The Perception of Dermatologists towards the Outcome of Ayurvedic Therapy for Psoriasis

Abstract

Introduction: The use of Ayurvedic medicines have been increasing for skin ailments. The medical fraternities are concerned about the safety and efficacy of Ayurvedic products. We conducted this study because there is a scarcity of data regarding the perception of dermatologists towards the Ayurvedic treatment for psoriasis. Objective: We would like to understand the perception of dermatologists regarding the outcome of Ayurvedic therapy for psoriasis. Method: This cross-sectional pilot survey was executed after an approval from the institutional ethics committee, in Mumbai metropolitan area in India using pre-validated questionnaire to collect the data from 100 dermatologists. The questionnaire consisted of 4 sections: 1) Dermatologists’ demographics, 2) Dermatologists’ perception regarding the Ayurvedic therapy, 3) Dermatologists’ general attitude towards the use of the Ayurvedic therapy for psoriasis and 4) Their personal experiences about the Ayurvedic therapy. The data were analyzed by descriptive statistics. Results: The dermatologists perceived that the impact of the Indian culture and the desire for a better outcome were the primary reasons for the use of Ayurvedic medicines by the patients. 95% of the dermatologists were aware about the patients’ use of the Ayurvedic medicines for psoriasis. 56% dermatologists observed various skin related untoward effects in the patients who claimed taking Ayurvedic medicines for psoriasis. 55% dermatologists did not comment on the effectiveness of the Ayurvedic therapy on scaling, thickness and the redness of skin. 57% dermatologists did not comment on the effectiveness of the Ayurvedic therapy on itching and the size of the affected areas in psoriatic patients. 22% Dermatologists strongly agreed and 55% agreed that they should have the knowledge of Ayurvedic drugs for psoriasis. As per the dermatologists (53% strongly agreed and 38% agreed), the patients should inform them about their use of Ayurvedic medicines. 36% dermatologists strongly agreed and 40% agreed that they should be able to advise their patients about the pros and cons of the concomitant use of the Ayurvedic therapy with the modern medicine. 56% dermatologists strongly agreed and 26% agreed that the Ayurvedic medicines not tested by modern scientific methods should be discouraged. 16% dermatologists reported that they used Ayurvedic medicines. Conclusion: The perception of dermatologists regarding the Ayurvedic drugs-use is mixed. Rigorous steps are needed to bridge the gap between dermatologists and their knowledge about Ayurvedic therapies for treating the patients suffering from incurable diseases like psoriasis. We provide recommendations to bridge this gap.

Full text

The Perception of Dermatologists towards the Outcome of Ayurvedic
Therapy for Psoriasis
Ujjwala Manish Kulkarni1*, Yashashri C Shetty1, Atul M Dongre2, Jayati S Dave2, Uday S Khopkar2 and Nirmala N Rege1
1Department of Pharmacology and Therapeutics, Seth Gordhandas Sundardas Medical College and King Edward Memorial Hospital, Mumbai, India
2Department of Skin, STD and Leprosy, Main Hospital Building, King Edward Memorial Hospital, Mumbai, India
*Corresponding author: Ujjwala Manish Kulkarni, Department of Pharmacology and Therapeutics, Seth Gordhandas Sundardas Medical College and King Edward
Memorial Hospital, Mumbai, India, Tel: +91-996730087; E-mail: writeumk@gmail.com
Received date: July 17, 2018; Accepted date: August 23, 2018; Published date: September 01, 2018
Copyright: ©2018 Kulkarni UM, 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 author and source are credited.
Abstract
Introduction: The use of Ayurvedic medicines have been increasing for skin ailments. The medical fraternities
are concerned about the safety and efficacy of Ayurvedic products. We conducted this study because there is a
scarcity of data regarding the perception of dermatologists towards the Ayurvedic treatment for psoriasis.
Objective: We would like to understand the perception of dermatologists regarding the outcome of Ayurvedic
therapy for psoriasis.
Method: This cross-sectional pilot survey was executed after an approval from the institutional ethics committee,
in Mumbai metropolitan area in India using pre-validated questionnaire to collect the data from 100 dermatologists.
The questionnaire consisted of 4 sections: 1) Dermatologists’ demographics, 2) Dermatologists’ perception
regarding the Ayurvedic therapy, 3) Dermatologists’ general attitude towards the use of the Ayurvedic therapy for
psoriasis and 4) Their personal experiences about the Ayurvedic therapy. The data were analyzed by descriptive
statistics.
