Mohsin M. Asian J Trad Com Alt Med.

3(1-2), Summer 2020:40-54

Asian Journal of Traditional,
DOI: 10.22040/ATCAM.2019.108142
Complementary and Alternative Medicines

REVIEW Open Access

Psoriasis (Dau-S-Sadaf) with Reference to Unani Medicine and

Modern Medical Updates
Mohammad Mohsin, MD1*

1
Department of Amraze Jild wa Zohrawia, Faculty of Unani Medicine, Aligarh Muslim University, Aligarh, India

Received: 2020-01-05 Accepted: 2020-03-27

ABSTRACT
The Unani classical literature and manuscripts are rich sources of knowledge which must be brought on
surface and revealed. The descriptions of diseases and disorders are either available with other terms or as per
clinical sign and symptoms. The descriptions are required to be compiled and furnished in a sequential and
more understandable manner for the medical world. After exhaustive review of authentic texts of Unani system
and knowledge update of psoriasis, it was found that yet the modern medicine has no conclusive idea about
the disease pathogenesis, while descriptions of Unani physicians have a lot of scope to be explored in terms
of pathogenesis and treatment of psoriasis. Their descriptions show the idea and interest of Unani scholars in
psoriasis like dermatological presentations. The provided principle of management and Unani pharmacopeia
is a rich treasure that needs to be highlighted and its reverse pharmacological studies are demands of the time.
The description of disease as per the humoral concept and concept of Tabiat and temperament is interesting
and logical. The management based on blood purification, elimination of morbidity either direct or through
concoctive and purgative principles is more effective than other so far available and trending modes of treatment.
The morbidities of heavy molecular weights could be removed directly through cupping and leeching, which has
an add on effect in the treatment process with blood purification and concoctive and purgative regimes.

Keywords: Taqashure-Jild, Dau-s-sadaf, Unani Medicine, Amraze Jild, Psoriasis, Blood purification

Citation: Mohammad Mohsin. Psoriasis (Dau-S-Sadaf) with Reference to Unani Medicine and Modern Medical
Updates. Asian J Trad Com Alt Med, 3(1-2), Summer 2020: 40-54.

Corresponding Author:
Mohammad Mohsin, MD. Department of Amraze Jild wa Zohrawia, Faculty of Unani Medicine, Aligarh Muslim
University, Aligarh, India. Email: aqdas2005@gmail.com.
© 2020 The Author(s). Open Access. This article is distributed under the SINAWEB Publication in http://sinaweb.net.
Asian Journal of Traditional, Complementary and Alternative Medicines (ATCAM) is licensed under a
Creative Commons Attribution-NonCommercial 4.0 International License. https://creativecommons.org/licenses/by-nc/4.0

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Mohsin M. Asian J Trad Com Alt Med.3(1-2), Summer 2020:40-54 41
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Introduction heading of “Lopoi”. This group probably included

psoriasis and leprosy. Between 129 and 99 BC the

I t is extracted from the ancient literature that

skin diseases were always the priority concern in
word “psore” (meaning desquamatic condition)
was first used by scholars for eyelid corner of the
eyes and scrotum with excoriation and pruritis,
all human civilizations and particularly of Greeks. though he called psoriasis but probably it was
Skin care, and its related disorders are mentioned a type of eczema, and until the psoriasis was
even prior to most ancient manuscripts and recognized as entity distinct from leprosy 6.
literatures. Although the descriptions do not In all ancient texts it is described either with
clearly mimic the disorders termed in later ages, leprosy or with chronic skin presentations such
they can be correlated as per the descriptions of as scaling and chronic itching and it is always
lesions and other clinical manifestations, etc. intermingled with eczema particularly dry eczema
It obviously reflects that the knowledge or a lichenified or parchmentised lesion. But as
in the field of fundamental medical sciences the fundamental medical knowledge evolved, the
likewise anatomy, physiology, pathology and then terminology of disease became more and more
histopathology was gradually generated, and the objective; It was similar in case of psoriasis. The
terms of diseases were evolved accordingly. temporal profile as reflected from the ancient to
Therefore, the terms or descriptions were middle age literature can obviously be understood
always proportional to the knowledge of which is as below.
mentioned area of medical sciences, and it is Dry white scales over the effected parts with talc
evident from ancient manuscripts to modern (Abrak) was termed by eminent Unani physician
medical era. [98-171 AD] as “Talaq” 7. Rhazes (Razi) (850-
The term psoriasis is given by the modern 731 AD) has given more profound description of
medical era and is therefore, not found in ancient disease presentation and even the management
texts, but similar descriptions are found in under the heading of Taqashur-e-jild 8.
literature6. Similar descriptions are given by Avicenna
(980-1037 AD) under the heading of Qobae-e-
Historical Perspectives Mutaqashira in Kitabul taiseer fil Madawaat wa
In the Egyptian papyrus (300 BC), Hippocratic tadbeer by Ibne-Zohar (1091-1162 D) 9.
descriptions (460-377 BC) 1, 2, 3 similar features are The description under Taqashure-jild is quite
mentioned but as a curse of divine forces. Even on similar to psoriatic presentations.
commentary of Bible (70 AD) it is described as a The description of Ibne Rushd (1126-1198
leprotic manifestation and even up to middle ages AD) is also important particularly in terms
all chronic scaling conditions were considered of pathognomonic features which are due
leprosy in either way 3, 4, 5. to excessive abnormal black bile, but he has
Hippocrates and his school (460-377 BC) described the disease as a variety of leprosy 10.
provided meticulous description of many skin In Ayurveda, the ancient literature is also not
disorders 1, 2. In their description, dry scaly clear about psoriasis but as evident from Chark
eruptions were grouped together under the Sanghita, Rogh Vigyan it is described under
the heading of Kushtrogh, Kusht Kutam and

