A case of plaque psoriasis treated in homoeopathy

Dr Sushmitha

ABSTRACT
Being a chronic, relapsing condition, psoriasis frequently requires long-term therapy. Psoriasis therapy options are influenced by comorbidities, disease severity, and healthcare accessibility. Depending on the clinical severity of the lesions, the percentage of body surface area affected, and the patient’s quality of life, psoriatic patients are typically divided into two groups: mild or moderate to severe psoriasis. ¹A variety of metrics can be used to assess the clinical disease severity and response to treatment. In clinical trials, the PASI score has been applied widely.² Modern medicine employs both local topical ointments and systemic antibiotic treatment. Topical treatment for mild to moderate psoriasis can involve glucocorticoids, vitamin D analogues, and phototherapy. Treatment for moderate-to-severe psoriasis frequently involves systemic treatment.³ Homoeopathic medicines have been found to be useful in treating psoriasis cases. One such case, treated using homoeopathic medicines is presented in this paper with photographic evidence. A case reported was a male of 47 years of age, suffering from symptoms of itching, red scaly plaques, eruption all over the body from 10 years, itching which aggravates at night and in the winter and was diagnosed as plaque psoriasis. The homoeopathic medicines are prescribed on the basis of totality of symptoms, Materia Medica and miasm. Plaque psoriasis was reduced considerably within a month, and it disappeared completely in 4months. No recurrence of plaqu1 psoriasis was observed for another 1 year as well. Photographs during follow-up visits have provided as documentary evidence about the effectiveness of homoeopathic medicine homoeopathic medicine in plaque psoriasis.

Keywords: Plaque Psoriasis, Arsenicum Iodum, Petroleum, Plaques, Sclaes.

INTRODUCTION
Psoriasis is a chronic dermatosis characterised by an unpredictable course of remissions and relapses and presence, at typical sites, of papules and plaques which are well-defined, erythematous and have large, silvery and loose scales. Psoriasis ranges in prevalence across the globe from 0.1% to 3%. Psoriasis’s onset is though it can manifest immediately after birth or in old age, it is more common in the second to fourth decades of life. Due to the high frequency of psoriasis in families (7% to 36%), genetic factors may be involved in the aetiology of the condition. Males and females are equally prone to psoriasis.⁴

 Psoriasis is thought to be inherited as an unevenly penetrating autosomal dominant trait. In 10 to 30 percent of instances, it affects multiple family members. It is unknown exactly what causes this sickness, however it is observed that the normal one-month period required for the epidermal cells to migrate from the basal cell layer to the outer surface of the skin is significantly shortened to three to five days. Immature epidermal cells are formed as a result, and they eventually shed as scales. It has occurred in all age groups and in both sexes. Two Wintertime worsens most patients.⁵

Psoriatic arthritis, an inflammatory form of arthritis affecting the spine and other joints, has been linked to psoriasis. Finger nail involvement affects about half of the patients. Precise pitting, also known as Thimble pitting, onycholysis, and subungual hyperkeratosis are the typical nail abnormalities. Pinpoint bleeding at the lesion’s base is seen when a psoriatic lesion is scraped away from the silvery scales. Auspitz’s sign is the name given to this symbol. Five to ten percent of people get psoriatic arthritis

The different types of psoriasis are as follows – Psoriasis vulgaris, Guttate psoriasis, Flexural psoriasis, Pustular psoriasis and Plaque psoriasis. Here we are discussing a case of Plaque psoriasis – It appears in big patches of thickened skin usually with white/silvery scales on the elbows and knees, but also other parts of the body⁶

A CASE PROFILE
A male patient, aged 47 years, who is a BMTC conductor by profession, residing in Pombara Halli, Uthnur, Kolar, Karnataka, reported to outpatient department of Government Homoeopathic Medical College and Hospital on 14th December 2022 with the complaint of itching, red scaly plaques, eruption all over the body from 10 years

HISTORY OF PRESENTING COMPLAINTS
Patient was apparently normal 10 years back. He has a history of prick by a thorn on dorsum of Left foot 10 years back. After 3 months, at the same place slowly started with small skin lesion around 1-2cm round shaped eruption, which was slightly raised dry eruption. It started to itch. On scratching powdery scales started to peel off. Over the period of 6 months, gradually it was spread to B/L knees and then to B/L elbows. Consulted dermatologist and took allopathic treatment. He had some relief then again relapse and also skin eruption was spread to scalp. He used topical ointment for 9 years. In last one year, once in 6 months Inj Kenacort was taken. 1^st time, January 2022, all lesion was cleared. Again, there was a relapse.  2^nd time in the month of August 2022 Inj Kenacort  was taken. Lesions got extensively spread to entire body.