Results: The dermatologists perceived that the impact of the Indian culture and the desire for a better outcome
were the primary reasons for the use of Ayurvedic medicines by the patients. 95% of the dermatologists were aware
about the patients’ use of the Ayurvedic medicines for psoriasis. 56% dermatologists observed various skin related
untoward effects in the patients who claimed taking Ayurvedic medicines for psoriasis. 55% dermatologists did not
comment on the effectiveness of the Ayurvedic therapy on scaling, thickness and the redness of skin. 57%
dermatologists did not comment on the effectiveness of the Ayurvedic therapy on itching and the size of the affected
areas in psoriatic patients. 22% Dermatologists strongly agreed and 55% agreed that they should have the
knowledge of Ayurvedic drugs for psoriasis. As per the dermatologists (53% strongly agreed and 38% agreed), the
patients should inform them about their use of Ayurvedic medicines. 36% dermatologists strongly agreed and 40%
agreed that they should be able to advise their patients about the pros and cons of the concomitant use of the
Ayurvedic therapy with the modern medicine. 56% dermatologists strongly agreed and 26% agreed that the
Ayurvedic medicines not tested by modern scientific methods should be discouraged. 16% dermatologists reported
that they used Ayurvedic medicines.
Conclusion: The perception of dermatologists regarding the Ayurvedic drugs-use is mixed. Rigorous steps are
needed to bridge the gap between dermatologists and their knowledge about Ayurvedic therapies for treating the
patients suffering from incurable diseases like psoriasis. We provide recommendations to bridge this gap.
Keywords: Psoriasis; Dermatologists; Perception; Ayurvedic drugs;
Ayurveda; Questionnaire; Adverse eects; Concomitant ayurvedic;
Allopathic therapy
Introduction
e role of the traditional, complementary and alternative medicine
(CAM) is becoming important in the healthcare systems of both the
developing and the developed countries [1-3]. ere is a growing
evidence of an extensive CAM use among the patients of psoriasis. A
variety of therapeutic procedures as well as medicines derived from
plants are included in CAM. Medicinal plants are an integral part of
CAM. e plant-derived medicines have made large contributions to
human health and well-being [4]. Patients perceive that CAM has a
potential to heal diseases and improve the quality of life in skin
diseases including psoriasis. is is one of the primary reasons behind
the CAM usage. Some patients have chosen CAM because they have
an interest in a less toxic treatment, and are disappointed with
conventional treatments. Some patients also seek CAM in the hope of
the stress reduction needed for the psoriasis control [5,6].
However, the use of some of the complementary and alternative
therapies has been associated with adverse reactions, drug interactions,
and a low adherence to prescription drugs [7]. erefore, the
importance of open patient-doctor discussions on CAM has been
repeatedly highlighted [8]. Despite a high prevalence of the CAM
usage for skin ailments, there is very limited data on dermatologists’
attitudes and knowledge about CAM. e dermatologists are less likely
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ISSN: 2155-9554
Journal of Clinical & Experimental
Dermatology Research Kulkarni et al., J Clin Exp Dermatol Res 2018, 9:5
DOI: 10.4172/2155-9554.1000465
Research Article Open Access
J Clin Exp Dermatol Res, an open access journal
ISSN:2155-9554
Volume 9 • Issue 5 • 1000465

to predict the CAM use in their patients and in the majority of cases
the CAM use was not discussed [9,10]. Ayurveda, a well-recognized
alternative system of medicine by National Center for Complimentary
and Integrative Health (NCCIH), is the oldest Indian traditional
system of Medicine. It has been practiced in India since at least 5000
years. e Government of India has ocially accepted Ayurveda as a
system of medicines. Ayurveda has also been used in countries where
the modern medicine is primarily used in the national healthcare
system [11,12].
Ayurveda medicines have been used by a majority of the Indians
either alone or in combination with the modern medicines for various
ailments at least once in their lifetime [12-14]. Sometimes patients
used Ayurveda on their own without taking the advice of Ayurveda
physicians. As most of the Ayurvedic drugs are not tested in modern
scientic ways and as the system is not integrated with the modern
medicine therapy, there can be issues aecting the modern medicine
physicians as well as the patients. ere is a popular mistaken belief
about the Ayurvedic medicines that the Ayurvedic therapy is totally
safe and without any adverse reactions. In the study done by atte et
al., the majority of Ayurvedic physicians accepted the possibility of
adverse eects by Ayurvedic drugs if prescribed irrationally and or due
to faulty manufacturing processes [15].