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Upnishad Kutam and scaling are mentioned as diseases in a similar way. HLA B13, B17, B37,
key symptoms of lesions and lesions are described CW6, DR7 are the key genes identified for such
as anhydrotic. ailments and HLA CW6 are more commonly
The descriptions of medieval age physicians involved 17. In 20th century AD, the disease
are more objective, in terms of understanding its was more clearly differentiated into types of
etiopathology and also of management guidelines. presentation such as plaque pattern, pustular
The Greek physicians like Akbar Arzani (1722 pattern, Guttate and flexural pattern of disease.
AD) and Azam Khan (1813-1902 AD) have given
vivid description under the headings of Taqashur- Disease introduction
e-jild and Qashf-e-jild was Taqasshur-e-jild. The Psoriasis is a Greek word ‘Psore’ meaning
treatise of Azam Khan, Ekseer-e-Azam, is a great disquantive / scaly conditions and scales are the
milestone and torch bearer for the understanding most pathognomic character of it 6, 14.
of the disease relatively in more objective way 1, In modern Unani Medical literature it is
12, 13
. commonly termed as Daus Sadaf, meaning of
There is a clear paradigm shift as per the Da’á = disease and Sadaf = pearls resembling its
advancement of medical sciences and in 1840-41 scales with dry shells of snails or pearls.
AD F. Hebra described the clinical patterns and To bridge the gap of terminology from Talaq,
pathological features of psoriasis and differentiated Taqashshur, Muteqasshere, Al-Sadfia, it was
it from leprosy lesions and gave the term psoriasis necessary to resolve and use one terminology for
vivid and classified descriptions 14. its better understanding at par to psoriasis. The
Consequently, the work of F. Hebre was modern Unani scholars described it under the
followed up and Von Zumbush (1874-1940), heading of Da us-Sadaf.
a German dermatologist, identified pustular The Unani scholars whose descriptions are
psoriasis 2, 3. Meanwhile (1938-1904 AD), H. always given due considerations are: Zakrai Razi
Koebner, another German dermatologist, 18
, Majoosi and Ibn hubal, mentioned it under
reported his logical observations in 1972 about Saafa-e-yabis and described the character similar
the incidence in response to trauma and injuries to Da-us-Sadaf 19 (psoriasis).
on prone sites of body and also of its isomorphic The description of Roofas is quite accurate
phenomenon which is even known after him as as mica like (micaceous) scales which are dry
Koebner phenomena 15. enough and shiny and he termed it Abrak, Talaq.
In early 19th century AD, Ghulam Jeelani carry Ibne Zohar’s description are add on that of
forwarded the description of Taqasshur-e-jild itching and erythema.
and coined the term Sadafia and mentioned its In Kitabul Umdah Fil Jarahat by Ibn al Quf fishy
management more profoundly 16. scales and impetigo like lesions are mentioned in
As the new advancements came, the concept its description 9. Similarly, as per the description
of psoriasis got more strengthened. The discovery of Akbar Arzani, rough, dry thick scaly conditions
of Landsteiner for blood groups on the basis of on affected parts 12.
antigens and advancement in genetics, proposed In characterization and classification
the genetic descriptions and HLA typing to of diseases, modern medical literature has
understand not only psoriasis but also other enlightened more profoundly about the insight of

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diseases and similarly, about psoriasis. However, and 4.7% respectively. This contradicts with
psoriasis is a very common chronic and immune frequencies in Africans, Norwegian and Asians
mediated, polygenic recurrent inflammatory of between 0.4% and 0.7% 11.
disorder of the skin. The incidence of the disease in a given
Several environmental triggering factors, population in a defined time has been estimated
trauma infections or medication may elicit disease to 60 individuals per 100000, per year 20, 21. The
in predisposed individuals 6. studies provide support for seasonal variation,
The most characteristic presentation with 68% of cases first diagnosed particularly in
is erythematous, scaly, indurated plaques winter and spring seasons. The annual incidence
particularly over extensor body surfaces and of psoriasis has doubled in the last 30 years
scalp. between 1970 and 2000 as per the data of recent
The disease has enormous variables in duration, US study 20, 22.
periodical flare up and extent. Psoriasis may first appear at any age, from
Histopathalogically, hyperkeratosis, infancy to the 8th decade of life. Two main peaks
para`keratosis, acanthosis of epidermis, tortuous in age of onset have been reported, one at the
and dilated vessels and inflammatory infiltrate age of 20-30 years and second at 50-60 years. In
mainly composed of lymphocytes are observed. approximately 75% of patients, the onset is prior
Psoriasis is always considered as a symptomatic to the age of 40 years [11]. Though the age of onset
disease in which patients may have a chance is earlier in females than in males, both are equally
to develop psoriatic arthritis, cardiovascular effected 23. There is no incidence that the disease
disease and metabolic syndrome 6. Many studies has phenotypic difference between the sexes.
reportassociation of psoriasis with hepatitis ‘C’.
Psoriasis always has direct impact on quality of Etiology and pathogenesis
life 6. The etiology is multifactorial, and lot of key
factors play a pivotal role in the psoriasis 24, 25, 26,
Prevalence 27, 28, 29
.
After going through Unani literature, no As per the basic concept of Unani medicine,
conclusive study with report of its prevalence is the disease can be understood on the concept
found there. In modern literature, several studies of temperament and Humors. Su-e-mizaj-e-jild
have been reported regarding its prevalence may predispose several dermatological ailments
within the country and worldwide. But most of and if it becomes stagnant (Mustahkam), the cell
the modern scholars admit that it is difficult to biology of skin alters and it may invite the chronic
ascertain accurate figures about epidemiology dermatological presentation. It has been observed
and morbidity of psoriasis because the diagnostic in psoriatic lesions that there are extreme dryness
criteria yet have been validated and patient and scaling. The extreme dryness indicates the
ascertainment techniques varies. Nevertheless, it involvement of abnormal black bile; while the
is driven that psoriasis is a common skin disease underlying erythema and itching somehow give
worldwide 20. In most reviews the prevalence is a clue of involvement of safra muhtaraq (oxidized
said to be 2% of world’s population. However, in safra) converting finally into black bile.
USA, and Canada prevalence is as high as 4.6% The chronicity of disease and its seasonal

