Management of Chronic Foot Eczema Through Ayurvedic Shodhana Therapy: A Case Report

Eczema is a chronic relapsing inflammatory skin disorder characterized by pruritus, erythema, scaling, and oozing lesions. The disease results from a complex interplay of genetic predisposition, epidermal barrier dysfunction, and immune dysregulation. Persistent itching and visible skin lesions often contribute to psychological stress and impaired quality of life.

Genetic studies have demonstrated an association between filaggrin gene defects and increased susceptibility to eczema and other atopic conditions. In Ayurvedic literature, eczema is described under Vicharchika, a form of Kushta, involving vitiation of Kapha and Pitta doshas along with Rakta dhatu. Ayurvedic management emphasizes correction of internal imbalance through systemic purification and lifestyle modification. This report presents a CARE-compliant documentation of a chronic case of eczema successfully managed through Ayurvedic purificatory measures.

PATIENT INFORMATION

A 40-year-old male, working as a building construction laborer, presented with complaints of recurrent itchy rashes over both feet for four years. He also reported a chronic, non-healing wound with serous discharge over the posterior aspect of the lateral malleolus and dorsum of the left foot for three years. There was no history of diabetes mellitus, hypertension, or other systemic illness. No significant family history was reported.

CLINICAL FINDINGS

On examination, dry scaly plaques were observed over the dorsum of the right foot. The left foot revealed a 4 × 3 cm serous-discharging lesion over the posterior lateral malleolus and dorsum, with mild edema, tenderness, increased local temperature, foul odor, and surrounding induration. Intense pruritus and burning sensation were noted.

DIAGNOSTIC ASSESSMENT

Routine hematological investigations including hemoglobin, total and differential leukocyte counts, erythrocyte sedimentation rate, and urine analysis were within normal limits. Culture and sensitivity testing of wound discharge showed no microbial growth. Based on clinical features, the condition was diagnosed as chronic eczema, corresponding to Vicharchika in Ayurveda. Occupational exposure to cement was considered a precipitating factor, suggesting exogenous eczema.

THERAPEUTIC INTERVENTION

The treatment plan focused on Shodhana therapy with classical Virechana, preceded by Purva karma procedures. Initially, Deepana–Pachana medicines were administered to enhance digestive fire and facilitate Ama pachana. This was followed by Snehapana with medicated ghee for an appropriate duration based on patient tolerance.

Subsequently, Sarvanga Abhyanga (whole-body oil massage) and Bashpa Swedana (steam sudation) were performed for three days to mobilize vitiated Doshas toward the gastrointestinal tract. Virechana was then administered, resulting in sixteen bouts of purgation, considered moderate and adequate.

Post-procedure dietary regulation (Samsarjana krama) was followed for three days. Local wound care included daily cleansing with Panchavalkala Kwatha Prakshalana. Supportive oral medications included Arogyavardhini Vati (one tablet thrice daily for one month) and Panchatiktaka Guggulu Ghrita (10 ml twice daily before food for one month).

FOLLOW-UP AND OUTCOMES

Noticeable improvement in inflammatory signs was observed within five days of treatment. Pruritus, burning sensation, and discharge gradually subsided. Complete healing of lesions occurred within one month, leaving mild hyperpigmentation. The patient was advised to use protective footwear and avoid direct exposure to cement. During a follow-up period of one year, no recurrence was reported.

Figure 1: BEFORE TREATMENT -

Figure 2: AFTER TREATMENT -