Case Report: Management of D<i>adru Kushtha</i>&nbsp;(Tinea Corporis) by S<i>hamana Chikits</i>

Manisha Panda; Sourabh Deshmukh; Trupti Thakre

doi:10.12688/f1000research.142589.1

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Case Report

Case Report: Management of Dadru Kushtha (Tinea Corporis) by Shamana Chikits

[version 1; peer review: 2 approved with reservations, 1 not approved]

Manisha Panda ¹, Sourabh Deshmukh², Trupti Thakre³

PUBLISHED 08 Jan 2024

Author details Author details

¹ Kaumarbhritya, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
² Kayachikitsa, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
³ Kaumarbhritya, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India

Manisha Panda
Roles: Conceptualization, Resources, Writing – Original Draft Preparation

Sourabh Deshmukh
Roles: Conceptualization, Methodology, Resources, Validation

Trupti Thakre
Roles: Validation, Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Datta Meghe Institute of Higher Education and Research collection.

Abstract

Background

Skin disorders are often seen as a result of a change in lifestyle, a lack of physical activity, and inadequate nutrition. Hygiene, emotional stress, and poor eating habits are also factors to consider. Kushta is the term used in Ayurveda to describe all skin disorders which is classified as Mahakushtha (major skin disorders) and Kshudrakushtha (minor skin disorders). Dadrukushta is a type of kshudrakushta that is commonly seen in clinical practice. In Ayurveda, the signs of dadrukushta are same as those of Tinea corporis, which is explained in modern science. Tinea corporis has a wide range of clinical symptoms that are mostly dependent on the infective organisms. By treating the condition with Ayurveda’s treatment therapy produces long term Outcomes.

Aim & Objectives

Aim of this contemporary study was to assess how Ayurvedic modality shamana chikitsa works on Dadrukushta.

Case

A 27 year old male patient approached to Kayachikitsa OPD with complaints of blackish lesions with raised borders and itching over the chest and back (upper) region for 15 days having disturbed sleep which undergone treatment of shamanachikitsa (palliative care). Dadrukushta (Tinea corporis) can be dealt with shamana karma (palliative care) using internally Gandhakrasayan (Moringa ovalifolia prepared from sulphur), Panchtiktaghrita (Pancha means five, Tikta means bitter in taste. Tikta Rasapradhan Dravyas are collectively called as Panchatikta Dravyas. The five Dravyas are Azadirachta indica (Neem), Trichosanthes dioica (Patola), Solanum xanthocarpum (Kantakari), Tinofpora cordifolia (Guduchi) and Adhatoda vasica (Adulsa), fungiwin cream, Karanjataila (Pongamia pinnata oil tree), S-kin powder for local application for 45 days.

Results

The Gradation Score was 8 before treatment, after 45 days it was 0. The patient in this case study experienced relief in the symptoms.

Conclusions

The patient obtained better results by Shamanachikitsa.

Keywords

Dadrukushta, Tinea corporis, Shamana, kshudrakushta, skin disorders, kushta

Corresponding author: Manisha Panda

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Panda M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Panda M, Deshmukh S and Thakre T. Case Report: Management of Dadru Kushtha (Tinea Corporis) by Shamana Chikits [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2024, 13:26 (https://doi.org/10.12688/f1000research.142589.1) First published: 08 Jan 2024, 13:26 (https://doi.org/10.12688/f1000research.142589.1) Latest published: 08 Jan 2024, 13:26 (https://doi.org/10.12688/f1000research.142589.1)

Introduction

Skin is the biggest and heaviest organ in the body, spanning an average of 20 square feet. The most obvious function of the skin is to protect our internal organs from the environment, but it does so much more.¹ Dermatophytes are fungi that invade and proliferate inside keratinized tissue (skin, hair, and nails).² Trichophyton (which causes infections in the skin, hair, and nails), Epidermophyton (which causes infections on skin and nails), and Microsporum (which causes infections in the skin and nails) (which causes infections on skin and hair) are the three classes of dermatophytes. Based on their route of transmission, they have been classified as anthropophilic, zoophilic, or geophilic. Finally, depending on the people who have been affected.³ Incubation period is 1-3 weeks.⁴