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irritation also indicate the involvement of varied psoriasis is found to be higher amongst first and
temperamental factors. The temperamentology second degree relatives of patients than unaffected
can be better understood with the help of control subjects 34. A study performed in Sweden
genetics, both by understanding phenotyping vs showed the prevalence of psoriasis to be 7.8% in
temperament and also genotyping vs temperament first degree relatives compared with a prevalence
in various cross sections of population. Though of 3.14% in matched controls and 1.97% in overall
the disease has its prevalence in certain races, there population 35. Based on such population data, a
are more aggravates in certain seasons and also number of investigators have calculated the risk
changes of its prevalence on genotypic variations. for a child to develop psoriasis. As per a German
Therefore, HLA typing gene identification and study, the risk was found to be 14% if one parent
raised level of certain genes in certain individuals was affected, 41% if both parents were affected,
can be better understood if the temperament is and 6% if one sibling was affected, compared to
assessed properly. 2% when no parents or sibling was affected 36.
Supports of such population studies come
Humours 9,10,13,30,31,32 from analysis of a range of family pedigrees in
As per the description of Unani scholars, no which psoriasis appears throughout multiple
single humoral etiology is found to be responsible generations 37.
for the disease; but they have mentioned varied The above studies have concentrated upon
humoral involvement in the genesis of psoriasis chronic plaque form psoriasis, the most common
like pictures. variant.
1. Abnormal Black Bile
The black bile may be abnormal both in terms HLA Studies 26,27,38,39
of quality (Kaifiat) or quantity (volume). The Human Leukocytic Antigens (HLA) are
production of natural black bile has its natural surface antigens on human cells, and the
discourse but it may be oxidized or produced subsequent chromosomal region is called the
by oxidation of other humours i.e. Safra, (bile) major histocompatibility complex (MHC). It
Balgham (Phlegm). is located on the short arm of chromosome 6.
Therefore, presentation of disease has variation. Psoriasis is linked with HLA-CW6, and delayed
Unani scholars have found the following abnormal age of onset has strong link with the HLA-CW6.
humours to be responsible in its etiology apart Some dermatologists designated patients
from Sauda-Ghair Tabai (Abnormal black bile) with early onset of psoriasis with positive family
• Khilte Haneef wa Laza 7 history and expression of HLA-CW6, as type-1
• Khilte Sauda Muhtaraq 13 psoriasis; while individuals with late onset, no
• Balgham Shor 10 family history and lack of expression of HLA-
• Balgham Zujaji 33 CW6 were regarded as type-2 psoriasis 6.
• Khushk Boraqi Madda 19
Immune Pathogenesis
Genetic Factors There is considerable and significant amount
There is substantial evidence that psoriasis of evidence that T-lymphocytes play an important
has a significant genetic component. Incidence of role in development of plaque psoriasis. Innate

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immune system that provides an early response injury, a study found that 25% of patients express
against harm to the host is dysregulated in a Koebner reaction and 67%, reverse Koebner
psoriasis 40. And the innate immune mechanism reactions.
leads to antigen driven T-cell expression and Moreover, the Koebner reactions are often
activation. considered to be more frequent in actively
In the skin, various cell types are involved in spreading, psoriasis. This might be true, but yet
innate immune response pathways. These include to be established by perspective studies.
dendrite cells (DCs), natural killer (NK)-T cell
and neutrophils as well as keratinocytes 40. Systemic triggering factors:
Triggering Factors: Both external and Infection
systemic Acute Guttate psoriasis has strong association
External factor: The Keobner phenomenon with streptococcal infection, particularly of upper
observed in approximately 25% of patients with respiratory tract 35, and HIV infection aggravates
psoriasis. psoriasis, too 35.
Any particular patient may be “Keobner
negative” at one point of time and later may Drugs 35
become “Keobner positive”. Anti-malarial Beta Blockers, NSAIDs,
Keobner phenomena postulate that psoriasis ACE inhibitors, lithium salts, withdrawals of
is a systemic disease that can be triggered locally corticosteroids are reported to be responsible for
in the skin. A psoriatic lesion can also be induced exacerbation of psoriasis.
by other forms of cutaneous injury. A wide range Metabolic factors: Hypocalcemia is reported
of injurious local stimuli including physical, to be a triggering factor for pustular psoriasis,
chemical, surgical, electrical, infective and any while vitamin D3 analogues improve psoriasis 20.
inflammatory insult, are predictable to illicit the Pregnancy may alter disease activity and 50%
lesions 20, 34. of cases reported improvement but pregnant
Sunlight is generally beneficial, but aggravation women may develop pustular psoriasis, which
of disease in strong sunlight and summer may be association with Hypocalcemia 20.
exacerbations in exposed skin is reported in some Psychogenic Factors: Stress is an established
patients 20. triggering factor in psoriasis 45.
Smoking and Alcohol: Alcohol consumption
Koebner and reverse Koebner phenomena 20,41-44 and smoking have a detrimental effect on psoriasis
The Koebner reaction is often seen 7-14 days 25
. Studies suggest that alcohol exacerbate the pre-
after injury, and the reported incidence varies existing disease, too but has no role in inducing
between 38 and 76% of patients with psoriasis. the disease 46.
All-or-none phenomenon occurs at various sites
of injury. Clearing in existing lesions following Pathogenicity 47, 48
injury has been observed and termed as reverse It is very obvious from the ancient texts of
Koebner reaction. This reaction also obeys an Unani medicine that this disease is not mentioned
all-or-none rule, and the Koebner and reverse anywhere with the name of psoriasis; therefore,
Koebner reactions are mutual. Using standardize the description of pathogenicity of it is also

