Abridged Form of Published Study
To assess the efficacy of oil prepared from the leaves of wrightia tinctoria (psoranil oil) externally, when used alone and along with internal indigenous medicines.
Prospective clinical trial of 90 days followed by one year follow up, comparative study of two groups, one with externally used oil preparation of wrightia tinctoria (psoranil oil) alone and the second with the same external medicine plus internal indigenous medicines.
Sixty patients of psoriasis with varying clinical types of lesions.
Clinical appearance with Auspits and koebner phenomenon.
Clinical improvement, i.e. Disappearance of lesions, reduction in surface area of skin involved and reduction scaling.
Psoriasis is a recurrent, non-allergic, non infectious papulo-squamous chronic inflammatory disorder constituting more than 3% of all skin diseases in this country.
The mode of inheritance is not clear, However, evidence of dominant as well as polygenic patterns exist with association of HLA antigens B13, B17, B27, CW6 and DR7.
Except in typical lesions, especially during the development or resolution of psoriasis, the clinical appearance is unmistakable. The lesion have well defined margins with silvery scales originating from the plaque.
The primary aim is to make the patient cosmetically acceptable by depressing the epidermal turnover. There should not be any damage to the skin or systemic complications either.
|Group||Mean Age||Sex||Mean Chronicity||Aggravated in winter|
|I||35.6 yrs||Male 60%
|II||34.5 yrs||Male 63.33%
|SI. No.||Name of Medicines||Dosage|
|1||Mahamanjishtadi Kashayam.||90 ml bid|
|2||Guloochee satwa.||1 g twice daily|
|3||Kaisora gulgulu vatika||1 twice daily|
|Days.||Group I. No. of cases/Percentage||Group II. No. of Cases/Percentage|
|15th day||Nil||1 (3.33%)|
|60th day||21(70%)||22 (73.33%)|
|90th day||24 (80%)||26(86.67%)|
Trial in psoriasis with the oil perepared from wrightia tintoria (Psoranil oil) is not new and was originally conducted as part of research in siddah medicine by CCRAS (Krishnamoorthy J.R. et.al.1987 – vide REF. NO.3). In this study the same oil was used internally also. However, in our study, we used the oil for external use only. As a comparative study involving concurrent administration of internal ayurvedic medicines was found lacking, we used ayurvedic drugs internally (Table II).
Wrightia tinctoria R.Br. Belong to the natural order apocynaceae and is known locally as Thondappala, Veppala etc. It is a deciduous tree with milky juice, commonly found in parts of south India.
Since the relation between psoriasis and arthritis is very close, the medicines selected to be given internally for group 2 was on the lines of Vatasonita Chikitsa.
Sixty cases of psoriasis were selected for the study irrespective of age, sex chronicity. Presentation, prediction to climate and food habits (see table 1). The cases were divided into two groups of 30 cases each, group I receiving the coconut oil based preparation of wrightia tinctoria for external use alone and group 2 receiving the above along with internal medicines (Table II-list of internal medicines).
All patients in both groups had routine haemogram (TC, DC, ESR & Hb%) Prior to the treatment. Routine urine examinations before and after treatment were also done, B.P.was recorded weekly and all who had arthirits were subjected to RA test
The oil was applied all over the affected area liberaiiy twice daily after bathing without soap .After painting the oil in the morning they were exposed to the sun for 10-15 minutes .Any excess oil was wiped off with a dry towel but never washed off.
The two group were similar with regards to mean age .chronicity ,nature of lesions,climate predisposition,relationship of lesions with stress etc.Duration of treatment for both the groups was fixed as 90 days .The patients were examined bi-weekly till the 90 days anfd bi-monthly for a further period of one year. All cases strictly advised to avoid during the study and follow – up, the following—fish, seafood, pungent/spicy food, excess of salt/chillies/sour food, eggs, synthetic dress materials and possible allergens during the study and follow-up period. They were advice to follow plain vegetarian diet excluding curd and black gram.
The Results are given in Table III.
Only patients who had complete symptomatic relief (Group 1-24 and group 2-26) were examined bi-monthly follow-up for one year. One of group 1 and 2 of the group II did not complete the follow-up. No patient had any relapse till the second visit. Two cases of group 1 (8.33 % ) and one of the group 2 (3.85%) showed mild relapse of lesions at the third visit (10%). These relapses were in the winter and on the repeatation of the treatment, they were asymptomatic within thirty days. Thereafter no relapse occurred.