A few studies were conducted in Europe to nd out the perception
of the modern medicine physicians regarding the integration of CAM
therapies for the benets of patient care [3,5,6,16]. Some studies were
carried out in India to nd out the perceptions of the modern
medicine physicians towards the Ayurvedic therapy and patients
seeking the Ayurvedic therapy [17-21].ey found some positive vibes
towards Ayurveda. However, there is a scarcity of data regarding the
perception of dermatologists toward this ancient medical science. With
this background of the increased use of Ayurveda medicines for skin
ailments [13,14] and the concerns of the medical fraternities’ regarding
the safety and ecacy of the Ayurvedic products [7,22,23], it is critical
to understand the perception of dermatologists towards the outcome of
the Ayurvedic therapy for psoriasis. erefore, we conducted this
study.
Methodology
is cross-sectional pilot survey was executed from December 2014
to January 2017 aer an approval from the institutional ethics
committee (EC/OA-01/2014) of Seth G.S.M.C. & KEM Hospital, Parel,
Mumbai, India. A pre-validated questionnaire was used for the data
collection. e questionnaire was distributed in-person to the
participating registered practicing dermatologists. eir written
consent was taken for the participation. 205 dermatologists practicing
either in a tertiary care or in a private clinic in Mumbai, and its
suburban area were approached in order to collect the data. Registered
dermatologists who were practicing in Mumbai metropolitan area,
having experience of treating psoriatic patients during their practice,
and able to give written consents for the volunteer participation were
included in the study. 100 practicing dermatologists consented to
participate (Figure 1).
e questionnaire consisted of 4 sections:
• Section 1: Covered dermatologists’ demographics. e questions
collected information on age, gender, qualication, the years of
experience, clinical practice set up, the number of psoriatic patients
seen per month and the training of Ayurveda.
• Section 2: Focused on the dermatologists’ perception regarding
the Ayurvedic therapy. e questions captured data on the
dermatologists’ awareness regarding the patients’ past use of Ayurvedic
drugs alone (without any allopathic therapy), the number of patients
taking the Ayurvedic therapy in combination with the allopathic
therapy, and the dermatologists’ perception regarding the reasons
behind the patients seeking the Ayurvedic care. e questions captured
information whether the dermatologists gathered Ayurvedic treatment
history of the patients, and the role of the dermatologists in
modulating the Ayurvedic treatment. We inquired about the
dermatologists’ role in deciding whether to make changes in the
allopathic therapy, stop the Ayurvedic drugs completely or taper the
dose of Ayurvedic drugs based on the patients’ needs. Questions
regarding the dermatologists’ awareness of various Ayurvedic drugs
and procedures received by psoriatic patients were asked. Questions
also inquired about any adverse eects related to the Ayurvedic drugs
observed by the dermatologists in their practice, and their perception
regarding the eectiveness of the Ayurvedic therapy.
Figure 1: Enrollment of the dermatologists for the study.
• Section 3: Included questions related to the dermatologists’ general
attitude towards the use of the Ayurvedic therapy for psoriasis and
communicating to the patients about the Ayurvedic therapy. e
dermatologists’ perceptions regarding the integration of the
Ayurvedic therapy with allopathy for psoriasis were also recorded.
• Section 4: Inquired about the dermatologists’ personal experiences
about the use of the Ayurvedic therapy for their own health or the
health of their friends or family.
All the questions were validated by 8 subject-experts. e range of
the Content Validity Ratio (CVR) of the questions was 0.5 to 1. e
Content Validity Index of the questionnaire was 0.96 [24]. e
questionnaire contained 12 yes/no type questions, 8 open-ended
questions, 12 questions with options in 5-points-Likert-scale. e data
were analyzed by descriptive statistics (i.e., providing useful summaries
of the data observed https://en.wikipedia.org/wiki/
Citation: Kulkarni UM, Shetty YC, Dongre AM, Dave JS, Khopkar US, et al (2018) The Perception of Dermatologists towards the Outcome of
Ayurvedic Therapy for Psoriasis. J Clin Exp Dermatol Res 9: 465. doi:10.4172/2155-9554.1000465
Page 2 of 8
J Clin Exp Dermatol Res, an open access journal
ISSN:2155-9554
Volume 9 • Issue 5 • 1000465

Descriptive_statistics). Results are reported in percentage (%), medians
and ranges of the parameters.
Results
e data analyses are depicted in Tables 1-4. Out of 100 participant
dermatologists, only 2 dermatologists had taken training in Ayurveda.