Tinea corporis often manifests as a well-defined, strongly delineated, oval or circular, moderately erythematous, scaly patch or plaque with a raised leading edge.⁵ As the active boundary extends outward, the centre region becomes hypopigmented or brown and less scaly.⁶The margins are frequently circular and uneven. Multiple lesions gather to form polycyclic patterns.⁷ Ayurveda classifies all skin diseases as ‘Kushtha,’ which is further subdivided into two types: Mahakushtha (major skin disorders) and Kshudrakushtha (minor skin disorders). Dadru (Tinea corporis) is one of them.⁸ Acharya Charaka⁹ defines Dadru (Tinea corporis) as Kshudrakushtha (minor skin disorders), although Acharya Sushrut and Acharya Vagbhat define it as Mahakushtha.¹⁰ Vishamashana (incompatible food), vega vidharana (suppression of natural urges), diwaswapa (daytime sleeping), atilavana, atitikshnaahar (excessive salty or spicy food), contaminated food, drinking cold water immediately after physical work, or atapsevana (exposure to sunlight) are all factors that contribute to Kushta.¹¹ Dadru’s principal lakshanas are Kandu (itching), Utsanna (elevated circular lesions), Mandala (circular patches), Raaga (erythema), and Pidakas (papule). Dadru samprapti is characterised by Pitta-kapha dosha vitiation and rasavaha and raktavaha strota dushti.¹² Dadru is associated with Tinea/Fungal Infections because to comparable features. Tinea infections affect 5 persons out of every 1000.¹³ Tinea Cruris, often known as Jock Itch, is a fungal infection that affects the groin, perineum, and peri-anal region. It might appear unilaterally or bilaterally as a red, raised, and active border. The most prevalent organisms that cause ‘Tinea cruris’ are Trichophyton rubrum and Epidermophyton floccosum.¹⁴ The climate in India favours the acquisition and maintenance of mycotic infections. Dermatophyte infection is more frequent in people aged 16 to 45.¹⁵ Scalings in ‘Tinea cruris’ are varied, and vesiculation is uncommon. It frequently happens to individuals who are wearing garments made of synthetic materials, which tend to trap heat and humidity in the skin.¹⁶ It is treated in modern medicine using topical and systemic antifungal medications, as well as corticosteroids. Shodhan, Shaman, and Bahirparimarjan (topical) Chikitsa are Ayurvedic remedies for Dadru.¹⁷ In this case study, all these therapy techniques are applied.

Dadrukushta (Tinea corporis) is one of the kshudrakushta (minor skin disease) having lakshanas (symptoms) like Kandu (itiching), Atasipushpa like Pidika, Varna with Mandal (patches), Unnata Mandala (raised borders), Dirghapratana (macular rashes), Tamra Varna Pidika (copper coloured macular rashes).¹⁸ Due to vitiation of sapta dhatus (seven tissue) like three Doshas (bodily elements), Twak (skin), Rakta (blood), Mamsa (muscles) and Lasika (blood vessels) for manifestation of kushta.¹⁹ Dadrukushta is having management with shamanachikitsa (pacification).

Case report

A 27-year man working as a farmer, came with complaints of blackish lesions with raised borders and itching over the chest and back (upper) region for 15 days and having disturbed sleep because of itching. The patient was symptomless before 15 days, after that he started complaining of multiple blackish lesions with raised borders and itching over chest and back, gradually it increased and spread over chest and back (upper)region. The patient approached to MGACH & RC Salod (H) Wardha for Ayurvedic management after examination he was advised for Shamanachikitsa (palliative care). Patient had no significant past history. On examination vitals like blood pressure, temperature, heart rate and respiration rate were within normal limits.

