A Case Study on Ayurvedic Management of Palmoplantar Psoriasis (Eka Kustha)

Background: There are independent studies on PUVA and NB-UVB therapy for the treatment of psoriasis, but studies comparing both PUVA and NB-UVB are scarce. Aim: The aim of this study was to compare the efficacy and safety of PUVA and NB-UVB therapy in chronic plaque psoriasis. Materials and Methods: Fifty patients of chronic plaque psoriasis of more than 20% of body surface area and of more than 2 years duration with Psoriasis Area Severity Index (PASI) score of more than 10, aged above 12 years, were subjects in the study. PASI score was recorded. Patients were randomly allocated to one of the two groups, each consisting of 25 patients and administered therapy as per protocol: Group A: PUVA—psoralens + UVA or Group B: NB-UVB phototherapy. Therapeutic response of patients was followed up every week and PASI score was calculated at 0, 2, 4, 6, 8, 10, and 12 weeks. Observations: Commonest age group afflicted in both the groups was 31–40 years. There was significant improvement (P-value <0.0001) from baseline to 12th week in patients subjected to PUVA as well as NB-UVB therapy. In the PUVA group, minimum and maximum duration of treatment for PASI 75 was 5 and 11 weeks, respectively, whereas in the NB-UVB group it was 6 and 12 weeks, respectively. In the PUVA group, minimum and maximum number of exposures for PASI 75 was 10 and 22, respectively, and in the NB-UVB group it was 18 and 36, respectively. Conclusion: PUVA and NB-UVB are both effective therapies. However, NB-UVB is considered as good, effective, and safer treatment for plaque psoriasis with no or minimal long-term carcinogenic risk, and it can be safely used in children, pregnant women, and in patients with hepatic and renal insufficiency. However, more number of exposures and less energy (joules) are required in NB-UVB to achieve therapeutic target. Limitations: The number of cases in the study is less.

British Journal of DermatologyVolume 183, Issue 2 p. e35-e35 Plain Language Summary Free Access A trial to compare two treatments for psoriasis: Guselkumab and fumaric acid esters First published: 02 August 2020 https://doi.org/10.1111/bjd.19269 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Plaque psoriasis is a common skin disease characterized by skin scales and red patches. It affects about 2% of all people. A complete cure is not possible, but several drugs can improve symptoms. This study, from Germany, aimed to compare a new drug called “guselkumab” with “fumaric acid esters (FAE)” that are commonly used in Germany to treat psoriasis. Psoriasis patients received, by random allocation, either guselkumab or FAE, and after 24 weeks the researchers evaluated how well the drugs worked (efficacy) and how well they were tolerated (safety). The Psoriasis Area Severity Index (PASI) is used to record the redness, thickness and scaling of a patient's psoriasis and to measure how well a treatment works, as a reduction in the PASI score means a reduction in these symptoms. For example, if a patient achieves PASI 75, it means they had a 75% or more reduction in their PASI score from the start. In this study, at week 24, 82% of guselkumab patients and 14% of FAE patients improved their baseline PASI score by at least 90% (PASI 90 response). This means that more patients in the guselkumab group had great relief in symptoms than patients in the FAE group. Patients answered the “Dermatology Life Quality Index (DLQI)” questionnaire to measure the impact of their skin disease on different aspects of their quality of life, like symptoms and feelings, daily activities, leisure, personal relationships and side effects of treatment. After 24 weeks of treatment, more guselkumab patients (62%) reported that their psoriasis no longer bothered them at all (DLQI score of 0/1) than FAE patients (17%). Undesired harmful incidents or side effects, called adverse events, occurred less often in the guselkumab group. In conclusion, guselkumab was more effective as a treatment for plaque psoriasis and better tolerated than FAE after 24 weeks. Linked Article: Thaçi et al. Br J Dermatol 2020; 183:265–275. Volume183, Issue2August 2020Pages e35-e35 RelatedInformation

Vipadika, or palmo-plantar psoriasis, is a chronic dermatological condition that causes debilitating symptoms like fissures, scaling, and intense itching. The condition is difficult to manage due to its persistent and relapsing nature. This case study explores the effectiveness of Ayurvedic treatments, including Panchakarma therapies, internal herbal formulations, and external applications, in managing a 48-year-old male patient suffering from vipadika. Significant improvement was observed in symptoms and overall skin health, emphasizing the potential of Ayurveda in addressing chronic skin disorders holistically.

