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It is well known that p38 is a core component of the MAPK pathway, and phosphorylated p38 can turn on the transcription of many target genes, such as TNF-, MCP1, and NLRP3 inflammasome

Furthermore, while ashwagandhas ability to modulate the hypothalamic-pituitary-adrenal (HPA) axis may enhance stress resilience, it could theoretically disturb the delicate hormonal balance in patients with adrenal insufficiency, potentially worsening their condition [6]

Pharmacologic treatment depends on the rash and is controversial, with inconsistent published outcomes

Quality assurance demands include GMP certification, batch traceability, and third-party heavy metal/preservative screening