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Daus Sadaf (Psoriasis) is an
autoimmune skin disease characterized by inflammatory patches on skin. Its
prevalence is increasing globally. In India the incidence are varies from 0.44
to 2.8%. It affects the quality of life the patient. The cause is uncertain but
according to Unani system the cause of the disease is abnormal Khilth-e-Sauda
(black bile) or Safra-e-GhairTabayee (burnt bile) in which there is qualitative
as well as quantitative changes leading to psoriasis. As Psoriasis is a stub
burn disease and has frequent relapses, the treatment for psoriasis is not
satisfactory in modern medicine. In Unani system oral drugs aiming to normalize
the humors of the patients by the actions of purification (alleviation of acrid
materials) of blood, relieving (normalization of hyper functioning) of skin
cells along with correctives for immune functioning of the body. The drug for
local application was prepared by adding the Unani drugs having required
actions; keratolylic, relieving, anti-inflammatory and anti-microbial along
with moisturization. This review paper will give detail information regarding
psoriasis and its management.
Keywords: Daus sadaf, Psoriasis, Abnormal sauda
and safra, Unani herbal medicine
INTRODUCTION
Psoriasis is a chronic, immune mediated papulo-squamaous skin disease
and is genetically determined, inflammatory disease of skin characterized by
well-defined, scaly, erythematous, itchy plaques, especially on extensor
prominence of the body and scalp [2]. It is having a substantial impact on
quality of life with the reported reduction in physical and mental functioning [3,4].
ETIOPATHOGENESIS OF PSORIASIS
The causes of this condition are uncertain but seem to be dependent on
the interaction of genetic, immunological and neurological factors.
According to conventional medicine Psoriasis is comes from T cells, a
type of white blood cell. T cells are designed to protect the body from
infection and disease. When these cells mistakenly become active and set off
other immune responses, it can lead to psoriasis symptoms. Even though there’s
no cure, many treatments exist to ease the symptoms of psoriasis [5,6].
According to Unani Medicine the cause of the disease is abnormal
Khilth-e-Sauda (black bile) or Safra-e-Ghair Tabayee (burnt bile) in which
there are qualitative as well as quantitative changes leading to psoriasis. The
body excretes the abnormal Khilth (humor) in the form of viscid fluid which
moves towards the skin and forms crests that cause malnourishment of the skin.
Toxins accumulate in the skin and decaying of skin appears in the form of
scales. According to modern medicine psoriasis is a multifactorial disease
triggered by environmental antigens in genetically susceptible individual [1].
PREVALENCE
Psoriasis is prevalent globally with varying prevalence rate with an
incidence rate of between 0.1% and 2%. Its prevalence varies from 2-11.8% in
different populations of the world and in India varies from 0.44 to 2.8%.
Prevalence
Prevalence rate 3.2% among adults (estimated total of 7.2 million in 2010
and 7.4 million in 2013) is reported. Globally various topical drugs,
phototherapy and systemic medications are available for the treatment of
Psoriasis with the variable outcome. In the year 2000, in United States, among
the estimated4.5 million patients of Psoriasis, about 1.5 million reported
their Psoriasis as a large problem of which 1 million were dissatisfied with
its therapy [7]. Survey of the National Psoriasis Foundation showed that the
most accepted external treatment of Psoriasis is phototherapy with UV-B and
methotrexate as an internal medication. Approximately 52.3% patients of
psoriasis and 45.5% patients of Psoriasis with Psoriatic arthritis were
reported to be dissatisfied with their treatment [8-10].
TYPES OF PSORIASIS [11]
In modern medicine psoriasis is classified in to different types namely,
nummular psoriasis, flexular psoriasis, guttate psoriasis, rupoid psoriasis,
elephantine psoriasis, circinate and annular psoriasis, pustular forms of
psoriasis, erythromermic or exfoliative psoriasis.
Epidemiologically, psoriasis is divided into two major groups:
Type-1 psoriasis: It has an onset
in the teenage and early adult life; such individuals frequently have a family
history and there is an increased prevalence of HLA CW6.
Type-2 psoriasis: The disease
onset is in an individual’s fifties or sixties, a family history is less common
and the HLA CW6 is not so prominent.
There are several types of psoriasis
·
Plaque
psoriasis: This is the
most common type characterized by dry, raised and red plaques that can be itchy
and painful. They can appear anywhere on your body.
·
Nail psoriasis: This type can
affect your fingernails and toenails. It can lead to discoloration, abnormal
nail growth, loose nails and nails that crumble.
·
Guttate
psoriasis: This type is
primarily found in children and young adults. It is characterized by small,
water-drop-shaped, scaling lesions triggered by a bacterial infection. It often
goes away on its own after the infection.
·
Inverse
psoriasis: This usually
occurs in your armpits, groins, under your breasts and around your genitals. It
is characterized by red, inflamed skin that may be triggered by fungal
infections.
