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Topic 17: Sira Snayu Rogas (Nervous System Disorders)
Topic 18: Unmada Rogas (Behavioral and Neurobehavioral Disorders)
Topic 19: Atyayika Rogas (Emergency Paediatrics)
Topic 20: Bala Panchakarma
Topic 21: Kishora Swasthya (Adolescent Health)
Topic 22: Anya Rogas (Miscellaneous Diseases)

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KAUMARABHRITYA - EXAM-ORIENTED NOTES

Topics 17-22 | Ayurvedic Pediatrics

TOPIC 17 - SIRA SNAYU ROGAS (Nervous System Disorders)

A. Examination of the Nervous System in Children

Component	What to Assess
Cranial nerves	I-XII; especially II (vision), VII (facial), XII (tongue)
Motor system	Tone, power (grade 0-5 MRC scale), reflexes (DTRs)
Sensory system	Pain, temperature, vibration, proprioception
Cerebellar	Finger-nose, heel-shin, Romberg, gait
Higher functions	Consciousness (GCS), language, behavior
Head circumference	Plotted on growth chart; key for hydrocephalus

Special pediatric signs:

Kernig's sign - Knee extension restricted with hip flexed (meningeal irritation)
Brudzinski's sign - Neck flexion causes involuntary knee flexion
Sunset sign - Eyes deviated downward (raised ICP / hydrocephalus)
Macewen's sign - "Cracked pot" sound on skull percussion (hydrocephalus)
Fontanelle - Bulging = raised ICP; Sunken = dehydration

B. Jalaseershaka (Hydrocephalus)

Definition: Abnormal accumulation of CSF within the ventricular system, causing progressive head enlargement.

Types:

Communicating (Non-obstructive): CSF flows freely but absorption is impaired (post-meningitis, post-hemorrhage)
Non-communicating (Obstructive): CSF flow blocked (Aqueduct of Sylvius stenosis - most common)

Causes in children:

Congenital: Aqueductal stenosis, Dandy-Walker malformation, Arnold-Chiari malformation
Acquired: Post-meningitis, post-intraventricular hemorrhage (prematurity), tumors

Clinical Features:

Rapidly increasing OFC (head circumference)
Bulging anterior fontanelle, dilated scalp veins
Sunset sign (Parinaud's sign)
Macewen's cracked-pot sign
Behavioral changes, irritability, vomiting
Papilloedema (in older children with closed sutures)

Investigations:

USG head (through fontanelle in infants)
CT/MRI brain (gold standard)
Head circumference chart

Management:

Surgical: VP (ventriculoperitoneal) shunt - preferred; Endoscopic Third Ventriculostomy (ETV) - preferred for aqueductal stenosis
Treat underlying cause

Ayurvedic correlation: Jalaseershaka - Vata-Kapha vitiation causing fluid accumulation in the head (Mastishka Koshtha)

C. Apasmara (Epilepsy)

Definition: Two or more unprovoked seizures; excessive synchronous electrical neuronal discharges in the cortex.

Classification (ILAE):

Type	Features
Focal (Partial)	Arising from one hemisphere; may be with/without awareness
Generalized	Both hemispheres involved; includes tonic-clonic, absence, myoclonic
Unknown onset	Cannot classify due to inadequate information

Common Epilepsy Syndromes in Children:

West Syndrome (Infantile Spasms): Age 3-12 months; Salaam attacks + hypsarrhythmia on EEG; Rx: ACTH, vigabatrin
Lennox-Gastaut: Age 1-7 yr; mixed seizure types + slow spike-wave on EEG; poor prognosis
Juvenile Myoclonic Epilepsy (JME): Adolescence; morning myoclonic jerks; responds to valproate
Benign Rolandic Epilepsy (BECT): 3-13 yr; focal face/throat seizures; self-limiting

Investigations: EEG (gold standard for diagnosis), MRI brain, blood glucose, electrolytes

Treatment (Ayurvedic + Modern):

Ayurveda: Brahmi, Shankhpushpi, Ashwagandha, Jatamansi; Shirobasti, Shirodhara, Nasya
Modern: Sodium valproate (broad spectrum), Phenobarbitone (neonates/infants), Carbamazepine (focal)
Ketogenic diet - useful in drug-resistant epilepsy
Pathyapathya: Avoid night vigil, excessive exertion, triggers

D. Ataxia

Definition: Impaired coordination of voluntary movements; usually cerebellar origin.

Common causes in children:

Acute: Post-viral cerebellitis (most common, follows varicella/EBV), drug toxicity (phenytoin)
Chronic: Ataxia-telangiectasia, Friedreich's ataxia, brain tumors

Features: Wide-based gait, dysmetria (finger-nose test), dysdiadochokinesia, nystagmus, intention tremor

E. Floppiness (Hypotonia)

Central (Upper motor neuron): Decreased tone with preserved/increased reflexes - HIE, Down syndrome, cerebral palsy Peripheral (Lower motor neuron): Decreased tone + decreased reflexes + fasciculations - SMA (Spinal Muscular Atrophy), Werdnig-Hoffmann disease

Floppy infant evaluation: "Frog-leg" posture, head lag, slip-through on vertical suspension

F. Cerebral Palsy (CP)

Definition: A group of permanent, non-progressive disorders of movement and posture due to a non-progressive disturbance in the developing fetal/infant brain.

Risk Factors:

Antenatal: TORCH infections, prematurity, multiple gestation
Perinatal: Birth asphyxia (HIE), low birth weight
Postnatal: Meningitis, head trauma, kernicterus

Classification:

Type	Features	Area affected
Spastic (70-80%)	Increased tone, brisk reflexes, scissors gait	Cortex/Pyramidal
Dyskinetic (Athetoid)	Involuntary writhing movements	Basal ganglia
Ataxic	Poor coordination, hypotonia	Cerebellum
Mixed	Combination of above	Multiple

Spastic CP subtypes:

Hemiplegia (one side) - most common
Diplegia (both legs more than arms) - prematurity related
Quadriplegia (all four limbs) - severe

Associated problems: Epilepsy (50%), intellectual disability, speech/language delay, hearing/vision impairment, feeding difficulties

Management:

Physiotherapy (most important), occupational therapy, speech therapy
Anti-spastics: Baclofen, Botulinum toxin injections
Treat associated epilepsy
Ayurveda: Abhyanga (medicated oil massage), Shashtika Shali Pinda Sweda, Bala taila, Ashwagandha

Referral criteria: All cases of cerebral palsy; children not meeting developmental milestones

TOPIC 18 - UNMADA ROGAS (Behavioral & Neurobehavioral Disorders)

A. Bala Unmada - ADHD

Definition: Attention Deficit Hyperactivity Disorder - a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity.

