Psoriasis, an immune mediated genetically determined common dermatological condition which affects skin, nails, joints and has various systemic associations. It’s a common disorder in India with prevalence and epidemiological characteristics similar to the presentation of diseases. This case report highlights potential of homoeopathic management in psoriasis. A 43-year old female came to the outpatient department with presenting complaints of severe itching and scaling off of skin on abdomen, back and thighs for 5 years. She was treated with allopathic for the same but complaints were relapsed within a month after quitting of medicines. After case taking, she was treated Mercurius solubilis. She was completely recovered symptomatically from skin lesion, itching. This is the documentary evidence about the effectiveness of homoeopathic medicines for psoriasis.
Keywords: Psoriasis, totality of symptoms, homoeopathy.
Abbreviations: human leukocyte antigen (HLA), outpatient department (OPD), International Classification of diseases (ICD)
Psoriasis is a common, chronic, non-communicable skin disease with no clear cause or cure. It is a papulo-squamous disorder of the skin characterised by sharply defined erythemato-squamous lesion. They vary in size from pin-point to large plaques, may manifest as localised or generalised pustular eruption. It affects people of all ages, and in all countries.1
It is chronic, inflammatory, immune-mediated, proliferated skin disorder that predominantly involves skin, nails and joints.2 Psoriasis is a disfiguring and disabling disease with great negative impact on patient’s quality of life. Numerous studies have reported the coexistence of psoriasis and other systemic diseases like cardiovascular disease, hypertension, dyslipidaemia. Diabetes mellitus and many more.3
Robert Willan, the father of modern dermatology, is credited with first detailed, clinical description of psoriasis and hence, it is also termed as Willan’s lepra. The association between arthritis and psoriasis was first described by Alibert in 1818, and the American Rheumatology Association recognised it as a separate entity in 1964.2
“Psora” is derived from a greek word meaning “to itch”. Galen identified psoriasis as a skin disease through clinical observation and was the first to call it psoriasis.4.
According to an article published in 2016; the world wide prevalence of psoriasis is estimated to be approximately 2-3%, with higher prevalence in polar regions of world. In tropical/sub-tropical countries like India, the prevalence of psoriasis may vary from region to region due to variable environmental and genetic factors. 2
The reported prevalence of psoriasis in countries ranges between 0.09%and 11.43%, making psoriasis a global problem with at least 100 million individuals affected world wide.3
Pathogenesis and risk factors
The pathogenesis of psoriasis is debatable. But the probable may be as follows:
1. Genetic, when a child with one affected parent has 14% chance of developing the disease and if both parents are affected this rise to 41%.HLA are regarded as the most important genetic marker for psoriasis and HLACw6 is most strongly associated.5
2. Hyperproliferation- Time necessary for psoriatic epidermal cells to travel from basal cell layer to the surface and be cast off is 3-4 days, in contrast to the normal 26-28 days. Similarly, cell cycle time reduces from 163 hours to 37 hours. This accelerated epidermopoiesis does not allow normal events of cell maturation and keratinisation.
3. Decrease in T-cells due to absence of clones of T suppressor cells .
The disease may be precipitated by factors like- trauma, infection, climate, emotional stress etc.1
Psoriasis is not only a disease having highly visible symptoms rather also associated with a multitude of psychological impairments. It causes embarrassment, lack of self esteem, anxiety and increased prevalence of depression leading to higher rate of suicidal ideation than other patient.3
According to Hamer theory, psoriasis involves two separation conflicts: one is conflict active phase, causing a flaky skin; other is healing phase, showing an inflammation. Bothe phases overlap at the same area, presenting as silvery scales on thick red surface. Location reveals which part of the body was associated with the conflict. Appearance of the condition is determined by which one of the two conflict is active or healing at the time.
Classification; clinical presentation and diagnosis
There has been different basis of classification:
Epidemiological classification – type I and type II
On the basis of morphology – stable, unstable
Size of lesion – thin /thick
Disease severity – mild, moderate and severe.
