Abstract:
Background- Palmoplantar psoriasis is autoimmune disease presenting chronic inflammation characterized with silvery scale covered , thickened erythematous plaques which are evidently seen among the pediatric age group in 1 to 3% .It is evidently been observed that inflammatory marker have a role in pathogenesis in psoriasis patients.
Case Report- 11 Yrs. boy presented with complaint of Chronic itching, erythematous papular eruptions, and cracks localized on the soles of the feet which was approximately 3×3 cm and according to the totality of the symptom considering mental and physical symptoms Carcinosinum was prescribed which consequently showed improvement within 8 months in the patient. The outcome to the treatment was evaluated by using Modified Naranjo Criteria for Homoeopathy [MONARCH] where it was observed to be +11 which suggested clinical improvement in PPP with the help of Homoeopathy.
Keywords:
Carcinosium, Homoeopathy, Palmoplantar Psoriasis, Pediatrics
Introduction:
Psoriasis is a chronic inflammatory disease of the skin with silvery scale-covered, thickened, well-defined erythematous plaques and it leads to abnormal immune responses, keratinocyte proliferation, and angiogenesis (1).
Palmoplantar psoriasis affects the palmar surface of the hands and the plantar surface of the feet. The incidence among children is around 1 to 3% (1). The involvement of both palms and soles is described as palmoplantar psoriasis, but there is indeed variation because both are involved in 59 percent of the cases, while palmar psoriasis is seen in 21 percent and Plantar Psoriasis is seen in 20 percent of the patients(3).
It is a papulosquamous skin disease occurring at any age which may cause burden to the affected individual which may also include psoriatic arthritis, depression, cardio metabolic disease
Immunological study shows IL -17 and IL – 23 are the key drivers of psoriasis pathogenesis.
This condition has both hereditary, environmental factors, which also affect social functioning
Genetics of Psoriasis is complex; this gene involves antigen presentation, T Cell receptor development and polarization, and the nuclear factor κβ (NF-κβ) pathway has been identified (6).
Characteristics of Palmoplantar Psoriasis:
1. Thick, scaly plaques
2. Pitting or cracking
3. Hyperkeratosis
4. Fissuring
5. Erythema
Pain, tenderness, itching discomfort which may affect quality of life Pain and discomfort in daily activities, emotional distress , social isolation
Topical therapy, phototherapy, and oral medicines constitute only palliative relief, Corticosteroid for reducing inflammation and scaling, Vitamin D used for to slow down skin cell growth and reduce scaling, Salicylic acid to reduce inflammation and scale formation; Common side effects include irritation, skin thinning, and skin drying
Role of Homoeopathy in PPP –
Case report of Dr. G R Kiranmayee Rompicherla Who treated the case of PPP for a year, where acute exacerbations of the symptom was treated with Merc sol 200 where in consequent follow up potency was increased, as complaints were reduced but repeated exacerbations were seen in such case constitutional medicine which may be from animal, plant, mineral also surprisingly nosodes can be prescribed here in this case author has prescribed plant based remedy i;ePulsatila200, but due to mild recurrence patient was prescribed with Psorinum200. With a view Nosodes has a great role in curing the patient.
Homeopathic view in plantar psoriasis with treatment by using Nosodes as a patient is cured as a whole where we look into both mental and physical well-being of the patient(2).
Considering the patient as whole and its multifactorial causation including chronicity of the complaints, the patient is approached with a holistic and individualization for treatment of psoriasis.
Evaluation of homeopathic drug in psoriasis it include group of remedies which are Arsenic Album , Tuberculinum , Kali Arsenicosum , Psorinum , Sepia , Sulphur , Thyroidinum , Opium , Nux Vomica , natrum Muriaticum , carcinosinum , sulphur , graphites , mercurius sol(4).
The presented case is of PPP which has been managed with individualized homeopathic medicine which has a beneficial role in treating the PPP.
Case History:
This case explores the progression of a long-standing skin condition in an 11-year-old boy with a history of skin eruptions, associated itching, and irritability.
Presenting Complaints –
| LOCATION | SENSATION | MODALITIES | CONCOMITANTS |
| Integumentary systemSkinRight soleLeft soleB/L Nailbeds of HandsMore on left than rightStarted at age 3-4 years | Started after small wound to Right leg at age 3yrs; wound++ didn’t heal for 1year Initially only itching of soles, later developed papular eruptions++ and cracks in feet. At present-Plaques with irregular margins++ Approximately 3×3 cm Redness++Itching++Occasional bleeding after scratching++ | Consulted Ayurvedic Physician & Dermatologist- No Relief <Dust< Night<Applying water++<Winter>Summer++ | No any |
Past Medical History –
Full term normal delivery (FTND).
No significant past medical history aside from the chronic skin condition.
Family History –
Father suffering from hypertension under treatment
Paternal grandmother suffering from Type2 DM under treatment.
Personal History –
Appetite: Reduced.
