Review on Evidence Based Ayurvedic Treatment Practices for Psoriasis

Psoriasis is characterized by sharply defined erythematous squamous lesions. It is one of the commonest chronic, non-infectuous papulo-squamous disorder of the skin. Several treatment modalities are in existence in modern system of medicine; however they have limitations due to their side effects due to long time use. Considering this, search for new safe therapeutic regime in psoriasis is going on. The present paper presents some of the promising evidence based Ayurvedic therapeutic approaches in the management of psoriasis.


Introduction
Psoriasis is one of the commonest chronic, noninfectious papulo squamous disorder of the skin, characterized by sharply defined erythematous squamous lesions. It is an immune-mediated and is not contagious disorder. Psoriasis is a recurring condition which varies in severity from minor localized patches to complete body coverage. The causative factors of Psoriasis are not known, but it is believed to have a genetic component. Certain factors like stress, excessive alcohol consumption and smoking are thought to aggravate psoriasis. Exudative skin patch, round, thick, and have severe itching, unctuous and black patch is known as Kitibha. Whereas, entire body becomes blackish red in Ekakushta.

Treatment
When disease is localised to skin, purification measures like V amana (therapeutic emesis), V irechana (therapeutic purgation) and external applications (lepa) should be done. When, Rakta dhatu (blood) is involved, purification measures, lepa (ointment) and kashayas (decoctions), Raktamokshana (bloodletting) are indicated. The above measures and arista (fermented medicaments) is indicated when mamsadhatu is involved. This disease becomes chronic when medodhatu (fat) is involved.
Among these, shodhana (purification measures) is essential, All kinds of skin diseases are termed as Kushta in Ayurveda. Shali (type of rice), Sasthtika dhanya (rice), Yava (Barley), Godhuma (Wheat), etc. are useful in Kushta (13). Vajrakataila is best for anointing and for massage. Khadira kashaya (decoction made from Acacia catechu) for drinking and for tub bath are useful in skin diseases.
Incompatible food, over eating, uncooked food, vidahi (food causing burning sensation), abhishyandhi ahara (food causing obstruction to the channels), and day sleep should be avoided by the skin disease patients (14).
In all kinds of Kushta, Tuvaraka taila and Bhallataka taila are effective.
In modern medicine, symptomatic relief and to slow down the disease progression and development of deformities are the main aims of the treatment.
Though, certain drugs are effective in modern medicine, liver scare of methotrexate, mutagenic potentials of PUVA, skeletal toxicity of retinoid and systemic and local side/ toxic effect of corticosteroids necessitate search for newer and safer drugs (15).

Aims and objectives
This study aimed to identify and compile the single and compound formulations/regimes having the beneficial effects on psoriasis and to identify the promising drugs, which have shown effective in clinical trials.

Materials and methods
Considering the above, clinical studies conducted Ayurvedic drugs on psoriasis have been collected and reviewed for their effectiveness.

Observations
The following observations are made by reviewing the clinical trials.
External application of Aloe vera gel is very much useful in Psoriasis. It is cooling, astringent and useful in various skin disorders. In a clinical study, Aloe vera gel alone found more effective than to 1% triamcinilone acetonide ointment (2).
Nimba (Neem-Azadirachta indica A.Juss.) is an important medicinal plant useful in various infectious diseases and skin diseases. Leaves, bark, seed and seed oil are the main useful parts of Nimba. Nimbidin is an important active ingredient of Nimbataila (seed oil of Nimba). 200mg of nimbidin in capsule form along with Aragwadha kera is found effective in psoriasis (4).
Seeds of Chakramarda (Cassia tora L.) are very effective in both Svitra and Kitibha. External application of paste made of Chakramarda seeds found more effective than deprovate ointment (5).

Conclusion
Hence, it can be concluded that some of therapeutic regimes mentioned and practiced in Ayurveda are time tested and showing promising results, when these regimes are judiciously used.