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Psoriasis is a chronic disease that can have substantial psychological and social impact on patient's life. Psoriasis has been shown to affect health-related Quality of Life to an extent similar to the effects of other chronic diseases such as depression, myocardial infarction, hypertension, etc. The modern treatment options not only provide temporary relief but also have serious side effects. Thus, the chronic and recurring nature of the disease hampers the Quality of Life to a great extent. In the present study, patients were randomly divided into two groups. Koshtha Shuddhi was done by Eranda bhrushta haritaki (6 g at night with ushnodaka) in patients of both the groups for 3 days before starting the treatment. A total of 111 patients were selected for the present study and were grouped into two. Patients of group A (45) were given “Navayasa rasayana leha” and “Dhatryadhyo lepa” for external application. Stress is a well-known precipitating factor of Psoriasis. Hence, to study the efficacy of Medhya rasayana drugs, patients of group B (49) were given Medhya rasayana tablet along with the application of Dhatryadhyo lepa. The duration of the study was 3 months and follow-up was done for one month. Both the groups showed equally good results on improving the quality of life in the patients in terms of Dermatology life quality index and Psoriasis disability index.
Psoriasis can have a significant impact on a patient's Quality of Life, sometimes profoundly altering their everyday life. Quality of Life patient survey published in the Archives of Dermatology in 2001 showed that physicians underestimate disease severity. 78% of severe psoriatics are frustrated by lack of efficacy of treatment and 26 minutes is the average time to apply topical medications per day.
Information from Quality of Life surveys suggest that 78% of psoriatics indicate the negative impact on their life quality, whereas 21% of patients suggest neither a positive nor a negative effect. It is important to note that the types of psoriasis are based on the effect of psoriasis on life quality as follows:
Also, it is interesting fact that any new intervention in patients of psoriasis initially gives good results, but later on, the therapy does not respond very well. This is also the major cause of impaired life quality in patients of psoriasis. Thus, looking at the impact of psoriasis on life quality, the present study was designed to find out the effect of Navayasa Rasayana leha, Dhatryadhyo lepa and Medhya Rasayana tablet on life quality of the patients.
A detailed study of Eka kushtha (psoriasis) and its effect on life quality was done, along with study of drugs selected for the present study. Various books of Ayurveda, Modern science and internet related to the subject were referred.
The trial drug Navayasa Rasayana leha is taken from Chakradatta Kushthaadhikara. The ingredients are Dhatri, Aksha, Haritaki, Vidanga, Chitraka, Shuddha Bhallataka, Bakuchi, Loha bhasma, Bhrungraj and Tila Taila (Q.S.) in increasing proportion. The fine powder of the drugs is to be licked with Tila Taila.
The drug selected for local application in both the groups, i.e. Dhatryadhyo lepa, has been described in Bharat Bhaishjya Ratnakara. It has ingredients like Amalaki, Bibhitaki, Haritaki, etc. The fine powder of the drugs was mixed with Tila Taila and was given for local application to the patients. Medhya Rasayana tablet is Anubhuta yoga. It contains Vacha, Haritaki, Jatamansi, Jyotishmati, Yashtimadhu, Shuddha Bhallataka, Guduchi, Brahmi and Shankhpushphi in increasing proportion.
For the clinical study, patients consulting the OPD, Department of Kayachikitsa, IPGT and RA, Jamnagar, were selected.
Patients having signs and symptoms of Eka kushtha (psoriasis) like well-circumscribed erythematous papules/plaques covered with dry, brittle, silvery grayish, white micaceous scales, Auspitz sign, Koebner phenomenon, Candle grease sign, etc. were selected. A special proforma including all the etiological factors of Kushtha with dushti lakshana of Dosha, Dushya, Srotas etc. was made for assessing the patients.
Patients were divided by random sampling method into two groups. Informed consent was taken from the patients for participation in the study. Koshtha Shuddhi was done by Eranda bhrushta Haritaki (6 g at night with ushnodaka) in patients of both the groups for 3 days before starting the treatment. The grouping was as follows.
Follow-up was carried out for 1 month after completion of the treatment.
The patients were strictly advised to follow the Pathyapathya of Kushtha roga.
Total 56 patients were registered in group A, out of which 11 dropped out and 45 patients completed the treatment, while in group B, a total of 55 patients were registered, out of whom 6 dropped out and 49 patients completed the treatment.