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lacking. The Unani scholars described it with the with psoriatic disease arthritis, cardiovascular
name of Talaq, Abrak, Taqashshur-e-jild, Saafa, disease, metabolic syndrome ‘X’, etc. The
yabis, Qashaf-e-jild, Al-Sadafia etc. and thus, the morbid melancholic humour may manifest
cumulative analysis indicates that Melancholic with individual variations depending upon the
(Black bile) humour is responsible in larger extent original condition of body temperament (Mizaj)
when it becomes deranged with abnormalities per and condition of innate immunity (Quwwate
se and become a morbid humour. Mudabbira-Badan) and power of tabiat 15, 47.
As per the description of Ibn Zohar, the Various studies and techniques confirmed that
morbid melancholic humour of body migrates the hyperproliferation of keratinocytes observed
from inside towards skin and gets accumulated in psoriasis, is mainly due to an increase in the
in skin. As a result, the skin tries to remove it in proliferating cell compartment in the basal and
his own defense, and also to get proper nutrition supra basal layers of epidermis and not because
and health; consequently, a condition of scaling of shortened cell cycle duration. The number
takes place. Moreover, the temperament of Sauda of cycling cell is increased by seven folds 20. The
(Melancholic humour) is cold and dry; thus, there proliferation is mainly driven by a complex
is dryness in scales. cascade of inflammatory mediators. T-cells and
The formation of morbid black bile cytokines play central role in the pathophysiology
(Melancholic humour) may be from Khilt-e- of psoriasis. The conceptual descriptions in Unani
Sauda by itself or by Khilt-e-Safra (Bile), and medicine per se is that the skin tries to eliminate
sometimes it is due to Khilt-e-Balghami or by and expell the abnormal morbid matters in its
Akhlate Ghaleeza after their Ihteraq (Oxidation) own defense; As a result, the changes like scaling
47
. Abnormal black bile is always considered as eruption and erythema arouses which are the
one of the Khilte Ghaleeza that do not expel out pathognomonic characters of the disease. The
easily. Therefore, the Quwwat-e-Mudabbira-e- morbid melancholic humour of body migrates
badan becomes hyper responsive and as a result, towards skin from inside and gets accumulated
the skin turns over time to have many folds 47. in skin (Ibn Zohar). As a result, the skin tries
At the site of lesions, it has been observed to remove it in his own defense, and also to get
that there is marked erythema and vascular proper nutrition and health; Consequently, a
dilatation and tortuosity which is due to hyper condition of scaling takes place.
responsive immune system or as per se Quwwat-
e-Mudabbira-e-badan or Quwwat-e-Tabiyah. Histology
Histopathological analysis also shows the Histologically, all psoriasis is pustular, and
finding of various defense markers, inflammatory the microscopic pustules include spongi form
markers both cellular and chemical forms, that intra-epidermal pustules, and Munro micro
strengthen the above concepts of pathogenicity. abscess within the stratum corneum. There is
Psoriasis is considered a systemic and focal parakeratosis within the stratum corneum,
multifactorial disease by modern medical neutrophils are above parakeratosis foci,
scholars. The Unani concepts and overview particularly in plaque psoriasis. Neutrophilic
also advocates the nature of pathology as micro abscesses are generally present at multiple
systemic and therefore manifestation may be levels in stratum corneum. There is epidermal

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Histopathology of psoriasis (Courtesy: Jem.rupress.org)

acanthosis and dilated capillaries with features soles.

of spongiosis 49. This is again strengthening the From a clinical point of view, psoriasis can
concept of accumulation of abnormal humors present with a range of cutaneous manifestations.
at the site of pathology and micro dilatation of At any one point of time, diverse variants may
capillaries as well as micro abscesses might be coexist in individuals, but the lesions share the
because of those morbid humors. same important hallmark: erythema, indurations
and dry scaling. As noted in the section of
Clinical Description epidemiology and genetics, there is also significant
The appearance of a typical lesion is inter individual variability. For example, in
characteristic. Chronic plaque psoriasis patients with chronic plaque psoriasis, those with
is the most common variant of psoriasis type I disease (HLA-Cw6’) have an earlier onset,
vulgaris, characterized by sharply demarcated more widespread disease and frequent recurrence,
erythematous and papulosquamous lesions. Less compared to those with type II psoriasis.
often, nearly the entire body surface is involved The size of lesion may vary from a pinpoint
or numerous, small, widely disseminated papules lesion to a papule of over 20 cm in diameter;
and plaques are seen. Occasionally, there are The outline of the lesion is either circular, oval
obvious macroscopic pustules, as in generalized or polycyclic. The classical findings of erythema,
pustular psoriasis or pustulosis of the palm and thickening and scales are reflection of the