The drug for external use was selected on the basis of studies conducted by ccras (Alam, M, et al). It was used by ancient practitioners of kerala in similar conditions. This study aims at assessing the efficacy of oil prepared from wrightia tinctoria (Psoranil oil), compared to those who were given also classical ayurvedic preparations alone does not produce any significant relief and hence a control was not included. The result of the study (table III) shows that group II did not show significant results. Oil prepared from Wrightia tinctoria (psoranil Oil)suits the management of the disease more than other drugs as it is produces good cosmetic results and by absence of complications. The drug may either be acting as a catalyst to the inhibiting factors of cell cycles or it may be inhibiting the stimulating factors. In both cases, the epidermal turnover is normalized. Due to the poor response to treatment, tendency to recure and link with arthritis, Psoriasis can be held as a thridoshja condition.
The claim of relief from the symptoms of psoriasis by the use of wrightia tinctoria based coconut oil (psoranil oil) is substantiated. Concurrent use of internal medicines were not much value.
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Psoriasis is a common genetically determined inflammatory and proliferative diseases of the skin .the diseases is widely variable in duration and extent of involvenment
.the exact etiology of psoriasis is unknown .but on a genetically predisposed in dividual,factor like trauma ,intection ,drugs hypercalcaemia and stress can precipitate as well as exacerbate psoriasis.
Even though a number of modalities for treatment of psoriasis is available ,they are far from satisfactory from the point of view of the patients.
In the present on going open study wrightiatinctoria oil (psoranil oil) is evaluated for efficacy patients acceptability and side effects .
Psoriasis patient attending the out-patient department of dermatology and venerology of medical college hospital ,thirissur are taken for the study .
Wrightia tinctoria is a small deciduous tree commonly seen in moist deciduous and dry deciduous forests of the Indo-Malasian region. The oil is prepared from it.
Patients with chronic plaque psoriasis are taken for the study. They are asked to apply Wrightia tinctoria Oil (Psoranil Oil) one hour before bath. After bath, patient is asked to apply coconut oil. The patients are evaluated by the same person on weekly intervals using PASI Score. In selected cases biopsies are done before and after treatment.
The haematological and biochemical parameters are monitored during and after treatment. The side effects are also noted (if they develop ) during treatment.
Twenty patients of the age group of 12-77 years arestudied. (The mean age 42.3 years) The patients belonged to the middle and low income group. The male : female ratio is 4:1. The percentage of involvement of body surface area on an average is Head: 24.38 % trunk: 31.5%, upper limp: 20.5 and lower limb: 35.25%. The PASI score at the beginning was 12.9 and at the end 1.31 i.e there is a reduction of 90% in the PASI Score Regionwise also it showed a marked reduction, i.e. Head: 89.92%; upperlimb: 87.03;88.97% and lowerlimb:90.16%.
At the beginning, biopsy showed classical histology of psoriasis. At the end of 14 weeks the biopsy is repeated from the same site as well as another site. Both biopsies showed reduction in Acanthosis, reduction in the rete peg length and marked reduction in the dermal infiltrate.
A number of treatment modalities are available for the treatment of psoriasis. None of these agents are curative; remissions can be prolonged with the present treatment regiments is that they are either toxic on long term usage or expensive.
In the present study the effect of the wrightia tinctoria oil (Psoranil Oil) on Psoriasis is evaluated. The evaluation is based on the PASI Score eas 12.9 and the end of 4 weeks it has came down to 1.31. This shows there is a marked reduction in the severity of the disease (90%).
The clinical response is supported by histopathological evidence. The biopsy at the beginning of the treatment showed classical histology of Psoriasis. After 4 weeks of treatment, there is marked reduction in the dermal infiltrate.
This shows the action of the oil is through the immune system. The present concept about the aetiology of psoriasis is that the antigen presenting cell takes up an unknown antigen which turn produces interleukin I (IL-I) which stimulates the CD4+T Cells. CD4+ cells produce IL-2, IL-6 and IL-8 and results in keratinocyte multiplication. So after therapy with Wrightia tinctoria oil (Psoranil oil), there is decrease in the dermal infiltrate. This shows that the action of the oil is either at the antigen uptake level or at the production of IL-1. This hypothesis needs further studies to be confirmed.
The haematological and biochemical parameters are monitored during and after treatment. There were no abnormalities in any of these parameters. This shows that the drug is relatively non toxic.
Clinically the patients were examined for any untoward reaction of the drug. Only one of the patients showed an increase in itching during treatment which necessitated the discontinuation of the drug. No other side effects are seen during treatment.
From the foregoing results it is presumed that the drug is effective, economical and patient friendly.
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