|Year : 2022 | Volume
| Issue : 3 | Page : 205-210
Ayurved management of a case of intensive Dadru (dermatophytosis)—A case report
Medha C Lakkawar, Pratima R Gaikwad, Anand B More, Shalini Rai
Roganidana Evum Vikriti Vigyana Department, All India Institute of Ayurveda, New Delhi, India
|Date of Submission||28-May-2022|
|Date of Acceptance||20-Sep-2022|
|Date of Web Publication||30-Sep-2022|
Pratima R Gaikwad
Department of Roganidana Evum Vikriti Vigyana, All India Institute of Ayurveda, New Delhi
Source of Support: None, Conflict of Interest: None
Introduction: Dermatophytosis (tinea) infections are superficial fungal diseases caused by dermatophytes, a fungus genus that penetrates and grows in dead keratin leading to reddish-colored erythematous cutaneous eruptions in circular lesions presenting with itching. If neglected, fungal infections are more likely to come back and can cause the emergence of more severe conditions. Relapses and recurrences demonstrate that the pathogenic organism is not simply eradicated, demanding more research to create new therapeutic options. Numerous medications used in Ayurveda are thought to have the Krimighna effect, which can result in a more effective course of therapy. Dermatophytosis can be simulated with Dadru Kushtha because the clinical characteristics of the disease are more closely related to those of dermatophytosis. Materials and Methods: This case report documents the case of a 37-year-old female patient with complaints of red circular patches and elevated edges over genitals, groin, flanks, axilla, and forehead regions with severe itching diagnosed with Dadru Kushtha. The case was intervened with Ayurvedic Shaman (pacifying therapy) and Bahirparimarjana chikitsa (external therapy). Result: A significant reduction was observed in Kandu, Daha, Raga, number and size of Mandala, and Pidaka after treatment and after follow-up. Conclusion: Dermatophytosis can be successfully treated with Ayurvedic oral and topical treatments, dietary and lifestyle limitations, and personal hygiene.
Keywords: Ayurvedic, Chakramarda beeja, Dadru Kushtha, dermatophytosis
|How to cite this article:|
Lakkawar MC, Gaikwad PR, More AB, Rai S. Ayurved management of a case of intensive Dadru (dermatophytosis)—A case report. J Indian Sys Medicine 2022;10:205-10
|How to cite this URL:|
Lakkawar MC, Gaikwad PR, More AB, Rai S. Ayurved management of a case of intensive Dadru (dermatophytosis)—A case report. J Indian Sys Medicine [serial online] 2022 [cited 2022 Dec 7];10:205-10. Available from: https://www.joinsysmed.com/text.asp?2022/10/3/205/357684
| Introduction|| |
Skin is the largest organ of the integumentary system. It is one of the Gyanendriya (sensory faculties) and also reflects Rasa Dhatu (the primary product of digested food). Its external location makes it more exposed to pathogens and allergens with changing environmental conditions. The skin has a defense mechanism that prevents possible infections from entering the body through the skin. As a result, complex populations of bacteria, fungus, and viruses thrive on the skin, leading to various skin disorders. According to the 2013 Global Burden of Illness study, skin disease is another global cause of disability. On the other hand, the skin itself is prone to superficial fungal infections. According to World Health Organization, the global prevalence of superficial mycotic infection ranges from 20% to 50%. In India, five out of 1000 people suffer from tinea infection. Tinea infection is seen more commonly in the geographical area having higher humidity, overpopulation, and poor hygienic living conditions. Recent advances in understanding the pathophysiology of dermatophytosis have confirmed the central significance of the “delayed hypersensitivity reaction,” which, in the presence of a positive immediate hypersensitivity response to the Trichophyton ante gene, indicates the chronicity of the disease. It occurs on any part of the body with annular, erythematous, scaly lesions having well-defined edges and central cleaning.
In Ayurveda, skin diseases are classified under Kushtharoga (skin disease). Clinical features of Dadru Kushtha such as Kandu (itching), Raga (erythema), Daha (burning sensation), Utsanna Mandala (elevated patches), and Pidika (papules) are mostly similar to cardinal characteristics of dermatophytosis infection. Thus, Dadru Kushtha can be correlated with dermatophytosis. Dermatophytosis infection is contagious in nature and Acharayas explained Kushtha as one of the contagious (Aupasargika) disease.
According to contemporary science, despite topical and systemic antifungal agents, the recurrence rate is more resulting in the chronicity of the infection. Also, the long-term use of these antifungals causes adverse reactions.
