Kitibha [Psoriasis]

 Kitibha is a skin disease, mainly caused by vitiation of the vata & kapha doshas. It is corelated with Psoriasis. Kitibha is more suitable to corelate with psoriasis as Acharya Caraka has described it as;

"Shyavam kinkharsparsham parusham kitibham smritam" 
Ca/Ci/7

The lesions which are shyava (reddish-black), Kin- like Vrana sthana (scar), on touch it should be khara (hard) and looks Parusha (dry).

According to Acharya Sushruta, "Kitibha-kushtha" is the disorder, in which the skin becomes oily, grayish black with lot of itching and oozing.

Psoriasis is a prolonged inflammation of skin. Patches of circular to oval shaped red plaques that itch or burn are typical of plaque psoriasis. The patches are usually found on the arms, legs, trunk, or scalp but may be found on any part of the skin. The most typical areas are the knees and elbows. 

The symptoms of psoriasis vary depending on the type. Some common symptoms for plaque psoriasis include:

• Plaques of red skin, often covered with loose, silver-colored scales. These lesions may be itchy and painful and sometimes crack and bleed. In severe cases, the plaques of irritated skin will grow and merge into one another, covering large areas.
• Disorders of the fingernails and toenails, including discoloration and pitting of the nails. The nails may also begin to crumble or detach from the nail bed.
• Plaques of scales or crust on the scalp.

Causes of Psoriasis:

• Abnormality in the immune system

According to Allopathic theory of Psoriasis,T cells (which normally help protect the body against infection) become active, migrate to the dermis and trigger the release of cytokines which cause inflammation and the rapid production of skin cells. But it is not known what initiates the activation of the T cells.

• family history

Trigger factors of Psoriasis:

• Injury to the skin: Associated with plaque psoriasis e.g:
  • skin infection
  • skin inflammation
  • excessive scratching

• Sunlight: strong sunlight aggravates symptoms. 
  
  bad sunburn may worsen psoriasis.

• Streptococcal infections: May cause a type of plaque psoriasis. These bacterial infections have been shown to cause guttate psoriasis, a type of psoriasis that looks like small red drops on the skin.
  
  
  Guttate psoriasis. Red drop-like lesions are found on the skin. This type of psoriasis usually occurs after a streptococcal (bacterial) infection. Image courtesy of Hon Pak, MD.
  
  
• HIV: Psoriasis typically worsens with HIV infection. However, psoriasis often becomes less active in advanced HIV infection.
• Drugs: A number of medications have been shown to aggravate psoriasis. eg:
  • Lithium - Drug that may be used to treat depression
  • Beta-blockers - Drugs that may be used to treat high blood pressure
  • Antimalarials - Drugs used to treat malaria
  • NSAIDs - Drugs, such as ibuprofen (Motrin and Advil) or naproxen (Aleve), used to reduce inflammation
• Emotional stress: Increase psoriasis in emotional stress.
• Smoking: Cigarette smokers have an increased risk of chronic plaque psoriasis. 
• Alcohol: Alcohol a risk factor articularly in young to middle-aged males.
• Hormone changes;
  Puberty and menopause- peaks
  Pregnancy -symptoms improve than worsen
  Postpartum period- more likely to flare

Causes of the Kitibha:

 Same as in skin disease i.e.

• Intake of mutually contradictory food, drinks which are liquid, unctuous and heavy.
• Suppression of natural urges
• Performance of physical exercise in excessive heat and after taking very heavy meals
• Transgression of the prescribed order of the intake of food and with reference to heat and cold, as well as fasting
• Use of cold water immediately after exposure to scorching sun, exertion, or exposure to frightening situations
• Intake of uncooked food and/or intake of food, before the previous meal is digested
• Excessive intake of food prepared of freshly harvested grains, curd, fish, salt, and sour substances.
• Untruthfulness, ungratefulness, insult of preceptors, sinful acts, misdeeds of past

According to Ayurveda, when Vata & Kapha doshas get vitiated due to causative factors, vitiated doshas affect the skin and blood tissues. They also influence water element of the affected region on skin. Then the symptoms of Kitibha appear. But Pitta also can be interfere in this pathogenisis & results much redish appearance & even pus formation.

Types of Psoriasis:

• Plaque psoriasis - small, water-drop-shaped sores on your trunk, arms, legs and scalp

• Scalp psoriasis - flakes of dead skin in hair

• Nail Psoriasis - common in people who also have psoriatic arthritis 

• Inverse Psoriasis - smooth patches of red, inflamed skin primarily in the armpits, groin, under the breasts and around the genitals

• Guttate Psoriasis - usually triggered by a bacterial infection such as strep throat

• Pustular Psoriasis - pus-filled blisters appears, skin becomes red and tender

• Psoriatic Arthritis -occurs in approximately 5-10% of people who have psoriasis. The small joints of the hands and feet may be swollen and deformed, nail changes are common if the arthritis affects the hands and feet. Back pain may indicate arthritis of the spine and/or sacroiliac joints. If you have joint pain or swelling. This occurs when psoriasis associates Gambhira dhatus like Asthi [Bones] & Majja [Bone marrows]

Ayurvedic treatment for Kitibha:

This aims at the detoxification of the body or elimination of toxins from the body fluids. It is achieved mainly by "Panchakarma" treatments. Ayurvedic treatment for psoriasis goes through several stages viz. lepana (application of ointments), abhayanga (oil massage), snehapana (taking medicated ghee), pizhichil (full body massage), avisnana (medicated steam bath), sirovasti (keeping oil on head) and other bastis (enema).

A psoriatic patient is also given a strict diet regime called 'Pathya'.

It is proud to say that the Panchakarma unit of Ayurvedic Teaching Hospital Borella, SriLanka has a succesful treatment in Psoriasis.

Dr. Indunil Weerarathne