A 56-year-old female agricultural worker from a tropical region presented with progressive thickening and painful callus-like lesions on both palms and soles over the past six months. She reported no history of trauma or systemic illness. Initially, she used over-the-counter moisturizers and emollients, which offered minimal relief. Over time, the lesions worsened, leading to painful fissures, a burning sensation, and difficulty performing manual work and walking. A course of topical antifungals and steroids provided no lasting improvement. On clinical examination, diffuse hyperkeratotic plaques with whitish to blackish discoloration, scaling, and deep fissures were noted symmetrically on both palms and soles. Based on history and findings, a diagnosis of palmoplantar psoriasis was made. Palmoplantar psoriasis is a chronic inflammatory skin disorder characterized by well-demarcated hyperkeratotic, erythematous plaques affecting the palmar and plantar regions. It commonly affects individuals engaged in manual labor or agricultural work, where repeated friction and mechanical stress can aggravate the condition. Typical presentation includes thickened scaly plaques, painful fissures, burning, and restriction of hand and foot function. Unlike simple calluses, palmoplantar psoriasis tends to be recurrent and resistant to routine emollient therapy. Management includes regular emollients, keratolytic agents (urea or salicylic acid), topical corticosteroids, and vitamin D analogs. In resistant or severe cases, phototherapy or systemic therapy (such as methotrexate, cyclosporine, or acitretin) may be required. Identifying aggravating factors and providing long-term dermatological care are essential for effective management.

Introduction: Psoriasis is a chronic inflammatory skin disease characterised by well demarcated erythematous scaly plaques. Psoriasis has been found to be associated with various systemic involvement including renal, metabolic syndrome and cardiovascular abnormalities. The association between psoriasis severity, chronicity and proteinuria is documented in literature. Understanding this relationship may help in early identification of subclinical renal involvement and guide timely intervention. Aim: To assess the correlation between albuminuria with chronicity and severity of psoriasis. Materials and Methods: The present cross-sectional study included 50 patients with psoriasis who fulfilled the inclusion and exclusion criteria, who were studied for a period of 12 months from April 2024 to March 2025. The study was conducted in the Department of Dermatology at the Government Medical College Kannur, Kerala, India. After obtaining consent, detailed history was taken and clinical examination was done. The severity of psoriasis was assessed by psoriasis Area Severity Index (PASI) and chronicity by the duration in days from the diagnosis. Urine Albumin Creatinine Ratio (UACR) was measured in these patients. The estimated Glomerular Filtration Rate (eGFR) was calculated in all patients using CKD-EPI equation. Descriptive statistics like frequency, percentage, mean and standard deviation were used for statistical analysis. Correlation between UACR values with PASI score were measured by Spearman rank correlation coefficient. All p-values <0.05 were considered significant. Results: Out of the 50 patients who were enrolled in the study, 54% (n=27) were males. Duration of psoriasis ranged between 84-17885 days. The mean±SD of eGFR was found to be 87.5±22.97 in mL/min/1.73 m2 . The PASI score ranged from 1 to 12 with mean±SD of 3.9±2.28. The UACR ranged from 1.5 to 33.0 mg/g with a mean±SD of 7.76±7.33. Among the 50 patients, UACR levels very weak positive correlation with PASI which was not statistically significant (p=0.684). Among the 50 patients, UACR levels showed a very weak positive correlation with chronicity, which was not statistically significant (p=0.387). Conclusion: The present study could find a very weak positive correlation between severity and chronicity of psoriasis and UACR levels. However, there was no statistically significant correlation between neither with chronicity nor with the severity. The take home message is at least in relatively less severe cohort of psoriasis UACR may not be a strong independent marker of renal involvement.

