Introduction

A palmo-planter psoriasis is distinct form of psoriasis primarily affecting palms of hands and soles of feet, although it can be manifest in other areas of body. This condition is subtype of both plaque psoriasis and pustular psoriasis depending on its presentation. Psoriasis, in general, is relatively common skin disorder impacting 2-5% of population with approximately 3-4% of patients experiencing palmoplantar psoriasis (PPS).^[1] PPS is characterized by specific symptoms, including well-defined areas of raised, thickened skin, scaling, itching burning sensations pain, and even skin cracking and bleeding.^[2] Condition often presents symmetrically on both hands, making it challenging to perform everyday tasks, including walking. Location of symptoms can also pose hygiene challenges and lead to feelings of embarrassment and social anxiety. Proper understanding of early recognition and medical management are vital for those affected by palmoplantar psoriasis. In Ayurveda, all skin diseases are considered as Kustha. Whereas palmo-plantar psoriasis can be co-related with Vipadika. Symptoms of Vipadika are Pani-Pada Sphutanam (cracks on palm and sole), Kandu (severe itching) Ruja (pain) and Ruksha Gatra (dry hand and feet).^[3] There are many treatment manners accessible but since its chronic relapsing nature, Palmo-plantar psoriasis is challenge to treat. In Modern medical science, psoriasis is treated with PUVA (Psoralen plus ultraviolet-A radiation) along with corticosteroids and immuno-modulators.^[4]

The patient was under close observation in the In-Patient Department of Government Ayurveda College, Nagpur, and no side effect was reported. The patient noted a good improvement since there was a reduction in the scaling of the skin, itching, and erythema on her palm and sole. On discharge, the patient reported a significant improvement in the complaints of itch and rash of her palms and soles, and a substantial improvement in the scale and erythema of the palms and soles was observed on examination, and complete relief after 1-month follow-up (Table no. 2)

Figure 1: At the time of admission

Figure 3: After Sansarjana Krama

Discussion

Vipadika – In Ayurveda, skin diseases are primarily attributed to an imbalance in the three Doshas i.e., Vata, Pitta and Kapha. These Doshas are vital life forces that govern various bodily functions including skin health. Vipadika is a disease of Vata-Kapha predominance. The Ayurveda treatment protocol (Table no. 2) showed marked improvement in symptoms like Pani-Pada Sphutana, Kandu, Strava as well as in SPI score from 23 to 10 which is improved as severe to moderate psoriasis.

Effect of Snehapana - In the present case study patient has cracks over the palms and soles also Kandu (itching) and Daha (burning) were present. The cracks are due to Ruksha Guna of Vata and as Sneha Guna is the opposite of Ruksha Guna, the Snehapana acted best in this case. Mahatikta Ghruta controls dryness and reduces irritation due to its Snigdha (oily) and Pitta balancing properties.

Effect of Virechana - Virechana drugs have properties like Ushna, Tikshna, Sukshma, Vyavayi & Adhobhaghar Prabhava. By their potency, Virechana Dravya reach heart & circulate in body through vessels. Due to their Agneya Guna, they liquefy compact Doshas. Due to their Tikshna Guna, they separate adhered Doshas in channels of entire body. Due to its nature to move through channels they flow towards gastrointestinal tract (through which this morbid material reaches stomach). Due to predominance of Prithvi & Jala Mahabhutas in Virechana drugs & bec. of their spec. action (which we call in Ayur. as Prabhava) to move downwards,