DSM-5 Criteria (simplified):

Symptoms present in 2+ settings (home + school)
Onset before age 12
Duration ≥ 6 months
Causes functional impairment

Types:

Predominantly Inattentive (ADD)
Predominantly Hyperactive-Impulsive
Combined (most common)

Management:

Behavioral therapy (first line, especially <6 years)
Methylphenidate (Ritalin) - first line medication (>6 years)
Parent counseling, school interventions
Ayurveda: Brahmi, Shankhpushpi, Medhya Rasayana; counseling

B. ASD (Autism Spectrum Disorder)

Triad (Wing's Triad):

Impaired social communication
Restricted, repetitive behaviors/interests
Sensory sensitivities

Red Flags (DO NOT miss):

No babbling by 12 months
No single words by 16 months
No 2-word phrases by 24 months
Loss of any language/social skills at any age

Screening tools: M-CHAT (Modified Checklist for Autism in Toddlers) at 18-24 months; CARS (Childhood Autism Rating Scale)

Management:

ABA (Applied Behavior Analysis) - gold standard behavioral therapy
PECS (Picture Exchange Communication System)
Occupational therapy, speech therapy
No cure; early intervention is key
Ayurveda: Brahmi, Saraswatarishta, Panchakarma (Abhyanga, Nasya), sensory integration

C. Temper Tantrums

Peak: 18 months to 4 years (normal developmental behavior)
Causes: Frustration, need for autonomy
Management: Parental counseling - extinction/ignore, time-out technique; avoid reinforcing behavior; consistent routines

D. Learning Disabilities

Dyslexia (reading), Dysgraphia (writing), Dyscalculia (arithmetic)
Normal intelligence with specific domain difficulty
Management: Special education, resource room support, remedial teaching

E. Scholastic Backwardness

Broad term covering poor academic performance
Causes: Intellectual disability, sensory deficits (hearing/vision), emotional problems, poor environment, learning disabilities

F. Breath Holding Spells

Types:

Feature	Cyanotic	Pallid
Trigger	Frustration/anger	Pain/fright
Color	Cyanotic	Pallid (white)
Mechanism	Prolonged expiratory apnea	Vagal-mediated
Treatment	Reassurance to parents	Same + iron supplementation

Age: 6 months - 5 years; self-resolving
Key point: NOT epilepsy; EEG normal; reassure parents

G. Mritbhakshana (Pica)

Eating non-food substances (mud, chalk, clay, paint) persistently >1 month in age-inappropriate manner
Association: Iron/zinc deficiency, neglect, intellectual disability, pregnancy
Risk: Lead poisoning (paint), parasitic infections
Management: Treat nutritional deficiency, behavioral therapy, parent education

H. Thumb Sucking

Normal up to 4 years; problematic if persistent beyond eruption of permanent teeth
Complications: Malocclusion, dental problems
Management: Distraction, rewards, appliances (dental guard) if persistent

I. Shayyamutra (Enuresis)

Definition: Involuntary urination in a child ≥5 years age.

Types:

Primary (never been dry for 6 months) vs. Secondary (relapse after dry period)
Nocturnal (most common) vs. Diurnal
Monosymptomatic vs. Non-monosymptomatic

Causes of secondary enuresis: UTI, diabetes mellitus, diabetes insipidus, emotional stress, constipation

Management:

Alarm therapy (bell and pad) - most effective long-term
Desmopressin (DDAVP) - fastest short-term response
Imipramine - if above fail; monitor ECG
Motivational therapy, fluid restriction at night

Ayurveda: Chandraprabha Vati, Kanchanara Guggulu, Ashwagandha

J. Buddhi Mandya (Mental Retardation / Intellectual Disability)

Definition: IQ < 70 with deficits in adaptive functioning, onset before 18 years.

Classification:

Category	IQ	%
Mild	50-70	85%
Moderate	35-50	10%
Severe	20-35	4%
Profound	<20	1%

Common causes:

Genetic: Down syndrome (Trisomy 21) - most common identifiable cause; Fragile X (most common inherited)
Prenatal: TORCH infections, alcohol (FAS), hypothyroidism
Perinatal: Birth asphyxia
Postnatal: Meningitis, severe malnutrition

Down Syndrome features: Flat facies, epicanthal folds, single palmar crease, Brushfield spots, congenital heart disease (AVSD), short stature, hypotonia

Referral: All children with intellectual disability - ICDS (Integrated Child Development Centre), special schools, disability certificate

K. ICDS (Integrated Child Development Services)

Services (mnemonic: SHIN-HN):

Supplementary nutrition
Health checkups
Immunization
Non-formal pre-school education
Health & nutrition education
Referral services

Target group: Children 0-6 years, pregnant/lactating mothers

TOPIC 19 - ATYAYIKA ROGAS (Emergency Paediatrics)

A. Status Epilepticus

Definition: Seizure lasting >5 minutes OR two or more seizures without recovery of consciousness between them.

Management Protocol (Time-based):

Time	Action
0-5 min	ABC, O2, IV/IO access, blood glucose, labs
5-20 min (1st line)	Lorazepam 0.1 mg/kg IV (OR Diazepam 0.2-0.5 mg/kg IV; OR Midazolam 0.2 mg/kg buccal)
20-40 min (2nd line)	Phenytoin 20 mg/kg IV (over 20 min) OR Phenobarbitone 20 mg/kg IV OR Levetiracetam 20-60 mg/kg IV
>40 min (Refractory SE)	RSI + intubation; Phenobarbitone/Midazolam/Propofol infusion; ICU

Key points:

Hypoglycemia causing seizures: Dextrose 10%, 5 mL/kg IV
Hypocalcemia: Calcium gluconate 10%, 100 mg/kg IV over 5-10 min (with cardiac monitoring)
INH poisoning seizures: Pyridoxine 70 mg/kg IV (child), 5 g (adult)
Hyponatremia seizures: 3% saline 3 mL/kg IV over 30 min

B. Febrile Seizures

Definition: Seizure with fever (>38°C) in child 6 months - 5 years, without CNS infection or metabolic cause.

