A systems-oriented Ayurvedic approach in chronic plaque psoriasis with renal inflammatory indicators: a 2-year longitudinal case report.

Background: Psoriasis is increasingly recognized as a chronic systemic inflammatory disorder associated with multisystem involvement, including psychological and renal manifestations. Emerging evidence suggests possible links between psoriasis, inflammatory renal abnormalities, psychoneuroimmunological stress pathways, and metabolic dysregulation. However, longitudinal integrative management data with extended follow-up remain limited. Case presentation: A 22-year-old female with chronic plaque psoriasis of 4 years duration and childhood nephrotic syndrome with prolonged corticosteroid exposure presented with extensive erythematous scaly plaques associated with severe itching, burning sensation, and recurrent relapses. Baseline evaluation demonstrated positive candle grease sign and Auspitz sign with a Psoriasis Area and Severity Index (PASI) score of 52. Laboratory investigations revealed persistent urinary abnormalities, including elevated urine protein-creatinine ratio (UPCR), microscopic hematuria, and trace albuminuria despite preserved renal function. Perceived Stress Scale (PSS) scores improved from 37 at baseline to 25 following the first treatment schedule, increased to 28 during recurrence, and subsequently decreased to 17 after the second treatment schedule. The patient underwent a staged Ayurvedic treatment protocol consisting of Deepana-Pachana, Snehapana, Abhyanga, Swedana, Vamana, Takradhara, and follow-up medications. Marked clinical improvement was observed following treatment, with PASI score reducing from 52 to 6, improvement in stress scores, and reduction in urinary inflammatory parameters. The patient subsequently maintained near-complete remission for approximately 2 years. Mild recurrence associated with academic stress occurred in 2026 with PASI score of 12 and absence of severe inflammatory signs previously observed during baseline presentation. A second treatment schedule incorporating Deepana-Pachana, Snehapana, Virechana, and Takradhara again resulted in substantial improvement, with PASI score reducing to 5 and further improvement in urinary findings and psychological assessment scores. Conclusion: This case highlights the potential role of staged integrative Ayurvedic intervention in achieving sustained remission and reducing inflammatory severity in chronic plaque psoriasis associated with psychological stress and persistent urinary abnormalities. Parallel improvement in dermatological severity, stress assessment, digestive-metabolic status, and urinary parameters suggests possible systemic effects involving interconnected inflammatory and psychoneuroimmunological pathways. Further large-scale longitudinal studies integrating clinical, biochemical, immunological, and psychometric assessment are required to validate these observations.