Thirst: Reduced, approximately 1-1.5 liters per day.
Desire: Craving for spicy foods++ and chicken++
Aversion: milk++ and eggs++
Thermally: Ambithermal
Perspiration: Scanty++
Sleep: Normal, 6-7 hours sound sleep with vivid dreams which makes him get up.
Mental Symptoms –
The patient is described as a joyful and social child and loves to take good care of his younger brother. He has a very hectic schedule of school and he has been studying in military school since the age of 5 years. His family expects to get good results though he faces significant stress due to academic pressures. He exhibits a high degree of responsibility++, frequently suppresses emotions++, and is sensitive to criticism. Notably, he is irritable under stress and experiences crying spells in response to anger+++. He harbors fears of darkness and heights.
He is fastidious regarding cleanliness+++ and also loves playing with animals.
He himself told the family member to get treatment for skin complaints as in summers itching is less.
Local Examination-
| Right sole | Right palm | Left sole | Left palm |
| Plaques with irregular margins++ Approximately 3×3 cm | Nailbed of right palm affected | papular eruptions and cracks in feet.Plaques with irregular margins++ Approximately 3×3 cm | Nailbed of left palm affected |
Analysis of Case :
1. MENTAL GENERAL CHARACTERISTICS-
- Fastidious for cleanliness+++
- Fear of dark
- Fear of heights
- Loves animals
- Precocity in children++
- Responsibility taking++
- Sensitivity to criticism++
- Weeps during anger+++
2. MENTAL GENERAL COMMON –
- Irritability due to academic stress
3. PHYSICAL GENERAL CHARACTERISTICS –
- Desire for chicken++
- Desire for spicy food++
- Aversion for egg++
- Aversion for milk++
- Wound heal slowly++
4. PARTICULAR CHARACTERISTICS –
- Skin of palm and sole itching++
- Skin of palm and sole eruption
- Skin complaint aggravated by applying water++
- Perspiration is scanty++
- Bleeding on scratching++
Evaluation of Symptoms –
GRADE 1 –
- Fastidious for cleanliness
- Weeps during anger
GRADE 2 –
- Precocity in children
- Responsibility taking
- Sensitivity to criticism
- Desire for chicken
- Desire for spicy food
- Aversion for egg
- Aversion for milk
- Skin of palm and sole itching
- Skin complaint aggravated by applying water
- Perspiration is scanty
- Wound heal slowly
- Bleeding on scratching
GRADE 3 –
- Fear of dark
- Fear of heights
- Loves animals
- Irritability due to academic stress
- Skin of palm and sole eruption
Totality of Symptoms –
1. Fastidious for cleanliness +++
2. Fear of the dark.
3. Fear of heights.
4. Sensitivity to criticism (++).
5. Responsibility taking (++).
6. Precocity in children (++).
7. Weeps during anger (+++).
8. Loves animals
9. Irritability due to academic stress.
10. Desire for chicken (++).
11. Desire for spicy food (++).
12. Aversion for egg (++).
13. Aversion for milk (++).
14. Perspiration is scanty (++).
15. The wound heals slowly (++).
16. Skin of palm and sole itching (++).
17. Skin of palm and sole eruption.
18. Skin complaint aggravated by applying water (++).
19. Bleeding on scratching [++]
Repertorial Totality –
- MIND – Fastidious for cleanliness
- MIND – Fear of dark
- MIND – Fear high places of
- MIND – Loves animals
- MIND – Precocity of children
- MIND – Responsibility taking responsibility too seriously
- MIND – Sensitive to criticism
- MIND – Weeping anger
- PERSPIRATION – Scanty sweat
- SKIN – Eruptions psoriasis
- SKIN – Itching
- SKIN – Washing aggravation
- GENERALS – Weather Hot
- GENERALS – Food and drinks chicken desire
- GENERALS – Food and drinks eggs aversion
- GENERALS – Food and drinks milk aversion
- GENERALS – Food and drinks spices desire
- GENERALS – Wound heal tendency slowly
Diagnosis:
Locally there were cracked lesions with thickened skin with dimension of 3×3 cm which bleeds after scratching.
According to ICD – 10 classification PALMOPLANTAR PSORIASIS is classified as –
L40.3:Palmoplantar Pustulosis
Table 1: Timeline of Follow ups
| Date of Follow Up | Symptoms | Prescription |
| 24 MARCH 2022 | Chronic itching, erythematous papular eruptions, and cracks localized on the soles of the feet, extending to nail beds of both hands. | Carcinosinum 200 Single DoseSL Pills BD for 6 weeks |
| 20 APRIL 2022 | Improvement: Marked reduction in itching, less scratching, and visible changes in the eruptions, with normalization of nail beds. | Treatment continued Carcinosinum 200 (single dose every 15 days) and SL Pills (twice daily for 6 weeks). |
| 14 JUNE 2022 | Improvement: Significant reduction in eruption size, no itching episodes, dryness of skin++ | Treatment: Carcinosinum 200 (single dose every 15 days), SL Pills (twice daily for 6 weeks), and moisturizers for dryness. |
| 5 OCTOBER 2022 | Complete resolution of eruptions. The skin texture became normal.New Concerns: Increased irritability due to academic stress. | Continued Carcinosinum 200 and SL Pills with periodic follow-up. |
Prognosis:
Homoeopathic remedies help to reduce itching, scaling, discomfort associated with PPP and individualized approach addresses physical symptoms and underlying stress, potentially improving overall health .