Real-world data in patients with moderate psoriasis treated with apremilast is limited. To evaluate the effectiveness and safety of apremilast in bio-naïve patients with moderate psoriasis in real-world clinical settings. This was a 52-week multicenter, observational, prospective study of adult outpatients with moderate psoriasis {[10% < body surface area < 20% or 10 < psoriasis area severity index (PASI) < 20] and 10 < dermatology quality of life index (DLQI) < 20} initiated on apremilast ≤7 days before enrollment. Missing data were imputed using the last observation carried forward method. A total of 287 eligible patients (median age: 54.2 years; median psoriasis duration: 9.8 years) were consecutively enrolled. At baseline, the median DLQI and PASI scores were 12.0 and 11.8, respectively. The 52-week DLQI ≤ 5 and PASI75 response rates were 68.3% and 61.0%. At 52 weeks, 70.8% and 72.7% of the patients shifted from moderate/severe/very severe to clear/minimal scalp and palmoplantar psoriasis involvement, respectively; the pruritus severity state improved in 67.2%. The 52-week Kaplan-Meier estimated drug continuation rate was 85.3%. The adverse drug reaction rate was 19.9%. Apremilast is a safe and effective treatment for bio-naïve patients with moderate psoriasis and specific psoriasis manifestations.

Background: Vipadika, a subtype of Kshudra Kushtha described in Ayurveda, closely resembles palmoplantar psoriasis in modern dermatology. It is characterized by painful fissures, dryness, scaling, and itching of the palms and soles, often leading to functional disability. Conventional therapies provide symptomatic relief but are associated with recurrence and side effects. Ayurveda emphasizes holistic management through Shodhana and Shamana therapies. Case Presentation: A 61-year-old male farmer presented with chronic symmetrical hyperkeratotic lesions, painful fissures, and pruritus on both soles for five years. The condition was aggravated by occupational pesticide exposure and continuous footwear use. Previous allopathic treatments provided only temporary relief. The patient was managed with an integrative Ayurvedic approach, including Panchatikta Ghrita Guggulu, Avipattikara Churna, Arogyavardhini Vati, local application of Shatadhauta Ghrita, and Cutisora ointment, along with Panchavalkala Kwatha foot soak for 42 days. Results: Progressive improvement was noted at each follow-up. Pain, itching, burning sensation, and fissures showed significant reduction, with complete resolution by day 42. Final assessment score was 0, indicating 100% relief. Photographic evidence demonstrated marked healing of fissures and restoration of normal skin texture.Conclusion: This case highlights the effectiveness of an integrative Ayurvedic regimen in managing Vipadika (palmoplantar psoriasis). The observed relief in symptoms and prevention of recurrence support the potential role of Ayurveda as a safe, holistic, and patient-centric approach for chronic skin disorders.

Eosinophilic annular erythema (EAE) is a rare dermatosis characterized by persistent pruritic erythematous annular plaques with dermal eosinophilic infiltrates. It typically has a chronic, relapsing course with variable treatment responses and frequent refractory cases. This retrospective multicenter study reports the clinical and histopathological features of EAE and the treatment outcomes in a case series of 10 patients. Ten patients with a confirmed clinical and histopathological diagnosis of EAE were referred to the Dermatology Departments of the University of Brescia and the University San Raffaele of Milan for evaluation and treatment. The cohort included six females and four males, all Caucasian, with a median age of 56 years. Time from lesion onset to diagnosis ranged from two days to seven years. Patients exhibited annular, figurate, or polycyclic plaques with erythematous borders-dashed in 80% and centrally pigmented in 70% of cases. Intense itching was reported by 90%. Histopathology displayed dermal infiltrate primarily composed of lymphocytes with various numbers of eosinophils, ranging from scattered (10%) to abundant (40%) and numerous (50%). Treatment responses were variable, oral corticosteroids, either alone or in combination with hydroxychloroquine, being the most used therapies. However, flares frequently occurred following discontinuation of treatment. Dupilumab has shown promise in achieving long-term remission. Most patients exhibited pruritic lesions with dashed borders and central pigmentation, strongly suggesting a diagnosis of EAE. The positive response to dupilumab in refractory cases, along with long-term follow-up, reinforces the growing body of scientific evidence from case reports documented in the literature.