History of present illness

Before 15 days, the patient was OK, but then he acquired round and reddish spots across his abdomen, accompanied by acute itching. He had received Allopathic treatment from a local practitioner for this but had not received satisfying results, so she came to MGAC Hospital for care.

There was no history of diabetes mellitus/insipidus, hypertension, bronchial asthma, or hypothyroidism. There was also no related family history. Except for the patient’s constipation, Ashthavidh pariksha was within normal limits. The patient was of madhyam akruti/medium body build andlocal examination revealed 4-5 circular erythematous, well-demarcated areas with vesicular eruption across the abdomen. There is no drainage from the lesion. The vital values were normal. Dadru (Tinea corporis) was identified based on clinical characteristics.

Personal history

Ahar (diet) is mostly Mixed (Veg-Non veg),nidra (sleep) isdisturbed due to itching, patient has no bad Vyasan (habits), Occupation of the patient is farmer.

AshtavidhaPariksha:

1. Nadi/pulse – 74/min
2. Mala/ bowel movement – Saam/bowel with undigested toxins
3. Mutra/micturition – Samyak/proper
4. Jivha/tongue – Saam/coated
5. Shabda/speech – clear/Spashta
6. Sparsha/temperature on touch – rough/khara
7. Druka/eyes – Prakruta/normal with no pallor or icterus
8. Akruti/body build – Madhyam/average

Agni (digestive fire) = Agnimandya/poor

Bala/strength = Madhyam/average

Raktadaaba (Blood pressure) = 130/80 mm/Hg.

Skin examination

1. Inspection:
- • Size shape – annular lesions
- • Color – blackish lesions
- • Lesions – scaly patch
2. Palpation:
- • Moisture – dryness
- • Temperature – warmth of the skin
- • Texture – rough

Laboratory investigation

Blood routine – Normal

Samprapti Ghataka²⁰

• Dosha/bodily humors – Tridosha/dominance of three bodily humors
• Dushya/elements affected by bodily humors – twaka, rakta, mamsa, lasika
• Ama (undigested food particle) – Jatharagnijanya Ama/digestive fire related umdigested toxins
• Agni (digestive fire) – Jatharagni
• Srotas(inner transport system of the body) – Rasavaha, Raktavaha
• Srotodushtiprakara/type of imbalance in inner transport system – Sanga/obstruction
• Rogmarga(path of disease) – Bahya/external
• Udhbhavasthana (site of location) – Amashaya/stomach
• Vyaktasthana – twacha/skin
• Rogaswabhava – chirakari/long-term
• Sadhyasadhyaata – Sadhya/curable

Samprapti: (pathogenesis)

↓

Nidan (causative factor) sevana like Aharaja-Viharaja-Manasika (irregular food habits, Non Veg diet, consumption of alcohol), Ativyayam (excessive exercise), Atichinta (excess worry), Ratrijagarana (awakening at night).

↓

TridoshaPrakopa (Vitiation of all three elements)

↓

Twaka, Rakta, Mamsa, Lasika (Dushya)

↓

Sthanasamshraya in Twacha (localized in skin)

↓

Rukshapidika/dry lesion with kandu/itching

DadruKushta/Tinea corporis

Methods

The patient came to the OPD having the complaints of reddish patches. Written informed consent was taken from the patient before administration of conservative treatment and his detailed information was kept confidential.

Treatment plan given

Shamanachikitsa (Pacifying treatment) for 15 days comprising Gandhakrasayana, Panchatiktaghritawhich is to be given orally and fungiwin cream, Karanjataila and s-kin powder with Gomutra for localapplication (Table 1). After 15 days patient was called for followup. All medicines were continued except Gandhakrasayan, it was temporarily stopped for period of 7 days. After 7 days, the patient was asked to continue Gandhakrasayan for another 15 days with other medicines.

Table 1. Table showing Shamana Aushadhi/palliative care and Bahirparimarjana Chikitsa/external procedures.

