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Effectiveness of Panchakarma (detoxification therapy) followed by Rasayana (rejuvenation) in the treatment of erythrodermic psoriasis - A case report
* Corresponding author: Dr. Anushri Suryabhan Urkude, Department of Dravyaguna, All India Institute of Ayurveda, Sarita Vihar, New Delhi, 110076, India. anushriurkude707@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Sharma AS, Urkude AS, Thakar AB. Effectiveness of Panchakarma (detoxification therapy) followed by Rasayana (rejuvenation) in the treatment of erythrodermic psoriasis - A case report. Future Health. doi: 10.25259/FH_96_2025
Abstract
Erythrodermic psoriasis is a rare and severe form of psoriasis with a prevalence of 1 to 2.25%, characterized by widespread erythema, scaling, and inflammation. Along with conventional therapies, traditional alternatives are being explored. In Ayurveda, this condition can be correlated with Audumbara Kushtha (∼ a type of skin disease). A 56-year-old male patient diagnosed with erythrodermic psoriasis had symptoms of reddish-white patches and scaling over the body, particularly on the abdomen, lower back, forearms, and lower limbs, for 5-6 years. He received a comprehensive Ayurveda regimen including Shodhana (∼purification) and Rasayana (∼rejuvenation) therapies, along with Tuvaraka Rasayana (∼medicated oil prepared from Hydnocarpus laurifolia (DENNST.) STEUM.), a classical remedy for skin disorders. A remarkable improvement was noted, with the PASI score reduced from 48 to 11.2 and the DLQI score from 10 to 0 in 6 months of Ayurveda treatment. No relapse was observed during 6 months of follow-up.
Keywords
Audumbara Kushtha
Erythrodermic psoriasis
Panchakarma
Rejuvenation therapy
INTRODUCTION
Psoriasis is a chronic inflammatory skin condition with having prevalence ranging from 0.2% to 4.8%.1 Various factors like mild cutaneous trauma, sunburn, infections, medications, and stress can trigger psoriasis.2 Plaque, guttate, pustular, inverse, and erythrodermic are types of psoriasis.3 Erythrodermic psoriasis is a rare and severe variant form of psoriasis affecting about 1-2.25% of individuals.4 Erythrodermic psoriasis typically manifests in individuals with a history of worsening or unstable psoriasis; however, it can occasionally present as the initial manifestation of the condition. Onset can occur acutely over a few days or weeks, or gradually evolve over several months from pre-existing psoriasis.5 Psoriasis exerts a substantial influence on the quality of life, with prominent manifestations such as visible plaques, discoloration, and itching. The current treatment modalities for psoriasis are frequently inadequate over an extended duration, and issues persist in connection with therapy.5 Some cases have been reported to have successful outcomes with biological agents, including the TNF-α inhibitors adalimumab, etanercept, and infliximab, the IL12/23 inhibitor ustekinumab, and the IL17 inhibitor bimekizumab, but these cause serious adverse effects to the patient.6 The clinical features are erythematous pruritic lesions, generalized burning sensation, pain, swelling, and gross micaceous scaling, which resemble Audumbara Kushtha mentioned in Ayurveda. It is among the Audumbara Kushtha, which shows Pitta (∼type of Dosha) predominance and Raktadushti (∼vitiation of blood) manifestation characterized by symptoms such as Daha (∼burning sensation), Kandu (∼itching), Ruja (∼pain), and Raga (∼redness or discoloration of the skin).7
CASE REPORT
A 56-year-old male cart vendor presented with reddish-white, scaly patches over the body, predominantly on the abdomen, lower back, forearms, and lower limbs, which had persisted for 5 to 6 years. The lesions first appeared 6 years ago on the chest, with redness and itching, gradually spreading and increasing in severity, with minor bleeding on scratching. Early lesions were small and circular (3-4 cm), later merging into large, map-like plaques. Symptoms of reddish discoloration, burning sensation, and itching worsened with sunlight exposure. The patient also complained of constipation, reduced appetite, and burning in the chest for 3 months. The patient was diagnosed case of erythrodermic psoriasis, and was confirmed by the dermatologist. The patient had a history of topical steroid application for 4-5 months, with no history of systemic or oral medications. Despite the short-term use, the symptoms worsened subsequently. The patient had no comorbid conditions, addictions (such as smoking or alcohol), or any notable family or surgical history.