Simple vs. Complex:

Feature	Simple	Complex
Duration	<15 minutes	>15 minutes
Type	Generalized	Focal
Recurrence	Once in 24 hours	>1 in 24 hours
Age	6 mo - 5 yr	Outside this range

Risk of recurrence: ~33% overall; higher if: age <1 yr at first episode, strong family history, low-grade fever at onset

Risk of epilepsy: General population 0.5-1%; after simple febrile seizure 1-2%

Management:

Acute: ABC, Diazepam 0.2 mg/kg IV/IO or 0.5 mg/kg rectal
Investigations: LP only if signs of meningeal irritation; NOT routine EEG or neuroimaging
No prophylactic antiepileptics for simple febrile seizures
Parent education: Fever management, when to seek help
Intermittent rectal diazepam prophylaxis considered for complex febrile seizures

C. Acute Breathlessness (Respiratory Distress) in Children

Signs of respiratory distress: Tachypnea, nasal flaring, intercostal/subcostal retractions, grunting, cyanosis, head bobbing

Common causes by age:

Age	Causes
Neonate	Transient tachypnea, RDS, pneumonia, CDH
Infant	Bronchiolitis (RSV), pneumonia, foreign body
Older child	Asthma, pneumonia, croup

Immediate management:

Position: Upright/sniffing position; neutral in infants
O2 supplementation (target SpO2 >94%)
Bronchospasm: Salbutamol nebulization (2.5-5 mg); consider steroids
Severe: IV access, blood gas, consider non-invasive ventilation

Nebulization technique: Drug in 3-4 mL saline, flow 6-8 L/min, tight mask, 10-15 min duration

D. Poisoning in Children

General Management (A-B-C-D-E):

Remove from source; ABC stabilization
Decontamination:
- Skin/eye: copious water wash
- Oral ingestion: Activated charcoal (1g/kg) within 1-2 hours (if not corrosive/hydrocarbon)
- Do NOT induce vomiting in corrosives, hydrocarbons, altered consciousness
Antidotes:

Poison	Antidote
Organophosphate	Atropine + Pralidoxime (2-PAM)
Paracetamol	N-acetylcysteine
Opioids	Naloxone
Iron	Deferoxamine
Benzodiazepine	Flumazenil
CO poisoning	100% O2 / Hyperbaric O2
Snake bite	Polyvalent antivenom

Enhance elimination: Alkaline diuresis (salicylates), dialysis (severe cases)

E. Shock in Children

Definition: Circulatory failure - inadequate oxygen delivery to tissues.

Types:

Type	Cause	Features
Hypovolemic	Dehydration, hemorrhage	Cold extremities, tachycardia, low BP
Distributive (Septic)	Infection	Warm early / cold late; wide pulse pressure
Cardiogenic	Heart failure, arrhythmia	Gallop, hepatomegaly, JVD
Obstructive	Tension pneumothorax, cardiac tamponade	Muffled heart sounds, tracheal deviation

Signs: Tachycardia (most sensitive early sign), capillary refill >3 sec, cold peripheries, altered consciousness, hypotension (LATE sign)

Fluid resuscitation:

Isotonic crystalloid (Normal saline / Ringer's Lactate): 20 mL/kg IV/IO bolus over 5-10 min
Repeat up to 3 boluses; reassess after each
Septic shock: Early antibiotics + fluids
In trauma/hemorrhagic shock: 10 mL/kg packed RBC after 2nd fluid bolus unresponsive
AVOID: Hypotonic fluids, excessive fluid in cardiogenic shock

F. Burns in Children

Wallace Rule of Nines (modified for children):

Head = 18% (9% each for front/back); each leg = 13.5%; each arm = 9%; trunk = 36%; perineum = 1%

Classification:

1st degree (superficial): Erythema only; no blistering
2nd degree (partial thickness): Blisters, painful
3rd degree (full thickness): Charred, painless, needs grafting

Fluid resuscitation (Parkland formula): 4 mL x kg x % TBSA burn (Lactated Ringer's); give 50% in first 8 hours, 50% in next 16 hours (in addition to maintenance)

Minor burns management: Cool water (not ice); wound care; tetanus prophylaxis; analgesics

Referral criteria: >10% TBSA, face/hands/feet/genitalia/perineum, circumferential burns, inhalation injury

G. Foreign Body Aspiration

Peak age: 6 months - 3 years (mouthing stage); nuts are the most common FB

Presentation (Choking Triad):

Sudden onset cough
Wheeze (usually unilateral)
Decreased breath sounds

CXR: Hyperinflation of affected side (ball-valve effect); mediastinal shift to contralateral side; expiratory film most revealing

Immediate management:

Conscious child, mild obstruction: Encourage coughing
Severe obstruction (<1 yr): 5 back blows + 5 chest thrusts
Severe obstruction (>1 yr): 5 back blows + 5 abdominal thrusts (Heimlich)
Unconscious: CPR; look for FB before breaths
Definitive: Rigid bronchoscopy (gold standard)

H. Insect Bite / Anaphylaxis

Anaphylaxis management (mnemonic: A-E-I-O-U):

Adrenaline (Epinephrine) 0.01 mg/kg IM (1:1000) - FIRST line, anterolateral thigh
Position: Supine with legs raised (or recovery position if vomiting)
O2 high flow
IV antihistamine (Chlorphenamine); IV hydrocortisone (secondary)
IV fluid bolus 20 mL/kg for hypotension

I. Cardiorespiratory Arrest - Pediatric BLS/ALS

Pediatric CPR ratios:

1 rescuer: 30:2 compressions to ventilations
2 rescuers: 15:2
Rate: 100-120/min; depth: 1/3 AP diameter of chest

Defibrillation: Shockable rhythms (VF/pulseless VT): 4 J/kg

Pediatric Chain of Survival:

Prevention
Early CPR
Rapid EMS activation
Advanced life support
Post-resuscitation care

J. IV Access and PR Medications

Intraosseous (IO) access: Used when IV access fails in emergency; tibial site (2 cm below tibial tuberosity) preferred in <6 yr

PR (per rectum) medications commonly used in pediatric emergencies:

Diazepam 0.5 mg/kg rectal - seizures
Artesunate - severe malaria
Paracetamol 20-40 mg/kg rectal - fever/pain

TOPIC 20 - BALA PANCHAKARMA

Overview

Panchakarma in children follows the same principles as adults but with modifications in intensity, dosage, and specific procedures based on age and tolerance (Bala Bala).

