Complete Resolution of Charmakeela with Special Reference to Chronic Myrmecia Wart using Anushastra Karma – A Case Report.

Abstract

Plantar warts caused by human papillomavirus (HPV) are common, painful, and often recurrent, particularly the deep-seated Myrmecia variant. Myrmecia, a specific type of deep palmar or plantar wart, characterized by its occurrence mostly in the deep layers of the epidermis and predominantly affect pressure points on the palms and soles. In Ayurveda, warts are correlated to charmakeela, treatment modalities advocate agnikarma(cauterization), kṣhara karma (alkali application), and chedana karma (excision). This report highlights a case of a palmoplantar wart, also known as a ‘Myrmecia wart,’ due to its unique clinical presentation and deeper tissue involvement. A 23-year-old male presented with multiple, bilateral, painful plantar warts of one-year duration, resistant to prior topical keratolytic therapy. On examination lesions were deep-rooted, hyperkeratotic, tender, and associated with thrombosed capillaries, significantly impairing ambulation and occupational functioning. Based on clinical features, the condition was diagnosed as charmakeela with special reference to myrmecia warts. The patient underwent agnikarma (electrocautery-assisted excision) in two sittings at a 15-day interval under local anesthesia. Post-operative wound management included kshara taila(alkali oil) application for controlled chemical debridement and prevention of residual lesion growth. Shamana auṣhadhis(internal medications)—Tab. Gandhaka rasayana and Tab. Arogyavardhini vati were administered to enhance immunity and tissue metabolism. Significant reduction in pain, tenderness, and lesion size was observed after the first sitting. Complete resolution of all lesions with restoration of normal skin texture was achieved following the second sitting. No recurrence or adverse events were noted during one year of follow-up. This case demonstrates Ayurvedic approach combining agnikarma, post-operative kṣhara taila application, and shamana aushadhis can effectively manage chronic, deep-rooted myrmecia warts with sustained outcomes. The concept of charmakeela offers a reliable Ayurvedic framework for understanding and treating recalcitrant plantar warts.