Management of Vaipadika Palmo Plantar Psoriasis Through Shodhana and Shamana: A Case Study

A localized form of Psoriasis known as Palmo plantar psoriasis is characterized by the development of thick, scaly and hyperkeratotic plaques. Despite the fact that this disease mostly affects the palms and soles, the hardness of the skin makes it difficult to do daily tasks. This condition is related to Vaipadika in Ayurveda . In the framework of Kshudra kusta, Vaipidika is explained. This illness is mostly caused by the Vatakapha dosha , which is identified by Pani pada sphuthana and Teerva vedhana . Here is a case of a 55 years old female with history of dryness ,scaling and cracks over her bilateral palms and soles associated with pain , blackish discoloration and severe itching and burning sensation, associated with bloody discharge since 1 year .Patient was treated with Snehana and Swedana and later Shamana oushadi were given for 7 days along with life style modification. Patient had good relief in symptoms.


Introduction
Palmoplantar psoriasis refers to a condition that affects the palms and soles, however the illness can also have many distinct morphologic patterns 1 .ranging from painful, thick, scaly, hyperkeratotic plaques with pustular lesions as the prominent feature 2 .The incidence of palmoplantar psoriasis among psoriasis cases ranges from 3 to 4% 3 .Palmoplantar psoriasis is a long lasting autoimmune disease.This condition is described in the context of Kshudra Kushta in Ayurveda and is corelated to Vaipadika..According to Archarya Charaka 4 it is referred as Vaipaidika and with a different name as Paadadari according to Archarya Sushrutha 5 According to Charaka, the primary doshas responsible for symptoms like Panipada Sphutana (cracks in the palms and soles) and Teevra Vedana 6 (severe pain) are Vata and Kapha doshas 7 .The present case is having a history of 1 year on the basis of the clinical features such as of dryness ,scaling and cracks over her bilateral palms and soles associated with pain , blackish discoloration, severe itching and burning sensation, associated with bloody discharge along with swelling of bilateral foot.Based on the presentations the underlying dosha can be understood and specific line of treatment such as shodhana and shamana chikitsa has been performed and the condition has been improved.• Email: editor@ijfmr.com

Case Report
A 55 years old female patient visited Agada Tantra outpatient department (opd) of our institute with the clinical features such as of dryness ,scaling and cracks over her bilateral palms and soles associated with pain , blackish discoloration, severe itching and burning sensation, associated with bloody discharge along with swelling of bilateral foot which was disturbing her daily activities. .She is known case of hypertension since 5 years and is under medication.Initially she neglected the complaint but as the complaint got aggravated she approached an nearby allopathic hospital and was prescribed with topical applications and some medications (details not known) but there was no relief found and the symptoms occurred frequently.So as there was no relief found she approached Ayurvedic hospital for further management.

Past History
There was no history of similar complaints in the past.k/c/o HTN and under medication since 5 years

Clinical Findings
On the day of general examination the person was of normal built without any pathological presentation.On local examination there were dryness, scaling and cracks over her bilateral palms and soles associated with pain , blackish discoloration, severe itching and burning sensation, associated with bloody discharge along with swelling of bilateral foot.

DISCUSSION
As this is a chronic condition, the path of treatment chosen in this instance is shodhana followed by shamana chikitsa.Therefore, in this instance, virechana, which is kapha pitta hara and vatanulomaka, is being chosen.Considering the potent action of Mahatiktha gritha for its pittahara and kandugna action .Mahatikta Ghrita contains a large number of medicinal herbs which are bitter in nature.Tikta Rasa (bitter taste) is very useful in balancing the Pitta Dosha, it has been opted in this case for snehapana.Madhuchistha one of the ingrident of Pinda taila helps in the reduction of roughness of skin.It has the ingridents such as sarja rasa and manjistha which are having varnya properties helps in curing the discoloration of the skin. 8.Trivruth lehya where trivruth is best sukha virechaka was given for Virechana 9 .Patient found relief after Virechana and 12 vegas .As there was madhyama shuddhi 5 days of peyadi samsarjana karma was explained to the patient. 10

CONCLUSION
Palmoplantar psoriasis which can be correlated with Vaipadika is been explained in the context of Kshudra kustha.It has been effectively managed through Shodhana karma.The present case was successfully treated and managed through Virechana karma.After the treatment there was much reduction in signs and symptoms such as.dryness ,scaling and cracks over her bilateral palms and soles associated with pain , blackish discoloration, severe itching and burning sensation, associated with bloody discharge along with swelling of bilateral foot. .From the current case study we can draw a conclusion that Vaipadika kustha can be successfully treated and managed through Ayurvedic line of treatment.No adverse reactions were observed during the course of treatment and later patient was advised to follow proper ahara and vihara to avoid the recurrences of the disease.
Hb was 11.8 gm%, ESR was 50 mm/hr, PCV was 33.1%, MCV was 70fl, MCH was 25.2 Pg (RBC, WBC, PALTELET COUNT SERUM CREATNINE BLOOD UREA are within normal range).On local examination there were dryness ,scaling and cracks over her bilateral palms and soles associated with pain , blackish discoloration, severe itching and burning sensation, associated with bloody discharge along with swelling of bilateral foot.