Sr.no	Medicine	Ingredient	Botanical name	Dose	Anupana	Route
1.	*Gandhak Rasayana*	Gandhaka Godugdha (cow milk) Twak Ela Patra Nagakeshara Guduchi Haritaki Amalaka Vibhitaki Shunthi Bhringaraja Ardraka Sita (sugar syrup)	Purified Sulphur Cinnamomumzeylanicum Elettariacardamomum Cinnamomumtamala Mesuaferrea Tinosporacordifolia Terminalia chebula Emblica officinalis Terminalia bellirica Zingiber officinalis Eclipta alba Zingiber officinalis	500mg twice daily after lunch and dinner	Lukewarm Water	Orally
2.	*PanchatiktaGhrita*	Nimba Patola Vyaghri Guduchi Vasa Haritaki Vibhitaki Amlaki	Azadirachtaindica Luffa acutangular Solanum xanthocarpum Tinosporacordifolia Adhatodavasica Terminalia chebula Terminalia bellirica Emblicaofficinaliss	10 ml twice daily after breakfast and dinner	Lukewarm Water	Orally
3.	*Karanja Oil*	Karanja Saptachada Langali Snuhi Arka Anala Bhringaraja Nisha Gomutra VishaMurchhita Sesame oil	Pongamiapinnata Alsoniascholaris Gloriosa superb Euphorbia nerifolia Calatropisprocera Plumbago zeylanica Eclipta alba Curcuma longa Cow urine Aconium ferox	3 times a day	--------	Local application
4.	*Fungiwin Cream*	Shuddhagandhak Krishna jeerak Avalguja Garudaphala Bakuchi Mathulunga Eshwari Madatanthika Edagaja	Purified Sulphur Nigella sativus Vernonia anthelmintica Hydnocarpuspentandra Psoraleacorylifolia Citrus aurantifolia Aristolochiaindica Lawsoniainermis Cassia alata	Two times a day	-------	Local application
5.	*S-kin Powder*	Manjishtha Amalaki Haridra Vibhitaki Nagarmotha Shuddhagandhak	Rubiacordifolia Embilica officinalis Curcuma longa Terminalia bellirica Cyperusrotundus Purified sulphur	Application before bath	Gomutra	Local application

Assessment criteria

Patient evaluation was based on improvements in subjective criteria such as Kandu (Itching), Raaga (Erythema), Utsanna mandala (Elevated Circular Skin, Lesion), and Pidika (Eruption), as well as images of the lesion before, during, and after therapy. Raaga (Erythema) was present prior to therapy and persisted during the first follow up, however it was eliminated on days 15 and 45, respectively, following treatment completion. Thus, following therapy, there was total improvement in all indices. The same can be observed in the photos below, which were taken before, during, and after therapy.

Observation

Tinea corporis is a Dermatophyte that causes inflammatory and non-inflammatory lesions on glabrous skin.²¹After 15 days treatment, symptoms subsided in patient but there were still some annular lesions present. Hence Shamanachikitsa was continued with the gap of 7 days except Gandhakrasayan. After completion of Shamanachikitsa, the patient was assessed as per the gradation of Lakshana of Dadru like Utsanna Mandala, Pidikas and Kandu as shown in Table 2 which became grade 0 after 45 days of treatment as given in Table 3. Also, the patient was symptomatically improved (Figure 1).

Table 2. Showing gradation.

Sr.no	Gradations	Grade 0	Grade 1	Grade 2	Grade 3
1.	Utsanna mandala (Elevated Circular Skin, Lesion)	Absent	Mild elevated lesion	Moderate elevated lesion	Severe elevated lesion
2.	Pidikas (acne)	Absent	1-3 eruptions	4-7 eruptions	>7 eruptions
3.	Kandu (itching)	Absent	Mild or occasional itching	Moderate or frequent itching	Severe itching

Table 3. Evaluation performed before, during, and after therapy.