Chronic kidney disease (CKD) represents a progressive loss of renal function over time and poses significant challenges in global healthcare. In Ayurveda, CKD is understood as an Upadrava (complication) of urinary system disorders or systemic conditions such as Prameha (diabetes). This review explores the Ayurvedic perspective on CKD, focusing on its pathogenesis, prognosis, and therapeutic approaches. The disease is characterized by the vitiation of Dosha and their impact on Basti (renal system), leading to impaired filtration and systemic toxicity. Early stages are considered Krucchrasadhya (difficult to treat), whereas advanced stages are Yapya (manageable with palliation) or incurable. Management strategies in Ayurveda emphasize purification (Shodhana), pacification (Shamana), and rejuvenation (Rasayana) therapies. Detoxification procedures like Virechana and Basti therapy are employed to eliminate vitiated Dosha and restore systemic balance. Rasayana drugs such as Punarnava, Gokshura, and Shilajit enhance renal function, act as antioxidants, and provide nephroprotective effects. Clinical studies indicate improvements in digestion, vitality, and quality of life with these interventions. The integration of Ayurvedic principles, including dietary and lifestyle modifications, offers a holistic approach to CKD, addressing its systemic effects and slowing disease progression. This study underscores the potential of Ayurveda as a complementary and cost-effective therapeutic framework for CKD, particularly in resource-limited settings, by reducing reliance on conventional renal replacement therapies and improving patient outcomes.

In patients with reflux oesophagitis, endoscopic healing and symptom relief are considered important treatment goals in long-term care. To compare the effect of lansoprazole 15 and 30 mg daily on maintaining endoscopic healing and symptom relief in patients with moderate reflux oesophagitis. In a single-centre, double-blind randomized clinical trial, 103 patients with grade 1 or 2 reflux oesophagitis who were endoscopically healed and asymptomatic after lansoprazole 30 mg daily for 12 weeks, were randomized to maintenance therapy with either lansoprazole 15 mg or 30 mg o.m. Endoscopy was repeated after 3, 6 and 12 months, and symptom relief assessed after 3, 6, 9 and 12 months. Relapse of oesophagitis or symptoms were considered end-points. After 12 months, 14/50 patients (28%) receiving lansoprazole 15 mg daily had suffered an endoscopic relapse compared to 8/53 patients (15%) treated with lansoprazole 30 mg daily. A life table analysis showed no statistically significant difference between the two groups (P = 0.086). Significantly more patients were kept in complete symptomatic remission in the 30 mg group (P < 0.01). In the 15 mg group, 23/50 (46%) had suffered either an endoscopic or symptomatic relapse on completion of the study, compared to 12/53 (23%) in the 30 mg group. A life table analysis showed this difference to be statistically significant (P = 0.010). Lansoprazole 15 and 30 mg daily were equally well tolerated. No statistically significant differences were found in endoscopic relapse rate or occurrence of adverse events, while lansoprazole 30 mg proved superior to 15 mg in maintaining patients in symptomatic relief and combined endoscopic and symptomatic remission.

Diabetic foot ulcers (DFUs) are among the most challenging complications of diabetes mellitus, affecting nearly 15% of diabetic patients globally during their lifetime. These ulcers often arise due to a combination of peripheral neuropathy, vascular insufficiency, immune compromise, and delayed wound healing. If not managed effectively, they can progress to severe infections, gangrene, and amputation, thereby reducing mobility and quality of life. Standard treatment involves glycemic control, topical care, antibiotics, and occasionally surgical intervention, yet many cases remain chronic and resistant to healing. This paper presents the case of a 58-year-old female patient with a long-standing history of Type 2 diabetes and palmo-plantar psoriasis, who developed non-healing ulcers on both lower legs. Despite extensive allopathic treatment, the ulcers remained painful and static. A homeopathic approach was adopted at Dr Batra’s, based on individualized case-taking, totality of symptoms, and constitutional prescribing. Acute support remedies and lifestyle advice were also integrated into the treatment plan. Over a four-month treatment period, notable improvements were observed. Pain and discharge gradually reduced, ulcer size decreased significantly, skin regeneration occurred without secondary infection, and psoriatic patches also showed marked improvement. The patient reported better energy levels and overall well-being. This case highlights the potential of classical homeopathy as a complementary therapy in managing chronic non-healing ulcers in diabetic patients, emphasizing a holistic and individualized approach that can lead to significant clinical outcomes when standard care alone is insufficient.

