Chronic plaque psoriasis treated with topical Unani formulation Marham Ḥina – A series of case reports

Psoriasis is a common chronic inflammatory disorder of the skin manifested as sharply demarcated, circumscribed, erythematous, pruritic, scaly papules and or plaques [1]. It affects 0.51–11.43 % of adults worldwide and up to 1.37 % of children [2]. In India, its reported prevalence ranges from 0.4 % to 2.8 % [3]. The exact causes of psoriasis remain unclear and the mechanism of immune response is also not well understood. However, hyperproliferation of keratinocytes, acanthosis, parakeratosis, and T cell-mediated inflammatory response are some reported findings for its pathophysiology [4]. The conventional treatment for psoriasis includes the use of topical corticosteroids with vitamin D analogs for mild cases [5]; phototherapy (Psoralen + ultraviolet light A), systemic therapy (methotrexate, acitretin, or cyclosporine), apremilast, and biologic agents for moderate to severe cases [6].

The disease remains largely incurable and recurrent amidst all of these treatments. Moreover, some of these medications are associated with serious adverse effects, such as carcinogenesis, hepatotoxicity, and worsening of the disease [7]. Thus, exploring novel and alternative treatments with potent anti-psoriatic action is urgently needed.

Psoriasis is clinically similar to Taqashshur al-Jild in Unani medicine [8] and is caused by the accumulation of Sawdā’ Ghalīẓ (thick black bile) in the skin, which interferes with its normal functions, resulting in the shedding of dead skin in the form of scales [9]. The treatment is based on the evacuation of Sawdā’ Ghalīẓ (thick black bile), Taṣfiya al-Dam (purification of blood), Tajliya-i Jild (cleansing of the skin), Teḥlīl (resolution of inflammation), Taskīn (local sedation), Dāfi‘-i ‘Ufūnat (disinfectant), and Tarṭīb-i Badan (moisturizing the body). Based on this therapeutic principle, numerous systemic and topical drugs as well as ‘Ilāj bi’l Tadābīr (therapeutic regimens) have been described in Unani classical texts [10]. The topical Unani formulation, Marham Ḥina has Tajliya-i Jild (skin cleansing), Muḥallil (resolvent), Musakkin (local sedative), and Dāfi‘-i ‘Ufūnat (disinfectant) proprieties. Hence, it is prescribed for conditions similar to psoriasis [11], but the formulation has not been scientifically evaluated for psoriasis as a single entity and, thus, this study was conducted to explore its efficacy and safety in the treatment of psoriasis.

The data from the participants in this study were obtained in accordance with the principles of the Helsinki Declaration. After obtaining written informed consent from the participants, they were instructed to apply the ointment to the affected area twice a day in an amount sufficient to cover the skin lesions. No concomitant therapy was permitted during the course of the study. This series of case reports followed the CARE case report guidelines [12] and publication guide for integrative medicine case reports [13].

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