Purvakarma (Preparatory Procedures)

Snehana (Oleation):
- Internal (Abhyantara): Medicated ghee/oil orally - Bala taila, Ashwagandha ghrita
- External (Bahya): Abhyanga (massage) with Bala taila, Ksheerabala taila
- Duration: 3-7 days based on Prakriti and condition
Swedana (Sudation/Sweating):
- Shashtika Shali Pinda Sweda - Most commonly used in children; medicated rice bolus massage; excellent for neuromuscular conditions, CP
- Nadi Sweda - Steam through tube (localized)
- Bashpa Sweda - Steam bath (avoided in infants)

Pradhana Karma (Main Procedures)

Vamana (Therapeutic emesis):
- Indicated: Kapha dominant disorders - respiratory conditions, skin diseases
- Less commonly performed in young children; adapted doses
- Drug: Madanaphala, Yashtimadhu, Saindhava
Virechana (Therapeutic purgation):
- Indicated: Pitta dominant disorders - liver conditions, jaundice, skin diseases
- Commonly used in children
- Drug: Trivrit Leha (mild), Eranda taila (castor oil)
Basti (Enema) - MOST IMPORTANT Panchakarma:
- "Best of all procedures" (Ardhachikitsa / half of all treatment)
- Niruha Basti (Kashaya/Decoction enema): For Vata disorders; larger volume
- Anuvasana Basti (Oil enema): Medicated oil; smaller volume; nourishing
- Uttara Basti: Urethral/vaginal route; for urinary/reproductive disorders
- Matra Basti: Smaller dose oil basti; can be given daily; safe for children
- Indications in children: CP, neuromuscular disorders, constipation, wasting disorders
Nasya (Nasal administration):
- Routes: Nose is gateway to brain (Shiro-vireka)
- Types: Pratimarsha (daily Nasya with 2 drops oil per nostril) - safest in children
- Marsha Nasya - 4-8 drops in each nostril
- Indicated: Sinus disorders, neurological conditions, headache, ASD, ADHD
- Common drugs: Anu taila, Shadbindu taila, Brahmi ghrita
Raktamokshana (Bloodletting):
- Rarely done in children
- When needed: Jalaukavacharana (leech therapy) preferred
- Indicated: Skin conditions with Pitta-Rakta vitiation

Special Procedures for Children

Netrakalpa (Eye treatments):
- Tarpana (retention of medicated ghee), Seka (eye wash), Anjana (collyrium)
- For eye conditions, improving vision
Nasa (Nasal) procedures: (see Nasya above)
Karna procedures (Ear):
- Karna Poorana - filling ear canal with warm oil
- Karna Dhoopana - fumigation
- For ear disorders, tinnitus, improving hearing

Paschat Karma (Post-procedures)

Samsarjana Krama - graduated diet after major Panchakarma
Light, easily digestible food; Peya → Vilepi → Akrita yusha → Krita yusha → normal diet

Key Points for Exam:

Basti = Ardhachikitsa (half of treatment) - most asked
Vamana = best for Kapha; Virechana = best for Pitta; Basti = best for Vata
Minimum age for Vamana/Virechana: Generally after 7 years (some say 5 years)
Shashtika Shali Pinda Sweda - most suitable Swedana for children

TOPIC 21 - KISHORA SWASTHYA (Adolescent Health)

Definition

WHO: Adolescence = 10-19 years
Early adolescence: 10-14 years
Late adolescence: 15-19 years
Youth: 15-24 years; Young people: 10-24 years

Sexual Maturity Rating (Tanner Stages)

Girls - Breast Development:

Stage	Description
I	Prepubertal; elevation of papilla only
II	Breast bud; areolar enlargement - first sign of puberty in girls
III	Further enlargement; no contour separation
IV	Areola and papilla form a mound above breast
V	Adult; only papilla projects

Girls - Pubic Hair:

Stage	Description
I	Prepubertal; no pubic hair
II	Sparse, pigmented, straight hair along labia
III	Darker, coarser, curled hair over pubis
IV	Adult type but not to medial thighs
V	Adult distribution with spread to medial thighs

Pubertal sequence in girls (mnemonic: Breast first): Breast development (thelarche) → Pubic hair → Growth spurt → Menarche (average 12.8 yr)

Boys - Genital Development (Tanner):

Stage	Description
I	Prepubertal
II	Testicular enlargement (>4 mL or >2.5 cm) - first sign of puberty in boys
III	Penile lengthening; scrotal growth
IV	Penile widening; darker pigmentation
V	Adult genitalia

Pubertal sequence in boys: Testicular enlargement → Pubic hair → Growth spurt (later than girls) → Voice change, axillary hair, facial hair

Adolescent Health Issues

Physical:

Rapid growth spurt
Nutritional needs increased: Iron (girls - menstrual losses), Calcium (bone density peak)
Adolescent obesity, eating disorders (anorexia nervosa, bulimia)
Acne, menstrual irregularities

Mental/Behavioral:

Mood swings, identity crisis (Erikson: Identity vs. Role confusion)
Depression, anxiety; suicide risk
Substance use/abuse (tobacco, alcohol, drugs)

ARSH Clinics (Adolescent Reproductive and Sexual Health):

One ARSH clinic per district under NHM
Services: Counseling, iron/folic acid supplements, STI management, contraception guidance

RKSK (Rashtriya Kishor Swasthya Karyakram):

National Adolescent Health Programme
6 components: Nutrition, Sexual/Reproductive health, Mental health, Injuries/Violence prevention, NCDs, Substance abuse

Kishora - Ayurvedic perspective:

Transition period (12-16 years) - Pitta dominant phase
Rasayana recommended: Chyavanprasha, Amalaki, Brahmi
Pathyapathya: Adequate sleep, balanced diet, moderate exercise, avoid excess stimulants

TOPIC 22 - ANYA ROGAS (Miscellaneous Diseases)

(Common topics likely covered under this heading)

A. Protein Energy Malnutrition (PEM)

Feature	Kwashiorkor	Marasmus
Deficit	Protein	Calories
Edema	Present (hallmark)	Absent
Appearance	Edematous, "moon face"	Wasted, "old man face"
Hair changes	Flag sign, easily pluckable	Present
Skin	Flaky paint dermatosis	Wrinkled, loose
Mental status	Apathetic	Alert/irritable
Fatty liver	Present	Absent

MUAC (Mid Upper Arm Circumference):

<11.5 cm = Severe Acute Malnutrition (SAM)
11.5-12.5 cm = Moderate Acute Malnutrition (MAM)

SAM management (WHO 10 steps): Treat hypoglycemia → hypothermia → dehydration → electrolytes → infection → micronutrients → diet (F-75 → F-100 / RUTF) → catch-up growth → sensory stimulation → follow-up

B. Common Childhood Infections

Dengue:

Dengue Warning Signs: Abdominal pain, persistent vomiting, rapid clinical deterioration, fluid accumulation, mucosal bleeding, lethargy
NS1 antigen (day 1-5), IgM/IgG (after day 5)
Management: Fluid management; no aspirin/NSAIDs; platelet transfusion if <10,000 or active bleeding

Typhoid (Enteric fever):

Step-ladder fever, rose spots, relative bradycardia
Widal test, blood culture (gold standard)
Ceftriaxone (severe) / Azithromycin (uncomplicated)

Malaria:

Plasmodium falciparum - most dangerous; P. vivax - relapse
Severe malaria: Cerebral malaria, severe anemia, respiratory distress, hypoglycemia
Treatment: ACT (Artemisinin Combination Therapy)

