Abstract
Psoriasis vulgaris is a chronic, inflammatory, immune-mediated skin disorder with a multifactorial etiology involving genetic, environmental, and psychosomatic factors. commonly with erythematous plaques covered in silvery-white scales, primarily on the extensor surfaces. Nail involvement, joint pain, and significant psychological impact are frequently observed. Despite advancements in allopathic treatment, including topical agents, systemic immunosuppressants, and biologics, recurrence and resistance to treatment remain challenges—often leading patients to explore complementary therapies. This case study presents a 44-year-old male with chronic, relapsing psoriasis unresponsive to conventional allopathic treatment. Natrum muriaticum was given constitutionally. This case highlights the importance of holistic and individualized approaches in managing chronic skin conditions like psoriasis, especially when emotional factors play a pivotal role.
Keywords: PSORIASIS VULGARIS, HOMOEOPATHY
Introduction
The prevalent dermatological condition known as psoriasis is immune-mediated, genetically determined, and affects the skin, nails, and joints. It has multiple systemic links (1) Although it is rare in youngsters (0.71%) and most cases develop before the age of 35, psoriasis can occur at any age. Well-defined red, scaly plaques that range in size from a few areas to widespread
involvement is the hallmark of plaque psoriasis. It is by far the most prevalent type of psoriasis, affecting over 90% of those who have it. About 50% of those afflicted experience distinctive nail alterations, which are especially prevalent in psoriatic arthritis patients (2)
Causes
The cause of psoriasis is multifaceted. Risk factors for psoriasis include trauma, infection, medications, metabolic variables, stress, alcohol, smoking, and sunshine, in addition to genetic susceptibility. Antimalarials, beta-blockers, bupropion, calcium channel blockers, captopril, fluoxetine, glyburide, granulocyte colony-stimulating factor, interferon, interleukins, lipid
lowering medications, lithium, penicillin, and terbinafine are among the medications that can make psoriasis worse.
Pathogenesis
Psoriasis is characterized by persistent inflammation that results in faulty differentiation and unchecked keratinocyte proliferation. The psoriatic plaque’s histology reveals acanthosis, or epidermal hyperplasia, on top of inflammatory infiltrates made up of neutrophils, T cells, macrophages, and dermal dendritic cells. Another notable characteristic is neovascularization. Although the inflammatory mechanisms involved in plaque psoriasis and the other clinical variations overlap, they also show distinct distinctions that explain the variations in phenotype and response to treatment.
Clinical Classification
There are different types of psoriasis based on the clinical presentation. Psoriasis Vulgaris
Although there are many other types of psoriasis, the most common variety is psoriasis vulgaris, often known as plaque-type psoriasis. This chronic plaque-type psoriasis accounts for about 90% of all psoriasis cases. The scientific literature uses the words psoriasis and psoriasis vulgaris interchangeably, still there are significant differences between the various clinical subtypes. Sharply defined, erythematous, itchy plaques covered in silvery scales are the traditional clinical symptoms. The plaques may clump together and cover a lot of skin. The scalp, the limbs’ extensor surfaces, and the trunk are typical sites (4)The hyperproliferation of the epidermal cells causes the plaques to scale extensively. The majority of individuals experience acute flare-ups and relapses of plaque psoriasis, which can occasionally worsen and develop into the pustular subtype. Psoriatic arthritis will strike at least 15% of those with plaque psoriasis. The condition known as plaque psoriasis is unpredictable. The condition known as plaque psoriasis is unpredictable. In addition to the fact that there is no known cure, it is also hard to predict who will relapse, how long the disease will be active, or how often a patient will experience remissions. Although the disorder is not fatal, frequent relapses can have a major negative impact on quality of life. Early start of symptoms, family history, and stress are all poor prognostic markers. Sunlight and warm weather both help alleviate the symptoms. Mortality rates are high if the condition develops pustules. Furthermore, all therapies have serious side effects, such as increased vulnerability to infections, liver damage, and skin
malignancies. Poor appearance is the main cause of morbidity, which can lead to social disengagement, loneliness, and melancholy (3)
Other types of Psoriasis:
Inverse Psoriasis
