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Introduction

Skin disorders are comprehensively described under the umbrella term Kushtha in Ayurveda. All Kushthas are considered Tridoshaja,[1] involving the vitiation of Vata, Pitta, and Kapha along with dushyas such as Twak, Rakta, Mamsa, and Lasika.[2] Vipadika is categorized under Kshudra Kushtha and is predominantly Vata-Kapha pradhana.[3] Classical texts describe Vipadika as characterized by Pani-Pada Sphutana (cracks in palms and soles) associated with Teevra Vedana.[4] Acharya Vagbhata further mentions erythematous patches,[5] while Acharya Sushruta highlights itching and burning sensations. Although no exact correlation exists in modern dermatology, the clinical features resemble palmo-plantar psoriasis, contact dermatitis, and dyshidrotic eczema.

Ayurvedic management emphasizes Nidana Parivarjana, Shodhana, and Shamana Chikitsa to address the root cause. This case study documents the effective management of Vipadika Kushtha using classical Ayurvedic principles.

Materials and Methods:

 

Case Presentation

A 45-year-old female patient visited the Kayachikitsa OPD of SKAMCH & RC on 01/07/2024 with complaints of itching, extreme dryness, and blackish discoloration over bilateral palms and soles in the past one year, aggravated over the last three months. She also complained of peeling of skin and pain for four months.

History of Present Illness

The patient was apparently healthy until July 2023. During renovation of her house, she had repeated exposure to cement, paint, and paint thinners. Within one week, she developed itching and dryness over both palms, followed by blackish discoloration and inflammation, initially on the left palm and later involving the right palm.

She consulted a dermatologist in December 2023 and received treatment for three months with minimal improvement. By March 2024, similar symptoms developed over both soles, following which she discontinued the treatment. Negligence aggravated dryness and led to skin thickening and painful fissures. She also developed restriction of movement in the right little finger due to tightening of healed skin.

Personal History

Diet: Mixed (non-vegetarian once weekly with curd)

Appetite: Good

Bowel & Bladder: Regular

Sleep: Sound, 6 hours

Habits: Coffee with jaggery – 4 times/day

Clinical findings

General Examination

• Built: Endomorphic
• Appearance: Irritated
• Nutrition: moderately nourished
• Tongue: Coated
• Pallor/Icterus/Cyanosis/Edema: Absent

Vital Data:

Temperature- 98.5 F

Blood pressure- 130/90 mmHg

Pulse- 78bpm

Respiratory Rate- 18 bpm

Heart Rate- 78bpm

Systemic Examination (Integumentary System)

Inspection:

• Site: Bilateral palms and soles
• Color: Blackish
• Lesions: Hyperkeratotic plaques
• Distribution: Bilateral
• Border – Irregular
• Discharge – Absent
• Scaling: Present
• Itching: Present

Palpation:

• Tenderness: Mild
• Texture: Rough
• Elevation: Absent
• Skin thickening: Present
• Moisture: Absent
• Superficial Sensation of Skin- Aesthesia

Special Tests:

• Koebner phenomenon: Positive
• Candle grease test: Negative
• Auspitz sign: Negative

Differential diagnosis:

In the early phase, the patient presented with features suggestive of allergic contact dermatitis, including severe itching with oozing following exposure to chemical irritants. Over time, the clinical picture evolved into a chronic palmo-plantar dermatosis characterized by hyperkeratosis, fissuring, and moderate itching with occasional bleeding on scratching, which are more consistent with palmo-plantar psoriasis. The absence of vesicular eruptions and the presence of typical psoriasiform changes further support this progression. Thus, the case is interpreted as an initial contact dermatitis acting as a trigger, later manifesting as palmo-plantar psoriasis.

Differential diagnosis as per Ayurveda:

Vipadika can be differentiated from Padadari based on doshik predominance, clinical features, etiological factors, and the site of involvement. Vipadika is primarily a Vata-Kapha pradhana disorder, whereas Padadari is caused predominantly by vitiated Vata alone. Clinical manifestations such as Ruja (pain), Srava (discharge), and Kandu (itching) are commonly observed in Vipadika, while Padadari is mainly characterized by Ruja (pain) without associated discharge or itching.[6] In terms of distribution, Vipadika affects both the palms and soles, whereas Padadari predominantly involves only the soles.

Diagnosis

Kshudra Kushtha - Vata-Kapha Pradhana – Vipadika kushtha

Palmo Plantar Psoriasis

Nidana:

Aharaja : Ati snigdha ahara, anupa-janghala mamsa with curd, excess use of Tila, Guda etc

Viharaja: Exposure to paint, cement, paint thinners, Vega dharana

Samprapti

Nidana Sevana

Tridosha Prakopa                                                           

Spreaded In Tiryak Gata Siras               

Twak, Rakta, Lasika Dushana       

 Dosha Dushya Sammurchana In Twak

Sthana Samshraya In Pani-Pada

Vipadika

Purva Roopa: Kandu

Roopa: Kandu, Vedana, Pani pada sphutana, Pani pada rukskhta, Pani pada vivarnata

Upashaya: Applying coconut oil, petroleum jelly, soaking hands in water

Treatment Given:

Initially, Deepana–Pachana was carried out for five days using Avipattikara Churna and Chitrakadi Vati to normalize Agni. This was followed by Snehapana with Aragwadha Mahatiktaka Ghrita administered in an Arohana manner.[7] Subsequently, the patient was advised Vishrama Kala, during which Abhyanga and Swedana were performed. Thereafter, Virechana Karma was administered as the principal Shodhana procedure. Following Virechana, Samsarjana Krama was advised for five days, after which Shamana Aushadhis were prescribed for a duration of one month.