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histological findings of dilated capillaries that are of the disease, which produce the suspicion of
close to the skin surface and also the epidermal combination with other diseases, although there
acanthosis, cellular infiltrates and hyper is no confirmation of this.
keratinization, respectively.
Diagnosis
Course of prognosis 6, 20 Diagnosis of the psoriasis depends on the
The prognosis remains unpredictable, following points.
‘Psoriasis of all forms are very troublesome and • Family history of psoriasis
often, an intractable disease, but it is seldom • Presence of lesion at particular sites e.g.
dangerous to life‘ 50. ‘It is impractical to say, in any elbow, knee, scalp, back and nails.
particular case, how the disease will last, whether • Lesions covered with silvery scales.
a replace will occur, or for what episode of time • Candles grease sign, Auspitz sign, Koebner
the patients will remain symptoms free‘ 51. In a Phenomenon.
study, only 5 (33%) out of 15 patients developed • Itching
chronic plaque form of disease, a decade after • Seasonal variations
an initial episode of guttate psoriasis 52. An early Henery H has characterized the major and minor
onset having positive family appears to worsen stigmata for the diagnosis of psoriasis.
the prognosis 53. • Major signs
The sunlight and summer are found favourable • Intermediate signs
43, 54, 55
, pregnancy has no effect in approximately • Minor signs
half of patients 43, 55 rather improvement at some
extent are reported than worsening. Major Signs
• Erythematous, usually sharply marginated
Relapse plaques than often have silvery scales in hairy
Relapse is the rule, a study suggests only three sites areas.
of 260 patients in one series 43 reported to be • Severe dandruff, often with marginated
clear for 5 years or more and the rest hardly for plaque.
6 months. In another series, only three out of 95 • Nail changes
were reported clear for 5 years or more. Another • Multiple pitting
7 years follow up of 142 patients 56 indicated • Dystrophic nails and nail separation without
that intensive outpatient treatments have more evidence of fungus and seronegative arthritis.
remissions than those treated at home. Guttate
lesions were reported to have the best prognosis. Intermediate Signs 17
• Hyperkeratosis, localized, with or without
Association with other diseases 6, 20 scaling on elbows, knees, ankles, soles, palms
There has been extensive discussion on and knuckles.
whether psoriasis occurs more frequently in • Pruritus ani or other intertrigo with sharp
association with other diseases or not. This margination of erythema
applies particularly to metabolic disease, because • Corticoid-responsive penile macules,
the changes occur in the body during the course especially on the glans.

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• Recalcitrant, scaly otitis externa. . The compound formulations like Itrifal

13, 61, 62, 63

• Persistent, localized patches of nummular shahatra, Itrifal mundi, Itrifal Aftimoon, Majoone
eczema Ushba, Sharbate Musaffie-khoon, etc. are common
• Sterile paronychia, often multiple. blood purifiers recommended.

Minor Signs Use of Psoralens

• Eczematous plaques of palms, soles or both. The Unani medicines having psoralens
• Acute onset kertolysis like lesions of the and related alkaloids such as Babchi, Atrilal,
palms or soles. Injeer Dashti, Chaksu etc are in use to treat the
• Recurrent eczematous discoid eruptions of autoimmune dermatological disorders including
trunk and extremities. Psoriasis.
• Koebner phenomenon: new lesion
appearing at the site of trauma. Local application of emollients and anti-
inflammatory drugs
Management Many of the Unani physicians have
In Unani system of medicine, the management emphasized on applying any emollient over the
of psoriasis is very effective. The eminent Unani lesions frequently in the form of ointment or
physicians like Ibn-e-Sina, Ghulam Jeelani, Akbar oil. Beside this, anti-inflammatory drugs should
Arzani and Azam Khan have described the basic be applied locally to promote early healing e.g.
principles of treatment under the following Roghane- Babchi, Roghane Kamela, Marhame
headings. Hina, Marhame Safeda Kashghari, etc. 9, 47, 61, 62
along with sun exposure.
Excretion of morbid humours (fasid akhlat)
The disease is caused by morbid humours, Adjuvants
mostly black bile (Sauda) that must be excreted Kushta Sadaf, Kushta Jast, are helpful as
from the body for maintaining the balance of hypocalcemia may be a predisposing factor
humours. Excretion (Tanqia) can be done, after and zinc has a role in chronic dermatological
munzij to khilt-e-Sauda; use of purgatives like conditions including psoriasis.
joshandah-e-afteemoon or Fasd (venesection),
Hijamah (wet cupping), taleeq (Leeching), etc. 12, Hepato Protection
13, 60, 61, 62
are the means to eliminate the morbidity Unani scholars always advocate for the
directly. protection as well as tonics for liver which is
the prime seat of all metabolic, hematological,
Use of blood purifying drugs and immunological disorders. Thus, the drugs
As per the Unani system of medicine, the skin should be liver friendly or supportive to liver
diseases occur due to accumulation of unwanted actions. Modern medical updates also found the
metabolic products in blood. Thus, the drugs involvement of liver as co-morbidities associated
which help in purification process like Barge- with psoriasis.
Shahatrah, Gule-Mundi, Unnab, Charaita, Neem, The following regimes are used in modern
etc. are used for the treatment of skin diseases 12, system of medicine.