Table 3 depicts the dermatologists’ perception regarding the patients’
reasons for seeking the Ayurvedic care. e following were the other
reasons given by the dermatologists. 20% dermatologists felt that the
patients have a misconception that the Ayurvedic drugs have no side
eects, 10% dermatologists reported that the patients have a belief that
Ayurvedic drugs provide a permanent cure; 8% reported peer pressure
as another reason. According to 5% dermatologists, the patients
perceived that Ayurvedic drugs would be a better option for chronic
diseases. Dissatisfaction with the modern therapy was the reason given
by other 5% dermatologists. A social stigma with the disease,
advertisements of Ayurveda therapies and lower prices were the
reasons given by 2% dermatologists each. 1% dermatologists thought
self-medication might be the reason behind using the Ayurvedic
therapy.
Gender Male: 52, Female: 48
Years of Experience (range) 1-35 years
Median experience 10 years
Median Age 39 years (age-range 26-63 years)
Table 1: Demographics of the dermatologists.
Number of dermatologists aware about the past use of Ayurvedic therapy for
psoriasis in their patients 95 (95%)
Number of dermatologists aware about the past use of Ayurvedic therapy along with
allopathy for Psoriasis in their patients 81 (81%)
The range of psoriatic patients treated per year by dermatologists 24-3600 (Median=240) (Interquartile range=180-360)
The range of patients who consulted dermatologists in the previous year with the
history of the use of Ayurvedic medicines for psoriasis. 1-1080 (Median=72) (Interquartile range=24-144)
The range of patients who consulted dermatologists in the previous year with the
past history of the use of Ayurvedic Medicines along with allopathy for psoriasis 0-1200 (Median=24) (Interquartile range=5-72)
Table 2: e dermatologists’ awareness regarding the use of the Ayurvedic therapy for psoriasis in their patients.
Allopathic drugs have more side effects 59%
Allopathic drugs are not effective 18%
A desire for better outcome 63%
Due to lifestyle changes and dietary advices 46%
The impact of the Indian culture 72%
A high accessibility of Ayurvedic medicines without prescription 57%
Other reasons 46%
Table 3: e dermatologists’ perception regarding the patients’ reasons for seeking the Ayurvedic Care.
Strongly
agreed (%) Agreed (%) Neutral (%) Disagreed (%) Strongly
disagreed (%)
Did not attempt
the question (%)
Dermatologists should have some knowledge about the most
common Ayurvedic medicines/therapies used for psoriasis. 22 55 10 10 3 0
The use of Ayurvedic medicines/therapies should be asked
during history-taking 50 44 3 2 1 0
Patients should inform the doctor about their use of Ayurvedic
medicines for psoriasis 53 38 6 1 2 0
Citation: Kulkarni UM, Shetty YC, Dongre AM, Dave JS, Khopkar US, et al (2018) The Perception of Dermatologists towards the Outcome of
Ayurvedic Therapy for Psoriasis. J Clin Exp Dermatol Res 9: 465. doi:10.4172/2155-9554.1000465
Page 3 of 8
J Clin Exp Dermatol Res, an open access journal
ISSN:2155-9554
Volume 9 • Issue 5 • 1000465

Dermatologists should be able to advise their patients about
the pros and cons of the combination of Ayurvedic therapies
with allopathic medicines used for psoriasis.
36 40 13 7 1 3
The Ayurvedic medicine is complementary to regular
medicine for psoriasis 8 11 44 24 11 1
Clinical care should integrate the best of the allopathic and
Ayurvedic medicine/therapy to treat psoriasis 19 28 27 16 6 2
Ayurvedic therapies/medicines, which are not tested
scientifically should be discouraged 56 26 13 1 3 0
The use of the Ayurvedic medicine/therapy in the treatment of
psoriasis is debatable 25 33 26 8 1 7
Dermatologists should not discuss the Ayurvedic therapy/
medicine with their patients 10 22 34 22 3 10
Table 4: e dermatologists’ attitude towards the Ayurvedic therapy for psoriasis.
Ninety three percent of dermatologists asked their patients about
the history of the use of Ayurvedic Medicines for psoriasis. On the
question about the impact of the Ayurvedic therapy on allopathic
drugs, 52% dermatologists felt that the patients’ Ayurvedic therapy
have an impact on the allopathic treatment. When asked about the
dermatologists’ decision on the continuation of the Ayurvedic
medicines while starting an allopathic therapy; 66% dermatologists
stopped the Ayurvedic therapy before giving the allopathic treatment.
26% dermatologists tapered the Ayurvedic medicines. 28%
dermatologists started the allopathic therapy irrespective of the
Ayurvedic therapy (more than 1 option was selected by some
dermatologists). eir decisions were based on the types of the
medicines taken, and the patients’ conditions.