Gradation	Day 0	Day 15
Utsanna mandala (Elevated Circular Skin, Lesion)	2	1
Pidika (acne)	3	2
Kandu (itching)	3	2

Figure 1. Before and after treatment image of patient diagnosed with Dadru/Tinea corporis.

Discussion

In the context of Ayurveda, kushtha is the term used to describe many types of skin illnesses, which encompass all main skin manifestations such as Tinea. The symptomatic manifestation of tinea corporis resembles that of “DadruKushtha” mentioned in Ayurvedic Samhita. This skin condition adversely affects one’s own quality of life. Ayurveda offers a viable medication for Tinea corporis.

Gandhak Rasayan’s mechanism of action: Gandhak rasayan is generally used to cure Kushtha roga. It is antimicrobial and anti-fungal in nature. It primarily affects Rakta Dhatu, causing Raktashodhana (purification of blood). Its antifungal property aids in the reduction of infection. It also performs the role of Rasayana. Its RaktaShodhaka, Vranaropak, Krumighna and Kushthagna properties reduce the Kandu, Pidika,Raaga and Daaha^..²²

Contents: Gandhak, Haritaki, Amalaki, Bibhitaki, Detoxified ghee, Ginger and Bhringraj. Mode of action: It is Raktashodhak, Vranaropak, Twachya, and Krumighna. It acts as a blood purifier and reduces Kandu/itching and Daha/burning sensation. Gandhaka Rasayana keeps three bodily humors, vata, pitta and kapha in equilibrium. It is a familiar, usually used formulation and specified in Kushtha.²³

Mode of action of Panchatikta ghrita

Ghrita is recommended in Kushtha Chiktsa in Samhitas. Vata -Pitta Shamaka and Tvachya (improves complexion) properties of Panchatikta Ghrita helps to alleviate Kushthaghna (skin disease).²⁴

Mode of action of Karanja oil

Karanja oil is mentioned in Visarpa Chikitsa in BhaishajyaRatnavali. It consists of Krumighna (antifungal and antibacterial activities), Kandughana, Vranaropaka and Vranashodhaka properties.²⁵Local application is beneficial for rapid absorption and reduction of kharata/dryness.²⁶

Mechanism of action of S-kin Powder

Ingredients have antibacterial, antifungal, and antimicrobial characteristics, as well as Raktashodhaka (blood purification) and Vranaropak (wound healing) properties. While application of this powder Gomutra should be mixed which enhance its absorption property.²⁷

Mode of action of Fungiwin Cream

Fungiwin contains Shuddha gandhak, Krishna jeerak, Avalguja etc which acts as a Krimighna, Rasayana Deepan, Pachan, Vishagna as well as Balya.it acts on all the Dhatus by acting on Dhatwagni. Hence help to formation of new cells in body. It also works as Antifungal with the gap of 7 days rejuvenation hence used in various skin diseases.

Dadru is Pitta-Kapha dominance according to Acharya Charak and Vagbhata, and Kaphapradhan according to Acharya Sushruta. Rasa and Rakta are both involved in the samprapti. Kushta is characterised in Samhita by repeated Shodhana and Shamana medications with Kushtaghna, Krumighna, and Kandughna characteristics. In addition, Bahiparimarjana Chikitsa (local application of medications) in the form of lepa and oil was recommended for improved results.²⁸ In certain cases, the Ayurvedic therapy technique produces excellent outcomes. Pitta and Kapha are the most vitiated Doshas with Rasa and Rakta Dhatu, while Lasika and Tvak are Dushyas in Dadru.²⁹‘Nidana Parivarjana’ is regarded as the initial stage in Dadru management. Untidiness of the body, sharing cloths (towels), and so on should be avoided depending on Nidana’s involvement.³⁰ Dadru, in both its acute and chronic forms, causes physical and emotional distress in humans, as itching and other symptoms persist throughout the day.³¹ Ayurvedic medicine is a medical discipline that provides lasting cures by employing internal and external medicine. The qualities of Kushthaghna, Kandughna, and Krimighna might aid in the safe and successful treatment of Dadru patients.³² The skin is the index of a person’s mind; in daily life, people consume incompatible diets and dietary habits, which lead to many diseases, among which skin disorders are prominent, and Dadru is one of them. Dadru Kushtha is a very infectious Kaphapitta Pradhana Tridoshaja Aupasargika Roga. Dadru, while treatable, has a stubborn character. If the course of treatment is not carefully managed, remission and relapses are common; thus, treatment should be started as soon as feasible. Ayurvedic therapy focuses on avoiding etiological variables (Nidana Parivarjanam) and breaking down pathology (Samprapti Vighatana), which leads to Dhatu Samya.³³