Here, in this case report, the patient was diagnosed with Dadru Kushtha and successfully treated with Ayurvedic management without any adverse event being reported.
| Materials and Methods|| |
A 37-year-old female patient came to skin out patient department on December 21, 2021, presenting with chief complaints of red circular patches with elevated edges over genitals, groin areas, bilateral flanks, right axilla, and forehead since past 1 year with severe itching and mild burning sensation. The patient also complained of irregular bowel movement in the last 4–5 months. History revealed that 1 year back, she developed a round, reddish patch with a burning sensation and itching sensation over the groin region, and then the lesion gradually spread over the genitals and further bilateral hip regions. She took allopathy medicine from a dermatologist for 4–5 months but did not get significant relief; therefore, she discontinued the medicine. As symptoms get more aggravated, she came to skin out patient department for better treatment.
There is no specific history of any major illness, drug allergy, or previous surgery, and there is a positive family history showing same complaints of the erythematous patch with itching to her spouse.
General and Systemic Examination
Personal history revealed that appetite is good; the bowel movement is irregular, once in 2 days; and the bladder is regular. Sleep is disturbed due to itching. There is no specific history of addiction. On general and systemic examination, pallor, icterus, clubbing, cyanosis, and lymphadenopathy are absent, and blood pressure, respiratory rate, temperature are within the normal limit. Systemic examination did not reveal any abnormality.
On dermatological examination, multiple circular reddish erythematous plaques (Mandala) with vesicular eruptions (Pidika) over genitals, groin areas (18–20 cm in diameter), left flanks (3–5 cm in diameter), right axilla (12–15 cm in diameter), and forehead (7–8 cm in diameter) were found, having slightly raised reddened demarked edges with central clearing. These lesions were associated with the symptoms of severe itching (Kandu) and burning sensation (Daha) [Figure 1](A)]–(D).
- Asthavidha Pariksha
- Nadi: Vata-Pittaja, 78/min
- Mutra: Samyaka
- Mala: Asamyaka, Vibandha (constipation)
- Jivha: Saam
- Shabda: Spashta
- Sparsha: Samashitoshna
- Drika: Prakruta
- Akriti: Madhyama
- Dashavidha Pariksha
- Prakriti: Vata Pittaja
- Vikriti: Pitta-Kaphaja
- Saar: Madhyama
- Samhanana: Madhyama
- Pramana: Madhyama
- Satmya: Madhyama
- Satva: Madhyama
- Aharshakti: Madhyama
Diagnostic Features and Assessments
Based on the above clinical features and positive direct microscopy (using 10% potassium hydroxide solution [KOH]), the case was diagnosed as Dadru Kushtha.
Dermatophytes were identified by a microscopic examination using a 10% KOH. Before intervening, the patient keratinocytes were extracted by scraping the plaques’ perimeters, mounting the sample on a glass slide with a 10% KOH, and briefly heating the slide with a burner. The slide was then checked for dermatophytes identification under a 10× and 40× microscope after 5 min.[9 The skin-scraped sample of the present case study patient before starting the treatment showed a positive result for 10% KOH examination [Figure 2].
After analyzing Dosha, Dushya, and probable Samprapti (pathogenesis), the treatment was planned and prescribed, which can be classified as Shamana (pacifying therapy) and Bahirparimarjan Chikitsa (external application), as shown in [Figure 3]. Along with treatment, the patient was advised dietary restrictions. The patient was directed to avoid and restrict the usage of sour, spicy, salty, junk food, tinned food, soft drinks, and milk products such as paneer and curd during the treatment period, and the patient was advised to wear loose-fitting clean clothes and advised to wash clothes in warm water and dry in the sunlight. The assessment was done before treatment, intermittently, after treatment, and after follow-up.
The assessment criteria were based on the clinical characteristics of Dadru Kushtha [Table 1].
| Observation and Result|| |
The symptoms were assessed on the basis of the scoring pattern as mentioned in [Table 2]. After 20 days of treatment, a considerable result was found in Kandu, Raga, Daha, and Pidaka. Further, she was advised to continue the same treatment [Figure 4]. After 40 days, a complete relief was observed in all the parameters. The medicines were stopped after this period, and the patient was advised for dietary restrictions. The patient was further followed up after 10 days. After the follow-up period, no sign of recurrence was seen. Bowel movement was also regular and all the symptoms of Vibandha (constipation) subsided.