Guinot et al. have classified psoriasis in six phenotypes on basis of age of onset, course of disease, extent of lesion and association.2
Psoriasis is characterised by well circumscribed sharply demarcated erythematous papule and/ or plaques. Woronoff’s ring is found; if removed candle grease sign is seen ;on further grattage Barkley’s membrane is seen which comes off as a whole. when this membrane is removed, a wet surface with multiple pin point bleeding is revealed called as auspitz’s sign. Typical nail changes are seen like-thick, brittle, pitting of nail plate, distal onycholysis.1
Diagnosis is clinical; based on recognising the cardinal morphological lesions of psoriasis.
A female patient aged 43 came to OPD of R.B.T.S. Govt. Homoeopathic Medical College and Hospital, Muzaffarpur in the month of September 2019 with OPD Reg no –A08221/4020. She complained of severe itching with scaling off of skin. The case was diagnosed as psoriasis and referred to the Research OPD, Dermatology in the hospital premises enrolled with number RD-123. Her complaints included itching with scaling off of skin on abdomen, back and thigh for last 5 years. Itching aggravated at night during sleeping hours, winter season, on perspiring, on sun exposure while it ameliorated on application of oil. Scratching of skin caused burning. Her symptoms confirmed the ICD-10 criteria of L40.9 for psoriasis and psoriasis like symptoms.
She also complained of prolapse of uterus for past one year which she felt more while passing stool especially on straining.
Patient wasa housewife belonging to middle class socio-economic group with normal built and of was of mild nature. The progression of the disease was gradual with onset in infra mammary region. She already had taken allopathic treatment 2 years back.
Past history—Filariasis – 6-7 years back.
Family history—Maternal side- Mother had Koch’s disease previously and suffering from Diabetes mellitus. Own side—Sister and brother both had suffered from Koch’s disease.
Personal history and physical generals— She was a married woman having two children with history of two abortions. Her appetite was good and she couldn’t tolerate hunger; her food habits were marked with desire for sour, spicy food and warm food; aversion to milk and sweet. The stool used to be clear; but there were burning in urination with frequency and itching of the genital parts after urination. She suffered from sleeplessness because of severe itching at night. There used to be profuse perspiration which was offensive. Her tongue was examined and found to be flabby and moist with much salivation especially at night; thermal reaction- ambithermic. Her menstrual cycle was regular with scanty discharge.
Mental generals—Sensitive to noise which cause anger; want to be alone; contradiction causes anger.
On examination, skin appeared pink in colour with well defined margin with watery discharge after scratching.
Based on these complaints and examination, the case was diagnosed as psoriasis, the case was analysed and symptoms were classified to find out the indicated simillimum.
ANALYSIS OF SYMPTOMS-
Mental generals- contradiction causes anger; sensitive to noise; wants to be alone.
Physical generals- aversion to sweet, milk; desire for sour, spicy; tongue- flabby; perspiration profuse and offensive; salivation much; urine- burning while urination, with itching of the parts, aggravates after urination; thermal- ambithermic
Particulars – Itching and scaling of skin; itching aggravated at night and with perspiration; prolapse of uterus.
Totality of symptoms was made and was also cross checked by repertorisation with RADAR Opus software.
Conversion of symptoms into rubrics6–
|Sensitive to noise||MIND||Sensitive- noise, to|
|Contradiction causes anger||MIND||Anger- contradiction, from|
|Aversion to sweet||GENERALS||Food and drinks- sweet- aversion|
|Aversion to milk||GENERALS||Food and drinks-milk- aversion|
|Desire for sour||GENERALS||Food and drinks- sour food, acids, desire|
|Flabby tongue||MOUTH||Flabby tongue|
|Scaly skin eruption||SKIN||Eruptions- scaly|
|Itching aggravates at night||SKIN||Itching- night|
|Prolapse of uterus||FEMALE GENITALIA/SEX||Prolapsus- uterus|
Sepia officinalis – 27/11
Arsenicum album – 18/11
Sulphur – 21/10
Lycopodium clavatum – 19/10
Mercurius solubilis – 19/10
Remedy differentiation— After reportorial analysis, Sepia was found to be in highest grade but after consulting materia medica , Mercurius solubilis was found to be the indicated remedy.