When asked about the Ayurvedic therapy (either drugs or
therapeutic procedures) taken by the psoriasis patients, 60%
dermatologists came across the various Ayurvedic medicines or
procedures taken by their patients. However, only 9% were able to tell
names of the Ayurvedic medicines. ese were Immupsora, 777 Oil,
Manjisthadi kadha, Karanj oil, Gandhak Rasayan (detoxied Sulfur
processed with herbal juice), Skiwa capsules, Neem-leaves-water-bath,
Haldi (turmeric) capsule etc. 10% dermatologists told that the psoriatic
patients used the panchakarma (a 5-steps detoxication process
purifying the patient’s body) procedure as an Ayurvedic therapy for
psoriasis but couldn’t tell which types of medicines or procedures were
used for panchakarma. Most of the dermatologists were unable to tell
the name of the Ayurvedic procedures or medicines used by the
patients. e dermatologists mentioned that the patients could not tell
the name or did not have the prescriptions or sometimes showed loose
medicines in the form of powders (churna) or liquids without any
name tags.
Fiy six percent dermatologists observed untoward eects in the
psoriatic patients with a history of Ayurveda medicines. e types of
untoward eects observed in patients taking Ayurveda medicines
included contact dermatitis, precipitation of pustular psoriasis,
exacerbation of psoriasis or existing patches, allergic rashes,
erythroderma, increased pruritus, Cushing syndrome, sudden weight
loss, wait gain, acneiform eruption, multiple furuncles, bloating of face,
steroid induced moon face, erythema and irritation, pigmentation of
the skin, and phototoxic dermatitis.
e dermatologists felt that it was inappropriate to comment on the
eectiveness of the Ayurvedic therapy because they did not know
about Ayurveda as they were not exposed to Ayurveda in their medical
schools (Figure 2). We also wondered if the healing of psoriasis by
Ayurveda improved the social life of the patients. When asked the
dermatologists regarding this aspect; 59% did not comment, while 23%
remained neutral. 7% said it improved the patients’ social life (Figure
3).
When asked the dermatologists about their personal experiences of
Ayurveda, 16% dermatologists reported that they had consulted and
taken treatment from Ayurvedic practitioners for their own health and
8% dermatologists got beneted by the Ayurvedic therapy. When
enquired about the personal experiences of Ayurveda in regards to
family and friends; 59% dermatologists reported that their friends or
family members consulted Ayurvedic practitioners for various
ailments. Out of 59%; 31% dermatologists reported that their friends/
family beneted due to the Ayurvedic treatment obtained from
Ayurvedic physicians (Figure 4).
We also wondered if the dermatologists used Ayurvedic therapies to
treat illnesses for their own. Only 16% dermatologists self-
administered Ayurvedic medicines or homemade remedies. 12%
dermatologists benetted from the self-administration of the
Ayurvedic medicines or homemade remedies. 16% dermatologists
followed dietary restrictions. 15% dermatologists got a benet from
dietary restrictions. 4% dermatologists reported the use of Ayurvedic
therapeutic procedures (panchakarma) under the guidance of
Ayurvedic physicians. e dermatologists also mentioned the self-
administered lifestyle changes.
e dermatologists gave the name of Ayurvedic preparations like
Kutaj, Adulsa syrup, Triphala churna, Sitophaladi churna,
Ashwagandha, Yastimadhu, Kumari asav, Amala, Haridra, Vekhand,
Curcumin powder with milk, Cystone, Septiline, Spirulina, capsule
Swika, psoralen, Liv 52, Vitiloplex, Whit Care ointment, and Ayurvedic
lotions. Shirodhara (head-bath with oil), Nasya (nasal instillation),
Abhyangsnanam (oil-massage followed by a shower), Basti (enema)
were the panchakarma procedures used by the dermatologists
themselves under the guidance of an Ayurvedic physicians. Relaxation
and improved skin tone were the benets experienced by them.
Citation: Kulkarni UM, Shetty YC, Dongre AM, Dave JS, Khopkar US, et al (2018) The Perception of Dermatologists towards the Outcome of
Ayurvedic Therapy for Psoriasis. J Clin Exp Dermatol Res 9: 465. doi:10.4172/2155-9554.1000465
Page 4 of 8
J Clin Exp Dermatol Res, an open access journal
ISSN:2155-9554
Volume 9 • Issue 5 • 1000465

Figure 2: e dermatologists’ perception regarding the eectiveness
of the Ayurvedic therapy on psoriatic skin lesions.
Figure 3: e dermatologists’ perception regarding the time
required for the improvement due to the Ayurvedic therapy in
psoriatic patients.
Figure 4: e dermatologists’ perception regarding the duration of
the improvement due to the Ayurvedic therapy in psoriatic patients.