·
Pustular
psoriasis: This type is
uncommon. It can develop quickly into blisters filled with pus accompanied by
itching, fever, chills and diarrhea.
·
Erythrodermic
psoriasis: This type is
the most uncommon characterized by red, peeling and itchy rashes all over your
body.
·
Psoriatic
arthritis: This form is
characterized by inflamed, scaly and red skin and also by painful, swollen
joints. Psoriatic arthritis is usually less painful than other forms of
arthritis yet it can still lead to progressive joint damage and pain.
SIGNS AND SYMPTOMS OF
PSORIASIS [11]
The most common signs and symptoms of psoriasis include:
·
Red, inflamed and raised patches of skin covered with
thick, silvery scales
·
Small scaling spots
·
Dry skin that may crack or bleed
·
Itching, burning, and soreness around the patches
·
Thick, pitted, and ridged nails
·
Swollen and painful joints
DIAGNOSIS OF PSORIASIS
Physical exam and medical history helps to diagnose psoriasis. Examination
of skin, scalp and nails should be done. A skin biopsy is rarely required,
however, it is required to identify the type of psoriasis you have and to rule
out any other conditions.
DIETARY CHANGES [12]
Dietary supplements should be given to improve immunity. Fish oil, vitamin
D, milk thistle, aloe vera and evening primrose oil have all been reported to
help ease mild symptoms of psoriasis, according to the National Psoriasis
Foundation.
In Unani practices generally revolve around a vegetarian diet. Foods to
avoid include those contain an excess of carbohydrates and products that
contain lots of sugar. In addition, Unani practices suggest a person should
avoid foods that are “in the extreme,” such as ones that are too salty, too
sour or too acidic.
PREVENTION
Prevent dry skin, avoid fragrance, reduce stress, avoid alcohol and
smoking.
TREATMENT
As Psoriasis is a stubborn disease and has frequent relapses, treatment for
psoriasis is not satisfactory in modern medicine.
Treatment was initiated according to Principles of Unani (Greek) Medicine
with the oral drugs aiming to normalize the humours of the patients by means of
Unani drugs having required actions of purification means alleviation of acrid
materials of blood, relieving (normalization of hyper functioning) of skin
cells along with correctives for immune functioning of the body. The drug for
local application was prepared by adding the Unani drugs having required
actions; keratolylic, relieving, anti-inflammatory and anti-microbial along
with moisterization.
Unani treatment
Advia-e-Mufradah (Single
drugs) [13]: Afsanteen (Artimesia
absinthium Linn), Asgand (Withania somnifera),
Tukhm-e-Babchi (Psoralia corylifolia
seed), BaadAaward (Volutarella divaricate),
Chiraita (Swertia chirayita),
Post-e-Neem (Azadiracta indica),
Kamela (Mallotus philippinensis),
Shahatra (Fumaric parviflora), Sandal
(Santalum album), Haleela (Terminalia chebula), Unnab (Zizyphus jujuba), QustShirin (Saussurea lappa), Berg-e-InderjauShirin
(Wrightia tinctoria), Haldi (Curcuma longa), Mundi (Spheeranthus indicus), Bisfaij (Polypodium vulgaris), ChobChini (Smilax china), Ghongchi (Abrus practorius), Ushba (Smilex ornata), Gul-e-GaoZaban (Borago officinalis). As per need, all
above medicine to be used in psoriasis (daus-sadaf)
as single or multiple in the form of Joshanda (decoction), Khesanda/Zulal
(infusion), Safoof (powder) orally [13].
Advia-Murakkabah
(Compound drugs) [13]: The formulation drugs for the treatment of psoriasis (daus-sadaf) are administered by oral as
well as topical. Descriptions of these formulations mostly belongs to the
Pharmacopeal, drugs in details are:
Majun Ushba: It is a Musaffi-e-Dam (Blood Purifier) and indicated in all
types of psoriasis (daus-sadaf). 5-10
g to be taken in the morning and evening with plain water on empty stomach.
Sharbat Ushba Khas: It is an excellent Musaffi-e-Dam (Blood Purifier) and
cures all types of psoriasis (Daus-sadaf).
25 ml to be taken after mixing with water in the morning and evening on empty
stomach.
ArqUshba: It is also Musaffi-e-Dam (Blood Purifier) and useful in all types
of psoriasis (da-us-sadaf). 125 ml to
be taken after mixing with 25 ml of Sharbat Ushba in water at the morning and
evening on empty stomach.
Itrifal Shahatra: It has Musaffi-e-Dam (Blood Purifier),
MunzijwaMushil-e-Sauda (Concoctive and Purgative Melancholic Humor) and
Murattib-e-Umoomi (General Moisturizer) properties. It is used in all variety
of psoriasis (da-us-sadaf). 5-10 g to
be taken in the morning and evening with plain water on empty stomach.
