Psoriasis is an autoimmune, non-infectious, inflammatory and hyperproliferative disorder of the skin characterized by well-defined erythematous (reddish) plaques with large adherent silvery scales [1]. Psoriasis and its symptoms as a whole are not mentioned as a single entity in Ayurveda. Psoriasis may be considered as the vitiation of Vata and Kapha [2]. The characteristics of Ek kustha resemble with the generalized psoriasis vulgaris [3,4]. Ayurveda advocates various palliative and purification therapies for the management of psoriasis. Several single drug and compound formulations are described in Ayurvedic texts but none of the treatment is specific for psoriasis. Presently the Ayurvedic physicians prescribe the nonspecific formulation for the treatment of this disease. The various drugs have been indicated in Ayurvedic classics for different skin diseases. The Neem (Azadirachta indica A.juss), Tulsi (Ocimum sanctum ) and Henna (Lawsonia inermis) are one of them. These drugs have been using since thousands of years for skin diseases. Neem used by Charak in Kustha chikitsa as Churna, Paan, Lepa, Tail [5]. Sushruta used neem in Kustha as Churna, Kwath, Lepa and Snana [6]. Tulsi used by Charak in Kustha as Lepa, Nashya, Kshir and Tail [7]. Heena is the important ingredient of Mahanila ghrita used by Sushruta in kustha chikits [8]. Therefore, this study was planned with the aim to assess the efficacy of neem, tulsi and heena in the treatment of psoriasis.

A total of 30 patients of Psoriasis attending the Out Patient Department of Dravyaguna, L.H.S.P.G. Ayurvedic College and Hospital, Pilibhit (U.P.) were selected for the Randomized Parallel Group Clinical study. During the period of study incidence of disease in relation to different factors like Age, Sex, Prakriti (constitution), Dietary habits, Personal hygiene were evaluated.

Inclusion criteria

A classically diagnosed and uncomplicated case of psoriasis patients of both sexes of age group between 18 years to 50 years were taken in the study. Patients having more than 50% of the symptoms were selected for the clinical study.

Exclusion criteria

The patient having active hepatic and renal disorders, endocrinal disorders like diabetes mellitus, thyrotoxicosis, and exfoliating dermatitis were not taken in the study. The patients having active infectious diseases like Syphilis, Gonorrhea and other chronic diseases were also excluded.

Criteria for assessment

1. Sharply demarcated lesion with clear-cut borders.

2. Surface consists of non-coherent scales.

3. Under the scales, the skin has a glossy homogenous erythema.

4. Candle grease sign or onion peeling sign positive.

5. Auspitz’s sign positive [9].

The lesion of Psoriasis was graded as mild (+1), moderate (+2), severe (+3) on the basis of symptoms-

• Mild-if there were itching and 1-3 lesions with 1-3 cm size

• Moderate- if there were itching, scaling and 4-8 lesions with 4-6 cm size

• Severe- if a number of lesions were more than 8 with more than 6 cm size with intense itching, scaling, and papules.

Grouping and posology

All the 30 patients are randomly divided into two groups Group A and Group B (n=15 each).

Group A: Nimb churna and Tulsi churna 2.5 gm each twice daily.

Group B: Nimb churna and Tulsi churna 2.5 gm of each twice daily. Nimb-Tulsi-Henna oil for external use twice a day. During the treatment period, the use of soap was strictly restricted. The duration of treatment was 90 days.

The following Tables 1-16 represents the statistical data.

Table 1: Incidence of psoriasis in either sex of 30 patients. Z=4.13, P< 0.001; No. of male patients is significantly higher than female patients.

Table 2: Relationship with seasonal variation in psoriasis of 30 patients. X²=7.8, P< 0.05; No. of patients was maximum in Sharad ritu and significant.

Table 3: Relationship with duration of the disease. X²=0.60, P=0.70; No of patients were same in different duration and non-significant.

Table 4: Deha prakriti in 30 patients of Psoriasis. X²=31.2, P< 0.001; Vata-Kaphaja is most common Prakriti and significant.

Table 5: State of Agni in 30 patients of Psoriasis. X²=16.7, P< 0.001; Mandagni is most common and significant.

Table 6: Incidence of kandu in the lesion of 30 patients of Psoriasis. Z=7.75, P< 0.001; Kandu was present in all patients and significantly significant.

Table 7: Incidence of progressive scaling and lesion in 30 patients of psoriasis. Z=7.75, P< 0.001; Scaling was present in all patients and significantly significant

Table 8: Incidence of Raktata in 30 patients of Psoriasis. Z=2.58, P< 0.01; papules were present in 66.6% of patients and highly significant.

Table 9: Incidence of site of lesions. X²=20.40, P< 0.05; Below the knee was most common site followed by extensor surface of foot and significant.

Table 10: Incidence of other complaints in 30 patients. X²=27.30, P< 0.001, cosmetic problem were most common complaint followed by fear about the lesion and significant.

Table 11: Comparison of severity of Kandu Before treatment & After treatment. Z=1.83, P=0.01; Severity of symptoms of Kandu decreases significantly after treatment in all group. In group B the cure rate was 100% and in group A it was 80%. Cure rate was higher in group B than group A (P=0.06).

Table 12: Comparison of severity of progressive scaling and lesions Before treatment & After treatment. Z=3.02, P< 0.01; there was significant improvement in group A & group B and improvement is higher in group B and significant.

Table 13: Comparison of severity of Pidika before treatment and after treatment. Z=1.31, P=0.20; there is significant improvement in pidika in group A & group B and improvement is higher in group B than A.

Table 14: Comparison of severity of Raktata before treatment and after treatment. Z=1.32, P=0.22; there is significant improvement in severity of raktata after treatment in group A & group B. improvement is higher in group B.

Table 15: Drug results noted during 90 days. X²=24.21, p< 0.01; relief is higher in group B than group A at different time intervals and slow increases in relief significantly with time.

Table 16: Showing result in term of severity of patient before treatment and after treatment.

Out of 30 patients in group A 53.3% patient showed cured, 33.3% showed improved and 13.3% showed mild improved. In group B 80% patient showed cured, 13.3% improved and 6.6% mild improved. Findings of both the groups suggest that selected drugs are effective, but better results were observed in Group B where both the drugs were administered to the patients. This can be because administration of oral drug alone is not sufficient to reverse the biochemical changes happening in the whole body and to attain sufficient quantity of drug to skin tissues. Local drug application keeps the drug in longer contact with the skin surface.

Internal use of Neem and Tulsi churna along with external application of Neem-Tulsi-Heena oil combined therapy in Group B showed better result. It can be concluded that systemic and topical administration required for better management of Psoriasis. Another important aspect of the study is that the results could have been more effective if study would have been done for longer duration considering the chronic nature of disease.