Carmakila: An effective management by kshara karma
We describe the case of a 22-year-old woman with a 5-year history of verrucous plaque on the posterior area of the right ear pinna extending into the scalp. Lesions were well-circumscribed, 3 cm × 12 cm, oval, characterized by flat, slightly elevated black-colored papules, and were smooth, slightly hyperkeratotic ranging from few to hundreds in number [].\nIn Ayurveda, we do get references relating to warts as charmakila.[] Author sushruta recommends chedana (excision), agnikarma (cauterization), kshara karma (applying caustic alkali) in the management of charmakila.[] Further, there is direct indication of pratisaraneeya (to be applied) kshara for charmakila.[]\nThere are number of drugs mentioned to be used in the kshara preparation in Ayurveda. Five kilogram of dried apamarga (Achyranthes aspera) plant was burnt down to ash. 500 g ash of apamarga panchanga was added with 6 times its quantity of water, kept overnight, and filtered for 21 times. Filtrate solution was boiled till 2/3rd part evaporated. To the remaining solution, red-hot lime stone, Shankha and Shukti were added in the quantity of 1/10th of apamarga solution. Further, the mixture was heated on a mild fire till it attained a paste-like form. Finally, 5 g of paste of citraka (Plumbago zelanica) was added and allowed to cool. The final product was stored in glass container and used as teekshna pratisaraneeya kshara.\nWhile the lesion was larger in size, it was decided that the teekshna pratisaraneeya kshara would be applied in two settings at two different sites on same lesion with a gap of 3 days. The kshara is allowed to stay at site for 15 min or till the patient develops a slight burning sensation []. Subsequently kshara was washed with lemon juice.[] With the application of kshara, the hyper-keratinized tissue was corroded out, which can be best understood by the pain expressed by the patient. Finally, the lesion was washed with normal saline.\nOn the subsequent day, it was observed that the lesion where teekshna pratisaraneeya kshara was applied was raised with slight collection appearing like wet scab []. The scab was removed to see a red-colored wound at the base. Further, the wound was managed on the principles of shuddha vrana (healing ulcer) with jatyadi taila for daily dressing. The same procedure was followed for remaining lesion.\nContemplating the vata kapha prakriti of the patient, tablet gandhaka rasāyaṇa 500 mg one tablet twice a day and triphalā guggulu 500 mg one tablet thrice a day, were orally administered for 10 days to hasten the healing and the course was uneventfull. Within 15 days, the wound was completely healed with minimum scar tissue [].