Inverse psoriasis, also known as flexural psoriasis, is characterized clinically by mildly erosive erythematous plaques and patches that afflict intertriginous areas (4)
Guttate Psoriasis
Small erythematous plaques appear suddenly in guttate psoriasis, a variation of the condition. It typically affects kids or teenagers and is frequently brought on by tonsil infections caused by group-A streptococci. Approximately one-third of adults with guttate psoriasis will go on to develop plaque psoriasis (4)
Pustular psoriasis
Multiple, sterile pustules that coalesce are a hallmark of pustular psoriasis. Both localized and widespread pustular psoriasis are possible. Psoriasis pustulosa palmoplantaris (PPP) and acrodermatitis continua of Hallopeau are two different localized manifestations that have been identified. Both conditions impact the hands and feet; the former only affects the palms and soles, while the latter affects the nail apparatus and is more widely distributed at the tips of the fingers and toes (4)
Diagnosis
Since psoriasis is a clinical diagnosis, a skin biopsy is typically not required for the disease’s classic manifestations. The distinctive lesions are erythematous, scaly, and well-defined plaques. The plaques could hurt and/or itch. Their form might be uneven, circular, or oval, and they are frequently placed symmetrically. Points of little bleeding (the “Auspitz sign”) may appear when the xerotic scale is scraped off. The Koebner phenomenon is the development of lesions at trauma or injury sites(5)
Complications
Pain, redness, warmth, swelling, or stiffness in one or more joints are symptoms of psoriatic arthritis. A characteristic feature is swelling in the fingers or toes that resembles sausage. In a few instances, nail alterations are also evident. White nail patches (leukonychia), yellowish red specks under the nail (“oil drops”), horizontal ridges on the nail (Beau’s lines), nail pitting, and thickening of the nail plate (subungual hyperkeratosis) are all possible. Little black lines under the nail that are brought on by splinter haemorrhages or ruptured capillaries. Onycholysis may cause the nail plate to lift, maybe crumbled and fragile. Eye conditions include blepharitis (eyelid inflammation), conjunctivitis (pink eye), and uveitis. Mood changes can also present. Heart conditions include hypertension (high blood pressure) and atherosclerosis (so-called hardening of the arteries), which both are associated with heart attacks and strokes. There is increased risk for lymphoma also (6)
General Management
Phototherapy, stress reduction, climatotherapy, topical and systemic medicine, and a variety of adjuncts like sunshine, moisturizers, salicylic acid, and other keratolytics like urea are used conventionally to treat psoriasis (7)
Homoeopathic Management
Arsenicum album
The main sign that Arsenic Album should be used is the appearance of dry, rough, red, papular eruptions that have scales on them. Silver is the color of the scales. Except for the hands and face, the majority of the body is covered in eruptions (8)
Graphites
Patches of painful, dry, rough, scaled skin are typically the cases where Graphites Naturalis works best. There may also be a tendency for surface cracks to form. After scratching, the skin may get sticky (8)
Arsenic iodatum
When there is significant scale shedding from skin eruptions, arsenic iodatum is employed. Scale-covered, inflammatory areas cover the skin. The spots continue to itch, and the scales that are shed leave behind rough skin (8)
Sulphur
When psoriatic skin lesions are really itchy and burning, it can assist. The person has intense itching and continues to scratch the skin until it bleeds. Scratching is followed by a burning feeling. The itching is sporadic and varies in location (8)
Petroleum
Deep skin cracks caused by psoriasis can be effectively treated with petroleum. The afflicted skin has unbearable itching and a burning feeling. There may also be bleeding in the fissures. Best treatments for cases of psoriasis that get worse in the winter (8)
Antimonium crudum
When the defining traits include twisted and out-of-shape nails with discolouration, pitting, or ridges, Antimonium crudum is quite helpful. Because they are brittle, the nails break easily. Additionally, the area beneath the nails is extremely sensitive and unpleasant (8)
Materials and Methods
This is a single descriptive case study conducted in a clinical homoeopathic setting. The case was evaluated using classical homoeopathic methodology, focusing on detailed case-taking, mental and physical totality, and constitutional analysis. A comprehensive history was obtained during multiple consultations, including personal history, past medical history, family history,
emotional background, physical generals, and mental generals. Dermatological examination of skin and nails was documented at each follow-up.