| Discussion|| |
Direct contact history with the Dadru Kushtha infected person is one of the Nidana for the manifestation of the disease Dadru Kushtha.Krimi is one of the Hetu (cause) in the pathogenesis of the manifestation of disease Kushtha described in classic. In the present case, contact history is the main cause of the manifestation of the symptoms. Also, continuous taking of an unwholesome diet (Ahara) and unhygienic conditions (Vihara) played a secondary role in vitiating the Doshas locally and aggravating the symptoms. As the dermatophytes cannot invade the skin layers and grow only on the superficial layer of skin, external therapy plays a major role in eradicating the fungi and further sustaining the skin’s normal integrity. On the basis of Nidana, Dosha, Dushya, and Prakruti of the patient, the Vyadipratyanic, Pitta-Kapha Shamaka external with internal treatment were adopted along with Pathya-apathya (do’s and dont’s).
Probable Mode of Action of the Drugs
Chakramarda Beeja (Cassia tora Linn.)
Vyadipratyanic effect of Chakramarda is well documented by Bhavamishra as “Chakram Dadrurogam Mardayati iti.” It is Laghu, Ruksha Guna, Katu Rasa, Katu Vipaka, Ushna Virya, and Kushtghna Prabhava. It pacifies Pitta due to its Tikta Rasa and Ruksha Guna and Kapha dosha due to its Laghu, Ruksha Guna, and Ushna Virya. By the virtue of its Lekhana qualities, it acts locally to make the site unfavorable for the growth of fungus by reducing the Kleda (moisture), Snigdhata (unctuous), and clearing the channels; Kushthghna, Dadrughna, Kandughna properties if the drug pacifies the Doshas locally. Antifungal and antimicrobial properties of the drug are well reported., As previously stated, dermatophytosis infection symptoms are a delayed hypersensitivity reaction to a specific antigen of dermatophyte fungi. The study reported that Cassia tora Linn. seeds extract suppresses the inflammatory markers IgE, mast cells, lymphocytes, and cell-mediated response, thus acting as antiallergic and ultimately reducing the symptoms.,
It contains Sariva (Hemidesmus indicus R.Br.), Nagarmotha (Cyperus scariosus R.Br.), Lodhra (Symplocos racemosa Roxb.), Shati (Curcuma zedoaria Rosc.), Ananta (Gardenia jasminoides), Pippali (Piper longum Linn.), etc. Vitiated Pitta-Kapha Dosha in Dadru Kushtha further causes the vitiation of the Rakta Dhatu due to Ashray-ashrayee bhav (the relation between the regulatory function of the body and tissue element) of Pitta and Rakta. The majority of ingredients of Sarivadyasava are Tikta (bitter), Kashaya (astringent) Rasa, Shita Virya (cold potency), and Katu Vipaka (bitter biotransformed rasa), which pacify the vitiated Pitta and ultimately pacify vitiated Rakta. Having properties such as Sheetavirya (cold potency), Dipanam (digestion and metabolism), and Pachanam (enhancing digestion) reduces Daha, Raga by pacifying Pitta. Vitiated blood also gets pacified due to the Raktashodhaka (blood purifier) property of Sariva, Lodhra, etc.
Khadira (Acacia catechu Willd.) is mentioned under Kushthaghna Gana and also as the best drug for alleviating Kushtha. Most of the ingredients in Khadirarishtaare Tikta, Katu (pungent) Rasatmaka, Katu Vipakand Ushna Viryatmaka (hot potency) pacify the Kapha along with Pitta. It has antioxidant properties. Its antifungal activity against dermatophytosis is also documented in studies.
Tankana (Borax) is the salt of tetraboric acid. It is a significant boron compound, also known as sodium borate. It is described under Uparasa, and it has Katu Rasa, Amla Vipaka, Ushna Virya, Tikshna, Laghu, Sara, Sushma Guna, Kaphahara properties that can aid in the alleviation of itching by calming the Kapha dosha. The antifungal and antibacterial activity of Tankana is well documented in various studies.
Trivrutta (Operculina turpethum Silva Manso) is the main drug of the Avipattikar churna. Trivrutta has Virechana (purgative) property, which helps to pacify the symptoms of Vibandha. It has Pitta-Kapha shamaka and Kushthghna property which helps in pacifying the Dadru Kushtha. Shunthi (Zingiber officinale Roscoe), Pippali (Piper longum Linn.), Maricha (Piper nigrum Linn.) act as Dipana and Pachana to resolve the Ama produced as a result of Vibandha, Aruchi (tastelessness).