Mercurius solubilis affects every organ and tissues of the body. Lesions produced by mercury are very similar to those of syphilis. It acts more especially upon the mucous and serous membrane and glandular system. It penetrates the entire organism and permeates every tissue. Skin looks dirty and constantly moist; itching all over body worse at night. There are eruptions of watery vesicles. There is viscid perspiration but patient is not relieved. There is vesicular and pustular eruption, yellowish brown crusts are found. There is hastiness inall motion, offensiveness of breath and whole body. Ambithermal. 7
REMEDY PRESCRIBED (18/9/2019)—Mercurius solubilis 30/3 doses, once a day for 3 days, followed by placebo.
1st Follow up- (9/10/2019)- Itching with scaling of skin- ameliorated by 50%, now itching is there for sometimes only; now scratching causes no burning; prolapse of uterus ameliorated .
Remedy prescribed- Rubrum for 1 month
2nd Follow up- (27/11/2019)—Itching with scaling of skin –ameliorated by 70%; itching reduced; now no burning; prolapse of uterus by 25%
Remedy prescribed- Rubrum for 1 month.
Follow up-(11/12/2019)- Itching of skin was markedly reduced; slight burning in whole body for last 4-5 days; scaling off of skin not there; Frequency of urination – decreased.
Remedy prescribed- Rubrum for 1 month.
Follow up (8/1/2020)- Now, there was no itching of skin; scaling off of skin was also not there; burning in whole body which was present in last visit also reduced gradually.
Remedy prescribed—Rubrum for 1 month.
Follow up (22/1/2020) — Patients condition was stable; no itching, scaling and burning sensation in whole body. Her generals were normal and she was feeling perfectly good.
Psoriasis is a long-term (chronic) disorder that causes skin cells to grow too quickly, resulting in thick, white, silvery or red patches of skin. The homoeopathic medicines for psoriasis need to be specific to every individual person. That is the reason a detailed history is required to customise the treatment for psoriasis. The Homeopathic treatment for psoriasis is chalked out after a detailed analysis and review of the past treatment for psoriasis and medicines taken for psoriasis.
In the present case, the patient had symptoms of psoriasis with scaling off of skin in the region of abdomen, back and thighs. Totality of symptoms and the reportorial analysis on the basis of these symptoms presented the picture of Mercurius solubilis which is characterised by vesicular and pustular eruption with yellowish brown crusts accompanied with a foul smelling emission. On the basis of these symptoms, Mercurius solubilis was prescribed to the patient and the patient gradually improved with the medicine.
- Sehgal, V.N., Textbook of Clinical Dermatology; fourth edition, 2004; Jaypee brothers Medical Publisher (P).Ltd.
- Dogra S. Mahajan R. Psoriasis: Epidemiology, clinical features, co-morbidities, and clinical scoring. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134160/; Date- 12/7/2020
- Global report on Psoriasis, WHO library cataloguing-in-publication data, ISBN978 92 4 1565189, World Health Organisation 2016
- Fry L. Psoriasis. Wiley Online Library. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2133.1988.tb03248.x Date-12/7/2020
- Sardana K; Ailawadi P;Textbook of Dermatology and Sexually transmitted Diseases with HIV Infections, first Edition 2019,;CBS Publishers and distributors Pvt. Ltd.
- RADAROpus Software
- Cowperthwaite AC; A Textbook of Materia Medica and therapeutic; B. Jain Publishers. New Delhi. Reprinted 1984
Dr Manila Kumari, PGT
R.B.T.S. Govt. Hom. Med. College & Hospital, Bihar