Clinical findings
On general examination, vitals were normal (temperature: 98.0°F, pulse: 80 bpm, RR: 18/min, blood pressure: 130/90 mmHg, SPO2: 98%). There were no systemic abnormalities or lymphadenopathy. Dermatological examination revealed reddish, scaly, and slightly elevated plaques with dry, rough surfaces, 3-4 cm in size, annular and map-like in shape, and well-demarcated elevated borders. The lesions were asymmetrical and covered with silvery-white scales. Clinical signs, including Auspitz sign, Koebner’s phenomenon, and Candle grease sign, were present, confirming psoriatic pathology. Parameters, including the Psoriasis Area Severity Index (PASI) and Dermatological Life Quality Index (DLQI), were assessed at the baseline, showing PASI 48 and DLQI 10, indicating severe disease with a significant impact on quality of life. Based on the above clinical presentation with a relapsing-remitting course, the condition was diagnosed as erythrodermic psoriasis by a dermatologist.
There were no signs of pallor, icterus, clubbing, cyanosis, or lymph node enlargement. The normal complexion of the patient was unidentified due to the presence of gross lesions, and was afebrile. The cardiovascular, respiratory, urinary, and central nervous system evaluation revealed no abnormalities.
Timeline and follow-up
The patient underwent a Panchakarma protocol, including Vamana (∼therapeutic emesis) and Virechana (∼ therapeutic purgation) Karma with preparatory Deepana-Pachana (∼digestive and carminative), Snehapana, Abhyanga (∼oleation) and Swedana (∼fomentation), followed by Sansarjana Krama (∼Post Panchakarma diet), Shamana therapy (∼palliative), Raktamokshana (∼bloodletting) and Rasayana medicine. The patient was admitted on 10 January 2023 for planned Panchakarma and Rasayana therapy and underwent sequential procedures, including Vamana Karma, Virechana Karma, and Raktamokshana over several months. The Vamana Karma phase was completed on 31 January 2023, after which the patient was discharged for one month of rest and observation before readmission for Virechana Karma on 4 March 2023. Following completion of the intensive Panchakarma phase on 20 May 2023, the patient was discharged in a clinically stable condition with significant symptomatic improvement. Subsequently, Rasayana and Shamana Chikitsa were continued on an outpatient basis from 21 May to 26 June 2023, as these therapies did not require hospitalization. Regular follow-ups were advised every 15 days to monitor disease remission, dietary regimen, and recurrence prevention.
The detailed Panchkarma timeline has been presented in Table 1.
