“I am silvery, scaly. Puddles of
flakes form wherever I rest my flesh.
Lusty, though we are loathsome to
love. Keen-sighted, though we hate
to look upon ourselves. The name of
the disease, spiritually speaking, is
Humiliation.”
– John Updike
A famous writer and being as a
person with psoriasis quoted in his
novel “At war with the skin”.
Psoriasis, dreadful villain of skin. The name which makes fear and sympathy in other eyes. Many at times, a person’s socio economical life is getting affected by this skin manifestation. They may lose hope and confidence in their life. But is the disease that much dreadful? Let us have a look at it.
Psoriasis is a common, chronic, disfiguring, inflammatory and proliferative condition of skin in which both genetic and environmental influences play a critical role. Apart from skin, it affects nails, joints and is now being described as a metabolic disorder. The characteristic lesions consist of red, scaly, well-demarcated plaques mainly over extensors and scalp. The prevalence of psoriasis varies in different parts of the world. According to published reports, the prevalence in different populations may vary from 0% to 11.8%. A study from a tertiary health care centre in north India showed that psoriasis accounted for 2.3% of all dermatology outpatients. In most of the studies, the most common type of psoriasis reported is chronic plaque-type psoriasis or psoriasis Vulgaris.
Most of the patients get worse in winter. Considering the etiological factors, it can be described as genetic factors and predisposing factors. In genetic factors, it is a T- cell-mediated autoimmune disease and is also having familial history. Considering the triggering factors, we can say mental stress and agony as a major one. Apart from that, endocrine factors, alcohol consumption, extreme weather, smoking etc also help in triggering Psoriasis.
Psoriasis can be manifested at any age and its duration may vary from a few weeks to a whole lifetime. The course is unpredictable and the variations are numerous. The typical age of onset is in the third decade, though it may develop at any time from birth onwards.
Classification
Based on morphological descriptions, psoriasis is classified as
- Chronic Plaque – Most common
- Guttate
- Flexural/ inverse
- Erythrodermic
- Pustular
- Local forms – Palmoplantar, scalp variety etc
- In Chronic Plaque variety, there will be well-demarcated plaques with an overlying silvery scale and underlying erythema. Chronic plaque psoriasis is typically symmetric and bilateral. Plaques may exhibit two signs; they include the Auspitz sign (bleeding after removal of scales) and the Koebner phenomenon (lesions induced by trauma).
- Guttate psoriasis – This is characterized by lesions which appear in several drops (as a shower) of small erythematous papules. The trunk is the site mostly affected; the palms and soles are spared. It may be precipitated by streptococcal infection.
- Inverse/flexural – Erythematous plaques in the axilla, groin, inframammary region, and other flexural areas. It May lacks scale due to the moistness of the area.
- Erythrodermic psoriasis – It is characterised by generalised erythema and scaling, with gradual or acute onset. There are many causes of erythroderma, in which 20% have underlying psoriasis. Diagnosis of psoriatic erythroderma includes plaques in classic locations, characteristic nail changes, and facial sparing.
- Pustular Psoriasis – Characterized by psoriatic lesions with pustules. Often triggered by corticosteroid withdrawal. When generalized, pustular psoriasis can be life-threatening.
- Palmoplantar Psoriasis – characterized by recurrent eruptions of sterile pustules on erythematous skin; hyperkeratosis and fissures on the palms and soles are additional features.
In the local variety of psoriasis, scalps and nail-affecting ones are also common. Patients with nail involvement appear to have an increased incidence of psoriatic arthritis.
Ayurvedic Concept of Psoriasis
In general, Ayurveda considers all skin diseases under the heading “kushta rogas”. According to quantitative study of dosha involved in each disease, we can grade them into various categories of kushta including sidhma, charma kushta, vicharchika, eka kushta, kitibha, vipadhika etc.
In general psoriasis is a vatakaphaja vyadhi with a major involvement of pitta dosha (pittanubhandata). Due to the presence of kapha, kleda formation and deerghakalanubhanda (long lasting) is usually seen. Pustular characteristics and visarpana (spreading nature) show the involvement of pitta.
For limiting the article size, the relation of psoriasis with various kushta vikaras (skin diseases) is not described. For example, plaque variety can be considered under sidhma, Palmoplantar is corelated under vicharchika.
Treatment
The choice of treatment to be adopted for psoriasis depends on many factors like the extent and type of Psoriasis, the psychological condition of the patients, the health status of the patient, previous treatment, and age of the patient etc. The major medicines that can be given include –
Commonly Used Kashaya:
- Shonithamritham Kashaya
- Thikthakam Kashaya
- Mahathikthakam Kashaya
- Aragwadhaamrutadi Kashaya
- Guduchyadi Kashaya
- Patola katurohinyadi Kashaya
Gudika – Dushivishari gulika, arogyavardhini vati, kaishoraguggulu, jeevaraksha gulika etc
Lehya – manibhadram guda, gandhaka rasayana, satavari ghrta etc
Apart from this, periodical purgation (virechana) can be done with avipathi churna, trivrt lehya etc.
If there is more dosha involvement, then shodhana (purificatory therapies) like panchakarma can be advised on an IPD basis.
All the medicines described here should be administered considering the dosha, dushya, avastha, bala, prakruthi of the patient. Medicines should only be taken after consulting a registered ayurveda practitioner.
As Psoriasis is an autoimmune genetic condition, long-term treatment is needed. Considering the recurrence rate of the disease, sodhana therapy is much more effective than samana. Patients must recurrently visit the doctor and should update the progress of disease timely. Whenever symptoms reappear, timely management should be done before worsening the condition. If we are following medicines and pathya apathyas it’s quite normal for a psoriatic patient to maintain socio- economic wellbeing with confident skin and mind. After all, let us all smile from the inner beauty of ourselves.