Discussion
is study reports the perceptions of the practicing dermatologists
regarding the outcome of the Ayurvedic therapy for psoriasis. We
found that psoriatic patients ranging from 24-3600 (Median=240,
interquartile range=180-480) consulted the dermatologists in the
previous year for psoriasis. It is a self-reported gure by the
dermatologists. So there could be a potential recall bias. A proper
record/register of the psoriatic patients visiting the dermatologists
could give a more accurate rate of psoriasis patients visiting the
dermatologists.
e data of our study indicate that a substantial percentage of the
dermatologists enquired about the use of Ayurvedic medicines for
psoriasis while capturing the history. is indicates an awareness of the
dermatologists regarding the patients’ inclination towards Ayurveda.
As per the dermatologists’ perception 1 to 1080 (median=72,
interquartile range=24-144) psoriatic patients (seen in the previous
year in their practice) used Ayurveda (without allopathy) for psoriasis
during their lifetime. As per the dermatologists’ perception 0 to 1200
(Median=24, interquartile range=5-72) psoriatic patients (seen in the
previous year in their practice) used Ayurveda along with allopathy for
psoriasis. e dermatologists felt that an impact of the Indian culture
and a desire for a better outcome were the main reasons for the
psoriatic patients to seek the Ayurveda treatment.
59% dermatologists opined that the patients perceived that
allopathic drugs have more side eects. A majority of the
dermatologists felt that Ayurvedic drugs may aect the allopathic
therapy if given concomitantly. A tendency to stop the Ayurvedic
therapy before starting allopathic therapy was observed among
dermatologists. Despite dermatologists’ awareness about the use of
Ayurvedic medicines by their patients, dermatologists were not able to
tell the names of the Ayurvedic medicines. e dermatologists’ major
concern was their patients were not able to tell the names of the
Ayurvedic preparations or did not have prescriptions and sometimes
brought loose medicines without name tags. On enquiry from
dermatologists, the patients simply mentioned that they had taken
Ayurvedic medicines.
Many dermatologists observed untoward eects in their psoriatic
patients who claimed using Ayurvedic medicines. As per the
dermatologists, exacerbation of psoriatic lesions like erythema, itching,
scaling, contact dermatitis, irritant dermatitis, photosensitivity,
localized pustular psoriasis, etc., were the observed untoward eects in
psoriatic patients (seeking their help) who claimed taking Ayurvedic
therapy. However, there should be a proper investigation and a
causality assessment before coming to any conclusion. e causality
assessment for skin related adverse-drug-reactions (ADRs) from
Ayurvedic therapies are not clear and whether the practicing
dermatologists are really trained enough to do this analysis is an area
for future investigation.
e majority of the dermatologists could not comment on the
eectiveness of the Ayurvedic therapy for psoriasis because they felt it
was inappropriate to comment on the therapy for which they did not
have an expertise. In the dermatology curriculum as well as in the
MBBS curriculum, the students are not exposed to the alternative
medicine science. As per the medical council of India, allopathic
practitioners are not allowed to prescribe the Ayurvedic medicines
[25]. However, in India, the use of the Ayurvedic medicines is common
in the society [12-14,19-21]. Under such a background, there is an
urgent need to sensitize the dermatologists toward this ancient
Citation: Kulkarni UM, Shetty YC, Dongre AM, Dave JS, Khopkar US, et al (2018) The Perception of Dermatologists towards the Outcome of
Ayurvedic Therapy for Psoriasis. J Clin Exp Dermatol Res 9: 465. doi:10.4172/2155-9554.1000465
Page 5 of 8
J Clin Exp Dermatol Res, an open access journal
ISSN:2155-9554
Volume 9 • Issue 5 • 1000465

traditional therapy of “Ayurveda” in order to prepare them in handling
such cases with a positive approach. According to 6% dermatologists;
some of their patients felt relief from psoriasis while on the Ayurvedic
therapy.
Regarding the general attitude of the dermatologists towards the
Ayurvedic therapy; the following things emerged from the study. A
majority of the dermatologists were open to learn about the most
common Ayurvedic medicines/therapies used for psoriasis. is
indicates the willingness of the dermatologists to understand the
Ayurveda. As the Ayurvedic therapy-use is increasing in the society,
this type of attitude of dermatologists is very important and necessary.
is is a positive vibe for a condition like psoriasis where dierent
disciplines are tried by patients as well as physicians. A study
conducted by Al Ghamdi et al. [26] has a nding similar to our study,
where they have reported that 69% of the dermatologists were
interested in CAM therapies and 65.6% dermatologists were interested
in receiving CAM-specic-education. Shankar et al. [27] carried out a
study in a medical school in Nepal to nd out the medical students’
opinion about CAM. ey also reported that 62.2% of Medical
students agreed to introduce the study module on CAM in the medical
curriculum. As per Mankar et al.’s study on undergraduate medical
students [28], most of the medical students felt the knowledge of
Ayurveda was important. 89% of the students wished to gain the
knowledge of Ayurveda [28]. e study done by Gawde et al. [21] in a
tertiary care hospital in Mumbai reported that 76% modern medical
physicians were interested in Ayurveda and they felt the integration of
the modern medicine with Ayurveda might attract more patients.