QUICK REVISION BOX - HIGH-YIELD FACTS

Topic	Key Fact
Hydrocephalus	Sunset sign + Macewen's sign; VP shunt is treatment
Febrile seizures	6 mo-5 yr; <15 min = simple; NO routine EEG/LP
Status epilepticus	Seizure >5 min; 1st line = Lorazepam 0.1 mg/kg IV
Cerebral Palsy	Non-progressive brain injury; spastic = most common
ADHD	Methylphenidate first-line (>6 yr); behavioral therapy first-line (<6 yr)
ASD	M-CHAT screening; no single words by 16 months = red flag
Enuresis	Alarm therapy = best long-term; Desmopressin = fastest
Breath holding spells	Not epilepsy; cyanotic (anger) vs pallid (pain)
Pica	Non-food eating >1 month; r/o iron deficiency
Basti	Ardhachikitsa; best for Vata disorders
Shock (pediatric)	20 mL/kg NS/RL IV bolus; tachycardia = earliest sign
Burns - Parkland formula	4 mL x kg x %TBSA in RL; 50% in first 8 hours
Foreign body aspiration	<1 yr: back blows + chest thrusts; >1 yr: Heimlich
Anaphylaxis	Adrenaline 0.01 mg/kg IM (1:1000) = first-line
Tanner stage I boys	Testicular enlargement = first sign of puberty
Down syndrome	Most common identifiable cause of intellectual disability
ICDS	0-6 yr + pregnant/lactating; 6 services
SAM	MUAC <11.5 cm; F-75 → F-100 / RUTF

Sources: Rosen's Emergency Medicine, The Harriet Lane Handbook (Johns Hopkins), Park's Preventive & Social Medicine, Campbell-Walsh Urology, Katzung Pharmacology, plus Ayurvedic Kaumarabhritya curriculum.Here's a summary of what's covered in these comprehensive exam-oriented notes:

Topics covered (from your syllabus image):

Topic 17 - Sira Snayu Rogas (Nervous System Disorders)

Neurological examination in children (cranial nerves, motor/sensory/cerebellar)
Jalaseershaka (Hydrocephalus) - types, signs, VP shunt
Apasmara (Epilepsy) - classification, epilepsy syndromes, management
Ataxia, Floppiness/Hypotonia, Cerebral Palsy (full classification + Rx)

Topic 18 - Unmada Rogas (Behavioral/Neurobehavioral Disorders)

ADHD, ASD (with red flags + screening tools)
Temper tantrums, Learning disabilities, Breath holding spells
Pica (Mritbhakshana), Thumb sucking, Enuresis (Shayyamutra)
Mental retardation (IQ classification, Down syndrome), ICDS

Topic 19 - Atyayika Rogas (Emergency Paediatrics)

Status Epilepticus - time-based protocol with drug doses
Febrile seizures - simple vs complex, management
Acute breathlessness, Poisoning (antidote table), Shock (fluid resuscitation)
Burns (Parkland formula), Foreign body aspiration (Heimlich), Anaphylaxis, CPR

Topic 20 - Bala Panchakarma

All 5 main procedures with pediatric modifications + special procedures (Netrakalpa, Karna, Nasya)
Key exam points (Basti = Ardhachikitsa)

Topic 21 - Kishora Swasthya (Adolescent Health)

Tanner stages (complete) for boys and girls
Pubertal sequence, ARSH clinics, RKSK programme

Topic 22 - Anya Rogas - PEM (Kwashiorkor vs Marasmus), Dengue, Typhoid, Malaria

The Quick Revision Box at the end contains all high-yield one-liners for rapid revision before exams.

$attachment$

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The image shows Topic 16 - Twak Rogas (Dermatological Disorders) from the same Kaumarabhritya syllabus, covering:

Kushtha, Charmadala, Arumshika, Visarpa, Scabies, Eczema, Atopic Dermatitis

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TOPIC 16 - TWAK ROGAS (Dermatological Disorders)

Kaumarabhritya - Exam-Oriented Detailed Notes

SECTION A - AYURVEDIC SKIN DISEASE FRAMEWORK

Twak (Skin) - Ayurvedic Basics

Skin layers (7 layers of Twak as per Sushruta):

Layer	Name	Function
1st	Avabhasini	Reflects color and complexion
2nd	Lohita	Contains rakta (blood)
3rd	Shweta	White; contains Pitta
4th	Tamra	Copper-colored; base of skin
5th	Vedini	Sensation; pain perception
6th	Rohini	Healing and regeneration
7th	Mamsadhara	Supports muscles; deepest

Doshas involved in Twak Rogas:

Primarily Pitta and Kapha (skin diseases are Pitta-Kapha dominant)
Vata also contributes in dryness, cracking conditions
Rakta Dushti (vitiation of blood) is the cornerstone of most skin diseases

1. KUSHTHA (Skin Diseases - Broad Category)

Definition

Kushtha is the Ayurvedic term for all skin diseases (Twak Vikara). It encompasses a wide spectrum of conditions ranging from superficial to deep, involving skin, blood, lymph, and deeper tissues.

Nidana (Causes) of Kushtha

Aharajanya: Viruddhahara (incompatible foods - e.g., fish + milk), excessive sour/salty/pungent foods, excessive sesame, alcohol, fermented foods
Viharajanya: Suppression of natural urges (Vega Dharana), excessive sun exposure, contact with infected persons
Manasika: Stress, grief, excessive emotional disturbances

Classification of Kushtha

Two main types:

Type	Count	Doshas	Tissue involvement	Prognosis
Mahakushtha (Major)	7	Tridosha involvement	Deeper tissues (Sapta Dhatu)	Difficult to cure
Kshudra Kushtha (Minor)	11	Usually 2 doshas	Superficial (skin + blood)	Easier to cure

7 Mahakushtha (major skin diseases):

No.	Name	Predominant Dosha	Modern Correlation
1	Kapala	Vata	Psoriasis (thick, dry scaling)
2	Audumbara	Pitta	Pemphigus / erythroderma
3	Mandala	Kapha	Pityriasis rosea / tinea
4	Rushyajihva	Vata-Pitta	Leprosy (tuberculoid)
5	Pundarika	Pitta	Stevens-Johnson syndrome
6	Sidhma	Vata-Kapha	Pityriasis versicolor
7	Kakana	Tridosha	Drug reaction / erythema multiforme

11 Kshudra Kushtha (minor skin diseases): Ekakushtha (Psoriasis vulgaris), Charmadala (Eczema), Kitibha (Psoriasis/lichen planus), Vipadika (Cracked heels/palms), Alasaka (Intertrigo), Dadru (Ringworm/Tinea), Pama (Scabies), Shwitra (Vitiligo), Vicharchika (Eczema/contact dermatitis), Sathanyu (wart-like), Charmakhya (Ichthyosis)

Samanya Lakshana (Common features of Kushtha)