Table 1.  Shodhana Treatment plan

Table 2. Shamana Aushadhi given after the shodhana karma

Obseravtions and Results:

Table no. 3 obseravtion evaluation table

Discussion

The present case illustrates a chronic palmo-plantar dermatosis that appears to have evolved over time from an initial contact dermatitis into a psoriasiform condition, clinically correlating with Vipadika Kushtha. The onset of symptoms following repeated exposure to chemical irritants such as cement, paints, and solvents strongly suggests an Agantuja origin in the early phase. Contact dermatitis is known to occur due to disruption of the epidermal barrier and sustained inflammatory activation, particularly when exposure is repeated or prolonged. In the present case, the persistence of the irritant stimulus and incomplete resolution of inflammation likely contributed to chronicity and progression of the disease. Over time, the clinical picture shifted from an acute inflammatory presentation to a more chronic hyperkeratotic state characterized by thickened skin, fissuring, pain, and discoloration over the palms and soles. In modern dermatology, such progression is explained by continued immune activation and epidermal hyperproliferation, which may occur in susceptible individuals. Chronic irritation and mechanical trauma are recognized triggers capable of inducing psoriasiform changes through a Koebner-like response. This is supported in the present case by the presence of Koebner phenomenon and the development of well-defined hyperkeratotic plaques, which are not typical of simple contact dermatitis.[11] From an Ayurvedic perspective, the initial Agantuja Nidana leading to Pitta involvement gradually progressed into a Vata-Kapha pradhana state due to chronicity, resulting in rukshata, sphutana, shoola, and skin thickening—features classical to Vipadika Kushtha. Kushtha is described as a Bahudosha Avastha involving deep-seated dosha vitiation along with dushyas such as Twak, Rakta, Mamsa, and Lasika. In this case, the presence of chronic inflammation, hyperkeratosis, fissuring, and discoloration indicates Rakta Dushti with associated Pitta involvement, later compounded by Vata-Kapha dominance. In such conditions, Shodhana is considered essential rather than relying solely on local or palliative measures. The selection of Virechana Karma was therefore appropriate, as it is the principal Shodhana therapy indicated for disorders involving Pitta and Rakta, especially when the pathology has its origin in the Amashaya. Prior Deepana-Pachana helped in correcting Agni and preparing the patient for Shodhana, thereby preventing complications during Snehapana and Virechana. Snehapana with Aragwadha Mahatiktaka Ghrita facilitated the loosening of the dosha-dushya complex and mobilization of vitiated doshas from peripheral tissues into the gastrointestinal tract. Virechana Karma resulted in effective elimination of vitiated Pitta and Kapha, purification of Rakta Dhatu, correction of metabolic imbalance, and proper Anulomana of Vata. Clinically, this was reflected by a marked reduction in itching, pain, fissuring, and hyperkeratosis, indicating interruption of disease progression at a systemic level.

Following Shodhana, Shamana Aushadhis were administered to maintain doshic balance and prevent recurrence. Drugs like Patola Katurohinyadi Kashaya possess Tikta and Kashaya Rasa, which are Kapha-Pittahara and Rakta Shodhaka. Avipattikara Churna aided in maintaining digestive fire and preventing re-accumulation of Pitta. These medicines help control residual inflammation, support tissue metabolism, and maintain the benefits achieved through Shodhana. The sustained improvement observed during follow-up suggests that post-Shodhana Shamana therapy plays a crucial role in long-term disease control, especially in chronic and recurrent conditions like Vipadika Kushtha. External application with Jeevantyadi Yamaka played a supportive role by restoring the skin barrier, reducing transepidermal water loss, and alleviating dryness and itching. Ingredients such as Tila Taila, Sarja Rasa, and Ghrita possess Snigdha, Vatahara, and Tvachya properties. This topical therapy helped soften hyperkeratotic skin, promote healing of fissures, and reduce local irritation, thereby complementing systemic therapy.

Conclusion

This case study highlights the successful Ayurvedic management of Vipadika Kushtha through Shodhana and Shamana Chikitsa, effectively relieving dryness, itching, and skin thickening by addressing the Vata-Kapha imbalance. Avoiding the root cause (Nidana Parivarjana) played a key role in preventing recurrence, ensuring long-term benefits beyond symptom relief. The results reaffirm Ayurveda’s root cutting approach in treating chronic skin conditions by restoring skin health and overall well-being.