Panchakarma in the Management of Vipadika With Special Reference to Palmoplantar Psoriasis: A Review

Background: Palmoplantar Psoriasis (PPS) is a chronic, non-infectious inflammatory dermatological condition primarily confined to the palms and soles, afflicting approximately 3–4% of all psoriatic patients globally.1 In Ayurveda, all skin diseases are classified under the broad category of Kushtha, and PPS is closely correlated with Vipadika — a subtype of Kshudra Kushtha — based on similarities in its clinical presentation. Objective: To critically examine the therapeutic efficacy of Virechana, Raktamokshana, and Snehapana in the Ayurvedic management of Vipadika as correlated with palmoplantar psoriasis. Clinical Illustration: A 50-year-old female patient presenting with a 3-year history of pruritic rashes, cracks (Sphutana), burning sensation (Daha), and bloody-watery discharge on both palms and soles was managed with a structured Shodhana protocol encompassing Shodhnartha Snehapana with Mahatikta Ghrita, Virechana using Icchabhedi Rasa, Samsarjana Krama, Raktamokshana by Siravedha, and Shamana Aushadhi. Outcome: Significant improvement was noted in the Simplified Psoriasis Index (SPI) score — reducing from 23 (severe) to 10 (moderate) — along with marked relief in itching, scaling, burning, and discharge. Complete remission of Kandu and Daha was achieved after Raktamokshana and Shamana therapy. Conclusion: Panchakarma therapies, particularly Snehapana, Virechana, and Raktamokshana, offer a safe and effective therapeutic approach for Vipadika, providing lasting symptomatic relief with minimal adverse effects.