Homeopathic Intervention in a Case of Psoriasis Capitis (Scalp Psoriasis): A Clinical Perspective

Definition:

Psoriasis Capitis (also called scalp psoriasis) is a chronic, non-infectious, inflammatory skin condition characterized by well-demarcated, erythematous plaques with silvery-white scales predominantly affecting the scalp. It is a localized form of plaque psoriasis.

Types:

1. Mild Psoriasis Capitis:
   
   • Fine scaling with minimal redness and itching.
     
   • May resemble dandruff.
     
2. Moderate Psoriasis Capitis:
   
   • More defined plaques.
     
   • Thicker scales, redness, and itching.
     
3. Severe Psoriasis Capitis:
   
   • Extensive scaling covering large portions of the scalp.
     
   • May extend beyond the hairline to the forehead, neck, and ears.
     
   • Significant itching, burning, and hair loss (temporary).
     
4. Sebopsoriasis:
   
   • Overlapping condition between seborrheic dermatitis and psoriasis.
     
   • Occurs in the scalp, face, and oily areas.
     

Etiology (Causes):

Psoriasis Capitis is multifactorial. Key factors include:

• Genetic predisposition – family history of psoriasis.
  
• Autoimmune dysfunction – abnormal T-cell mediated immune response causing keratinocyte proliferation.
  
• Triggers:
  
  • Stress
    
  • Cold weather
    
  • Skin trauma (Koebner phenomenon)
    
  • Infections (especially streptococcal)
    
  • Certain drugs (e.g., beta-blockers, lithium, antimalarials)
    
  • Hormonal changes
    
  • Alcohol and smoking
    

Clinical Features:

• Location: Scalp, especially behind ears, nape of neck, and forehead margins.
  
• Appearance:
  
  • Thick, well-demarcated plaques.
    
  • Silvery-white, dry, adherent scales.
    
  • Red base (erythema).
    
• Itching and irritation – variable in intensity.
  
• Bleeding points (Auspitz’s sign) on scale removal.
  
• Hair loss – usually non-scarring and reversible.
  
• Scalp tightness or burning sensation in severe cases.
  

Differential Diagnosis:

Condition	Differentiating Features
Seborrheic Dermatitis	Greasy, yellow scales; less well-defined borders; no silvery scales.
Tinea Capitis	Fungal infection; may show broken hairs, lymphadenopathy; positive KOH test.
Lichen Planopilaris	Violaceous flat-topped papules; scarring alopecia.
Atopic Dermatitis	Itchy eczema patches; early onset; history of allergies.
Lupus Erythematosus (Discoid)	Scarring lesions, depigmentation, photosensitivity, ANA positive.

Homoeopathic Treatment:

Note: Homoeopathic medicines should be selected based on the totality of symptoms, miasmatic background, and constitutional type.

Common Remedies:

Remedy	Key Indications
Arsenicum album	Dry, scaly eruptions; intense burning; worsens at night; anxious and restless.
Graphites	Thick, dry eruptions with sticky, honey-like discharge; cracks behind ears and in scalp folds.
Mezereum	Thick crusts on scalp; pus oozing out; intense itching, worse from warmth.
Sulphur	Dry, scaly, itchy eruptions; worse from heat and bathing; scratching causes burning.
Lycopodium	Dry eruptions with hair fall; worse on the right side; digestive issues.
Thuja	Dry white scales on scalp; sycotic miasm; often associated with vaccination history.
Petroleum	Cracks and fissures on scalp; worse in winter; dryness and itching.
Kali arsenicosum	Severe itching of scalp with chronic eruptions; useful in stubborn cases.

Intercurrent Remedies:

• Psorinum – Indicated in psoric miasm, chronic relapsing cases.
  
• Tuberculinum – For tubercular miasm with family history of TB or chest complaints.
  
• Sulphur – Used as an intercurrent to awaken reactive forces.
  

Case Presentation: Psoriasis Capitis

Presented by: Dr. Chinna Solanki, MD Part 2 (Practice of Medicine)
HOD: Dr. S.K. Sharma
Institution: RKDF Homoeopathic Medical College Hospital and Research Centre
Date: [Insert Date]
Diagnosis: Psoriasis Capitis

 1. PATIENT INFORMATION

• Name: Mr. Abhishek Jain
  
• Age/Sex: 32 years/Male
  
• Occupation: Bank Clerk
  
• Address: [Insert City, State]
  
• Date of First Visit: 15th April 2025
  
• OPD No.: 1025/25
  

 2. Chief Complaints

Complaints	Duration	Description
Itching and burning on scalp	8 months	Worse at night, especially after scratching. Causes disturbed sleep.
Scaly eruptions on scalp	8 months	Thick, white crusts that bleed on removal.
Occasional hair fall	6 months	No bald patches; reversible hair loss.
Extension behind ears and into nape	3 months	Dry, cracked skin with flakes.