CASE STUDY
Patient Identification
• Name: [Withheld for confidentiality]
• Age/Sex: 44-year-old Male
• Marital Status: Married, 2 children
• Occupation: Driver
• Date of First Visit: 20/08/2024
Chief Complaints
• Multiple eruptions on:
o Extensor aspect of legs and forearms
o Flexor aspect of forearms
• Uncontrollable itching
• Silvery white scales that shed more with dryness
• Bleeding spots after scratching
• Nail changes: discoloured, disfigured
Duration:- Present continuously since 1 year.
Progression: Gradually spreading, no relief with allopathic treatment over 6 months
Past Medical History
• Age 4: Eczema – Treated with Ayurveda – Relieved
• Age 25: Warts – Treated with Homoeopathy – Relieved
• Age 39: Psoriasis (Scalp, back, forehead) – Treated with Allopathy – Relieved • Current (Age 44): Relapse of Psoriasis – Not responding to Allopathy
Family History
• Mother: Diabetes mellitus
• Father: Renal calculi
History of Present Illness
• Complaints began 5 years ago, he took allopathic treatment at that time and got relieved but again appeared at new sites.
• Trigger: Emotional trauma due to betrayal by a childhood friend during financial dealings.
• Emotional state: Deep disappointment, cannot forget the incident even after an apology.
Mental Generals
• Deep sense of betrayal and mistrust following a financial deception by a close friend
• Continues to be mentally disturbed by the incident even after 5 years • Cannot forgive or forget easily
• Finds it difficult to trust others
• Emotionally reserved, took time to express feelings
• Strong moral values, does not tolerate injustice
• Carries emotional wounds silently
Physical Generals
• Thirst: Excessive, unquenchable
• Appetite: Normal
• Perspiration: Profuse
• Desire: Salt
• Thermal State: Hot patient
• Sleep, Bowel, Bladder, Sexual function: NAD
Diagnosis (Clinical)
Chronic Psoriasis vulgaris, based on classical symptoms:
• Silvery scaling
• Multiple lesions
• Extensor distribution
• Nail dystrophy
• History of recurrence
• Emotional aggravation
Miasmatic Diagnosis
Psora–Sycosis Dominant, with possible Syphilitic element (nail involvement and bleeding spots)
Totality of Symptoms
1. Ailments from deception
2. Unable to forgive or forget, even after apology, dwells on past disagreeable occurrences 3. Reserved personality — emotionally suppressed, took time to open up 4. Strong sense of duty and responsibility
5. Intolerance to injustice — emotionally disturbed by perceived wrongs 6. Serious, principled, inwardly tormented nature
7. Thermally hot patient
8. Thirst unquenchable — drinks large quantities of water
9. Profuse perspiration
10. Desire for salt
12. Psoriatic eruptions on extensor and flexor surfaces — thick, dry, silvery-white scaling 13. Intense itching, worse from dryness, with bleeding on scratching
14. Nail changes — discoloured, disfigured nails improving with treatment Rubrics(9)
MIND -AILMENTS FROM -deceived; from being
MIND- AILMENTS FROM – disappointment
MIND – DWELLS-past disagreeable occurrences, on
MIND- INJUSTICE, cannot support
MIND- RESPONSIBILITY- taking too seriously
STOMACH -THIRST –unquenchable
EXTREMITIES – CRACKED skin- feet -Heels
EXTREMITIES- NAILS; complaints of – distorted nails
PERSPIRATION – PROFUSE
SKIN – ERUPTIONS – psoriasis
GENERALS- FOOD and DRINKS-salt- desire
Remedy Selection
Based on mental and physical totality: Natrum Muriaticum – well-suited for chronic skin eruptions linked to grief, reserved nature, and constitutional match (salt desire, heat, emotional disappointment)
Outcome
• Marked improvement in skin eruptions
• Disappearance of itching and plaques
• Nails improving
• Mental and emotional well-being restored
• Patient satisfied with treatment
Management & Advice
• Avoid skin irritation (scratching, harsh soaps)
• Maintain adequate hydration
• Stress management (emotional balance)
• Regular follow-up every 2–3 months to prevent relapse
• Counselling advised if emotional triggers resurface
• Avoid suppressive local applications
Prognosis
Favourable – based on constitutional improvement and return of emotional balance
Tables Charts Pictures
Image of rubrics from synthesis repertory- available in radar (9)
Prescription and Follow-Up :-
Date Prescription Remarks
20/08/2024 SL (Placebo), due to lack of complete
picture First visit, patient emotionally closed
04/09/2024 Natrum Mur 200 / 1 dose (morning, empty stomach), SL x 7 (alt. nights)
Patient opened up emotionally; full picture available
20/09/2024 SL x 8 (1 dose every 3 days) Improvement noticed 16/10/2024 Natrum Mur 1M / 1 dose, SL x 10
(alternate nights) Slow progress, potency raised 09/11/2024 SL x 10 (alternate nights) Appreciable improvement
22/11/2024 SL continued Lesions disappeared, nails improved, patient mentally relaxed
Discussion
This case shows the effectiveness of individualized constitutional homeopathic treatment in managing chronic psoriasis vulgaris. The patient’s long-standing skin condition, resistant to allopathic modalities, demonstrated clear improvement following the administration of a carefully selected simillimum — Natrum Muriaticum — based on a well-defined totality of symptoms, especially the mental and emotional landscape.
