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www.wjpr.net Vol 9, Issue 5, 2020.
Kasta et al. World Journal of Pharmaceutical Research
2241
KSHARASUTRA MANAGEMENT OF CHARMAKILA W.S.R TO
ACQUIRED DIGITAL FIBROKERATOMA – A CASE STUDY
Dr. Ranjan Kumar Kasta*4, Dr. Ajit Kumar Pradhan3, Dr. Priyanka Giri2 and
Dr. Arpita Sahoo1
1Reader, Department of Shalya Tantra, Gopabandhu Ayurveda Mahavidyalaya & Hospital,
Puri.
2Medical Officer AYUSH (Ayurveda), Department of AYUSH, All India Institute of Medical
Sciences, Bhubaneswar.
3P.G. Scholar, Department of Kaumarabhritya, Gopabandhu Ayurveda Mahavidyalaya &
Hospital, Puri.
4P.G. Scholar, Department of Sharir Kriya, National Institute of Ayurveda, Jaipur, Rajasthan.
ABSTRACT
INTRODUCTION: Acquired digital fibrokeratomas are a benign soft
tissue tumor with typical appearance and anatomical locations. This
lesion generally occurs in middle aged males with common sites of
occurrence in the digits of upper or lower extremities. It is commonly
correlated with Charmakila in Ayurveda. Vyana Vayu and Kapha
Dosha are responsible for its origin. CASE PRESENTATION: A 33-
year-old man came to Shalya (Surgery) OPD of Gopabandhu
Ayurveda Mahavidyalaya and Hospital, Puri, Odisha, India,
complaining with abnormal slow growing lesion at palmar surface of
middle phalanx of middle finger of right hand diagnosed as acquired
digital fibrokeratoma by physical, clinical and histological examination. The base of lesion
was trans-fixed and ligated by Ksharasutra and the resulting wound was dressed with Jatyadi
Ghrita. The skin eventually healed, and the patient had a good outcome. CONCLUSION:
This case is of interest because of the rarity of digital fibrokeratoma. Ksharasutra treatment
was preferred to minimize the recurrence rate of curettage and surgical excision.
KEYWORDS: Acquired digital fibrokeratoma; Charmakila; Ksharasutra.
World Journal of Pharmaceutical Research
SJIF Impact Factor 8.084
Volume 9, Issue 5, 2241-2244. Case Study ISSN 2277– 7105
Article Received on
17 March 2020,
Revised on 07 April 2020,
Accepted on 28 April 2020
DOI: 10.20959/wjpr20205-17482
*Corresponding Author
Dr. Ranjan Kumar Kasta
P.G. Scholar, Department of
Sharir Kriya, National
Institute of Ayurveda, Jaipur,
Rajasthan.
www.wjpr.net Vol 9, Issue 5, 2020.
Kasta et al. World Journal of Pharmaceutical Research
2242
INTRODUCTION
Acquired digital fibrokeratoma is a rare solitary benign fibrous tumor that usually occurs in
adults. These tumours are commonly originated at the fingers and toes. The size of the
tumour is generally small, approximately 3 to 5 mm in length. But sometimes it may be larger
up to 3 to 4 centimeters. Clinical examination reveals a solitary, round, firm, skin colored
lesion less the 1 centimeter in diameter with either a sessile, dome-shaped or pedunculated
base.[1] Acquired digital fibrokeratoma can be correlated with Charmakila in Ayurvedic
medical sciences. Ayurveda describes about Charmakila very briefly. The provoked Vyāna
Vāyu along with the Kapha Dosha producing firm and finger with nail-like growths
externally which are known as Charmakila Arsha. Acharya Dalhana mentions the site may
be outside the anal verge or at other places of body. Charmakila is classified into three types.
Vataj manifested as Toda (pricking pain); Kaphaj manifested as Savarnatva (similar colour)
and Granthitva (knottiness), Pittaj and Raktaj manifested as Ruksha (roughness), Krishna
(blackness), Shlakshna (glossiness). The outstanding feature of Charmakila is pronounced
roughness.[2]
Histology of Acquired digital fibrokeratoma shows polypoid lesion with variably hyperplastic
epidermis covering a dermal proliferation composed of dense collagen fibres and variable
amounts of mature fibroblasts, small blood vessels and elastic tissue, thickened collagen in
dermis is oriented predominantly in the vertical direction, stellate stromal cells may be
present, covered by variably acanthotic epidermis with hyperkeratotic orthokeratosis, lesion
merges with adjacent normal dermis, neural structures are absent or inconspicuous and lacks
adnexal structures.[3]
CASE REPORT
We describe a case of 33-year-old man with a 7-year history of slow growing lesion on
palmar surface of middle phalanx of middle finger of right hand came to Shalya (Surgery)
OPD of Gopabandhu Ayurveda Mahavidyalaya and Hospital, Puri, Odisha, India. The lesion
was projected like extra finger with nail at tip. Its length was approximately 1 centimeter and
diameter about 5mm. The colour of lesion was like normal skin and it was slightly mobile in
all direction, not adherent to underneath bone and pedunculated. The growth was mildly
painful and gradually increasing in size which made difficulty in his daily work. The patient
had no history of injury prior to the onset of the lesion. The lesion was diagnosed as acquired
www.wjpr.net Vol 9, Issue 5, 2020.
Kasta et al. World Journal of Pharmaceutical Research
2243
digital fibrokeratoma by physical and clinical examination. We described about Ksharasutra
to the patient and consent was taken.
Under local anesthesia, intradermal infiltration of 2% Lignocaine solution at the base of
lesion Ksharasutra was transfixed and ligated and part of the lesion excised distal from the
ligation. The excised part was sent for histological study. The created fresh wound dressed
with Jatyadi Ghrita. Daily dressing was done and the stump of lesion was mobilized. After 3
days the stump of lesion was sloughed out and wound was dressed with Jatyadi Ghrita. After
10 days the wound was healed without any scar.
DISCUSSION
There are different types of treatment options described in modern medical science for
Acquired digital fibrokeratoma like cryotherapy, shave excision, curettage and cutter. The
surgical excision is the mainstay of effective treatment. These treatment procedures may have
disadvantage like recurrence of disease.[4]
Acharya Sushruta recommends Chedana[5] (excision), Agnikarma[6] (cauterization), Kshara
Karma (applying caustic alkali) in the management of Charmakila. He also recommends
Pratisaraneeya kshara (local application of caustic alkali) for management of Charmakila.[7]
Ksharasutra acts as chemical cauterization and mechanically strangulate the blood vessels
which results local gangrene of the tissues or ischemic necrosis and debridement of unhealthy
tissues.[8] The mass sloughed out within 5 days of application. Healing of the created wound
takes 10 days. Ksharasutra treatment has minimal recurrence rate. The Jatyadi Ghrita has
analgesic and wound healing properties.[9]
CONCLUSION
Acquired digital fibrokeratoma is a benign tumor with no risk of malignant transformation.
Surgical excision is with a risk of pain, bleeding, infection and recurrence. Ksharasutra
treatment is a simple, safe, cost-effective para-surgical procedure. The recurrence rate is
minimal and there are no surgical complications. Excellent functional recovery is expected
after Ksharasutra trans-fixation and ligation in acquired digital fibrokeratoma.
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Kasta et al. World Journal of Pharmaceutical Research
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REFERENCES
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