Psoriasis – a case study

Dr (Mrs) Neeraja J Kshirsagar 

This article will provide knowledge about psoriasis, its course and prognosis.

Definition: It is a common chronic disease of skin consisting of erythematous papules which coalesce to form plaques with distinct borders.

ABOUT PSORIASIS

• Psoriasis affects   1% to 3% of the world’s population. 
• Psoriasis is a long-lasting and relapsing skin disease that affects the life cycle of the skin.
• Psoriasis is a chronic inflammatory skin disease characterized by thickened, silvery-scaled patches. 
• There is currently no cure in modern medicine and treatments only attempt to reduce the severity of symptoms.

WHAT CAUSES PSORIASIS

The exact cause of psoriasis is unknown, but most researchers believe that a combination of several factors contributes to the development of this disease.

Some contributing factors include:

• Overactive immune system
• Environmental causes

What triggers psoriasis

Environmental causes can trigger a psoriasis flare in people who have psoriasis.

 The good news is that avoiding these triggers can cut down of the number or severity of the flares. 

• The bad news? Some are hard to avoid. 
• Skin injury
• Weather
• Stress
• Infection
• Low levels of calcium

 There are a few factors that can increase the risk of psoriasis:
      • A family history of psoriasis
      • Recurring infections
      • Obesity
      • Smoking

FACTS ABOUT PSORIASIS

• There is no cure for psoriasis  
• The multiple treatments currently available only attempt to reduce the severity of symptoms. 
• Treatments range from topical applications, systemic therapies, and phototherapy. 
• Psoriasis is a chronic inflammatory disorder affecting about 2 to 3 percent of adults 20 years old and older.

PROGRESS AND LOCATIONS

• As disease progresses and if it is untreated, a silvery, yellow-white scale develops.   
• New lesions tend to appear at sites of trauma.   
• They may be in any location, but frequently are located on the scalp, knees, elbows, umbilicus and genitalia.                                                                                                

COURSE

• The clinical course is variable but less than one half of the patients followed for a prolonged period will have prolonged remissions
• Normal skin produces about 1250 cells a day for each square cm, psoriatic skin produces 35000 new cells each day for each square cm.
• Normal duration of the cell cycle of skin is 311 hours, but it reduces to 36 hours for psoriatic skin.

SEVERITY

• May range from a minimum cosmetic problem to a life threatening emergency.
• In about 5% of psoriasis patients, arthritis will develop and in most of these , joint involvement will occur after the onset of the skin lesions.
• The course of the arthritis is mild, affects only a few joints and spontaneous remissions occur. 

AUXILLARY LINE OF TREATMENT:

• One promising idea was that fish oil would benefit those with Psoriasis.
• improvement in psoriasis with the adoption of a gluten-free diet
• abundant intake of vegetables, fresh fruits, Saffron tea ,fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates.

TYPES OF PSORIASIS

• Part of the reason psoriasis is such a complicated disease is that there are several different types of psoriasis. 
• A  person with psoriasis can have one or more of them, and the type could change throughout the person’s lifetime. Examples of the types of psoriasis include:

• Plaque psoriasis 
• Scalp psoriasis 
• Nail psoriasis 
• Inverse psoriasis 
• Guttate psoriasis 
• Pustular psoriasis

Symptoms of psoriasis

• Psoriasis signs and symptoms will differ from one individual to another. But here are some of the common symptoms of psoriasis:
  • Red patches of skin covered with silvery scales
  • Small scaling spots
  • Dry, cracked skin with occasional bleeds
  • Itching, burning or soreness
  • Thickened, pitted or ridged nails
  Psoriatic patches can vary from a few spots of scaling, to eruptions that cover large areas.

Plaque Psoriasis:

The most common type of psoriasis is plaque psoriasis.

Plaque psoriasis lesions are round or oval-shaped with defined borders and thick, silvery-white scales atop a red, irritated base. It most often appears on the scalp, just above the buttocks and on extensor surfaces, or joints: the insides and outsides of knees and elbows. 

 The plaques tend to be more than half a centimeter in diameter and have very thick scales; so thick that it’s difficult to see any skin underneath.  .

CASE OF PLAQUE PSORIASIS

• Name: Mrs. K. M.
• Age: 43 years
• Occupation: House wife
• Add: Pimple Gurav, Pune.
• Chief complaint:

       K/C/O Psoriasis for 7 years. Taking Allopathic medicines regularly. Initially felt better.  But for 2 years no improvement in lesion. 

TOTALITY OF SYMTOMS

• Psoriatic lesion is on the lumbar back
• Weakness on exertion, 
• Un refreshing sleep, 
• Sleepiness in the evening, 
• Aversion to work
• Desire for sweet
• Chilly patient 

REPERTORY USED: HOMPATH SOFTWARE

REASON: RECENT REPERTORY

METHOD OF REPERTORIZATION: CLASSICAL

               REPERTORIAL TOTALITY

• Psoriatic lesion is on the lumbar back
• Weakness on exertion , 
• Un refreshing sleep, 
• Sleepiness in the evening, 
• Aversion to work
• Desire for sweet

POTENTIAL DIFFERENTIAL FIELD

• Chilly patient
• Female Patient
• Chronic case 

PRESCRIPTION

• Calcaria Carb 30 one dose stat
• SL for 7 days for all visits

           

                1^ST VISIT                                                            1^ST FOLLOW UP                              2^ND FOLLOW UP

Guttate psoriasis:

    Guttate psoriasis is a type of psoriasis that presents as small lesions over the upper trunk and proximal extremities; it is found frequently in young adults. The term “guttate” is used to describe the drop-like appearance of skin lesions. Guttate psoriasis is classically triggered by a bacterial infection, usually an upper respiratory tract infection.

CASE OF GUTTETE PSORIASIS

• Name: Mrs. M. P.
• Age: 65 years
• Occupation:  Corporator
• Add:  Sant Tukaram nagar, Pimpri, Pune.
• Chief complaint:

       K/C/O Psoriasis since 3years. History of Taking Allopathic medicines. But for 2 years no improvement in lesion. 

TOTALITY OF SYMTOMS

• Complaining nature
• Domineering
• Indigestion
• Hot patient
• Psoriatic lesion is on upper limbs and lower limbs
• Black discoloration of lesions
• Un refreshing sleep, 
• Flatulence aggravated in the evening
• Obesity
• Old age

REPERTORY USED: HOMPATH SOFTWARE COMPLETE REPERTORY

REASON:

GENERALS ARE DOMINATING

 RECENT REPERTORY

METHOD OF REPERTORIZATION: CLASSICAL

REPERTORIAL TOTALITY

• Complaining nature
• Domineering
• Love for power
• Suspicious about recovery
• Indigestion
• Flatulence 
• Psoriatic lesion is on upper limbs and lower limbs and abdomen
• Eruptions itching
• Black discoloration of lesions
• Obesity
• Old age

POTENTIAL DIFFERENTIAL FIELD

• Hot patient

         

1^ST VISIT                                                                                   1^ST FOLLOW UP

           

2^ND FOLLOW UP                                                                         3^RD FOLLOW UP

                   

4^TH FOLLOW UP                                                                5^TH FOLLOW UP

 

Dr. (Mrs.) Neeraja J. Kshirsagar (B.H.M.S.)
Associate Professor& OPD In-charge
Department of Repertory
Dr. D. Y. Patil Homoeopathic Medical College, Pune, Maharashtra, India