Psoriasis and its variants with homoeopathic therapeutics

Dr Nandini J D

ABSTRACT–  Psoriasis is an immune-mediated inflammatory disorder that affects the skin and mucous membrane. The cause is unknown , it may be due to genetic predisposition, with environment playing a critical role in the pathogenesis. This article emphasizes on clinical presentation of different variants Psoriasis and some homoeopathic therapeutics.

INTRODUCTION- it is a papulo-squamous, chronic, immune-mediated, inflammatory, proliferative, non-contagious disease that affects the skin, hair nail and scalp. The primary cutaneous lesions consists of Itchy, Deep pink to reddish, Well demarcated, Indurated plaques with Silvery-micaceous scaling particularly over the extensor surfaces. There are different variants of Psoriasis with diverse clinical presentation. These clinical sub-types are based on morphology of the lesion and the site of involvement.

Pathogenesis:  Etio-pathogenesis is  unknown however it is considered to be an immune-mediated disorder. Studies show that Psoriasis is multi-factorial in pathogenesis.  There may be genetic susceptibility associated with HLA-CW6 or Psoriasis gene: PSORS 1-9 located on different chromosomes. The triggering factors shows association with Beta-hemolytic streptococcal infection, drugs, stress, excessive intake of alchohol , smoking and trauma.

CLINICAL FORMS OF PSORIASIS

DISTRIBUSTION AND SPECIFIC SITES

• Scalp psoriasis
• Follicular psoriasis
• Sebborrhoeic psoriasis (sebopsoriasis)
• Flexural psoriasis (inverse psoriasis)
• Genital psoriasis
• Non-pustular palmoplantar psoriasis
• Nail psoriaisis
• Mucosal lesions
• occular lesions

BASED ON MORPHOLOGY OR NATURAL HISTORY

• Plaque psoriaisis (psoriaisis vulgaris)
• Acute guttate psoriasis
• Unstable psoriasis
• Erythrodermic psoriasis
• Pustular psoriasis
• Atypical forms of psoriasis

OTHER SPECIFIED FORMS OF PSORIASIS (Based on age or precipitants)

• Linear and segmental psoriasis
• Psoriasis in childhood and old age
• Photoaggravated psoriasis
• Drug-induced or exacerbated psoriasis
• HIV-induced or exacerbated psoriasis

PLAQUE PSORIASIS

• Most common type.
• Typical lesions are red scaly plaques reffered as (Salmon patches) with well demarcated from unaffected skin, with sharply delineated edges.
• Silvery white Plaques may be encircled by halo or ring of Woronoff.
• Single or multiple
• Symmetrical  in distribution
• Oval or irregular in shape
• On scratching, the removal of the scales reveals an underlying smooth, glossy red membrane with small bleeing points ( Auspitz’s sign)
• Linear configuration may arise at the sites of trauma as an isomorphic (koebner) phenomenon.

ACUTE GUTTATE PSORIASIS
Commonly seen in children and adolescents, with a history of preceding upper respiratory tract infection. Small lesions varying  from 3mm to 1cm appearing diffusely over the body, particularly on the trunk and proximal part of the limbs.

UNSTABLE PSORIASIS
In contrast to the lesion of plaque psoriasis which are static for prolonged period , I some individuals there is marked activity in the form of enlargement of plaques and they become excessively erythematous, with new small plaques. Usually presents with pain and pruritis within plaques.

ERYTHRODERMIC PSORIASIS

Here, most of or all the body surface is affected by psoriasis. It is due to gradual  extension of plaque psoriasis in chronic form. In acute form triggred by environmental factors. Patient may be febrile and systematically ill. Dependent oedema is common. Severe itching is present.

PUSTULAR PSORIASIS
Localised or generalised. In generalised variety, erythema and sterile pustules present all over the body. Pustules dry with crusts and scales. Along with fever, chills, malaise, arthralgia may be present.

SCALP PSORIASIS
First site to be involved, especially the occiput. Presents with well -defined thick plaques. Hair growth is normal and is not frequent cause of alopecia.

FOLLICULAR PSORIASIS
Affects then hair  follicles on the trunk  and the limbs, the lesions may be smaller than the guttate psoriasis.

SEBORRHOEIC PSORIASIS
It involves para-nasal areas, external ears, medial eyebrows, hairline, presternal and interscapular chest wall. Plaques of thin sharply demarcated areas seen.