As it suggests no intervention of other medicine is needed.
Treatment Plan:
Carcinosinum was selected according to homoeopathic similimum principle which was given orally in the form of pills, potency 200 was selected according to the susceptibility which was repeated in 15 days and a single dose was prescribed.
Case Analysis:
The totality of symptoms was formed by analysis and evaluation. Repertorization of the case was done using RADAR SOFTWARE
Discussion:
Carcinosinum is derived from cancerous tissue and it falls under Tubercular miasm under homeopathic philosophy(10).
The case report highlights the effectiveness of individualized homeopathic treatment based on constitutional factors in managing palmoplantar psoriasis. The emotional stress reported by the child stemming from academic pressure and family expectation could be linked to the chronicity of the skin condition where Patient initiated itching and erythematous papular eruption on right sole which were approximately 3x3cm in dimension with marked redness and itching which further developed on nail beds also used to bleed occasionally it was treated with Carcinosinum 200 single dose and PL for 6 weeks which consequently reduced itching and scratching in 8months , but marked dryness of skin was seen and irritability further all eruptions disappeared.
With detailed case taking and based upon analysis , evaluation and repertorization; Sulphur came on top, as Sulphur suggest to be peevish, difficult thinking, affection vitiated also covering anti-psoric miasm so it was not prescribed even when exact physical symptoms were to be observed but mental picture was deviated.
Carcinosinum patient evolve in tubercular miasm, having significant mental suppression or may be triggered due to stress evidently in the pediatric age group due to parents’ domination leading to destructive outburst, with great sense of responsibility, fastidious regarding cleanliness it also involves immune system deregulations or emotional factors the body’s immune system which has shown overreaction leading to psoriasis. So the patient was prescribed Carcinosinum.
Also looking forward with age, gender, occupation , sensitivity for 200 potency was selected.
With the individualized homoeopathic treatment improvement in local symptoms and general well-being of the patient was to be observed. The frequency of acute exacerbation of lesions was reduced.
Key Notes
Table 2: Timeline
Modified Naranjo Criteria
| DOMAINS | YES | NO | NOT SURE OR N/A |
| Was there an improvement in the main symptom or condition for which the homeopathic medicine was prescribed? | +2 | ||
| Did the clinical improvement occur within a plausible time frame relative to the drug intake? | +1 | ||
| Was there an initial aggravation of symptoms? | 0 | ||
| Did the effect encompass more than the main symptom or condition [i.e., were other symptoms ultimately improved or changed]? | +1 | ||
| Did overall well-being improve? | +1 | ||
| 6 A. Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease? | 0 | ||
| 6 B. Direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms:From organs of more importance to those of less importance?From deeper to more superficial aspects of the individual?From the top downwards? | +1 | ||
| 7. Did ‘old symptoms’ [defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved] reappear temporarily during the course of improvement? | 0 | ||
| 8. Are there alternate causes [other than the medicine] that -with a high probability -could have caused the improvement? [consider known course of disease ,other forms of treatment ,and other clinically relevant interventions] | +1 | ||
| 9. Was the health improvement confirmed by any objective evidence? [e.g laboratory test, clinical observation ,etc] | +2 | ||
| 10. Did repeat dosing ,if conducted, create similar clinical improvements? | +1 |
TOTAL SCORE: 11
Conclusion:
The patient’s positive response to Carcinosinum 200 suggests that individualized treatment can provide both symptomatic relief and address the emotional stress contributing to the condition also hampering quality of life.
Quality of life is a critical outcome; it encompasses physical, social, emotional well-being which was seen to be improved in the patient.
The case report suggests that Homoeopathy has a significant role in treatment of palmoplantar psoriasis.
Acknowledgement:
The authors would like to show gratitude to Dr. Dhanashree Kulkari MD (Hom. Peads) for clinical help in managing the patient’s illness. The author would like to thank Dr. Vaishali Shinde and Smt. Archana Mangave for technical help in manuscript writing.
Conflict of Interest:
The author declares no conflict of interest
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About the Author:
Dr. Ashwin Kulkarni, Assistant Professor, Dept. of Practice of Medicine,
Late.Mrs. Housabai Homoeopathic Medical College and Hospital Nimshirgaon. MH
Miss. Sejal Upadhye, IV BHMS, Late Mrs. Housabai Homoeopathic Medical College and Hospital, Nimshirgaon, MH.