Location	Sensation / character with pathology	Ailments from/ Modalities	Concomitant
Integumentary system Eruption All over body B/L upper limb flexor and extensor More eruption below elbow B/L dorsal aspect of hands B/L lower limbs anterior and posterior aspect of legs B/L thighs from the groin B/L axilla Lower back lumbar region and scalp	Eruption extensively itching Itching +, Scratches, powdery scales, continuous scratching leads to raw spots and become red.	< night < winter >bathing, hot water application, rubbing, sleep	NIL

No h/o DM, HTN, Allergy, Asthma, Joint or nail complaints, fever

LIFE SPACE INVESTIGATION AND MENTALS
B/B in Kolar, I live in a joint family- parents ,wife, children and brothers and sister in laws and their children. Childhood- good relationship with parents and siblings. I have done my BA. I also look after agriculture work at my hometown. I usually talk after analysing whatever other say- why? – suddenly if I talk it would create problems. I analyse what is right or wrong. Problems with property sharing with dads siblings. They always wanted to take away the property what we had as it gives the good earning there, though divided the property equally among ourselves. So I always had a thought they might go to any extent which may even risk any of our life. So sold the property and bought a land 2km far from them. Because I don’t like to fight. Thoughts like What would happen to my family/ me/ what if someone from family sent to jail. Fear what if family would get broken. We might become poor if family isn’t together. We need support for each other. Some misfortune might happen.

I am the person with patience. They complain I take decision slowly. I do that because I think about future and take any kind of decision so that it doesn’t create any problem or fight between us. I am timid, mild and towards calmer side. In any gatherings, if called in front I avoid. I am happy with whatever I have

Anger: I dint show usually I keep myself calm. I am reserved, if gets close to someone, would do anything to them. .  I Share with only close friends. But not with wife as much as I do with close friends. Why? She doesn’t keep it within us. So that might lead to 100 opinions from different people so I avoid sharing everything to wife. For me most important in life family. Im attached to family.

I doesn’t like loud noice, affects my mind, no sun aggravation, doesn’t like tight clothing feels hot. Memory good. Diligent – in spite of not feeling well goes to work. Take decision on his own. Will- I take up challenges. Morals good. Il try my best. I have confidence in doing things alone.

Health : what mistake I have done to this skin disease. how to find the solution . I do gods work in first place. I think over what mistake I might have done, what others would say or think looking at my skin condition.

PROVISIONAL DIAGNOSIS
Plaque psoriasis

MIASMATIC DIAGNOSIS:
Red scaly plaques, eruption with offensive body odour, aggravation at night, and family history of psoriasis all pointed to syphilitic miasmatic diagnosis.

RUBRICS:

• Mind-anxiety family about his
• Mind-fear- misfortune of
• Mind- quiet disposition
• Mind -forebodings
• Skin-eruptions-psoriasis
• Causticum 9/4
• Calcarea  8/4
• Psorinum 8/3
• Arsenicum album 7/5
• Petroleum 6/4
• Lycopodium 6/3
• Medorrhinum6/3
• Rhus tox 6/3

INTERVENTION
First Prescription (14^th December , 2022) Arsenicum Iodum 200 prescribed thrice daily. Basis of Prescription The patient was suffering from plaque psoriasis since 10years. The following symptoms were considered for repertorisation:- Mind-anxiety family about his, fear- misfortune of, quiet disposition, forebodings, eruptions-psoriasis and the patient was hot, diligent and having hunger aggravation. Based on these symptoms, Arsenicum Iodum was selected.

After Repertorisation, with the help of HOMPATH classic homoeopathy software repertory, Ars Iodum was selected. In subsequent follow-ups, medicines and potency were given based on loo

RESULTS
Gradually, the patient improved symptomatically after prescription of homoeopathic medicine potencies. There was significant reduction in all symptoms which resolved completely over 4 months-6months) of duration. Follow up done over phone call every month for any new lesions for 8 months.

