A CASE OF PALMOPLANTAR PSORIASIS
Author:
Dr.Madona Joseph BHMS MD PGDBEME
Professor, Head of the Department
Forensic Medicine &Toxicology
Father Muller Homoeopathic Medical College
Deralakatte Mangaluru 575018
Co-Author: Dr.Remya Varghese
PG Scholar
Department of Homoeopathic Materia Medica
Father Muller Homoeopathic Medical College
Deralakatte Mangaluru 575018
Abstract: A known case of palmoplantar psoriasis treated homoeopathically with constitutional and specific medicine based on the symptom similarity.
Key words: psoriasis, palmoplantar, homoeopathic medicine.
Abbreviations: + = present, G = good, = amelioration, s = same, D = decreased, A = absent.
Introduction:
Psoriasis is an inflammatory disease that manifests most commonly as, well circumscribed erythematous papules and plaques covered with silvery scales. It affects both epidermis and dermis and leads to hyperprolifertion of epidermal keratinocytes combined with inflammation. Epidemiological studies shows that it affects approximately 2.0% to 3.0% of world’s population. Cause is unclear but seems to involve immune system and the common triggering factors are trauma, infection, and certain drugs. Clinically it can be classified into different types.
Here we have a case of palmoplantar psoriasis which we were managed with homoeopathic medicines. The remedy selected based on individualization and the symptom similarity.
CASE HISTORY:
A 58 year old lady presented with the complaints of itching, peeling of skin and bleeding in the palm and sole bilaterally since 7 months. Her complaints started on the palms then later on the soles. It started with itching followed by peeling of skin and bleeding. Patient experience severe itching with dryness and burning of palm and soles, that increases early morning around 3to 4 am and with perspiration. To reduce the itching patient used to apply ointment or coconut oil and also she dip the hands in hot water. It gave temporary relief to the complaint. She had been under allopathic medication for the same presenting complaint since the onset.
Past history:
Nothing significant
Family history:
Nothing significant.
Treatment history:
Taken allopathic medicine for presenting complaint.
Patient as a person:
Appearance: stocky.
Appetite: good.
Thirst: 1-2 liter per day.
Desire: sweets 2+.
Bowel habit: once per day, no difficulty.
Bladder habit: 4-5 times per day, once per night.
Perspiration: more on face.
Sleep: decreased (12am to 5 am).
Thermal: hot patient.
Dreams: nothing significant.
Menstrual history:
FMP: at the age of 13 years.
Menopause: at the age of 52.
Life space investigation:
Patient hails from a middle socioeconomic family. Her parents were daily wage workers and she has one younger brother. Had apparently a pleasant childhood. At the age of 29 she got married. It was an arranged marriage. A year later they blessed with a daughter. Two years after marriage patient came to know about the extra marital affair of her husband. It was very shocking to her and then she stopped talking to her husband and asked about it her family members. They had known it before, but they did not inform to patient. She kept everything in her mind. Tried to behave nothing happened to her life. She became silent and always things about her daughter and her future. But inside difficult to handle the pain, and keep on think on the incident happened her life. When she tried to approach her family, they neglected these issues. From that moment onwards she stopped talking to her husband and family members and pretended to happy in front of others. She told about her life to everyone till she was contended. She felt both angry and sad about her life. And she expressed during case taking no one is there for me, husband also no their family members also.
General physical examination:
Moderately built and moderately nourished.
Well oriented with time, place and person.
No signs of pallor, cyanosis, clubbing, icterus and lymphadenopathy.
Vital signs:
Temperature: afebrile at the time of examination
Pulse: 79 beats per min
B.P: 130/90 mm of hg
Local examination:
Skin: palm and soles:
Inspection:
Dryness
Scales and peeling of skin.
Cracks present.
Palpation:
Auspitz spots present while removing the scales.
Systemic examination:
Respiratory system:
NVBS heard.
No added sound.
CVS:
S1 S2 heard.
No murmur.
Clinical diagnosis:
Palmoplantar psoriasis.
Homoeopathic management:
Constitutional totality:
Mental generals Physical generals Characteristics particulars
Want of love
Grief
Brooding
Weepy
Insecurity
<contradiction
Craving : sweets
Perspiration :more on face
Sleep: disturbed
Thermal: hot Itching warmth
Prescription on 3/6/2020
- Ignatia 200 (2p)
1p tonight
1p next day morning - No ii Pills
4-0-4 2 weeks
Follow up criteria:
- Sleep
- Itching
- Scaling
- Peeling of skin
- Dryness
- Bleeding
- Burning
- Ausptiz spots
Abbreviations: + = present, G = good, = amelioration, s = same,
D = decreased, A = absent.
Follow up no 17/6/ 2020
1 2 3 4 5 6 7 8
G + ++
+ > > A
Prescription
- Ars Iod 30 (TDS) for 2 weeks
Follow up on 1/7/2020
1 2 3 4 5 6 7 8
G > > > + A > A
Prescription
- S:L (1p) H.S
- Ars Iod 30 (od) for 2 weeks
Follow up on 15/7/2020
1 2 3 4 5 6 7 8
G A > > > A > A
Prescription
- S.L(2p) weekly HS
- No ii Pills
4-0-4 2 weeks
Follow up on 12/8 /2020
1 2 3 4 5 6 7 8
G A > > > A > A
Prescription
- Ars Iod 200 (1p) HS
Follow up on 29/8/2020
1 2 3 4 5 6 7 8
G > > A > A
Prescription
- SL (2p) weekly HS
- No ii Pills
4-0-4 2 weeks
Conclusion: Patient named Mrs.Rv came with the complaint of peeling of skin, cracks and itching and silvery scales on the palms and soles bilaterally. The case was diagnosed as palmoplantar psoriasis. Ignatia 200 prescribed constitutionally and followed up with Ars Iod Patient completely recovered from the peeling of skin, cracks, itching and silvery scales.
References:
- Porter RS, Kaplan JL. The Merck manual of diagnosis and therapy. Merck Sharp & Dohme Corp.; 2011.
- Valia RG, Valia AR. IADVL Textbook of dermatology. Bhiani publication house. 2008.
- Boericke W. New Manual of Homoeopathic Materia Medica & Repertory. New Delhi: B Jain Publishers (P) ltd. 2002.
- Clarke JH. A dictionary of practical Materia Medica. Homoeopathic Book Service; 2000.
- Phatak SR. Materia medica of homoeopathic medicines. B. Jain Publishers; 2002.
