Efficacy of Modified Putikadi Ointment and Ketoconazole in the Treatment of Dadru (Tinea Corporis)

Dadru is one of the most common but miserable Twak Vikar affecting all the ages of population. Increasing urbanization and industrialization have posted greater danger due to pollution and contamination with toxic, allergic and chemicals in our daily life, this fungal infection is commonly found in higher society and also in lower society due to unhygiene. According to Ayurveda, Dadru kushtha is Kapha-pitta predominance disease. It is managed by Shodhana, Shamana and Local application which may be called as Bahiparimarjan chikitsa. In today’s fast life no one has spent so much time, they want quick relief so Local application is the best line of treatment. It works fast due to its physiological effect on external skin in the form of Lepa or ointment. Putikadi Lepa which is mentioned in Sushruta Samhita and Ashtanga Hridaya includes fresh leaves of Karanja (Putik), Arka, Aragwadha, Snuhi and Jati with Gomutra reduces the symptoms of Dadru. All the drugs of Putikadi Lepa are kushtaghna, kandughna, and krimighna type. So it is more effective in Dadru kushta. But it is not possible every time to give fresh Lepa to the patients, so formulation was prepared in the form of ointment for convenience of patients in previous study. When the pilot study was carried out on Putikadi ointment, it was observed that the ointment has pungent smell after application due to Gomutra, so to remove this drawback some drugs should be added like Manjistha and Yashtimadhu to enhance the complexion of skin. This study should be taken to evaluate the efficacy of modified Putikadi ointment in the treatment of Dadru. Study Protocol Urkude et al.; JPRI, 33(60B): 993-1001, 2021; Article no.JPRI.80075 994


INTRODUCTION
In today's modern era, peoples were attracting towards modern lifestyle, change their food habits like crazier about Chinese, Japanese or fast food but there is an ignorance about health, personal hygiene. Due to these foodie habits, disturb sleep and also by environmental pollution like humid and hot climate leads too many skin disorders mainly fungal and bacterial infections or so many allergic condition will occurred. Skin disorders might have got more importance from medical sciences as well as public health due to experiencing mental, physical and socioeconomic embarrassment in the society by disfigured appearance.
In Ayurvedic classics, all skin diseases are included under the heading 'Kushta'. Dadru kushtha is one of the common skin disease which is described under the Mahakushta by Acharya Sushruta [1] and Vagbhata [2] and Kshudra Kushta by Acharya Charaka [3]. Dadru is also a rasa, rakta and mamsdhatu pradoshaja vikara, tridosha prakopak with kapha-pitta predominance [4]. The causative factors of Dadru explained by Acharya under three major classification that is Ahar, Vihar and Krimi [5]. Ayurveda has given prime importance to Aahar (Diet) among the Trividha upasthambha (three sub-pillars) of life [6]. Diet plays an important role in our life that means if we have taken proper diet, it results good health and if the diet is improper or Viruddha like incompatible food may leads to adverse effect on body like Dushi Visha rogas.

Aim of Study
Comparative efficacy of Putikadi Ointment and Ketoconazole in the treatment of Dadru (Tinea corporis).

Materials
Data should be collected from different literary sources, research article, Ayurvedic Samhita and internet.  [8]. Excessive exercises and over exposure to sunlight causes excessive production of sweat, work place contradicting with hot and humid environment, day sleep late night sleep and complications of Panchakarma therapy which results in the production of Krimi casuses Dadru.

Concept of Dadru
All the classical symptoms of Dadru are similar to Tinea infection. Dermatophytes are the main cause of Tinea infection or Dermatophytosis or Ringworm which is highly contagious and segmented mycelia fungus [9]. The route of transmission of Tinea infection is by direct contact of person to person, through pet animals, clothes exchanging and by unhygienic habits [10].
According to Charaka, the classical symptoms of Dadru are Kandu, Raga, Pidaka and Udgata mandala [11] which may similar to clinical features of Tinea infection such as itching, erythema, eruption or vesicles and elevated circular patches.
According to Sushruta, Dadru kushtha is liked Atasipushpavarnani, tamrani, visarpani, pidakavat [12], means linseed flowers or coppery, spreading and with boil and also elevation, round patches, itching. But by Dalhana commentary, Dadru is classified into Sita and Asita Dadru [13]. or Dadru is of two types like white (Sita) and black (Asita), the latter is difficult to treat and is more persistent and as such is included under major (Maha) kushtha by Sushruta whereas the white one is easily curable, does not enter successive dhatus and free from severe pain and as such is read under minor (Kshudra) kushtha by Charaka.
Like that Tinea infection is also classified in two part such as superficial mycosis and deep mycosis. Tinea is classified depending on the affected area into Tinea faciei (ringworm of face), Tinea barbae (ringworm of beard), Tinea capitis (ringworm of scalp and hair), Tinea corporis (ringworm of extremities and thorax), Tinea cruris (ringworm of buttocks and groin), Tinea mannum (ringworm of palm), Tinea ungium (ringworm of nails) and Tinea pedis (ringworm of soles) [14].