Turmeric (Curcuma longa Linn.):
This herb is being frequently studied for its powerful anti-inflammatory and anti-oxidant
properties. Curcumin, the active ingredient in turmeric also has the ability to
alter gene expression. A 2012 review by the International Union of Biochemistry
and Molecular biology highlights turmeric’s ability to alter TNF cytokine
expression. This is the likely reason some patients find it helpful in
minimizing psoriasis and psoriatic arthritis flares. You can take turmeric
concentrated in pill or supplement form or if you like curries, adding it
liberally to your food. The FDA considers 1.5 to 3.0 g of turmeric per day to
be safe [14].
Oats: Oats are considered one of nature's best skin soothers. There is no
scientific evidence to support the use of oats to relieve psoriasis symptoms.
But many individuals with psoriasis report applying an oat paste or taking a
bath in oats relieves their itchy skin and reduces redness [15].
Topical solutions [16]
Aloe vera: Gel from the
aloe plant can be applied to the skin up to three times a day. Some research
shows it can help reduce redness and scaling associated with psoriasis.
Similar to turmeric, there are many other Unani drugs available, and
several could potentially benefit people with psoriasis [5]. One example is
applying fresh banana leaf to areas of skin affected by psoriasis. Other
topical use drugs are Aloe vera,
boswellia, garlic, gogil, neem, etc.
Applying natural soothing oils, such as coconut or olive oils may help to
soften the skin and relieve itching and discomfort associated with psoriasis.
Baths and moisturizers
Regular baths are helpful in keeping areas of psoriasis lesions clean and
soft. Additionally, baths can be soothing and reduce stress, which may offer
further benefits in reducing the incidence of psoriasis.
1.
Ibnsina, Al Qanoon Fit tib (2009) CCRUM publication 1:
367-388.
2.
Krueger JG, Bowcock AM (2005) Getting under the skin: The
immunogenetics of psoriasis. Nature 5: 699-711.
3.
Harlow D, Poyner T, Finlay AY, Dykes PJ (2000) Impaired
quality of life of adults with skin disease in primary care. Br J Dermatol 143:
979-982.
4.
deKorte J, Sprangers MA, Mombers FM, Bos JD (2005)
Quality of life in patients with psoriasis: A systemic literature review. J
Investig Dermatol Symp Proc 9: 140-147.
5.
Nickoloff BJ, Nestle FO (2004) Recent insights into the
immunopathogenesis of psoriasis provide new therapeutic opportunities. J Clin
Invest 113: 1664-1675.
6.
Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin
DM (1999) Psoriasis causes as much distress as other major medical diseases. J
Am Acad Dermatol 41: 401-407.
7.
Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T
(2004) Psoriasis is common, carries a substantial burden even when not
extensive and is associated with widespread treatment dissatisfaction J
Investig Dermatol Symp Proc 9: 136-139.
8.
Helmick CG, Lee-Han H, Hirsch SC, Baird TL, Bartlett CL
(2014) Prevalence of psoriasis among adults in 2003-2006 and 2009-2010 National
Health and Nutrition Examination Surveys. Am J Prev Med 47: 37-45.
9.
Icen M, Crowson CS, McEvoy MT, Dann FJ, Gabriel SE, et
al. (2009) Trends in incidence of adult-onset psoriasis over three decades: A
population-based study. J Am Acad Dermatol 60: 394-401.
10.
Kirby B, Smith A, Burrows P, Little R, Horan M, et al.
(2005) Replacement of routine liver biopsy by procollagen III aminopeptide for
monitoring patients with psoriasis receiving long-term methotrexate: A
multicentre audit and health economic analysis. Br J Dermatol 152: 444-450.
11.
Chalmers RJ, O'Sullivan T, Owen CM, Griffiths CEM (2000)
Types of psoriasis and interventions for guttate psoriasis. Cochrane Database
Syst Rev 2: CD001213.
12.
Afifi L, Danesh MJ, Lee KM, Beroukhim K, Farahnik B, et
al. (2017) Dietary behaviors in psoriasis: Patient-reported outcomes from a
U.S. National Survey. Dermatol Ther (Heidelb) 7: 227-242.
13.
(2010) Unani
treatment for psoriasis. CCRUM, New Delhi, pp: 13-14.
14.
Kang D, Li B, Luo L, Jiang W, Lu Q (2016) Curcumin shows
excellent therapeutic effect on psoriasis in mouse model. Biochimie 123: 73-80.
15.
Cerio R, Dohil M, Jeanine D, Magina S, Mahé E, et al.
(2010) Mechanism of action and clinical benefits of colloidal oatmeal for
dermatologic practice. J Drugs Dermatol 9: 1116-1120.
16.
Mason J, Mason AR, Cork MJ (2002) Topical preparations
for the treatment of psoriasis: A systematic review. Br J Dermatol 146:
351-364.
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