The DLQI is a questionnaire relating to the previous activities and feelings. Work, school, leisure, daily activities as well as the symptoms and feelings are measured as well as personal relationships and the impact of treatment.
The scoring of each question is as follows:
The DLQI is calculated by summing the score of each question, resulting in a maximum of 30 and a minimum of 0. The higher the score, the more the Quality of Life is impaired. The DLQI can also be expressed as a percentage of the maximum possible score of 30.
Meaning of DLQI scores
The DLQI can be analyzed under six headings as follows:
This is a questionnaire addressing 15 aspects including daily activities, personal relationships, vacation, work as well as the effects of actual treatment. This has been used in a number of clinical studies.
The Psoriasis Disability Index (PDI) can be analyzed under five headings as follows:
It is noteworthy that till date, no research work has been done regarding the assessment of this treatment on life quality of psoriatic patients as per the author's knowledge. Also, very few works have been done to find out the assessment of Ayurvedic drugs on life quality of psoriatic patients.
As per the DLQI scores, the effect of psoriasis on life quality was found as follows:
Thus, it can be understood that maximum patients had very large and extremely large effect of psoriasis on their life quality before treatment.
The effect of therapy on both DLQI and PDI was analyzed before and after treatment as follows.
Effect on PDI: It is observed that highly significant relief has been reported for all questions by patients in group A [Table 1].
Effect on PDI: It is observed that highly significant relief has been reported for almost all the questions of PDI by patients in group B [Table 2].
Thus, it can be understood from Table 3 that both the groups showed equally good results in all subdivisions of PDI. The overall effect on PDI shows that both the therapies showed highly significant relief (P< 0.001), but percentage wise, group A showed better relief by 72.20% whereas group B showed relief by 65.99%. On comparing the effect of therapies by χ2 method, it was found that in daily activities and personal relationships, group A showed better relief in comparison to group B, while in all other parameters, both the groups showed almost equal effect. Also, on comparing the overall effect of both the therapies by χ2 method, insignificant difference was found between the effect of both the groups (P> 0.10) which means that both the therapies were equally effective.
Effect on DLQI: It is observed that highly significant relief has been reported for almost all the questions of DLQI by patients in group A [Table 4].
Effect on DLQI: It is observed that highly significant relief has been reported for almost all the questions of DLQI by patients in group B [Table 5].
Thus, it can be understood from Table 6 that both the groups showed equally good results in all subdivisions of DLQI. When we look at the overall effect of therapy, group A showed 70.26% relief, whereas group B showed 67.64% relief. On comparing the overall effect of both the therapies by χ2 test, insignificant difference was found between the effects in both the groups (P>0.10) which means that both the treatments were equally effective.
Psoriasis is not a cosmetic problem. In a survey study, nearly 60% reported their disease to be a large problem in their everyday life. Nearly 40% with psoriatic arthritis reported their disease to be a large problem in everyday life. Patients with psoriasis covering more of their body (more extensive skin disease) experienced a greater negative impact on their Quality of Life.
Psoriasis has a greater impact on the Quality of Life in women and younger patients.
In a 2008 National Psoriasis Foundation survey of 426 psoriasis sufferers,
A 2009 study looked at the impact of psoriasis by using interviews with dermatologists and exploring the patient's viewpoint. It found that in cases of mild and severe psoriasis, itch contributed the most to the diminished health-related quality of life (HRQoL). Here, it can be seen that both the therapies provide significant effect on improving the life quality of the patients as shown in Table 7.
As, described previously, the effect of psoriasis in patients was very large effect in 44.14% and extremely large effect in 19.81% patients, which reduced completely showing that there were no patients having very large and extremely large effects on the Quality of Life. Also, after treatment, maximum number of patients in group A had small effect (40%), whereas maximum number of patients in group B had moderate effect (57.14%) [Table 7].
Also, based on the results, it can be inferred that both the groups showed highly significant relief in all the questions of DLQI and PDI. On comparing the overall effect of therapy by χ2 test, insignificant difference was found which proves that both the treatments were equally effective in improving the life quality of the patients.
Thus, it can be concluded that today psoriasis is a great problem hampering the life quality of the patients and the aim of the therapy should be focused on improving it. Both the therapies provided highly significant improvement in life quality of the patients.