According to Modern
 Tinea infection or ringworm is highly contagious fungal infection caused by mycelia fungus or parasites which can live on the cell in the outer layer of skin. This Tinea infection spread by following three ways: Human to Human, Animal to Human and by touching external object.  Human to Human: Tinea infection should be spread by direct skin to skin contact to an infected individual.  Animal to Human: Tinea infection can be spread by rubbing or grooming cats and dogs.  By touching external objects: Tinea infection can be spread by direct contact with surfaces or objects that has been touched by infected animals or humans such as towel, comb, brushes, clothes, bedding and linens.

Samprapti of Dadru [16]
The knowledge of Samprapti not only helps in the comprehension of the specific features, but is also useful in deciding their line of management. All Acharyas have demarcated the common Samprapti of the disease Kushtha and they have not fractionalized it for sub types of Kushtha.
However, we know that, Dadru is a type of Kshudrakushtha and Mahakushtha according to different Acharya's.
Hence the common Samprapti of Kushtha is applicable in case of Dadru Kushtha also.  Agadtantra is one of the branch of Ashtanga Ayurveda by classical texts which deals with detailed study of Visha, its classification, examination, and treatments. Acharya Charaka says that even a strong poison is used properly works as best medicine like effect of Amruta and medicine is used in improper dose, it acts as poison [18].

Collection of Drugs
Fresh drugs will be collected from the Herbal Garden of Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha and crude drug from local market.

Identification and authentication of drugs
Identification and authentication of drugs will be done from department of Dravyaguna Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H) Wardha.

For analytical study
Preparation of Putikadi ointment: i.

Preparation of Taila [21]
 Fresh mature leaves will be collected from the herbal garden of MGACH & RC, Salod (H).
 Swarasa of each five herbal drugs, kwath of Manjistha and Yashtimadhu and Gomutra will be taken in equal quantity to that of Sarshap Tail.  The process of Sarshapa taila Murcchana will be carried out.  To be mentioned quantity of Swarasa and Gomutra will be added in that vessel containing Murcchita taila and boil with frequent stirring.  When the 'Sneha Siddha Lakshana's will occured, the hot taila shall be filtered.  When cool on its own, it will pack and preserve in appropriate air tight container. ii.

Preparation of Ointment: [22]
 Five parts of prepared oil will mix with one part of melted liquid paraffin wax.  This mixture will be heated on mandagani for 15 mins.  Filter the mixture through the clean cloth, and then stir with ladle for cooling.  Ointment will form on cooling.  Pack in 30ml small container. iii.

Study design
Randomized Standard Control Single Blind Study.

Study type
Interventional Study.

Sample size
55 patients in each group.

Source of study
Patient will be selected from Kayachikitsa OPD, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha and also from special camps conducted for the purpose.

Grouping: Group A and Group B
Group A -55 patients will be applied Ketoconazole ointment Group B -55 patients will be applied Putikadi ointment

Inclusion criteria [24]
1) The patients with classical lakshanas of Dadru will be included in the study. 2) Patients of either sex or age group between 18 -60 years will be included. 3) Patients of only Tinea Corporis will be selected.

Exclusion criteria
1) Tinea associated with other skin diseases will be excluded like eczema, scabies, psoriasis 2) Pregnant and lactating women will be excluded. 3) Other types of Tinea will be excluded.

Withdrawal criteria
Patient will be withdrawn from the study if there will be any allergic reaction occurs.

Statistical Method
The data will be analysed by using 'Wilcoxon's sign rank test and X 2 test.

ASSESSMENT OF RESULTS
 Result will be drawn in tabulated form by observation after completing the study.

DISCUSSION
Normally 10-15% of the general practitioners encounter with all types of skin disorders in their day to day practice. 5 out of 1000 people are suffering from Tinea infection. In the contemporary science, management of Tinea is carried out with usage of tropical, systemic antifungal or corticosteroids. Long lasting use of these drugs produces the adverse effect or recurrences occurred after stopped the treatment and treatment goes to very costly also.
In all types of skin diseases due to unyielding nature, some conditions are easy to manage and some are complicated or difficult to manage, so proper classical diagnosis is more important. If it is neglected then there is a chance of recurrences and prognosis may be poor. As per modern researches, the contents present in the ointment possess antibacterial and antifungal properties. So it will be more effective in Dadru kushta.

CONCLUSION
Conclusion should be drawn after completing the study by their results and observation.

CONSENT
As per international standard or university standard, respondents' written consent will be collected and preserved by the author(s).