Ayurveda Treatment Protocol in the Management of Relapse of Palmo-Plantar Pustulosis (PPP) - A Case Report

Background: Palmo-Plantar Pustulosis (PPP) is one of the debilitative skin disorders having a prevalence of 0.050 to 0.12 % worldwide, which is hallmarked by sharply demarcated erythematous pustular lesions over the body. Modern treatment provides certain moisturizers, topical steroids, light therapy, and systemic therapies in the long run, but recurrent crops of pustular lesions are the main problem. Here a case of PPP treated with Ayurvedic protocol is discussed. A 65-year old female patient complained of blackish-red pustular desquamative lesions over the upper and lower limb associated with occasional oozing after itching with extreme hardness and rough texture over the affected area for three years. The ailment was diagnosed as kitibha (a type of psoriasis), and the treatment was organized accordingly. The patient received continuous virechana (purgative therapy) for three months at a rate of six days per month, followed by pathya (wholesome food), topical application, and internal medications. Auspitz signs and PASI (Psoriasis Area and Severity Index) assessment, along with symptomatic improvement in signs and symptoms, were used to quantify the outcome of the disease. After receiving the initial bowel cleansing medications such as Patolakaturohinyadi Kashaya, Saribadyasava, and Manibhadragula, the patient claimed complete recovery from the acute phase. The second phase was followed by continuous virechana (purgation therapy) for three months at a rate of six days per month, which showed no signs of relapse for three consecutive months in the affected areas. Even though PPP is incredibly challenging to treat, shodhana (purificatory therapy) for six consecutive months can potentially prevent relapse. This opens up the future scope for structured clinical trials in the treatment of disease.