Conclusion

Tinea corporis is associated with DadruKushtha based on signs and symptoms. Chikitsa is planned in Kushtharoga, depending on the severity of Roga. ShamanaChikitsa is administered in Alpadoshaavastha (least severe). Dadru kushta is a kind of Kshudrakushta, according to Acharya Charak, and Mahakushtha according to Acharya Sushruta and Acharya Vagbhata. Tinea corporis or dermatophytosis may be involved. Because it is an infectious illness, personal hygiene is critical in its treatment. From this case study it can be concluded that use of Chikitsa upakramas described in Ayurveda like Shodhana (Nitya virechana with Gomutra siddha haritaki), Shamana (formulations like Arogyavardhini vati, Gandhak rasayan) and Bahiparimarjana (lepa of S-kin powder in gomutra and local application of Karanj oil) are effective in the management of Dudru kushta.

Consent

Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient.

Data availability

All data underlying the results are available as part of the article and no additional source data are required.

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Author details Author details

Manisha Panda
Roles: Conceptualization, Resources, Writing – Original Draft Preparation

Sourabh Deshmukh
Roles: Conceptualization, Methodology, Resources, Validation

Trupti Thakre
Roles: Validation, Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

version 1

Published: 08 Jan 2024, 13:26

https://doi.org/10.12688/f1000research.142589.1

© 2024 Panda M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Panda M, Deshmukh S and Thakre T. Case Report: Management of Dadru Kushtha (Tinea Corporis) by Shamana Chikits [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2024, 13:26 (https://doi.org/10.12688/f1000research.142589.1)

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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Version 1

VERSION 1

PUBLISHED 08 Jan 2024

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Reviewer Report 11 Sep 2024

Manjunath M. Shenoy, Department of Dermatology, Yenepoya Medical College, Yenepoya (Deemed to be university), Mangalore, Karnataka, India

Not Approved

https://doi.org/10.5256/f1000research.156156.r245763

Dear author/s,
Happy to observe a case report on treatment of tinea corporis, however, please note my following comments.
1.Is this a novel treatment modality or is it a known form of treatment?
2. Having treated a lot of tinea corporis for many years, these lesions appear to be of more than 15 days duration. Please confirm the history once again. Is there any follow up to assess recurrence of the disease. This is important because tinea corporis is known for recurrence.

Is the background of the case’s history and progression described in sufficient detail?

Partly
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Partly
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dermatology with special interest in mYcology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report 24 Apr 2024

Paradkar Hemant, APM Ayurveda Mahavidyalaya, Sion, Mumbai, India

Approved with Reservations

https://doi.org/10.5256/f1000research.156156.r265859

Introduction: The introduction offers a comprehensive overview of Tinea corporis (Dadru kushtha) and its manifestations, including its clinical presentation, etiology, and conventional treatment approaches in both modern medicine and Ayurveda. However, enhancing its readability could be achieved by breaking down the text into smaller paragraphs or sections for better organization.
History: In the history section, it's mentioned that the patient had received Allopathic treatment. It would be ideal to specify the treatment taken and its duration in detail to provide a clearer understanding of the patient's medical history.

