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Table of Contents
CASE REPORTS
Year : 2019  |  Volume : 7  |  Issue : 4  |  Page : 240-244

Contribution of Ayurveda for management of paronychia: A case report


1 Department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital & Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
2 Department of Rachana Sharir, Mahatma Gandhi Ayurved College, Hospital & Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India

Date of Submission04-Dec-2019
Date of Decision27-Jan-2020
Date of Acceptance19-Mar-2020
Date of Web Publication14-Apr-2020

Correspondence Address:
Dr. Gaurav Sawarkar
Department of Rachana Sharir, Mahatma Gandhi Ayurved College, Hospital & Research Centre, Datta Meghe Institute of Medical Sciences (DU) (DU), Salod (H), Wardha 442001, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_57_19

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  Abstract 

Nail is an important part of body, which plays crucial role in the beauty of female. A pink and lustrous nail is always equated with good health. Paronychia is one of the clinical conditions. It is a type of nail bed infection. It induces severe ugliness to hands due to chronic recurrent infection, which is generally bacterial or fungal in nature. A single case study showing Kunakha condition, which had resistant to therapy in contemporary science, induces encouraging results after the administration of external and palliative treatment (Shaman Chiktsa). Administration of Ayurveda treatment (external and internal) consecutively for 20 days had yielded good results in clinical symptoms as well as significant improvement in cosmetic view. The Shothahara, Rakta Prasadaka, and Strotoshodhaka properties of this remedy successfully subside the pathological features and improve the normal appearance of nail. Combined therapy, which is planned on the basis of basic principles of Ayurveda, conquers over the condition, which becomes resistance to contemporary established treatment.

Keywords: Asthimajjavruta vata, beauty Ayurveda treatment, Kshudraroga, paronychia


How to cite this article:
Sawarkar P, Sawarkar G. Contribution of Ayurveda for management of paronychia: A case report. J Indian Sys Medicine 2019;7:240-4

How to cite this URL:
Sawarkar P, Sawarkar G. Contribution of Ayurveda for management of paronychia: A case report. J Indian Sys Medicine [serial online] 2019 [cited 2020 Jun 2];7:240-4. Available from: http://www.joinsysmed.com/text.asp?2019/7/4/240/282382


  Introduction Top


Paronychia is a nail disease that is an often bacterial or fungal infection of the hand or foot where the nail and skin meet at the side or the base of a finger or to nail.[1] It generally occurs commonly in housewives and housemaids who are indulged frequently with work related to water. It is very simple disease and maximum time recovers itself gradually within a week but the problem arises when the pus formation continues and aggravates after exposure to water or chemical or dirty things continues.

According to cosmetic view, this clinical condition affects the appearance of hands, is embarrassing, even disfiguring, and hampering person’s day-to-day activity. It induces severe ugliness to hands due to chronic recurrent infection. Antifungal and topical steroid creams have been found to be more effective in the treatment of chronic and recurrent paronychia.[2] But modalities available in contemporary science to treat the aforementioned Kshudrarogas are not satisfactory and have high cost. Paronychia is generally correlated with the Kshudraroga Kunakha in Ayurveda, which is the ancient science of cosmetology. Kunakha (discoloration of nail) is one of the most common physical signs of nail disease.[3]Kunakha is explained in Kshudraroga by Sushruta Samhita, Astang Samgraha and Ashtang Hridaya, Bhavaprakash, and Sharangadhara Samhita. Many local formulations are explained in Sushruta Samhita and Bhaishajya Ratanavali for the treatment of Kunakha, but in this case, along with external application, more emphasis is given for the internal administration of various drugs, which helps to break the basis pathophysiology.


  Patient Information Top


A 43-year-old female patient was clinically diagnosed as a case of Kunakha presented with following chief complaints for 15–20 days. It was associated with multi-joint stiffness and pain, loss of appetite and constipation, pallor, lassitude, and difficulty in doing her normal day-to-day activities such as walking, sitting, squatting, and taking bath [Table 1].
Table 1: Chief complaints

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  Progression of Disease Top


The patient was previously having Aamvata (seropositive rheumatoid arthritis) for 12 years. She had taken treatment from multiple contemporary sciences including Ayurveda and homeopathic medicines. At present, the patient is continuing homeopathic medicines and one steroidal tab (prednisolone) daily orally for rheumatic complaints. However, suddenly she developed gradual swelling and dull pain over the thumb of her right hand. She had advised for local application of steroidal and antifungal ointment with oral antifungal treatment. However, the symptoms worsened, and watery discharge started from that lesion. After few days, dull pain was replaced with throbbing pain.