| Sr. No. | Procedure | Medicine with dose/duration | Timeline |
|---|---|---|---|
| 1. | Vamana karma (∼ therapeutic emesis) |
Deepan-Pachana with 1. Arogyavardhini Vati 250 mg (2 tabs TID after meals), 2. Avipattikara Churna (5 gram BID before meals) |
7 days (10/1/23 to 16/1/23) |
| Shodhanartha snehapana (∼internal oleation for purification) | Escalating dose (30-330 ml, 7 days) with Panchtikta Ghrita in early morning between 7-7:30 am for 7 days Empty stomach with Lukewarm water as an Anupana. | 17/1/23 to 23/1/23 | |
| Sarvanga abhyanga (∼ Full body massage), Swedana (∼fomentation therapy) | Bala Taila (between 9 am to 11 am for 20-30 min followed by Swedana for 5-10 min | 24/1/23 to 25/1/23 | |
| Main procedure of vamana karma | Combination of powder of (Madanphala- Randia dumetorum Lam. - 5g) +, (Yashtimadhu Glycyrrhiza glabra L.- 3 g), + (Pippali Piper longum L. - 2 g), + Saindhava Lavana (Rock salt) - 1 g in early morning at 7 am |
25/1/23 No. of Vega: 7 Time taken: 1:30 hour Any untoward event: not reported. Samyaka Yoga (adequate therapeutic effect) |
|
| Sansarjana krama (∼Post Panchakarma diet) | Peyadi Krama (sequential administration of liquid to solid diet like rice gruel, porridge, plain soup) 150-200 ml 2-3 times/day. | 7 days (25/1/23 to 31/1/23) | |
| 2. | Shamana aushadhi (∼Pacifying medicines) | Panchtikta Ghrita Guggulu 500 mg 2 BID after meal with normal water. | 1 month (1/2/23 to 3/3/23) |
| 3. | Virechana karma (∼ Therapeutic purgation) |
Deeepana – Pachana with with Arogyavardhini Vati (2 tabs TID after meals), Avipattikara Churna (5g BID before meals) Panchtikta Kwatha (20 ml BID before meals) |
7 days (4/3/23 to 10/3/23) No. of Vega : 15 Time taken : 10 hours Any untoward event: not reported. Samyaka Yoga (adequate therapeutic effect) |
| Shodhanartha snehapana (∼internal oleation for purification) | Escalating dose (30-330 ml, 7 days) with Panchtikta Ghrita in the early morning between 7-7:30 am for 7 days | 11/3/23 to 17/3/23 | |
| Abhyanga (∼ Full body massage) + Swedana (∼fomentation therapy) | Abhyanga with Bala Taila in the morning, 9 am to 11 am, for a minimum of 20-30 min, followed by Swedana for 10-15 min. | 18/3/23 to 20/3/23 | |
| Virechana (∼ Therapeutic purgation) | Trivrutta Avaleha with Draksha Jala at 9:15 am | 21/3/23 | |
| Sansarjana krama (∼Post Panchakarma diet) | Peyadi Krama (150-200 ml 2-3 times/day). | 5 days (21/3/23 to 25/3/23) | |
| 4 | Raktamokshana (∼Bloodletting) |
50 ml blood - 3 sitting Siravedha (venesection) was done by identifying the superficial vein from both cubital regions in 3 sittings under all aseptic conditions. |
(25/4/2023), (2/5/2023), (9/5/2023) |
| 5 | Rasayana therapy (∼Rejuvenation) |
Tuvaraka Rasayana (5 mL oil daily on an empty stomach with normal water.) |
13/5/2023 to 20/5/2023 |
| 6 | Shamana chikitsa (∼Pacifying medications) |
Mahatiktaka Ghrita (10 mL daily), early morning empty stomach with lukewarm water. Manibhadra Guda 5 g at bedtime with lukewarm water Combination of powder of (Guduchi Tinospora cordifolia (Willd.) 3 g) + (Yashtimadhu Glycyrrhiza glabra L. 2g) + (Gandhaka Rasayana 125 mg) after a meal with lukewarm water twice a day. |
21/5/23 to 26/6/23 |
Diagnostic assessment/Differential diagnosis
In Ayurveda, Mahakushtha encompasses skin disorders with Tridosha predominance, among which Audumbara Kushtha is recognized as a distinct subtype. The colour skin lesions in this patient resembled the fruit of Ficus racemosa L. (∼ Audumbara Phala) and other symptoms like Daha (∼burning sensation), Kandu (∼itching), Ruja (∼pain), and Raga (∼redness or discoloration of the skin), consistent with the description of Audumbara Kushtha by Acharya Charaka.7 For differential diagnosis, the condition showed partial resemblance to Mandala (∼ a type of skin disease) and Kitibha Kushtha (∼ a type of skin disease); however, characteristic features such as Snigdha, Utsanna Mandala (∼unctuous, firm, elevated plaques) of Mandala Kushtha were minimal, and Shyava Varna (∼blackish discoloration) typical of Kitibha Kushtha was absent. Classical symptoms described in the Samhitas (∼classical texts) are often incompletely expressed in clinical presentation. The patient was a cart vendor by profession with continuous sun exposure of 6 to 8 hours, which may have acted as a Hetu (∼ contributing factor), as he reported aggravation of symptoms following sun exposure. Considering the observed symptomatology and contributing factors, the condition can be clinically correlated with Audumbara Kushtha.