Lab Investigations: While it's stated that the blood routine was normal, providing a detailed explanation of the investigations conducted along with their values would enhance clarity and understanding.

Treatment Plan: It would be beneficial to justify the specific duration of treatment and explain the rationale behind the decision to temporarily stop Gandhakrasayan for 7 days before resuming it.

Observation: The line “Hence Shamana chikitsa was continued with the gap of 7 days except Gandhakrasayan,” mentioned in the observation, seems to deviate from the treatment plan. Clarifying this discrepancy would improve coherence.

Assessment Criteria: The outlined criteria for evaluating treatment effectiveness, including subjective parameters such as itching, erythema, and lesion characteristics, are clear. However, providing details on how these criteria were measured or assessed during follow-up visits would enhance transparency and reproducibility

Therapeutic Approach: Elaborating on how each medication addresses Pitta-Kapha dosha imbalance and Dhatu involvement in Dadru Kushta would deepen understanding of the therapeutic approach and its mechanisms.

External Applications: Including information on the time and duration for external applications would improve transparency and reproducibility, ensuring clarity in the therapeutic process.

Conclusion: If this is purely a case study of Shaman Chikitsa, concluding with Shodhan (Gomutra siddha Haritaki – nowhere mentioned in the manuscript) and Arogyavardhini (nowhere mentioned in the treatment plan) is not understandable. Perhaps providing a more coherent and focused conclusion would better summarize the findings of the study.

Is the background of the case’s history and progression described in sufficient detail?

Partly
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Partly
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Yes
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Ayurvedic Clinical research, Ayurvedic Drug research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 26 Feb 2024

Ghazala Javed, Central Council for Research in Unani Medicine, New Delhi, India

Approved with Reservations

https://doi.org/10.5256/f1000research.156156.r245754

The case report lists management of Dadrukushta which is considered to be similar to Tines corporis. Somewhere it should be mentioned how the diagnosis of Tinea corporis was made?

Also, why 03 topical applications are being used? Do we have references in classical texts of Ayurveda to use them together? Is this the standard treatment plan for all cases of Dadrukushta?

Discussion should also mention limitations of this case study.

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Partly
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Yes
Is the case presented with sufficient detail to be useful for other practitioners?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Unani (Traditional ) medicine. Clinical Research in Unani medicine

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Author Response 13 Apr 2024

Dr. Manisha Panda, Kaumarbhritya, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India

13 Apr 2024

Author Response

Respected reviewer,
Diagnosis was made by signs and symptoms, gradations are also mentioned.
So, kindly consider. Yes Ayurvedic references are present for topical lotions.

Yours sincerely,
Manisha Panda
Competing Interests: no
Respected reviewer,
Diagnosis was made by signs and symptoms, gradations are also mentioned.
So, kindly consider. Yes Ayurvedic references are present for topical lotions.

Yours sincerely,
Manisha Panda
Respected reviewer,
Diagnosis was made by signs and symptoms, gradations are also mentioned.
So, kindly consider. Yes Ayurvedic references are present for topical lotions.

Yours sincerely,
Manisha Panda
Competing Interests: no Close
Report a concern
Author Response 13 Apr 2024

Dr. Manisha Panda, Kaumarbhritya, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India

13 Apr 2024

Author Response

Respected reviewer,
Diagnosis was done by observing signs and symptoms similar to Tinea corporis.
Ayurvedic references are followed for all medications.

Yours Sincerely,
Manisha Panda
Competing Interests: no
Respected reviewer,
Diagnosis was done by observing signs and symptoms similar to Tinea corporis.
Ayurvedic references are followed for all medications.

Yours Sincerely,
Manisha Panda
Respected reviewer,
Diagnosis was done by observing signs and symptoms similar to Tinea corporis.
Ayurvedic references are followed for all medications.

Yours Sincerely,
Manisha Panda
Competing Interests: no Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 13 Apr 2024

Dr. Manisha Panda, Kaumarbhritya, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India

13 Apr 2024

Author Response

Respected reviewer,
Diagnosis was made by signs and symptoms, gradations are also mentioned.
So, kindly consider. Yes Ayurvedic references are present for topical lotions.

