Lesions are:

• Well-defined and sharply demarcated
• Round/oval-shaped lesions
• Usually symmetrical
• Erythematous, raised plaques
• Covered by white, silvery scales
• Can affect any part of the body- typically scalp, elbow, knees and sacrum

Types of psoriasis:

• CHRONIC PLAQUE PSORIASIS: It is most common type – affects approximately 85%. Lesions are pink, well – defined plaques with silvery scale. Lesions may be single or numerous. Plaque may involve large areas of skin. Classically affects elbows, knees, buttocks and scalp.
• GUTTATE PSORIASIS, lesions are numerous and small- 1cm approx. lesions are pink with less scale than plaque psoriasis, Commonly found on trunk and proximal limbs.
• FLEXURAL PSORIASIS; Lesions are found in skin folds articulary groin, gluteal cleft, axillae and sub-mammary Regions, Often minimal or absent scaling.
• ERYTHRODERMIC PSORIASIS, here generalized erythema covers entire skin surface It may evolve slowly from chronic plaque psoriasis or appear as eruptive phenomenon. Patients may become febrile, hypo/hyperthermic and dehydrated.

PUSTULAR PSORIASIS It has two forms:

• Localized Form, this is more common and is presented as deep-seated lesions with multiple small pustules on palms and soles
• Generalized Form, it is uncommon associated with fever and widespread pustules across the body with inflamed body surface
• PALMOPLANTAR PSORIASIS; It can be hyperkeratotic or pustular, may mimic dermatitis. It gets aggravated by trauma
• SCALP PSORIASIS, It varies from minor scaling with erythema to thick hyperkeratotic plaques and may extend beyond hairline. Patient scratching may produce asymmetric plaques
• NAIL PSORIOSIS can accompany any type of psoriasis. It can take several forms:
• Pitting: discrete, well-circumscribed depressions on nail surface
• Subungual hyperkeratosis: silvery white crusting under free edge of nail with some thickening of nail plate
• Onycholysis: nail separates from nail bed at free edge
• Oil-drop sign’: pink/red colour change on nail surface

PSORIATIC ARTHRITIS

• Approximately 5-20% have associated arthritis
• Five major patterns of psoriatic arthritis
• Distal interphalangeal involvement
• Symmetrical polyarthritis
• Psoriatic spondylarthropathy
• Arthritis mutilans
• Oligoarticular, asymmetrical arthritis
• Clinical expressions often overlap

CLINICAL APPROACH
PROTOCOL-1

• Mild symptoms
• Recent origin
• Localized

CHIKITSA

• Sadyo virechana
• If saama lakshanas are seen – then first of niraama should be achieved with medicines.
• Followed by medicines for psoriasis

PROTOCOL 2

• Moderate symptoms
• History of 2-6 month
• Afflicted to a larger area

CHIKITSA

• Deepana pachana, followed by snehapana both Abhayantra and bahya
• Sadyo virechana or classical virechana, depend upon manifestations

EXTERNAL TREATMENTS

• Sidharthaka snana choorna for snana
• Takra dhaara (musta , amalaki )

PROTOCOL 3

• Severe symtoms
• History of 6 months and more
• Spread extensive areas
• With severe mental stress

CHIKITSA

• Starting with the previous protocol according to the bala, Avastha of roga and rogi , moving on to the additional treatments
• Rookshana – takra dhaara ( musta , triphala , aragwadhadi )
• Deepana – pachana – panchakola churna with takra/ usna jala
• Snehapana – dose acc to agni bala . ( mahatiktakam ghrutha/ guggulutiktakam ghruta
• Abhyangam – vitpala
• Swedana – usna jala snana , atapa sevan
• Vamana -madana, vacha , yashti , pipppali + madhu
• Virechana – avipatti choorna / trivrut leha

FOLLOW UP

• Need of rasa – rakta prasadana (Blood purifiers) – manobala vardhaka – rasayana chikitsa . rasa – rakta parasadana

PATHYA

• For a minimum of 3 month to control symptoms and relapse
• Ahara : avoid virudha , vidaahi , guru, abhishyandi , navaanna , Matsya , anupa mamsa , kanda varga: reduce the use pf lavana : include more haridra rasona pepper in the diet : avoid pickles dadhi at night , fermented food items : avoid bakery items ( maida ) oily and spicy foods: strictly avoid egg, beef and pork : avoid ready to cook items , tinned foods tec : avoid re – cooking refrigerated foods .
• Vihaara : maintain hygiene in all aspects : practice achara rasayana