Skin rash on site of application of Dashanga Lepa (polyherbal formulation): A rare and unexpected drug reaction
A 42-year-old, married, diabetic female presented with skin rash on the area around the knee joint, with itching, after applying Dashanga Lepa. She was suffering from rheumatoid arthritis since five years. The patient was admitted to KLE Ayurveda Hospital, Belgaum, Karnataka, for the treatment of rheumatoid arthritis. She was treated with Agnitundi vati (AFI), one tablet b.i.d and in the afternoon, Valuka Sweda (Mud fomentation therapy) followed by Dashanga Lepa as local application on both knee joints once a day. Agnitundi vati was stopped after three days and the remaining medications were continued. On the fifth day she was prescribed Dashanga Lepa twice a day (Morning and evening). Along with the above mentioned medications she was taking 1 tablet, 500 mg of Metformin (SR) in morning for her diabetes. The patient suddenly developed itching and redness with rashes around the applied areas, with a gap of 10 minutes of the second application.\nHer history includes type-2 diabetes mellitus managed uneventfully with Metformin, since five years. She did not have any history of allergic skin diseases. Her Prakruti (constitution) was assessed as Pitta kapha prakriti (Pitta kapha constitution) by a standard questionnaire.[] A lepa (semisolid paste) was prepared by mixing the Churna (Powder) of Dashanga Lepa (purchased from a Good Manufacturing Practices (GMP) certified company) with warm water.\nPresentation of her condition was sudden, after the application of Dashanga Lepa, with itching, redness and rashes on and around the site of the application. The application of Dashanga Lepa was stopped immediately. The rashes were treated with a local application of Shatadoutha Ghritha[] twice daily. No change was made in any other treatment. Within two days of treatment, the patient was completely relieved from the itching, rashes, and redness.\nAfter one month of the above-mentioned incidence, the same patient was admitted for a second course of treatment. During this time she was given a similar line of treatment with Valukasweda, Agnitundivati and Dashanga Lepa. Even this time, the patient developed similar kind of rashes in the first application itself, for which application of Dashanga Lepa was stopped and she was treated again with Shatadoutha ghritha, twice daily and the patient was completely relieved from the symptoms on the third day.\nInformed consent was obtained from the patient for documenting and publication. A copy of the written consent is available for review with the Editor-in-Chief of this journal.