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Antimitotic or cytotoxic agents.14, 26, 27, 64-68] Biological Agents 6, 20

Methotrexate, Azathioprine, Cyclosporin, Biological agents such as alefacept, efalizumab,
Retinoids like Acitretin, a derivative of vitamin A etanercept, adalimumab are the recently
and Tazarotene. introduced agents, which are used in certain
clinical setup but they are long term benefit
Photochemotherapy outlays. The hazards, is still a matter of question.
PUVA Therapy: A treatment with oral or topical Therefore, these alternative biological agents need
psoralen and subsequent long-wave ultraviolet-A further exploration.
radiation is known as PUVA therapy. Parrish et.
al. introduced it in 1974.14, 25, 26, 64, 67-69 Dialysis and related therapies 20, 7o, 71
An incidental clearance of psoriatic lesion
Topical therapy during hemo-dialysis for uremic condition
Antipsoriatic agent was reported in 1976. Similar experiences with
• Topical corticosteroids: 14, 25, 67, 69 Various both hemo-dialysis and peritoneal dialysis are
topical corticosteroids are successfully used in also reported. It is obvious that dialysis could
the treatment of psoriasis. Clobetasone is the favorably influence psoriasis patients with normal
most potent of the currently available topical renal function. Possibly the substances of heavy
corticosteroids. But the recurrence is more molecular weight could be removed easily in
common when the local steroid treatment is larger quantities. Although some patients clear
withdrawn. completely but relapse is reported afterwards.
• Anthralin also called Dithranol. It has a Similarly, in Unani medicine the bloodletting
cytostatic and a strong anti-inflammatory either by wet cupping, venesection or through
effect. leeching are in practice and reported to be effective
• Tars. It acts as an anti-bacterial, antifungal, and most probably it is because the removal of
anti-pruritic, antiacanthotic, anthrophogenic morbidities are more instant and in an easier
and photosensitizing. way. Therefore, several studies are in favor of such
• Vit-D. Analogue such as Calcipotriol. It intervention in psoriasis.
reduces the epidermal cell proliferation and
inhibits T cell proliferation is response to IL- Conclusions
1, and is used as a 0.005% ointment for the In Unani classical literature, the disease psoriasis
treatment of stable plaque psoriasis. 27, 68 is described as Taqshure-jild and Daus –Sadaf. The
morbidity is of melancholic predominance, and
Keratolytic agents the appearance of lesions is in response to skin’s
Salicylic acid is used in the treatment of own defense during the elimination of morbid
psoriasis, generally as a 2% to 10% ointment matter through it.
applied twice daily over a thick lesion. It causes The concept of blood purification is unique
shedding of scales of psoriasis lesions, by and the strength point of Unani medicine and is
dissolving the intercellular matrix and softening the basis of treatment of skin disorders including
the stratum corneum. 19, 63 psoriasis.

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Mohsin M. Asian J Trad Com Alt Med.3(1-2), Summer 2020:40-54 51
DOI: 10.22040/ATCAM.2019.108142

The concept of direct removal of morbid 1970, 23; p. 72.

substances particularly of heavy molecular weight 9. Ibn-ul-Quf, Abu-Al Farj: “Kitab-al-Umdah Fil Jarahat”
through Hijamah, Fasd, Leeching, are unique and Urdu Trans. CCRUM, New Delhi, 1:100, pp. 174-175.
therapeutically better options and have better 10. Ibn-e-Sina, Abu Ali Ibn-al-Hussain, “Al Qanoon”
outcomes compared with systemic and local Maktaba Al Nami, Lucknow 1906, 4, pp. 303-305.
medicines recommended and practiced. 11. Khan, Nisar Ahmad: “Marz-e-Dau-Sadaf main Ushban
The liver supplements most often advised aur Khameera-e-Sandal ke Ifadiyat ka Tahqeeqi Mutaala”
simultaneously, are the best way to counter co- Thesis, 1998, pp. 26,38-39.
morbidity like Non-alcoholic Fatty Liver Disease 12. Arzani, Hakeem Akbar: “Tibb-e-Akbar”, Faisal Pub.
(NAFLD).
Deoband, p. 739.
13. Khan Najmul Ghani: “Khazaenul Advia”, Idare Kitab al
Source of Funding
Shifa, New Delhi, pp. 187-189, 316-317, 421-422, 832-
None
834, 894-895, 1133-1134,1284-1285, 1352-1355.