In our study, the majority of dermatologists felt that they should be
able to advise their patients about the pros and cons of the
combination of the Ayurvedic therapy with allopathic medicines used
for psoriasis. Our results are in concordance with Corbin et al. study
[29]. ey have found that 60% of the physicians’ from a metropolitan
city like Denver were interested in learning more about CAM. eir
interest was mainly to understand the safety and ecacy of CAM; to
receive factual information about CAM as well as to satisfy the
patients’ queries related to CAM [29].
ere is a growing concern about the doctor-patient-
communication regarding the use of CAM. A majority of the patients
do not inform modern physicians about their use of CAM and the
patients are also hardly inquired by the doctors about CAM use
[13,14,29]. Our study indicated that a majority of dermatologists felt
that the use of Ayurvedic therapy should be asked to the patients
during the history-taking and the patients should co-operate in this
process by informing dermatologists about their use of Ayurvedic
medicines. So, the communication and history-taking becomes a
rigorous exercise, but is needed to get an up-to-date information from
the patients. is can help in prescribing a safe, eective patient-
centric therapy.
In our study, many dermatologists (48%) agreed to integrate the best
of the allopathic and the Ayurvedic medicine/therapy to treat psoriasis.
However, only 2% dermatologists have taken training related to
Ayurveda. If such a suggestion is taken into the consideration, and
common alternative medicine therapies are introduced in the
dermatology curriculum; it would open a new horizon for
dermatologists and psoriatic patients. e patients’ co-operation in
informing the dermatologists about the Ayurvedic medicine use, and
the dermatologists’ awareness about the Ayurveda and its basic
principles could be important in treating drugs-interaction cases. It
would also help to give a proper therapeutic guidance to psoriatic
patients. In any chronic disease like psoriasis; where there is no cure,
the patient has every right to venture into dierent medical disciplines.
erefore, the physicians handling such cases need to be aware of the
dierent therapies for a proper guidance to the patients and to manage
patients eectively.
A handful of dermatologists agreed that the Ayurveda medicine is
complementary to the regular medicine for psoriasis. Our results are
not in concordance with AlGhamdi et al. who reported 68% of
dermatologists considered CAM to be a useful supplement to
conventional medicine [26]. Our results might be due to a lack of
exposure of dermatologists to Ayurveda. e dermatologists also
expressed concerns about the safety of Ayurvedic medicines. ey felt
that the use of Ayurvedic medicines/therapy in the treatment of
psoriasis is debatable. A majority agreed that the Ayurvedic therapies/
medicines, which are not tested scientically, should be discouraged.
Our results are in accordance with AlGhamdi et al. who found that
69.9% dermatologists thought there should be a scientic basis for
CAM [26].
However, a majority of the dermatologists remain neutral when
asked if dermatologists should not discuss the Ayurvedic therapies/
medicines with their patients. ese might be because of MCI (Medical
Council of India) rules and regulations in India, which sets rules for
practicing allopathy [25]. As per the regulations; cross-discipline
practices are not allowed for dermatologists. e reported rate of
personal CAM use by dermatologists varies widely throughout the
world [9,26]. In our study, very few dermatologists consulted
Ayurvedic physicians for themselves and the most of those who
consulted got beneted. Very few dermatologists were able to tell the
names of Ayurvedic products. As these are not routinely used by
dermatologists, it is dicult to memorize the names. A handful of
dermatologists used Ayurvedic procedures for themselves with a
proper guidance of Ayurvedic physicians and they found it to be
benecial.
Roy et al. study [14] reported that 58% modern physicians used
CAM. Homeopathy and Ayurveda was two commonly used CAM by
the physicians (for treating themselves) of the modern medical
background in their study [14]. In our study, possible reasons for the
less usage of Ayurveda by dermatologists for themselves could be a lack
of knowledge of Ayurveda, their concerns regarding the eectiveness
and safety of the Ayurvedic therapy, and an absence of the scientic
evidence towards Ayurvedic therapies. ese were reected in the
questions related to their opinion on the eectiveness of the Ayurvedic
therapy for psoriasis.