Yours sincerely,
Manisha Panda
Competing Interests: no
Respected reviewer,
Diagnosis was made by signs and symptoms, gradations are also mentioned.
So, kindly consider. Yes Ayurvedic references are present for topical lotions.

Yours sincerely,
Manisha Panda
Respected reviewer,
Diagnosis was made by signs and symptoms, gradations are also mentioned.
So, kindly consider. Yes Ayurvedic references are present for topical lotions.

Yours sincerely,
Manisha Panda
Competing Interests: no Close
Report a concern
Author Response 13 Apr 2024

Dr. Manisha Panda, Kaumarbhritya, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India

13 Apr 2024

Author Response

Respected reviewer,
Diagnosis was done by observing signs and symptoms similar to Tinea corporis.
Ayurvedic references are followed for all medications.

Yours Sincerely,
Manisha Panda
Competing Interests: no
Respected reviewer,
Diagnosis was done by observing signs and symptoms similar to Tinea corporis.
Ayurvedic references are followed for all medications.

Yours Sincerely,
Manisha Panda
Respected reviewer,
Diagnosis was done by observing signs and symptoms similar to Tinea corporis.
Ayurvedic references are followed for all medications.

Yours Sincerely,
Manisha Panda
Competing Interests: no Close
Report a concern

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 08 Jan 2024

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Reviewer Reports

	Invited Reviewers
	1	2	3
Version 1 08 Jan 24	read	read	read

Ghazala Javed, Central Council for Research in Unani Medicine, New Delhi, India
Paradkar Hemant, APM Ayurveda Mahavidyalaya, Sion, Mumbai, India
Manjunath M. Shenoy, Yenepoya (Deemed to be university), Mangalore, India

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Reviewer Report

2 Views

11 Sep 2024 | for Version 1

Manjunath M. Shenoy, Department of Dermatology, Yenepoya Medical College, Yenepoya (Deemed to be university), Mangalore, Karnataka, India

2 Views Cite this report Responses(0)

Not Approved

Is the background of the case’s history and progression described in sufficient detail?

Partly
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Partly
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dermatology with special interest in mYcology

Respond to this report

Responses (0)

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Reviewer Report

12 Views

24 Apr 2024 | for Version 1

Paradkar Hemant, APM Ayurveda Mahavidyalaya, Sion, Mumbai, India

12 Views Cite this report Responses(0)

Approved With Reservations

Is the background of the case’s history and progression described in sufficient detail?

Partly
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Partly
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Yes
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Ayurvedic Clinical research, Ayurvedic Drug research

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

11 Views

26 Feb 2024 | for Version 1

Ghazala Javed, Central Council for Research in Unani Medicine, New Delhi, India

11 Views Cite this report Responses(2)

Approved With Reservations

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Partly
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Yes
Is the case presented with sufficient detail to be useful for other practitioners?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Unani (Traditional ) medicine. Clinical Research in Unani medicine

Respond to this report

Responses (2)

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Case Report: Management of Dadru Kushtha (Tinea Corporis) by Shamana Chikits

Abstract

Background

Aim & Objectives

Case

Results

Conclusions

Keywords

Introduction

Case report

History of present illness

Personal history

Skin examination

Laboratory investigation

Methods

Treatment plan given

Table 1. Table showing Shamana Aushadhi/palliative care and Bahirparimarjana Chikitsa/external procedures.

Observation

Table 2. Showing gradation.

Table 3. Evaluation performed before, during, and after therapy.

Figure 1. Before and after treatment image of patient diagnosed with Dadru/Tinea corporis.

Discussion

Mode of action of Panchatikta ghrita

Mode of action of Karanja oil

Mechanism of action of S-kin Powder

Mode of action of Fungiwin Cream

Conclusion

Consent

Data availability

References

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