NAIL PSORIASIS
Nails grow quickly in psoriasis patient. Nail dystrophy with pitting is characteristic. It involves any part of the nail unit including nail matrix, nail bed and hyponychium. Nail matrix disease presents with ridges, grooves, pits of the nail plate. Whereas, nail bed disease presents with ‘sub-ungual oil drops’, hyperkeratosis, splincter haemorrhages and distal onycholysis.

FLEXURAL PSORIASIS
Involves inguinal creases, axillary, and submammary folds, gluteal clefs, umbilicus and others associated with obese individuals.

DIAGNOSIS

CLINICAL EVALUATION

SKIN BIOPSY FOR HISTOPATHOLOGY

DIFFERENTIAL DIAGNOSIS

1. LICHEN SIMPLEX CHRONICUS– Lichenified skin due to rubbing or scratching.
2. LICHEN PLANUS
3. SEBORRHOEIC DERMATITIS
4. PTYRIASIS ROSEA– Acute self-limiting, herald patch, bright red colour progress to black over trunk.
5. PTYRIASISRUBRA PILARIS

HOMOEOPATHIC MANAGEMENT
Treatment with homoeopathy focuses on root cause, the triggering factors, the pathological changes, and the person as a whole, which is done by detailed medical history of the patient. The physical signs and symptoms appear because of the disturbed vial functions from the external impression which are having depressing effect and the consequent reaction of the vital force or from hidden miasm coming into its full expression.

INDICATIONS OF SOME HOMOEOPATHIC MEDICINES

SULPHUR

• Dirty, filthy people, prone for skin affections. Aversion to being washed.
• Red lips and face
• Dry, scaly unhealthy skin, every little injury suppurates. Itching and burning, worse scratching and washing.
• Pruritis, especially from warmth, evening. Skin complaints recurs every winter, and from bad effects of local medications.

ARSENICUM ALBUM

• Itching, burning, scaling.
• Eruption: dry, rough scaly. Worse scratching and washing.
• Lesions are raised, hard edges. Surrounded by red and  shining crown, with bottoms like lard or blackish or blue color, with burning and shooting pains when affected parts become cold.
• Complaints better by warmth.

ARSENICUM IODATUM

• Dry, scaly, itchy.
• Marked exfoliation of skin in large scales, leaving a raw exuding surface beneath.

BORAX

• Itching on the dorsum of finger.
• Unhealthy skin: slight injury suppurates.
• Eruptions on fingers and hands, itching and stinging. Ends of hair become tangled.

DULCAMARA

• Pruritis, worse in cold wet weather. Humid eruptions on face, genitals and hands especially palmar surface.
• Thick, brown, yellow crusts that bleed on scratching.

GRAPHITES

• Rough, hard, persistent dryness of skin. Rawness in bend of knees, groins and neck behind.
• Eruptions oozing thick exudation.
• Burning and stinging pains worse in warmth and at night.

SEPIA

• Itching not relieved by scratching: worse in bends of elbows and knees.
• Herpes circinate in isolated spots.
• Itching worse on going in open air, better in warm room.

KALIUM ARSENICOSUM

• Intolerable itching, worse undressing.
• Dry, scaly, wilted. Itching worse from warmth, walking, change of weather.
• Fissures in bend of arms and knees

REFERENCES

1. Burns T, Breathnach S, Cox N, Griffiths C. Rooks textbook of dermatology. 7^th ed. Volume 3. Blackwell Publishing Ltd.
2. Fauci As, Kasper DL, Braunwald E, Hauser SI, Jamesson JL, Loscalzo J, harrisons principles of internal medicine. 19^TH ed. Volume 2. New York  MCGraw Hill.
3. Roberts HA, Principles and Art of cure homoeopathy. Reprint edition.
4. Douglas ME. Skin Disease Their Description, Etiology, Diagnosis and Treatment. B Jain Publishers Ltd.
5. Boericke William, New Manual of Homoeopathic Materia Medica with Repertory. Bjain Publishers Ltd.

Dr. Nandini J D
PG Scholar, Department of Practice of Medicine
Government Homoeopathic Medical College & Hospital, Bangalore.
Under the Guidance of Dr. P D Praveen Kumar
Professor & HOD Department of Practice of Medicine.