A majority of the dermatologists reported that their friends and
family members consulted Ayurvedic physicians for many clinical
conditions. More than half of the dermatologists (who reported
positively about friends/family use of Ayurveda) reported that their
friends and family members got beneted from the Ayurvedic
therapies received from Ayurveda physicians. is shows the
popularity of Ayurveda and its inherent traditional culture which has
been followed for years in the Indian population. e perception of
dermatologists regarding Ayurvedic drugs-use is mixed. It would help
their practice if a proper guidance on Ayurveda is provided.
Limitations of the Study
Our study sample was from only one region i.e. the metropolitan
Mumbai, which represents only the urban area; so the data is not
generalizable to other setups. e questionnaire was not complete in
Citation: Kulkarni UM, Shetty YC, Dongre AM, Dave JS, Khopkar US, et al (2018) The Perception of Dermatologists towards the Outcome of
Ayurvedic Therapy for Psoriasis. J Clin Exp Dermatol Res 9: 465. doi:10.4172/2155-9554.1000465
Page 6 of 8
J Clin Exp Dermatol Res, an open access journal
ISSN:2155-9554
Volume 9 • Issue 5 • 1000465

terms of the detailing of Ayurvedic therapy enquiry (the information
on procuring Ayurvedic treatment from registered Ayurveda
practitioners or on their own or from quacks, the details of the
Ayurvedic therapy taken by the patients, drugs-names, the duration of
the Ayurvedic therapy taken by the patients, as well as the patients’
compliance) and the availability of Ayurvedic therapies. e project is
questionnaire-based so the data is based on the respondent’s memory
and his/her willingness to report it accurately. 50% practitioners, who
were eligible, denied participation (due to their busy schedule) and
their participation could have a dierent impact on the study ndings.
Recommendations
- Dermatologists-patients communication: Dermatologists and
patients should have an open and candid discussion regarding the use
of the Ayurvedic therapy. Dermatologists should proactively ask
psoriatic patients about the use of Ayurvedic medicines.
- An exposure to the Ayurvedic system of medicine:
•e dermatology students or medical undergraduates can be
sensitized to commonly used Ayurvedic preparations for psoriasis
in the medical curriculum. ey could be posted for 2-3 months in
Ayurvedic clinics in order to gain a basic knowledge of Ayurveda
as well as commonly used Ayurvedic therapies for psoriasis and
other skin ailments.
• Continuing Medical Education (CME) for practicing
dermatologists: Topics related to Ayurveda, its principle and its
role in treating chronic skin conditions like psoriasis should be
discussed during CMEs. Dermatologists should be updated for
commonly used Ayurvedic drugs for psoriasis as well as the basic
concepts of Ayurvedic therapies.
•Diploma/certicate courses in Ayurveda for dermatologists can
provide the gross knowledge of various Ayurvedic therapies as well
as the basic principles of Ayurveda. e therapies/drugs and
methodologies used in Ayurveda specically for skin ailment
including psoriasis should be incorporated in those courses.
- e guidelines from the Medical council of India, (including
judiciary section) and the government policies should be modied for
incurable chronic diseases such as psoriasis so that Ayurvedic
practitioners and dermatologists could administer integrated therapies.
- Dermatologists-Ayurvedic physicians’ communication: An open
discussion between dermatologists and Ayurveda physicians while
treating patients on concomitant therapy should be encouraged.
Dermatologists should seek an expert opinion from the Ayurvedic
doctor regarding the patients’ past history of Ayurvedic medicines and
potential untoward eects. A forum should be developed for both the
disciplines to share their experiences and create an awareness
regarding the common issues while treating patients on the
concomitant therapy.
With this knowledge, dermatologists could also educate patients,
answer the queries related to the concurrent use of both the therapies
condently and give a better individualized treatment to psoriasis
patients.
Acknowledgement
We sincerely thank Dr. Reshmikant M. Shah and Dr. Vijay V. Moghe
for introductions to practicing dermatologists of Mumbai area.
Without their help, this project would have been dicult to implement.
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J Clin Exp Dermatol Res, an open access journal
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Volume 9 • Issue 5 • 1000465

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Citation: Kulkarni UM, Shetty YC, Dongre AM, Dave JS, Khopkar US, et al (2018) The Perception of Dermatologists towards the Outcome of
Ayurvedic Therapy for Psoriasis. J Clin Exp Dermatol Res 9: 465. doi:10.4172/2155-9554.1000465
Page 8 of 8
J Clin Exp Dermatol Res, an open access journal
ISSN:2155-9554
Volume 9 • Issue 5 • 1000465