In combination, all the medications act as Doshapratyanic (antagonizing dosha) and Dhatupratyanic (antagonizing dhatus) and remove Kleda, purifying the channel and thus breaking pathogenesis [Figure 6].
| Conclusions|| |
Clinical manifestation of Dadru Kushtha closely resembles dermatophytosis infection. This infection has a substantial recurrence rate, necessitating long-term treatment, and modern medicine has its own long-term limits. The adopted treatment method is safe and cost-effective and has produced a significant outcome when used for a long time. This suggests that Ayurvedic treatment is useful in managing delayed hypersensitivity infection and opens the door to more research in this area.
Declaration of Patient Consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Yadavji T Sutra Sthan, Indriyaupakramniya Adhyaya, verse 10. In: Charak Samhita of Charak. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. p. 57.
Singal A, Grover C Comprehensive Approach to Infections in Dermatology. New Delhi: The Health Science Publisher; 2016. p. 3.
Eckert L, Gupta S, Amand C, Gadkari A, Mahajan P, Gelfand JM Impact of atopic dermatitis on health-related quality of life and productivity in adults in the United States: An analysis using the National Health and Wellness Survey. J Am Acad Dermatol 2017;77:274-9.e3.
WHO. Epidemiology and management of common skin diseases in children in developing countries. Geneva: World Health Organization; 2005. Available from: https://apps.who.int/iris/handle/10665/69229
Weitzman I, Summerbell RC The dermatophytes. Clin Microbiol Rev 1995;8:240-59.
Sahoo AK, Mahajan R Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatol Online J 2016;7:77-86.
Yadavji T Chikitsa Sthan, Kushthachikitsa Adhyaya verse 23. In: Charak Samhita of Charak. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. p. 451.
Yadavji T Chikitsasthana, Kushthanidana verse 33–34. In: Sushrut Samhita of Sushruta. Varanasi: Chaukhambha Surbharati Publication; 2022. p. 289.
Singh S, Beena PM Comparative study of different microscopic techniques and culture media for the isolation of dermatophytes. Indian J Med Microbiol 2003;21:21-4.
Yadavji T Chikitsasthana, Kushthanidanam verse 6. In: Sushrut Samhita of Sushruta. Varanasi: Chaukhambha Surbharati Publication; 2022. p. 283.
Sharma PV Dravyaguna vijnana (Vegetable Drugs). Vol. II. Varanasi: Chaukhambha Bharati Academy; 2006. p. 187-8.
Patil S, Shah R Standardization, formulation & antimicrobial activity of Cassia tora. Int J Pharm Sci Res 2019;10:1870-9.
Pandya MP, Sameja KD, Patel DN, Bhatt KD Antimicrobial activity and phytochemical analysis of medicinal plant Cassia tora
. Int J Pharm Chem 2017;3:56-61.
Lee EK, Song J, Seo Y, Koh EM, Kim SH, Jung KJ Inhibitory effects of AF-343, a mixture of Cassia tora L., Ulmus pumila L., and Taraxacum officinale, on compound 48/80-mediated allergic responses in RBL-2H3 cells. Molecules 2020;25:2434.
Kim M, Lim SJ, Lee HJ, Nho CW Cassia tora seed extract and its active compound aurantio-obtusin inhibit allergic responses in IgE-mediated mast cells and anaphylactic models. J Agric Food Chem 2015;63:9037-46.
Mishra S Pramehapidakadhikar verse 22–23. In: Bhaishajya Ratnavali. Varanasi: Chaukhambha Prakashan; 2021. p. 722.
Yadavji T Sutra Sthan, Shadavirechanshatashritiya Adhyaya verse 11. In: Charak Samhita of Charak. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. p. 33.
Yadavji T Sutra Sthan, Yajjapurishiya Adhyaya verse 40. In: Charak Samhita of Charak. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. p. 131.
Mishra S Kushtharogadhikar verse 357. In: Bhaishajya Ratnavali. Varanasi: Chaukhambha Prakashan; 2021. p. 895.
Shinde R Bhangale K Khadirarishta: A medical review. Int J Res—Granthaalayah 2017;5;72-5.
Gopalan R Inorganic Chemistry for Undergraduates. Chennai: Indian System of Medicine and Homeopathy; 2008;1:357-62.
Tarak RA, Kalpana SP, Virendra KK Rajagopala S, Manjusha R In-vitro antimicrobial activity of Tankan. European J Biomed Pharm Sci 2015;2:210-3.
Chunekar K Guduchyadivarga verse 193. In: Bhavaprakasha Nighantu. Varanasi: Chaukhambha Sanskrit Sansthan; 2020. p. 383.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]