Erythrodermic psoriasis is frequently misdiagnosed as plaque psoriasis, and its differentiation from other dermatological conditions can be challenging. Some other conditions included atopic dermatitis, pityriasis rubra pilaris, cutaneous T-cell lymphoma, drug drug-induced eruptions.8 In this patient, based on lesion pattern, morphology, distribution, and absence of systemic drug triggers or hematologic malignancy, other conditions were considered unlikely. Thus, the patient was clinically diagnosed with erythrodermic psoriasis, consistent with its characteristic cutaneous manifestations and pruritus.
DISCUSSION
In Ayurvedic terms, Kushtha (skin disorders) are included among the Ashtamahagada (∼eight major incurable diseases in Ayurveda) and are primarily caused by Tridosha (∼three fundamental bodily humors - Vata, Pitta, and Kapha) imbalance with Rasa-Rakta Dhatu (∼plasma and blood tissue), Twak (∼skin), Lasika (∼lymph), Rakta (∼blood), and Mamsa (∼ muscle) vitiation. Audumbara Kushtha, is Pitta-dominant and presents with Daha, Kandu, Raga and Ruja.8 In the present case, sequential Ayurvedic interventions played a crucial role in symptom alleviation and long-term disease control. Deepana-Pachana (∼digestive and carminative) corrected impaired Agni (metabolic energy) and prepared the patient for purification, with Arogyavardhini vati balancing the Tridosha and purifying Rasa-Rakta Dhatu, while Avipattikara Churna helped reduce aggravated Pitta. Shodhana therapies, including Vamana, Virechana, and Raktamokshana, systematically eliminated the vitiated Pitta and Rakta Dushti, addressing the core pathology of the disease.
After Vamana Karma, induration, redness, and itching subsided, though burning persisted. Virechana Karma provided significant relief from itching and burning, and no new lesions developed. Raktamokshana further improved erythema and scaling, while Tuvaraka Rasayana produced mild detoxifying episodes of emesis and purgation, leading to normalization of skin pigmentation, complete lesion healing. A classical Kushthaghna Rasayana (∼rejuvenation therapy to prevent or reduce skin diseases), Tuvaraka Rasayana (oral intake) contains Chaulmoogra and hydnocarpic acids with documented antimicrobial, anti-inflammatory, and immunomodulatory properties. These qualities balance Kapha-Pitta, facilitate detoxification, and rejuvenate skin tissues. Tuvaraka Rasayana was administered with normal water, as its hot potency makes it unsuitable for consumption with warm or lukewarm water.9 The integration of Shamana Chikitsa supported sustained remission and prevented relapse. Marked clinical improvement was documented, with the PASI score reduced from 48 to 11.2 and the DLQI from 10 to 0. No relapse occurred during the 6 months of follow-up.
CONCLUSION
Psoriasis is a complex, relapsing systemic condition with significant morbidity. This case demonstrates that Ayurvedic management, Shodhana, Shamana, and Rasayana therapies with Tuvaraka Rasayana can provide significant clinical benefit in erythrodermic psoriasis. The patient achieved a marked reduction in erythema, scaling, itching, and pain with complete normalization of DLQI and no relapse during the 6-month follow-up. Thus, integrating Ayurvedic interventions may offer a safe, effective, and sustainable therapeutic option for complex dermatological conditions like erythrodermic psoriasis.
Author contributions
A.S.S.: Conception and design of the report, drafting the manuscript, patient management, and literature review; A.S.U.: Involved in patient follow-up, interpretation of clinical findings and mode of action of Ayurveda formulations; A.B.T.: Reviewing the manuscript critically for important intellectual content, contributed to final manuscript approval.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of Artificial Intelligence (AI)-Assisted Technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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