Aswedanam (absence of sweating) or Atiswedanam (excessive sweating)
Kandu (itching)
Mahavastu (large spreading lesions)
Srava (exudation)
Daha (burning)
Raga (redness/erythema)
Vedana (pain)
Suptata (numbness) - in Mahakushtha

Treatment of Kushtha (General)

Shodhana (Purification/Panchakarma):
- Vamana - for Kapha dominant Kushtha
- Virechana - for Pitta dominant Kushtha (most common)
- Raktamokshana (bloodletting) - Pradhan Chikitsa for Kushtha; Jalaukavacharana (leech therapy)
Shamana (Palliative):
- Khadira (Acacia catechu) - specific herb for all Kushtha; Khadirarista - classical formulation
- Manjishtha, Neem (Nimba), Haridra (turmeric), Bakuchi (Psoralea)
- Arogyavardhini Vati - classical formulation for all skin diseases
- Mahamanjishthadi Kashaya
- Gandhaka Rasayana - for all types of Kushtha (especially chronic)
Pathyapathya:
- Pathya (do): Light food, bitter vegetables, old rice, barley, wheat, green gram, bitter gourd, garlic
- Apathya (avoid): Viruddha ahara (incompatible food), fish + milk, excessive sour/salty/sweet, fermented food, day sleep, suppression of urges

2. CHARMADALA (Eczema / Dermatitis)

Ayurvedic Correlation

Charmadala = one of the 11 Kshudra Kushtha; predominantly Vata-Pitta-Kapha with Raktadushti; features: Vaivarnyata (discoloration), Kandu (itching), Srava (oozing)

Modern Equivalent: Eczema / Dermatitis

Types of Dermatitis:

Type	Cause	Features
Atopic dermatitis	Genetic/immune	Flexural; associated with asthma/rhinitis
Contact dermatitis	External irritant/allergen	Site-specific; patch test positive
Seborrhoeic dermatitis	Malassezia yeast	Scalp, eyebrows, nasolabial folds; greasy scales
Nummular dermatitis	Unknown	Coin-shaped lesions; very itchy
Dyshidrotic eczema	Unknown/stress	Palms and soles; small deep vesicles

3. ATOPIC DERMATITIS (AD) - Detailed

Definition

A chronic, relapsing, inflammatory skin disease with intense pruritus, associated with personal or family history of atopy (asthma, allergic rhinitis, food allergy).

Epidemiology

Affects 15-20% of children worldwide
Onset: >90% present before 5 years of age (key exam fact)
Infantile form begins at 4-6 months of life

Pathogenesis

Th2-mediated immune response (in acute phase)
Key cytokines: IL-4, IL-13 (Th2); IL-17, IL-22 (Th17 in chronic phase)
Filaggrin gene mutation - impaired skin barrier; allows allergen penetration
IgE mediated sensitization - elevated total IgE
Staphylococcus aureus colonization worsens disease (superantigen effect)
TARC/CCL17 elevated - correlates with disease severity

Clinical Features by Age

Age	Distribution	Morphology
Infant (0-2 yr)	Cheeks, forehead, extensor surfaces, scalp	Erythema, weeping, crusting; diaper area spared
Childhood (2-12 yr)	Flexures - antecubital, popliteal fossae, wrists, ankles	Lichenification, dryness, excoriations
Adolescent/Adult (>12 yr)	Flexures, face, neck, upper chest	Lichenification, dry scaly plaques

Diagnostic Criteria (UK Working Party / Hanifin & Rajka)

Must have: Itching (pruritus)

Plus 3 or more of:

History of rash in skin folds (flexures)
History of asthma or hay fever (or in first-degree relative if child <4 yr)
History of dry skin in the past year
Visible flexural dermatitis
Onset in the first 2 years of life

Key Clinical Signs

Dennie-Morgan lines - extra fold under lower eyelid
Hertoghe sign - thinning of outer 1/3 of eyebrows
Pityriasis alba - white patches on face (hypopigmented)
Keratosis pilaris - rough follicular papules on upper arms
Lichenification - thickening + accentuation of skin lines from chronic scratching
Atopic dirty neck - reticulate pigmentation on neck

Complications

Secondary bacterial infection: Staphylococcus aureus (most common)
Eczema herpeticum (Kaposi varicelliform eruption) - HSV superinfection; punched-out erosions; medical emergency
Cataracts, keratoconus (eye complications)
Growth retardation (from prolonged steroid use)

Treatment

Step-up approach:

Severity	Treatment
Mild	Emollients (cornerstone), avoid triggers, mild topical steroids (hydrocortisone 1%)
Moderate	Moderate-potency topical steroids (betamethasone valerate), topical calcineurin inhibitors (tacrolimus, pimecrolimus)
Severe	Potent topical steroids, wet wrapping, systemic therapy
Refractory	Cyclosporine, methotrexate, azathioprine, Dupilumab (IL-4Rα blocker - biologic)

Emollients: First-line; apply within 3 minutes of bathing ("soak and seal"); applied multiple times daily

Topical Corticosteroids (TCS):

Hydrocortisone 1% - face, eyelids, intertriginous areas
Betamethasone valerate - trunk, limbs
Do NOT use fluorinated steroids on face (causes atrophy)
Apply once/twice daily; "fingertip unit" concept

Topical Calcineurin Inhibitors (TCIs):

Tacrolimus 0.03% (child), 0.1% (adult); Pimecrolimus 1%
Steroid-sparing agents; safe for face and sensitive areas
Do not cause skin atrophy

Antihistamines: Sedating (hydroxyzine, chlorphenamine) - for nighttime itch relief

Dupilumab (biologic): Anti-IL-4Rα; approved ≥6 months of age; blocks IL-4 and IL-13 signaling

Ayurvedic management:

Virechana (Pitta-dominant), Vamana (Kapha-dominant)
Nimbadi Churna, Mahamarichyadi taila (local application)
Khadirarishta, Manjishthadi Kashaya
Kumkumadi taila - for anti-inflammatory, skin restoration

4. ARUMSHIKA (Acne / Folliculitis in Children)

Ayurvedic Description

Arumshika = Kshudra Kushtha; characterized by Shotha (swelling), Paka (suppuration), Kandu; involves Pitta + Kapha; usually appears on face and upper body.