Conflict of interest: Declared none. 14. Braun-Falco O. et al.: “Dermatology”, Springer, Verlag
Berlin, Heidelberg, New York, 1991, pp. 417-434.
References 15. Kormeili, T. et al.: “Psoriasis Immunopathogenesis and
1. Dirckx JH: Dermatologic Term in the medicina of celsus. evolving Immunomodulator and Systemic Therapy: US
Am J. Dermatopathol. 1938; 5(4):2, pp. 363-369. experiences” British Journal of Dermatology, No. 1, July
2.Fitzpatrick, Freedberg, Irwin M et al: “Dermatology in 2004, 151:12.
general medicine, 6th ed. Vol. 1, Medical Pub. Div. 16. Kabeeruddin, Hakim Mohammad: “Tashreeh-e-Kabir”,
McGraw Hill Pub. Pp. 407-420. Qarool Bagh, Delhi, 1924, 2:563-570.
3. Valia, R. G: Iadvl: “Text book and Atlas of Dermatology” 17. Roenigk, Henry H, et al: “Psoriasis”, 2nd ed. Marcel Dekker
2nd ed. Bhalani Pub. House Mumbai, India, Vol. 2nd pp. INC, New York, Hong Kong, 1990, pp. 3-7,11,45,51,131-
812-834. 135,157,171-173, 177,181, 201-203, 209-219, 228-
4. Glickman FS: Lepra, Psora, Psoriasis. J Am, Acad. 231,233-235, 255.
Dermatol. 1986; 14 (5pt1) pp. 863,866. 18. Al Razi Abu Bakar Mohammad Bin Zakariya: “Kitab Al
5. Ibn-e Baitar, Ziauddin: “Al Jami li Mufredat Al Advia–wa– Hawi Fil Tib” 1st ed, Daeratul Maarif, Hydrabad, 1970,
Al Aghzia”, CCRUM, New Delhi, 1999, Vol 1, pp. 129-31, 23:72.
276-277, Vol. 3, pp. 87-88, 108-109. 19. Ibn e Rushd Abul Walid Mohammad: “Kitabul Kulliyat”
6. Peter CM Van Dekerkhof and Frank O Nestle: “Psoriasis”, Urdu Trans. CCRUM New Delhi, 1980, pp. 89-90.
Dermatology 3 ed. Elsevier Saunders, Vol. 1, 2013, p.
rd 20. Griffiths C.E.M. and Barker: J.M.W.N.: “Psoriasis”
135. Rook’s Text book of Dermatology. 8th ed., Vol. 1, Wiley-
7. Tabri, Ahmad bin Mohammad: “Al Moalejat-ul-Buqratia”, Blackwell A Jhon Wiley and Sons Ltd. Pub. 2010, p. 20.1.
Urdu Trans. Vol. 1, Part 1-5, pp. 183-185, Vol. 2, Part 6-8, 21. Bell L.M, Sed Lack R, Beard C.M. et al: “Incidence of
CCRUM, New Delhi, 197, pp. 153-155. Psoriasis in Rockester Minnesota”, 1980-1983. Arch
8. Al Razi, Abu Bakar Bin Mohammad Bin Zakariya: “Kitab Dermatol. 1991; 127:1184-7.
al Havi Fil Tibb”, 1 ed. Dairatul Maarif, Hyderabad,
st 22. Icen M, Crowson C.S., McEvoy MT et al.: “Trend in

http://www.ajtcam.ir
Mohsin M. Asian J Trad Com Alt Med.3(1-2), Summer 2020:40-54 52
DOI: 10.22040/ATCAM.2019.108142

Incidence of Adult onset Psoriasis over three decades: Morphology, Ingerritance and association with other
A population – Based study”, J Am. Acad., Dermatol: skin and rheumatic disease. Stockholm: Almqvist and
6:394-401. Wiksell, 1967.
23. Henseler T, Christopher E.: “Psoriasis of Early and late 36. Andressen C. Hanseller T.: “Inheritance of psoriasis:
onset: Characterization of two type of vulgaris”. J Am of Analysis of 2035 family histories”. Hauterzt 1982; 33:214-
Acad. Dermatol. 1985:13:450-456. 7.
24. Arnold, Harry L et al.: “Andrews disease of the Skin” Clin. 37. Elder JT, Henseller T, Christophers E. et al.: “Age at
Dematol. 8th ed. WB Saunders Co. 1990, pp. 1-13, 198- onset and different types of psoriasis”. Br. J. of Dermatol.
204. 1995:133:768-73.
25. Behl, P.N: “Practice of Dermatology” CBS Pub. And 38. Andria RE Neimann, Steven B, Porter and Joel M
Distributors, New Delhi. 2000, pp. 14-18, 253-256. Gelfand: The epidemiology of psoriasis, expert review,
26. Fitzpatrick, Freedberg, Irwin M. et al.: “Dermatology in Dermatol 1(1), 63-75, 2006.
Journal Medicine”, 6th ed. Vol. 1, Medical Pub. Division 39. Pasricha J.S: “Treatment of skin disease” 4th ed. 2000,
McGraw Hill Pub. pp. 407-420. Oxford and IBH Pub. CO. Pvt. Ltd. pp. 83-89.
27. Fitzpatrick, James et al.: “Dermatology Secrets” Hanley 40. Nickoloff BJ: “Skin inmate immune system in psoriasis:
and Belfus, Inc. Med. Pub. Philadelphia, 1996, pp. 1-5, friend orfoe”? J. CLin. Invest. 1999; 104: 1161-64.
15-21-39-42. 41. Eyre RW, Krueger, GG: “The Koebner response in
28. Mathew Meier. Pranab B, Sheth, Yawalkar N: Psoriasis: In: Roenigk HH” Maibach HI, eds. Psoriasis.
“Management of Psoriasis” Curr. Prob. Dermatology, New York: Marcel Dekker, 1985:105-116.
Basl Karger, 2009, Vol. 38, pp. 1-20. 42. Koebner H. Klinische: “Experimentalle und therapeutische
29. Pereira, P.Richa, et al.: “The Inflammatory response in Mitteilungen Uber Psoriasis”. Berlin, Klin Wochenschr 1978;
mild and severe psoriasis” B. J Dermatol. No. 5, May 21:631-32.
2004, 150:927. 43. Farber EM, Nall LM.: “The natural history of Psoriasis
30. Angarooni, Mulla Sadeed – Al Deen: “Sadeedi Sharah Al 5600 patients”. Dermatologica, 1974;148:1-18.
Mujiz” YNM, 823. 44. Eyre RW, Krueger GG.: “Response to injury of skin
31. Antaki, Daud: “Tazkeratul Ulul Albab wa Al Jame Lil involve and uninvolved with psoriasis and its relation to
Ajaebul Ajaeb”, YNM, 1:168. disease activity”. Br. J. Dermatol. 1982; 106:153-9.
32. Aqsarae, Jamaluddin: “Al Aqsarae” 1 ed. Matab Al Nami,
st
45. Melski JW, Bernhard JD, Stern RS.: “The Koebner
Lucknow, 1908, 4:169. (Isomorphy) response in psoriasis”. Arch. Dermatol.
33. Israili, Mohammad Ayyub: “Tarjuma Urdu Sharah e 1983;119:655-9.
Asbab”, Munshi Naval Kishore, YNM, 2:414-415. 46. Pacan P, Szepietouski JC, Kiejuo A.: “Stressful life events
34. Lomholt G., ed. Psoriasis: Prevalence, spontaneous and depression in patients suffering from psoriasis
course and genetic. A census study on the prevalence vulgaris”. Dermatol. Psychosom. 2003;4:142-145.
of skin diseases on the faroe Island. Copenhagen: GEC, 47. Roset M, Okig.: “Disease in alcoholic”. QJ Stud. Alcohol,
Gad, 1963. 1971;32-1017-24.
35. Hellgren L. “Psoriasis: The prevalence in sex age and 48. Kareem, N.M.: “Makhzanul Advia”, Urdu. Vol. 1, 1765,
occupational groups in total population in Sweden” Maktaba Munshi Naval Kishore Press, Kanpur, Jild 2, pp.