Recurring Norovirus & Sapovirus Infection in a Renal Transplant Patient.

Use of Outpatient Mental Health Services by Depressed and Anxious Children as They Grow Up

Background: The role of Helicobacter pylori eradication in the management of gastro-oesophageal reflux disease (GORD) is controversial. We hypothesised that H pylori eradication leads to worsened control of reflux disease....

Dear Editor: Hyperkeratotic hand eczema (HHE) is defined as a lesion of hand dermatitis that shows thick hyperkeratotic plaques with or without deep fissures. This diagnosis was established in 2%~5% of patients with hand dermatitis1,2. HHE is considered to have multiple causes, such as exposure to repetitive irritation, atopy, contact allergy, and friction3. Previous studies have revealed that contact sensitization is less common in HHE2. Here, we report a case of chronic HHE associated with contact sensitization to black rubber mix and thiuram mix. A 50-year-old nonatopic male patient presented with chronic HHE that had been refractory to previous treatments for the last 2 years. Physical examination revealed relatively well-demarcated erythematous scaly plaques on the palmar sides of both hands (Fig. 1A). He was a salesman who had always driven a car to his meetings. For 3 years, he had been wearing his work gloves, which had rubber on the palmar side, to prevent his hand from sliding off the steering wheel while driving because of his palmar hyperhidrosis (Fig. 2A). He had received eczema treatment with potent topical corticosteroid creams and moisturizer at local clinics; however, his symptoms did not improve. Then, he was referred to our hospital. We performed patch tests with a thin-layer rapid use epicutaneous (TRUE) test kit (Mekos Laboratories AS, Hillerod, Denmark). There were positive reactions to thiuram mix(++) and black rubber mix(++) at 48 h, and additional positive reactions to p-tertbutylphenol formaldehyde resin(+) and p-phenylenediamine(+) at 96 h (Fig. 2B). He was advised to apply a topical steroid with medium potency and to drive without wearing gloves, and his symptoms improved 2 weeks later (Fig. 1B). Thereafter, he underwent use tests with the work gloves, which worsened his symptoms. Fig. 1 (A) Localized scaly yellowish plaques on the palmar sides of both hands. (B) Two weeks after avoiding exposure to the offending allergen. Fig. 2 (A) Blue rubber dotted work gloves. (B) Positive patch test reactions to thiuram mix(++), black rubber mix(++), p-tertbutylphenol formaldehyde resin(+), and p-phenylenediamine(+) at 96 h. A hyperkeratotic morphology is known to be less frequently associated with contact sensitization, irritant exposure, and atopic dermatitis1. Thus, strongly positive reactions to more than two materials during the patch test have clinical implications. We made a diagnosis of HHE due to repetitive use of the work gloves on the basis of the patient's history, patch tests, and use tests. Thiurams are accelerants that are commonly used to manufacture natural rubber latex products. These mixes are present in natural or synthetic rubber products making up materials that are used either at work or at home4. Many tire workers are sensitized to black rubber mix. Concerning nonoccupational exposure, it has been shown that black rubber footgear and the rubber tips of walking sticks can also cause contact dermatitis5. Positive reaction to p-tertbutylphenol formaldehyde resin is related to contact with waterproof glue, bonded leather, and construction materials, whereas that to p-phenylenediamine is related to contact with permanent or semipermanent hair dyes, dyed textiles, and cosmetics; however, these are less relevant compared with our case. In conclusion, this report suggests that patients with HHE should be comprehensively evaluated through history taking and correctly treated by avoiding the suspicious material.