Dr Kallanagouda Kulkarni
In the study, total 86 known psoriasis patients were taken in the age group 45-55 years out of which 56% were males
ABSTRACT
Psoriasis is a chronic, autoimmune, disfiguring, inflammatory and proliferative condition of the skin characterized by silvery white to red color patches are usually seen over the extensor surfaces of limbs especially on knees and elbows, trunk and genitals and over the scalp.
Commonly associated co-morbidities are psoriatic arthritis, Crohn’s disease, metabolic syndrome, diabetes mellitus, arterial hypertension, obesity, quality of life, depression and malignant conditions.
OBJECTIVES
- To understand the co-morbidities of psoriasis in all types of psoriatic patients
- To understand the management of psoriasis with the help of materia medica.
KEYWORDS: Psoriasis, co-morbidities, Homoeopathic remedies
INTRODUCTION:
A chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration, in which both genetic and environmental influences have a critical role.
The most characteristic lesions consists of red, scaly, sharply demarcated, indurated plaques, present particularly over extensor surfaces and scalp. The disease is enormously variable in duration, periodicity of flares and extent. Morphological variants are common
EPIDEMIOLOGY
According to World Health Organization 125 million people were affected by psoriasis world-wide. And according to World Psoriasis Day Consortium.2-3% of the total population we’re affected worldwide. The prevalence of psoriasis in adults ranges from 0.91-8.5%.
In India, the incidence of psoriasis along with dermatological patients ranges between 0.44- 2.2%. Male and female proportion is 2.46:1. Among this chronic plaque psoriasis affecting about 80-90% of those of Psoriasis.1
Genetic predisposition and family history plays a major role in etiopathogenesis of psoriasis. In Indian studies showed that prevalence due to family history is 14%. Among which 1° degree relatives affected were 84% of case. Whereas 2° relatives affected were 2% of case.2
PRESENTATION
- Well demarcated erythematous scaly plaques
- Lesions can be itchy, burning or painful
- Common on extensor surface of the body and over scalp
- Auspitz’s sign (scratch and gentle removal of scales causes capillary bleeding)
- 50% have associated with nail changes( pitting, onycholysis)
- 5-8% suffer from associated psoriatic arthropathy
- Chronic plaque psoriasis on elbow and palms
- Nail psoriasis and oral psoriasis
COMORBIDITIES IN PSORIASIS
In the study, total 86 known psoriasis patients were taken in the age group 45-55 years out of which 56% were males. Commonly found co-morbidity was hyperlipidaemia, an increased prevalence of hypertension was also seen. Other co-morbidities were diabetes, metabolic syndrome, psoriatic arthritis, cardiovascular disease, COPD and Crohn’s disease. Depression was reported in great
Majority of psoriasis patients.3
| Co-morbidities (n-86) | Number of patients | % |
| Hypertension | 40 | 46.5% |
| Diabetes mellitus | 33 | 38.4% |
| Cholesterol | 42 | 48.8% |
| Cardiovascular diseases | 9 | 10.5% |
| COPD | 8 | 9.3% |
| Crohn’s disease | 1 | 1.2% |
| Psoriatic arthritis | 25 | 29.1% |
| Metabolic syndrome | 30 | 34.9% |
| Depression | 41 | 47.7% |
In another study, co-morbidities can be classified as physical and psychosocial and it can increase with increase in age. Patients with more than 65 years of age having higher prevalence of hypertension, 4 fold risk of diabetes, 3 fold risk of myocardial infection and expectancy of life is decreased by 4 years. Psychosocial one related with number of psychological problems like low self esteem, sexual dysfunction, anxiety, depression, suicidal tendency. Also associated with non-alcoholic liver disease, inflammatory bowel disease and eye inflammation especially uveitis is a prime feature of spondyloarthropathies.4
HOMOEOPATHIC REMEDIES FOR PSORIASIS
Arsenicum album
People likely to respond to this remedy usually are anxious, restless, and compulsively neat and orderly. They are often deeply chilly, experience burning pains with many physical complaints, and become exhausted easily. The skin is dry and scaly and may tend to get infected. Scratching can make the itching worse, and applying heat brings relief.
Graphites
People needing this remedy often have a long-term history of skin disorders. The skin looks tough or leathery skin with cracks and soreness. Itching is often worse from getting warm, and the person may scratch the irritated places till they bleed. Trouble concentrating, especially in the morning, is also often seen when this remedy is needed.