Family History

  • Mother: a known case of diabetes mellitus (DM) and hypertension with ischemic heart disease (IHD)


  • Father: a known case of hypertension (HTN) with IHD and osteoarthritis (knee)


  • Siblings: a brother, who was a known case of HTN


Past History

  • Known case of serum-positive rheumatoid arthritis in the last 12 years


  • History of facial palsy due to brain tumor


  • No history of any trauma/DM/HTN/tuberculosis (TB)


  • History lower (uterine) segment Caesarean section (twice before 12 years)


Personal History

  • Diet: vegetarian, daily intake of oily, sweet, and fermented food


  • Sleep: interrupted due to disturbed family life


  • Diwaswapa just after meal but disturbed sleep due to joint pain


  • Bowel habits: unsatisfactory (irregular and hard, sticky stool)


  • Micturition: satisfactory


  • No history of any addiction


  • Menstrual history: scanty irregular


Clinical Findings

  • Inflamed nail bed with reddish and yellowish swollen edges


  • Blackish and yellowish discoloration of nails of other fingers of both hands and feet


  • Watery and pus discharge from the nail bed of right thumb of right hand


  • Interrupted integrity of nail of that thumb


  • Bony deformity occurs in all fingers of both hands due to rheumatism


  • Severe tenderness in nail bed of right thumb of right hand


Diagnostic Assessment

The diagnostic assessment carried out is as shown in [Table 2].
Table 2: Scoring system for paronychia related to oncologic treatments (SPOT)

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Therapeutic Intervention

The line of treatment is as shown in [Table 3].
Table 3: Line of treatment

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  Observation and Results Top


Assessment before and after completion of treatment is present in [Table 4].
Table 4: Assessment before and after completion of treatment

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,


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Figure 2: After treatment (A and B)

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  Discussion Top


Dosh-Dushya Samurchana

Causative factor—Strotovaigunya (Dhatugatavastha) due to long occurrence of rheumatoid arthritis and consumption of steroid for 12 years; in diet, daily intake of oily, sweet, and fermented food; patient taking nap just after food but disturbed sleep due to joint pain and stress in disturbed family life; and patient having chronic constipation and straining while micturition.

Owing to multiple causative factors, there occurs vitiation of Kleda as well as Vata. Severe degeneration occurs because of rheumatic pathology, which is already present in the body along with a history of consumption of steroid, which is very harmful for bone tissue, including nail and surrounding structures that hamper the nutrition of surrounding tissue and make them vulnerable for such recurrent fungal or bacterial infection. Vata and Pitta together undergoing vitiation make the nails of fingers rough, dry, black, and injured through the effect of a blow.[3] The patient was diagnosed as Kunakha (paronychia). The Samprapti Ghatak observed in this case were as follows: Dosha: Tridosha (predominance of Pitta); Adhisthan: Pakvashaya; Dushya: Rasa, Rakta, Mansa, Asthi, Majja, and Purish; and Sthansanshray: Nakdhaagra.

Kunakha can be correlated with Asthi dusthi, the disease featured with vitiation of Tridosha having Pitta predominance. Nakha (nail) is Mala of Asthi dhatu. The disease chronicity leads to Asthi dushti.

After considering all factors and disease conditions, Vata-Pitta shamak, Shothahara, and Raktaprasadak treatment was planned and implemented.

Jatyadi oil has an effect of Vrana Shodhaka and Vrana Ropaka due to Kledahara properties. For local application, Pichudharana was suggested for the retention of medicine 20min over the lesion.[4]

Kaishor Guggulu has Rakta prasadak property. It augments the nutrition by its vasodilator property due to which it corrects Pitta dushti and reduces inflammation by providing fresh blood.[5] It contains various medicinal properties such as an adaptogenic, analgesic, antibacterial, anti-inflammatory, anti-arthritic, antioxidant, digestive stimulant, and carminative properties. Guggul contains the natural properties of blood cleansing and flushing out the toxins from the body.[6]

Gandhaka Rasayan is Pitta shamak in nature, which acts as anti-inflammatory.[7] It maintains the balances of Vata, Pitta, and Kapha Doshas. It possesses antibacterial, antiviral, and antimicrobial properties. It is useful in the treatment of skin diseases, itching, chronic fever, and urinary tract disorders. It provides healing effects in this condition by blood purification. It enhances the immunity of the body and hence helps to fight against infections.[8]