DISCUSSION :
Since modern medicine has a very limited role to play in case of psoriasis, homoeopathy comes as a rescue, not only as a palliative but also as curative in a vast majority of cases. In certain obstinate cases, it is difficult to achieve the cure. However, homoeopathic medicines used here after Repertorisation, where Calcarea Iodum was given as a constitutional medicine and petroleum was given to speed up the recovery based on the presentation. Mind-anxiety family about his Mind-fear- misfortune of, Mind- quiet disposition, Mind -forebodings, Skin-eruptions-psoriasis hot patient and hunger aggravation are the leading indications. The patient showed marked improvement in symptoms when constitutional medicine Arsenicum Iodum was given followed by petroleum during the period (4 months of treatment), and both the medicines were selected after repertorisation. After the first administration of Arsenicum Iodum, the patient showed mild improvement in his symptoms. For example, redness of skin and red plaques mildly reduced, thickness of plaques reduced, night aggravation of eruption was mildly reduced. Still the scales preset, Itching reduced, Rest of the generals were good. After another 10 days of treatment with the same medicine, the patient’s history was analysed and further improvement was observed with no new symptoms visible. The thickness of plaques reduced. Again, prescribed Arsenicum Iodum 200 and called him again after 10 days. On this follow up, patient c/o persisting itching at the night and persisting dry scales, <cold weather was present. On considering extensive dry scales and considering one of the great remedy for psoriasis, Petroleum 30 was given and asked to come after 10 days. The scales reduced, dry skin lesion reduced, entire skin lesion reduced by 70% [fig 2 (a,b,c & d)]. Hence for further follow up, same medicine and potency(petroleum 30) was prescribed as there was significant improvement[fig 3]. Dry scales reduced. Plaques thickness reduced, Itching present. On next follow up, only mild improvement seen after 1 month[figure 3(a,b,c,d & e). Hence, petroleum 200 was prescribed. Skin lesion almost resolved by 95% [figure 4 (a,b,cd,e & f)] . Petroleum 200 for prescribed for 3 days and rubrum for 1 month. Every month over call follow up was taken to check for any relapse till January 2024 [figure 5(a,b,c,d & e)]. No new lesions were seen. Complete normal skin noted.

Plaque psoriasis where Eruption were present All over body, B/L upper limb flexor and extensor surfaces, B/L dorsal aspect of hands, B/L lower limbs anterior and posterior aspect of legs, B/L thighs from the groin, B/L axilla and Lower back lumbar region before treatment (dated December 15th, 2022). Fig.1. before the treatment. Plaque psoriasis during treatment follow up [figure 2(a,b,c & d), figure 3(a,b,c,d and e), and figure 4 (a,b,c,d,e and f)]  dated 15th February, 15^th March and 12th April 2023 respectively. Repertorisation was done based on important symptoms and generals like hunger aggravation and hot patient were considered. The medicines covering under pathological rubric Skin- eruptions- psoriasis-agar. alum. am-c. ambr. Ant-t. arizon-l. arn. Ars. Ars-i. ars-s-f. ars-s-r. asaf. aster. aur. aur-ar. aur-M-n. bell. bell-p. berb-a. borx. bry. bufo Calc. Calc-s. Canth. carb-ac. carb-v. carc. caust. Chin.Chrys-ac. chrysar. cic. Clem. corr. cortiso. cupr. cupr-act. dros. dulc. dys. emetin. falco-pe. Fl-ac. Gal-met. gali. Graph. hep. hydro. hyos. ichth. iod. Iris Kali-ar. Kali-bi. kali-br. Kali-c. kali-m. kali-p. Kali-s. lac-Mat. led. Lob. Lyc. Mag-C.Manc. Mang. Mang-act. Merc,Merc-aur. Merc-c. merc-Ir, Merc-k-i. Merc-sul. Mez. morg-g.Mur-ac. naphtin. nat-ar. nat-M.Nit-ac. nit-m-ac. nuph. olnd. pall.Petr. ph-ac. Phos. Phyt. pix plat. plb. positr. Psor. Puls. rad-br. ran-b.Rhus-t. Sarr. Sars. scarl. Sep. Sil. staph. stel. still. stry-ar. stry-p. sul-i.Sulph. syph. tell. ter.teucr.thuj. thyr. tritic-vg.tub. ust.verat. x-ray. Arsenicum Iod is higher grade remedy 3 marks and Petroleum also covering 2 marks under the rubric psoriasis. Arsenicum was selected as covered all the symptoms. Arsenicum Iodum was given because patient had hunger intolerance and thermally, he was hot. This case study thus shows the importance of homeopathic medicines in achieving complete cure. The patient was followed up monthly, and no recurrence of the symptoms was observed for another 8months. Further long follow-up was necessary to monitor any remission of the symptoms due to seasonal aggravation, if any. This clearly shows that homoeopathic approach with proper selection of medicine, potency and repetition is more scientific with promising results as compared to conventional medicine.

REFERENCES:

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6. Hanuman Ram, Minakshi Kamboj., Effect of Individualized Homoeopathic medicine in Psoriasis: A Case Report https://www.researchgate.net/profile/Hanuman-Choudhary/publication/339713290_Effect_of_Individualized_Homoeopathic_medicine_in_Psoriasis_A_Case_Report/links/5e60d83892851cefa1def4cc/Effect-of-Individualized-Homoeopathic-medicine-in-Psoriasis-A-Case-Report.pdf

Dr. Sushmitha
PG scholar,
Guide name: Dr Praveen Kumar P.D.,
Department of Practice Of Medicine,
Government Homeopathic Medical College and Hospital, Bengaluru.
drsushmithanair@gmail.com

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