Petroleum
This remedy is often indicated for people whose physical problems are aggravated by stressful emotional experiences. It is especially suited to individuals with extremely dry skin, and problems that involve the palms and fingertips. The person may feel a cold sensation after scratching, and the skin is easily infected and may look tough and leathery. Itching will be worse at night, and from getting warm in bed. People who need this remedy may also have a tendency toward motion sickness.
Sepia
This remedy may be helpful to a person who feels dragged out and irritable, often with little enthusiasm for work or family life. The person’s skin may be look dry and stiff. Psoriasis may appear in many places on the body, including the nails and genitals. Signs of hormonal imbalance are often seen (in either sex), and problems with circulation are common. Exercise often helps this person’s energy and mood.
Sulphur
Intensely burning, itching, inflamed eruptions that are worse from warmth and bathing suggest a need for this remedy. Affected areas often look bright red and irritated, with scaling skin that gets inflamed from scratching. This remedy is sometimes helpful to people who have repeatedly used medications to suppress psoriasis (without success).
Calcarea carbonica
This remedy is suited to people who are easily fatigued by exertion, sluggish physically, chilly with clammy hands and feet, and often overweight. Skin problems tend to be worse in winter. Typically solid and responsible, these people can be overwhelmed by too much work and stress. Anxiety, claustrophobia, and fear of heights are common. Cravings for sweets and eggs are often also seen when Calcarea is needed.
Mercurius solubilis
People who seem introverted and formal—but are very intense internally, with strong emotions and impulses—may benefit from this remedy. They tend to have swollen lymph nodes and moist or greasy-looking skin, and are very sensitive to changes in temperature. The areas affected by psoriasis may become infected easily.
Mezereum
A person who needs this remedy usually is serious, and often feels strong anxiety in the region of the stomach. Scaly plaques may itch intensely, thickening or crusting over if the person scratches them too much. Cold applications relieve the itching (although the person feels generally chilly and improves with warmth). People who need this remedy often have a craving for fat, and feel best in open air.
Rhus toxicodendron
When this remedy is indicated for a person with psoriasis, the skin eruptions are red and swollen, and often itch intensely. Hot applications or baths will soothe the itching—and also muscle stiffness, toward which these people often have a tendency. The person is restless, and may pace or constantly move around. A craving for cold milk is often seen when a person needs this remedy.
Staphysagria
This remedy may be helpful to individuals whose psoriasis has developed after grief or suppressed emotions. Any part of the body can be involved but the scalp is often affected. People who need this remedy often seem sentimental, meek and quiet, and easily embarrassed — but often have a strong internal anger or deeply-buried hurt.
REFERENCES
- Dogra S, Mahajan R. Psoriasis: Epidemiology, clinical features, co-morbidities, and clinical scoring. Indian dermatology online journal. 2016 Nov;7(6):471.
- Dogra S, Yadav S. Psoriasis in India: Prevalence and pattern. Indian Journal of Dermatology, Venereology, and Leprology. 2010 Nov 1;76(6):595.
- Bhandary PR, Sanath PK, Shetty NJ, Girish PN, Lathika K. Clinico-epidemiological study of Psoriasis and associated co-mor
- Aurangabadkar SJ. Comorbidities in psoriasis. Indian Journal of Dermatology, Venereology, and Leprology. 2013 Jul 1;79(7):10.Sowmya C, Lavakumar V, Venkateshan N, Anitha P, Senthilnathan B, Srivilliputtur V. INTERNATIONAL RESEARCH JOURNAL OF PHARMACY bidities.
Dr Kallanagouda Kulkarni
PG scholar (Dept.of Medicine)
Govt. Homoeopathic medical college and hospital
Bangalore -79
MEZEREUM,Hughes describes it as veg merc with rheumatic periostitis nightly bone pains.Carroll Dunham has given deep insight that some parasitic infection of fixed nature like measles which produced scalp tinea kerion each hair cell has pus scaby, in future such past history patients may have all sort of disturbances like deafness etc with no interest left in life.he says key to Mezereum is VIOLENT whether it is pain itch cough or fever worse warmth of fire produces twitches jerks muscles needle pains esp right cheek pit stomach nausea gastric ulcer likes better by eating.pertinent issue is he declares is specific microorganism disease and if not properly cured has long lasting effects.with present carona type flareups some experienced homeopaths of DUNHAM type knowledge should share with public their views on if any side effects of such organism not properly treated suggest remedy.