Modern Correlations

a) Acne Vulgaris

Pathogenesis (4 key factors):

Follicular hyperkeratinization (plugging of pilosebaceous unit)
Increased sebum production (androgens stimulate sebaceous glands)
Cutibacterium acnes (previously P. acnes) colonization
Inflammation

Types of lesions:

Non-inflammatory: Open comedones (blackheads), closed comedones (whiteheads)
Inflammatory: Papules, pustules, nodules, cysts

Grading:

Mild: Comedones + few papules/pustules
Moderate: Many papules/pustules, some nodules
Severe (Nodulocystic): Nodules, cysts, scarring

Treatment:

Severity	Treatment
Mild	Benzoyl peroxide (BPO) 2.5-5%, Topical retinoids (tretinoin, adapalene), Topical antibiotics (clindamycin)
Moderate	Topical BPO + antibiotics, Oral antibiotics (doxycycline, azithromycin)
Severe	Oral isotretinoin (13-cis retinoic acid) - gold standard for severe/nodulocystic; teratogenic

Isotretinoin counseling: Teratogenic (Category X); iPLEDGE program; monitor LFTs, lipids; causes dryness, cheilitis

5. VISARPA (Erysipelas / Cellulitis)

Ayurvedic Description

Visarpa = rapidly spreading skin disease; named because it "visarati" (spreads fast); involves Pitta + Vata; associated with Rakta Dushti.

Types of Visarpa (7 types):

Vata Visarpa
Pitta Visarpa
Kapha Visarpa
Tridosha Visarpa
Agni Visarpa (Erysipelas - modern)
Kardama Visarpa
Granthi Visarpa

Agni Visarpa = Erysipelas (modern): Spreading, inflamed, hot, shiny lesion; well-demarcated borders

Modern: Erysipelas vs Cellulitis

Feature	Erysipelas	Cellulitis
Depth	Superficial dermis + lymphatics	Deep dermis + subcutaneous tissue
Border	Well-demarcated, raised	Poorly demarcated
Organism	Group A Streptococcus	GAS + S. aureus
Features	Bright red, hot, tender; "peau d'orange" skin	Red, warm, tender, swollen
Treatment	Penicillin V / Amoxicillin	Amoxicillin-clavulanate; severe: IV Cefazolin

Impetigo (superficial skin infection - common in children):

Bullous impetigo: S. aureus (phage type 71); flaccid bullae → honey-colored crust
Non-bullous (Crusted) impetigo: S. pyogenes; honey-colored crust on face; nasal-labial area
Treatment: Mupirocin (topical), Fusidic acid; systemic: Amoxicillin-clavulanate or Flucloxacillin

Ayurvedic treatment of Visarpa:

Rakta mokshana (bloodletting) - most important
Lepa (external application): Chandana, Kumkuma, Sariva paste
Internal: Triphala, Manjishtha, Neem
Pitta-shamaka measures

6. SCABIES (Pama in Ayurveda)

Ayurvedic Correlation

Pama = Kshudra Kushtha; Kapha-Vata Pradhana; features: Kandu (intense itching), Pidika (papules/pustules), predominantly on hands and feet.

Modern: Scabies

Causative organism: Sarcoptes scabiei var. hominis (obligate human parasite)

Epidemiology:

Over 100 million persons affected worldwide annually
Transmitted by close personal contact; fomites (mite survives off human skin for 3 days)
Incubation: 1-8 weeks after first exposure (4-6 days if re-exposed)

Pathogenesis:

Female mite burrows into stratum corneum and lays eggs
Average mites per host: < 20 (in classic scabies)
Itching = type IV hypersensitivity reaction to mite, eggs, and feces

Clinical Features:

Cardinal symptom: Intense pruritus, worse at night
Pathognomonic sign: Burrow - linear, grayish, 5-15 mm track (site of female mite)
Papules, vesicles, pustules in characteristic distribution
Distribution: Interdigital web spaces (first sign), wrists, elbows, axillae, waist, genitalia (penis/scrotum in males), breasts (areola in females), buttocks
Children: Can involve face, scalp, palms, soles (unlike adults)
Excoriations + secondary bacterial infection common

Variants

Type	Features
Classic scabies	<20 mites; intense pruritus; typical distribution
Norwegian (Crusted) scabies	Thousands-millions of mites; hyperkeratotic plaques on palms/soles; minimally pruritic; highly contagious; in immunocompromised/elderly
Nodular scabies	Persistent reddish-brown nodules; especially genitalia and axillae; post-treatment

Diagnosis

Clinical diagnosis (history + examination is usually sufficient)
Dermoscopy: "Delta-wing jet with contrail" sign (mite + burrow)
Skin scraping + microscopy: Mites, eggs, scybala (feces) under mineral oil/KOH
"Burrow ink test": Apply ink over suspected burrow, wipe off - ink persists in burrow

Treatment

First-line: Permethrin 5% cream

Apply from neck down (include face/scalp in infants and children)
Leave on for 8-14 hours (overnight)
Wash off; repeat in 1-2 weeks
Treat all household members simultaneously

Alternative / Resistant cases: Oral Ivermectin

200 mcg/kg single dose orally; repeat in 1-2 weeks
Used in: Norwegian scabies, permethrin failure, mass treatment programs
Contraindicated in children <15 kg or <5 years (due to immature blood-brain barrier)

Symptomatic relief:

Antihistamines (hydroxyzine) for itching
Mid-potency topical steroids for post-scabetic eczema
Treat secondary bacterial infection

Environmental decontamination:

Wash all clothing, bedding, towels in hot water (>50°C)
Items that cannot be washed: seal in plastic bag for 72 hours (to kill mites)
Treat all close contacts and family members

Ayurvedic treatment of Pama

Lepa: Gandhaka (sulfur) paste - direct anti-parasitic
Nimbadi Taila, Mahamarichyadi Taila (topical)
Internal: Gandhaka Rasayana, Khadirarishta
Sulfur-based preparations directly kill Sarcoptes scabiei

7. ECZEMA - Additional Points

(See Atopic Dermatitis above for detailed coverage)

Contact Dermatitis

Feature	Irritant Contact Dermatitis (ICD)	Allergic Contact Dermatitis (ACD)
Mechanism	Direct toxic damage to skin	Type IV (delayed-type) hypersensitivity
Onset	Immediate (hours)	24-72 hours after exposure
Distribution	Confined to contact area	May extend beyond contact area
Patch test	Negative	Positive
Common causes	Soaps, detergents, diapers, acids	Nickel (most common metal), rubber (latex), dyes, fragrances, poison ivy
Treatment	Remove irritant; barrier creams	Avoid allergen; topical corticosteroids

Diaper dermatitis (Napkin rash):

Most common ICD in infants
Caused by prolonged contact with urine/feces (ammonia), friction
Spares the skin folds (creases) - this distinguishes it from candidal infection
Candidal superinfection: Beefy-red erythema involving folds + satellite lesions
Treatment: Barrier creams (zinc oxide), frequent diaper change; antifungal if Candida

MEDICINES, PROCEDURE-BASED THERAPIES, PATHYAPATHYA & REFERRAL CRITERIA

(As specified in syllabus for Topic 16)