 3. History Of Present Complaints

• Complaints started insidiously 8 months ago after a bout of work stress.
  
• Initially thought to be dandruff. Worsened over winter.
  
• Tried anti-dandruff shampoos and topical steroids with temporary relief.
  
• Patient noticed worsening after emotional stress and dietary changes.
  

 4. Past History

• Chickenpox in childhood
  
• No major illness or surgery
  
• No known allergies
  

 5. Family History

• Mother has bronchial asthma
  
• Maternal uncle has psoriasis
  
• Father is diabetic
  

 6. Personal History

• Appetite: Normal
  
• Thirst: Moderate, prefers cold water
  
• Stool: Irregular, occasional constipation
  
• Urine: Normal
  
• Sleep: Disturbed due to itching
  
• Dreams: Frightening, often of falling
  
• Thermal reaction: Chilly patient
  

 7. Mental Generals

• Very anxious and insecure about health
  
• Gets irritated when questioned
  
• Sensitive to criticism
  
• Feels better when consoled
  
• Workaholic and perfectionist
  
• Emotionally suppressed
  
• Avoids conflict but internally feels angry
  

 8. Totality Of Symptoms

1. Itching and burning of scalp, < night, > cold applications
   
2. Thick crusts on scalp with pus and bleeding on removal
   
3. Cracks behind ears
   
4. Disturbed sleep due to itching
   
5. Hair fall with crust formation
   
6. Emotionally sensitive, easily offended
   
7. History of suppressed eruptions
   
8. Family history of skin disease
   
9. Craving for warm food, aversion to meat
   
10. < in winter and after bathing
    

 9. Repertorial Totality

Repertory Used: Synthesis Repertory

Rubrics	Chapter
Head; eruptions; crusty, scalp	Head
Head; eruptions; scales, scalp	Head
Skin; eruptions; itching; night	Skin
Skin; eruptions; bleeding on scratching	Skin
Generals; food and drinks; meat; aversion	Generals
Sleep; disturbed; itching from	Sleep
Mind; sensitive; to criticism	Mind
Mind; consolation amel.	Mind

Remedies Considered: Mezereum, Graphites, Arsenicum album, Sulphur
Selected Remedy: Mezereum 30 (based on physical, mental and miasmatic totality)

 10. Prescription

Medicine Prescribed:

• Mezereum 30C – 4 pills once a day × 7 days
  
• Placebo – BD × 14 days
  
• Advice: Avoid triggers (stress, cold weather), use mild shampoo, adequate hydration
  

 11. Follow-Up

Follow-up 1 (After 2 weeks)

• Itching reduced by 40%
  
• Crusts drying, healing observed
  
• Sleep improved
  ➡ Continued Mezereum 30C for another 7 days
  

Follow-up 2 (After 1 month)

• Most plaques resolved
  
• Mild discoloration behind ears
  
• No itching
  

➡ Gave Tellurium 200C, 1 dose (to address residual circular discolored patches)

Follow-up 3 (After 2 months)

• 95% improvement
  
  
• Scalp clear
  
• Mentally calm and emotionally stable
  

➡ Intercurrent remedy: Bacillinum 200C, 1 dose
(To manage underlying psoric/tubercular miasm, prevent recurrence)

 12. CONSENT FROM PATIENT

“I, Mr. Abhishek Jain, voluntarily consent to the homeopathic treatment provided to me. I understand the nature of my condition, and the homeopathic approach being followed. I also grant permission to use my anonymous case for academic purposes.”

13. REFERENCES

1. Boericke’s Materia Medica – William Boericke
   
2. Synthesis Repertory – Radar Opus
   
3. Allen’s Keynotes – H.C. Allen
   
4. Rook’s Textbook of Dermatology
   
5. Homeopathic Practice of Skin Diseases – Dr. Ramji Gupta
   
6. Miasmatic Prescribing – Dr. Subrata Banerjea