The hallmark signs of psoriasis — silvery white scales, itching, bleeding on scratching, and nail dystrophy — were accompanied by a deep-seated emotional trauma stemming from betrayal and unresolved grief. This emotional state acted as a maintaining cause, highlighting the need for a remedy that not only addressed the skin pathology but also the psychological distress of suppressed emotions, inability to forgive, and hypersensitivity to injustice.
Natrium Muriaticum, a salt remedy well-known for ailments from grief and disappointment, matched the patient’s thermal state, thirst, personality traits, and emotional reserve. The
selected potency schedule and gradual potency elevation from 200C to 1M helped to improve the patient’s emotional and physical sufferings gradually.
Conclusion
This case highlights that individualised and holistic homoeopathic approach can bring about significant relief in chronic, relapsing psoriasis, especially when emotional stressors are at the root of disease manifestation. The use of Natrum Mur, by considering patient’s physical, mental, and emotional profile, resulted in sustained clinical improvement and emotional stabilization. This shows the value of a mind-body approach in chronic dermatological conditions and encourages further study and documentation in similar cases to substantiate the role of individualized homeopathy in chronic inflammatory skin diseases.
References
1. Ijdvl.com. [cited 2025 May 13]. Available from: https://ijdvl.com/psoriasis-in-india prevalence-and-pattern/
2. Psoriasis: assessment and management. National Institute for Health and Care Excellence; 2017. https://www.ncbi.nlm.nih.gov/books/NBK553610/
3. Badri T, Kumar P, Oakley AM. Plaque psoriasis. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing; 2025. https://www.ncbi.nlm.nih.gov/books/NBK430879/
4. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci [Internet]. 2019;20(6):1475. Available from: http://dx.doi.org/10.3390/ijms20061475
https://www.ncbi.nlm.nih.gov/books/NBK430879
5. Nih.gov. [cited 2025 May 13]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7122924/
6. Goodless D. Health Complications of Psoriasis [Internet]. Verywell Health. 2008 [cited 2025 May 13]. Available from: https://www.verywellhealth.com/psoriasis-more-than-just-skin deep-2788331
7. Habashy J, MSc DO. Psoriasis treatment & management [Internet]. Medscape.com. Medscape; 2025 [cited 2025 May 13]. Available from: https://emedicine.medscape.com/article/1943419-treatment?form=fpf
8. 7 best homeopathic Medicines for Psoriasis [Internet]. Homeopathy at Drhomeo.com. 2018 [cited 2025 May 13]. Available from: https://www.drhomeo.com/homeopathy-for skin/psoriasis-and-its-homeopathic-treatment/
9. Radar Opus. Version 3.0.16. Archibel Homoeopathic Software. Belgium: Radar Opus; 2019.
AUTHOR
Dr Sreeshma K
MD Scholar, Department of Psychiatry
Govt Homoeopathic Medical College and Hospital, Bhopal, Madhya Pradesh.
CO-AUTHOR
Dr Nisanth Km Nambison
Associate Professor, MD (Hom)
Govt Homoeopathic Medical College and Hospital, Bhopal, Madhya Pradesh