Key Ayurvedic Medicines for Skin Diseases

Herb/Formulation	Indication
Khadira (Acacia catechu)	All types of Kushtha - specific drug
Neem (Nimba)	Anti-bacterial, anti-fungal, anti-inflammatory; all Kushtha
Haridra (Turmeric)	Anti-inflammatory, antimicrobial; Kushtha, Pama
Manjishtha	Raktaprasadana; Kushtha, skin discoloration
Bakuchi (Psoralea corylifolia)	Shwitra (Vitiligo); photosensitizing
Gandhaka (Sulfur)	Scabies, chronic Kushtha; Gandhaka Rasayana
Sariva	Blood purifier; chronic skin diseases
Khadirarista	Classical formulation for all Kushtha
Arogyavardhini Vati	Hepatoprotective + skin purifying; all Kushtha
Mahatikta Ghrita	Mahakushtha - specifically for major skin diseases
Panchatikta Ghrita Guggulu	Chronic skin diseases, deep-seated Kushtha
Nimbadi Churna	Eczema, dermatitis

Procedure-Based Therapies (Panchakarma for Skin Diseases)

Procedure	Indication
Virechana	Most important - Pitta-dominant Kushtha, Eczema, Psoriasis
Vamana	Kapha-dominant Kushtha
Raktamokshana	Pradhan Chikitsa (main treatment) for Kushtha; Jalaukavacharana (leech therapy) - most preferred
Jalaukavacharana (Leech therapy)	Localized Kushtha, Visarpa (erysipelas), Psoriasis
Takradhara	Shirodhara with medicated buttermilk; skin diseases with mental component
Lepana	Application of herbal pastes; local treatment

Pathyapathya (Diet & Lifestyle Guidelines)

Pathya (Beneficial):

Old rice, barley, wheat (light grains)
Bitter vegetables: Bitter gourd (Karela), drumstick leaves
Green gram (Mudga) - best pulse for Kushtha patients
Garlic, Turmeric, Neem leaves in diet
Avoid suppression of natural urges

Apathya (Harmful - must avoid):

Viruddha ahara (incompatible foods) - especially fish + milk
Excessive sour, salty, spicy foods
Curd (especially at night), sesame seeds (Tila) in excess
Fermented foods, alcohol
Day sleep (Divaswapna) - causes Kapha-Pitta aggravation
Excessive sweating followed by cold exposure
Exposure to dust, smoke, chemicals

Modern dietary advice:

Identify and avoid trigger foods (in atopic dermatitis): cow's milk, eggs, peanuts, tree nuts
Omega-3 fatty acid rich foods (anti-inflammatory)
Avoid harsh soaps, detergents
Use fragrance-free, hypoallergenic products

Counseling of Parents/Patients

For Atopic Dermatitis:

Disease is chronic but manageable; not contagious
Regular moisturization is the key
Identify and avoid triggers (dust mites, pet dander, foods, sweat)
Follow step-up treatment; do not stop steroids abruptly
Scratch-itch cycle - cut nails short; use cotton clothing

For Scabies:

Treat entire family simultaneously
Environmental decontamination is essential to prevent recurrence
Itching may persist 2-4 weeks even after successful treatment (dead mites still antigenic)

For General Skin Diseases:

Avoid self-medication
Regular follow-up essential for chronic conditions
Avoid using face creams containing steroids without prescription

Referral Criteria

Refer to specialist (Dermatologist/Higher center) if:

Erythroderma (>90% BSA involved) - medical emergency
Eczema herpeticum (HSV superinfection of eczema)
Norwegian/Crusted scabies in immunocompromised
Suspected Leprosy (Mahakushtha with anaesthesia/nerve involvement)
Severe/Nodulocystic Acne (requires isotretinoin)
Failure to respond to standard treatment within 4-6 weeks
Diagnostic uncertainty (biopsy needed)
Suspected malignancy (non-healing ulcer, pigmented lesion with ABCDEs)

QUICK REVISION TABLE - TWAK ROGAS

Disease	Ayurvedic Name	Key Feature	First-line Treatment
Psoriasis	Ekakushtha / Kapala Kushtha	Silvery scales; Auspitz sign; Koebner	Topical steroids + calcipotriol; Biologics
Atopic Dermatitis	Charmadala / Vicharchika	Flexural eczema; Hanifin criteria; AD triad	Emollients + Topical steroids + TCIs
Scabies	Pama	Nocturnal itch; burrows; family history	Permethrin 5% cream
Erysipelas	Agni Visarpa	Well-demarcated, bright red, hot	Penicillin / Amoxicillin
Impetigo	-	Honey-colored crust; face in children	Mupirocin topical / Amoxicillin-clav
Contact Dermatitis	Charmadala (irritant)	Patch test positive (allergic)	Remove irritant/allergen; TCS
Acne	Arumshika / Yauvanpidika	Comedones + inflammatory papules	BPO + topical retinoid
Diaper Rash	-	Spares folds; ICD	Zinc oxide barrier cream
Vitiligo	Shwitra	Depigmented patches; Koebner	Bakuchi, PUVA, tacrolimus
Tinea (Ringworm)	Dadru	Ring-shaped scaly lesion; KOH positive	Clotrimazole / Fluconazole

HIGH-YIELD ONE-LINERS FOR EXAM

Rakta Mokshana = Pradhan Chikitsa for Kushtha (especially Mahakushtha)
Khadira = specific drug for all types of Kushtha
Viruddha ahara = most important nidana (cause) for Kushtha
Atopic Dermatitis: >90% onset before 5 years; Th2 mediated; Filaggrin gene mutation; flexural distribution in older children
Scabies: Nocturnal itch + burrows = pathognomonic; Permethrin 5% = first line; treat entire household
Norwegian scabies = thousands of mites; seen in immunocompromised; treat with ivermectin
Eczema herpeticum = HSV superinfection of eczema; punched-out erosions; emergency
Auspitz sign (psoriasis) = pinpoint bleeding on removal of scale
Koebner phenomenon = skin disease appearing at site of trauma (seen in psoriasis, vitiligo, lichen planus)
Hanifin & Rajka criteria = diagnostic criteria for Atopic Dermatitis
Impetigo = honey-colored crust in children; non-bullous = Strep; bullous = Staph
Diaper dermatitis = spares the folds; candidal superinfection involves the folds + satellite lesions
Bakuchi (Psoralea) = specific drug for Shwitra (Vitiligo)
Mahatikta Ghrita = specific formulation for Mahakushtha
Gandhaka Rasayana = specific for chronic Kushtha + scabies (Pama)

Sources: Fitzpatrick's Dermatology (Volumes 1 & 2), Rosen's Emergency Medicine, Textbook of Family Medicine, Schwartz's Principles of Surgery, plus Ayurvedic Kaumarabhritya texts (Kashyapa Samhita, Sushruta Samhita)

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