Sukshma Triphala Vati is proprietary medicine having a combination of Kajjali and Triphala, which acts as anti-inflammatory and antibiotic in nature, corrects the infection, and inhibits further necrosis of local tissue due to its high penetration capacity at cellular level.[9]

Capsule Cutis inhibits inflammatory action and also helps in the natural healing process of the affected area. Panchnimb churna has been acclaimed for its antibacterial and antifungal properties.[10]

Asthi-Majja Pachaka is a polyherbal formulation mentioned in the Charak Samhita and Ashtang Hridaya in the Jwara adhikara, and commonly known as Ashtimajja pachak yoga.[11]Tikta rasa is predominant in the formulation, which is Agni deepak, removes Srotorodha, develops taste, and is antipyretic. Among the three contents of this yoga, Amalaki is useful in Pittanubandhi condition, which is predominant in Kunakha, which leads to necrosis of tissue. Musta acts as Pachak and digests Rasagata and Amashayagata dosha. Guduchi among them acts as excellent Kledahara and has anti-inflammatory and antioxidant property.[12]Gandharva Haritaki powder is best for Mrudu shodhana in this condition.[13],[14]


  Conclusion Top


The patient got relief from sign and symptoms such as swelling, throbbing pain, watery discharge oozing from the nail of right thumb, and foul smell, expressively reduced within 20 days with Ayurveda treatment without causing any undue side effect.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Introduction to paronychia. Available from: https://www.google.com/search?q=paronychia&rlz=1C1OKWM_enIN790IN790&oq=parony&aqs=chrome.0 .0j69i57j0l3j69i61.9239j0j4&sourceid=chrome&ie=UTF-8. [Last accessed on 2019 Sept 28].  Back to cited text no. 1
    
2.
Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol 2014;59:15-20.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Victoria Devi L, Khagen B. Contribution of Ayurvedic classics on Kshudra roga with special reference to cosmetic diseases. Int J Ayur Pharm Res 2016;4:83-7.  Back to cited text no. 3
    
4.
Shailajan S, Menon S, Pednekar S, Singh A. Wound healing efficacy of Jatyadi Taila: In vivo evaluation in rat using excision wound model. J Ethnopharmacol 2011;138:99-104.  Back to cited text no. 4
    
5.
Ramachandran AP, Prasad SM, Prasad UN, Jonah S. A comparative study of Kaishora Guggulu and Amrita Guggulu in the management of Utthana Vatarakta. Ayu 2010;31:410-6.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Guggul K. Ingredients, Health Benefits, Side Effects, Dosage. Available from: https://www.bloomingyourlifestyle.com/kaishore-guggul-benefit-side-effect/. [Last accessed on 2019 Sept 28].  Back to cited text no. 6
    
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Mitra S, Prajapati PK, Shukla VJ, Ravishankar B. Impact of Bhavana Samskara on physico-chemical parameters with special reference to Gandhaka Rasayana prepared by different media and methods. Ayu 2010;31:382-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Drug Library. Available from: https://www.planetayurveda.com/library/gandhaka-rasayana/. [Last accessed on 2019 Sept 28].  Back to cited text no. 8
    
9.
Sookshma Triphala Drug Information. Available from: http://ayurvedarasashala.com/i/sookshma-triphala.html. [Last accessed on 2019 Nov 30].  Back to cited text no. 9
    
10.
Salient Features of Cutis Capsule. Available from: https://www.vasuhealthcare.com/cutis-capsule/. [Last accessed on 2019 Sept 28].  Back to cited text no. 10
    
11.
Tripathi B. Charaka Samhita with Hindi commentary ‘Charaka Chandrika’, chapter 5, citation no. 204. Varanasi, India: Chaukhamba Prakashan. p. 186.  Back to cited text no. 11
    
12.
Yoga DP, Mishra BR, Mishra AB. Ayurline: International Journal of Research in Indian Medicine2018;2:1-8.  Back to cited text no. 12
    
13.
Vaidya Joshi YG. Book of Kayachikitsa. Reprint ed. Pune Publishing Academy; 2014. p. 646.  Back to cited text no. 13
    
14.
Sharama P, editor. Sutrasthana, chapter 20, verse 11. In: Charaksamhita of Charaka. Vol. I. 8th ed. Varanasi, India: Chaukhamba Orientalia; 2007. p. 139.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
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Progression of D...
Observation and ...
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