Homoeopathic management of PsoriasisClinical tips

Psoriasis is..

..a genetically determined , idiopathic, immune mediated inflammatory skin disorder

.. characterized by well defined raised red scaling lesions called plaques

.. chronic , remitting- relapsing , systemic disease

Source: World Health Assembly resolution on Psoriasis May 2014

125 million people are affected worldwide*

Pathophysiology

There is an increased rate of transfer of epidermal cells from basal layer to the outer surface of skin. This causes excessive buildup of cells resulting in the distinctive lesions

As turnover of epidermal cells is accelerated , immature cells are shed as scales

Inflammatory component- epidermis becomes oedematous , both epidermis and dermis are infiltrated with inflammatory cells

Vascular component- capillaries are greatly dilated and tortuous

Epidermal thickening- average thickness of cells is increased from 3-4 cells in normal skin to 12- 15 in psoriatic lesions

Pathological Features:

Two main causes are

Psoriasis is often familial though exact pattern of inheritance is not known

There is 10% chance of psoriasis in an offspring with one parent having the disease, whereas it is 50% with both parents having Psoriasis

.. Though the exact Cause of Psoriasis is unknown

Genetic factors:

Immune system mistakes normal skin cells for pathogens and sends signals for overproduction of new skin cells

Auto Immunity:

Triggers

DrugsLike chloroquin, lithium, indomethacin, NSAIDs, beta blockers

Trauma

Stress Change of season

InfectionSmoking

Certain triggers may precipitate the formation of new lesions and flaring up of existing lesions

Psoriasis tends to worsen in winters and improve in summers

Lesions are more common on extensors and friction prone areas

Clinical FeaturesPsoriasis may present in various ways

Plaque psoriasis: Appears on elbows , knees, lower back, scalp. Characterized by thick scaly plaques . Lesions may be asymptomatic or associated with severe itching. At times lesions may appear in a linear fashion along scratch marks , this is called Koebner’s Phenomenon

Guttate psoriasis: seen in children and young adults mostly after a bout of strep throat. There is a sudden appearance of numerous, erythematous scaly papules. These may clear but may recur and sometimes change into plaque type psoriasis

Flexural/inverse psoriasis: presents as smooth, shiny patches in skin folds such as groin, armpit, under the breasts

Pustular psoriasis appears as pustules surrounded by erythematous area, scales are also seen. These may be in an isolated area like palms and soles or may cover most of the skin

Erythrodermic psoriasis may occur after pustular psoriasis or as a result of poorly managed plaque psoriasis. Appears as large areas of erythema and scaling accompanied by chills, rigors and pain.

Nail psoriasis- some patients of Psoriasis may show characteristic nail changes such as nail pitting, discoloration, thickening , separation of nail plate from the nail bed

Psoriatic arthritis- it is a type of chronic inflammatory arthritis seen in Psoriasis pateints. Joints typically affected are interphalangeal joints esp. DIP , spine, knee, hip etc.

Diagnosis

History and clinical appearance Grattage test- bedside test for psoriasis.

On scraping the plaque it becomes silvery, further scraping reveals a thin membrane with multiple pin-point bleeding points

Skin biopsy

Complications and co-morbidities

Certain conditions are seen to be associated with Psoriasis:

Uveitis, blepheritis Type -2 Diabetes Hypertension Metabolic Syndrome Other autoimmune diseases such as Crohn’s Disease,

Celiac Disease Parkinson’s Disease Obesity Psychological effects- Psoriasis patients often suffer from

low self esteem, depression and social isolation

Hence a patient of Psoriasis is at a higher risk for developing these conditions

Homoeopathic Management As in the case of other chronic diseases

homoeopathic case management in Psoriasis involves careful selection of similimum.

Constitutional remedy is to be given intercurrently for long term relief

Remedy Indications

ARSENICUM ALBUM Dry, rough, scaly eruptions, itching with burning sensation, worse from cold, wet weather, at seashore, better from warmth, heat. Anxious, fearful and restless. Marked prostration

ARSENICUM IODATUM Marked exfoliation of skin in large scales, leaving a raw exuding surface beneath. Itching with burning sensation, worse from cold, better from heat. Debilitating night sweats of thin emaciated patients

BORAX Psoriasis with Itching on backs of finger joints

CICUTA VIROSA Lesions without itching, thick yellow scabs on scalp

KALI ARSENICUM Dry, scaly eruptions; itching < on undressing, warmth and change of weather. Patient is restless, nervous and anaemic

GRAPHITES Eruptions, oozing out a thin, sticky fluid or skin may be rough and hard; bends of joints, groins, neck and behind ears are mostly affected. Skin is rough and hard worse from exposure to cold

1 Homoeopathic Management

Remedy Indications

HYDROCOTYLE Circumscribed red scaly lesions with severe itching, worse at night and after scratching

KALI ARS Dry scaly or pustular lesions, fissures in bends of arms and knee. Intolerable itching especially on undressing, warmth and change of weather

KALI BROM Psoriasis itching on face, chest, shoulders, depression

KALI MUR Dry flour like scales on skin. Burning sensation

MANGNUM ACET Itching worse from perspiration , first appearing during puberty

MEZEREUM Psoriasis affecting scalp. Thick leathery crusts under which there is collection of pus. Intolerable itching with chilliness; worse from exposure to cold air, in bed, night. Better in open air

2 Homoeopathic Management

Remedy Indications

PETROLEUM Skin is dry, rough, cracked, fissured, painful, bleeds easily. Thick, greenish crusts, burning and itching, worse in winter, from mental emotions. Slightest injury suppurates. Irritable, quarrelsome disposition

RADIUM BROM Marked erythema with restlessness better in open air, and hot bathing, trophic changes in nails, arthritis worse at night

SARSAPARILLA Dry, itchy cracked skin of hands and feet, worse in summers

SEPIA Foul odor from the affected skin lesions. Itching, not relieved by scratching , worse every spring, better in warm room. Weakness, irritability and indifference are the guiding symptoms. Lesions in bends of skin

SULPHUR Skin dry, scaly with intense itching; sensation of internal heat and burning. Worse from washing, warmth, better in open, cold air

THYROIDINUM Psoriasis associated obesity. Symmetrical distribution of lesions. Skin is dry. Itching worse at night. Cold hands and feet

TUBERCULINUM Intense itching aggravated at night. Tall, slim, narrow chested, active and precocious mentally, weak physically. Very susceptible to changes in the weather

3 Homoeopathic Management

General Measures

Patient should be encouraged to expose to sunlight Emollient creams such as white paraffin application

helps to maintain the softness of skin and prevent further dryness

Patient should avoid trauma to the lesions during active phase of the disease

Patients who have scalp lesions should frequently shampoo their hair

Patients with widespread erythrodermic and pustular psoriasis may require urgent medical attention due to hypothermia, dehydration or nutritional deficiency.

Case history

Dr. Ram

Kumar

Senior Medical Officer(

H)Dte. Of AYUSH

Case history (Contd..)Before Rx

During Rx

After Rx

Case history (Contd..)

Dr. Paramjeet Kaur C.M.O Dr Pradip Kumar Roy, S.M.O Dr Ram Kumar, S.M.O. Dr. Anjali Miglani, S.M.O. Dr. Malaya Kumar Ray, M.O.

Dr Deepti ChawlaC.M.O, Dte. of AYUSH

Contributors: Compiled & Edited by: