usually given on an empty stomach, usually in the morning.The  medicines used for Virechana are:

• Gandharvahasthadi Eranda Tailam.
• Nirgundi Eranda Tailam.
• Sukumara Eranda Tailam.
• Eranda Tailam.
• Avipathi choornam.
• Triphala choornam.

The patient experiences multiple bowel movements within a few hours, effectively eliminating toxins.

3.Paschat Karma(Post-Procedure Care):

• Samsarjana Krama(Dietary Regimen): A light diet is given to restore digestive strength, starting with thin rice gruel(Peya), and a gradual transition to a normal diet.

Benefits of فيركانا in Psoriasis:

• It eliminates toxins and reduces Pitta dosha.
• It detoxifies blood(Raktha Shodhana).
• It reduces itching and scaling.
• It improves digestion and gut health.
• It strengthens Immunity.

VAMANA:

Vamana(Therapeutic Emesis)is one of the five Panchakarma therapies in Ayurveda, primarily used for eliminating Kapha and Pitta disorders. Psoriasis is considered a result of aggravated Kapha and Pitta doshas leading to toxins(ama)accumulation in the body.

The procedure of Vamana in Psoriasis:

1.Poorva Karma(Preparatory Phase):

• Deepana and Pachana(Digestive stimulation and Toxin reduction).
• Snehana(Internal Oleation).
• Swedana(Sudation therapy).

2.Pradhana Karma(Main vamana Procedure):

• The patient is given Madhana Phala(Randia dumetorum), Yashtimadhu(Licorice) decoction, and milk mixed with honey and salt.
• Pippali(Long pepper), Vacha(Acorus calamus), and SaindhavaLavana(Rock salt) can also be added to stimulate vomiting.
• The patient is made to drink a large quantity of milk, licorice decoction, or warm water until nausea is felt.
• Then tickling of the throat(Gala Pradesha Pramarjana) with fingers or a soft cotton swab is done to induce emesis.
• The process continues until proper Vamana symptoms appear, including expulsion of mucus and bile(Kapha-Pitta).
• The physician observes the consistency, quantity, and color of vomited material to assess whether the procedure is complete.

3.Paschat Karma(Post-Care and Rehabilitation Phase):

• After Vamana, mild medicated smoking(Dhoomapana) using( Haridra varthi)is advised to clear residual kapha.
• A light diet(Samsarjana Krama) should be followed for a few days to restore digestion. Avoid heavy, spicy, and processed foods.

Benefits of Vamana in Psoriasis:

• It eliminates excess kapha and Pitta.
• It enhances digestion and metabolism.
• It reduces itching and scaling.
• It strengthens immunity.
• It balances the mind and reduces stress.

RAKTAMOKSHANA:

Raktamokshana(bloodletting) is one of the five purification therapies(Panchakarma) in Ayurveda and is primarily used to treat blood-vitiated conditions.

Types of Raktamokshana used in Psoriasis:

a)Jalaukavacharanam(Leech Therapy):

• It is the most preferred method to remove vitiated blood.
• Here the medicinal leeches suck impure blood without inflammation and improve the circulation to that area.
• It is beneficial in chronic, inflammatory, and deep-seated skin disorders.

b)Siravyadha(Venesection):

• It involves controlled blood withdrawal using sterile needles or scalpels.
• It is recommended in severe psoriasis cases with deep-seated blood vitiation.

c)Pracchanna(multiple  incision blood letting):

• Small superficial incisions are made on affected areas.
• It helps in the removal of localized accumulation of vitiated blood and toxins.

d)Shringa(Cupping Therapy):

• It is more beneficial when there is Kapha dominance.
• Suction is created using cups to extract impure blood.

Benefits of Raktamokshana in Psoriasis:

• It enhances detoxification(Shodhana effect).
• It reduces inflammation and itching.
• It enhances skin regeneration.
• It strengthens immunity.
• It balances Pitta and Kapha dosha.
• It prevents recurrence.

DIETARY GUIDELINES IN PSORIASIS:

Diet plays a crucial role in managing psoriasis. The general dietary guidelines advised from our hospital during the course of treatment are:

Avoid:

• Milk, milk products, cold food, pickles, fruits, dry fruits, nuts, fast food, fried and oily foods.
• Fermented foods like dosa, idli, and fermented appam.
• Tuber items like potato, tapioca, and sweet potato.
• Nonvegetarian items like, Fish, egg, and meat(Can be taken in curry form, if necessary).

Have:

• Hot kanji.
• Steamed food items like idiyappam, put, and chapati.
• Vegetable in boiled form.

General Suggestion:

• Avoid strenuous activities.
• Drink enough water(2.5L-3L).

 

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

Maurya Ayurveda Hospital,opposite to Sabine Hospital,Pezhakkapilly P.O,Muvattupuzha,Ernakulam;PIN:686673,Contact no:9947183000

Email: [email protected]

مركز ماوريا أيورفيدا لتقويم العظام وإعادة التأهيل العصبي (مستشفى الأيورفيدا)