http://www.ajtcam.ir
Mohsin M. Asian J Trad Com Alt Med.3(1-2), Summer 2020:40-54 53
DOI: 10.22040/ATCAM.2019.108142

39-40, part 1, p. 266, part 2, 526,661,722,723. 61. Ibn-e-Zohr, Abu Marwan Abdul Malik: “Kitab Al Taiseer
49. William D. James Timothy G. Berger Dirk M Elston: Fil Madawat-e-wa Tadbeer”, 1st ed. Urdu Trans. CCRUM
International Ed. Saunders Elsvier, Andrew’s Disease of New Delhi, 1986, pp. 2004-2005.
the skin, Clinical Dermatology 10 ed., 2000, pp. 193-
th
62. Kabeeruddin, Hakeem Muhammad: “Tashreeh-e-
201. Kabeer”, Qarol Bagh, Delhi, 1924, 2:563-70.
50. Koebner H. Jur: “Aetiology Psoriasis”. Vjschr Dermatol. 63. Chughtai, Ghulam Muhiuddin and Chughtai,
1876, 3:559. Faseehuddin: “Desi Tibbi Farmacopeia”, 1st ed. Sheikh
51. Wilson E. Disease of the Skin. London Churchill, Muhammad Basheer and Sons, Lahore, Pakistan, 2:166-
1842:229. 67.
52. Hebra F, ed. “On Disease of the Skin”, Vol. II. London: 64. Habif P. Thomas: “Histoclinical Dermatology”, 4th ed.
New Sydenham Society, 868:11. Mosby Toronto, 2004:209-39.
53. Martin BA, Chalmers RJ, Telfer NR.: “How great is the 65. Lal S.: “Clinical pattern of psoriasis in Punjab”. India J.
risk of further psoriasis following a single episode of Dermatol. Venereol, 1966;35:5-12.
acute guttate psoriasis”? Arch Dermatol 1996; 132:717-8. 66. Ratan Viddiya.: “Handbook of Human Physiology”, JP.
54. Church R.: “The prospects of psoriasis”. Br J Dermatol Bros. Med. Pub. Pvt. Ltd. New Delhi, YNM, pp. 173-174.
1958; 70:139-45. 67. Sainani, Grumukh S. et al.: API Textbook of Medicine”,
55. Braun-Falco O, Burg G, Farber EM.: Psoriasis: Line 6th ed. Association of Physicians of India, Mumbai, 1999,
Fragebongen Studiebei 536 Patienten. Munch Med pp. 1198-99.
Wochenschr 1972; 114: 1-15. 68. Valia RG. IADVL, “Textbook and Atlas of Dermatology”,
56. Church R.: “The prospects of psoriasis”. Br J Dermatol 2nd ed. Bhalani Pub. House, Mumbai, India, Vol. 2, pp.
1958; 70:139-45. 812-34.
57. Singh Surjeet and Bhansali Anil: “Randomized Placebo 69. Pasricha, JS et al. “Illustrated Textbook of Dermatology”,
control study of metformin in psoriasis patients with 3rd ed. JP Bros., 2006, pp. 141-50.
metabolic syndrome (systemic treatment cohort)” Indian 70. Anderson PC. “Dialysis Treatment of Psoriasis”. Arch.
J. Endocrinal. Metab. 2017, July-August, 21(4):581-587. Dermatol. 1981; 117:67-68.
58. Samuel T. Hwang et al.: “Recent highlights in psoriasis 71. Steck WD., Nakamoto S, Balin PL. et al.“Heamofiltration
research”, J. of Inves. Dermatol. 2017, Vol. 137, Elsevier, Treatment of Psoriasis” J. Am. Acad. Dermatol.
pp. 550-556. 1982;6:346-9.
59. Prussick R.B.; Miele, L.: Non-alcoholic Fatty Liver 72. Mohsin, M.; Shoeb, M and Anas M.: “A clinical study
Disease in Patients with Psoriasis: A Consequence of of psoriasis and psoriatic arthritis with application of
Systemic Inflammatory Burden? The British Journal of wet cupping and majoon chob chini in its Treatment”,
Dermatology.  2018; 179(1):16-29.  Hippocratic Journal of Unani Medicine, CCRUM, New
60. Farber EM, Nall L: “Guttate Psoriasis. Cutis” Delhi, 2016, Vol. 11(3), pp. 1-7.
1993:51(3):157-159,163-164 and the natural history of
psoriasis in 5600, Dermatologica, 1974:148:118-122.

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DOI: 10.22040/ATCAM.2019.108142

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