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An evidence-based case of Psoriasis managed with keynote prescribing Apis mellifica – A case report
*Corresponding author: Dr. Yogyata Kashyap, Department of Repertory, Dr. Madan Pratap Khuteta Homoeopathy College and Research Center, Jaipur, Rajasthan, India. yogyata.kashyap@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Shakdvipiya Y, Kashyap Y. An evidence-based case of Psoriasis managed with keynote prescribing Apis mellifica – A case report. J Intgr Stand Homoeopathy. 2023;6:133-6. doi: 10.25259/JISH_44_2022
Abstract
Psoriasis is an autoimmune disorder that is chronic and inflammatory in nature. It is clinically characterised by erythematous, sharply demarcated papules and rounded plaques covered by silvery micaceous scales. Homoeopathic medicines have been found to be useful in such cases. This report highlights a case of psoriasis in a 37-year-old male patient with complaints of psoriatic patches on almost the entire body since 18 years. The patient was treated using keynote prescribing. The remedy prescribed was Apis mellifica 30C, which covered the patient’s symptoms, including burning, redness, sensitivity to heat, and urinary complaints. Photographic records show marked improvement in all skin lesions. This case report suggests that Homoeopathic medicine can help to treat such autoimmune disorders; conventional medicine has a limited success rate in treating such conditions. If the medicine is prescribed based on a few symptoms, but these symptoms match with the keynotes, the prescription will be successful.
Keywords
Psoriasis
Apis mellifica
Homoeopathy
Autoimmune disorder
INTRODUCTION
In India, with a prevalence of 0.44–2.8%, Psoriasis commonly affects individuals in their third or fourth decade, with males being affected two times more common than females.[1]
In 2014, the World Health Organization recognised Psoriasis as a serious non-communicable disease.[2]
Clinically, Psoriasis is a painful, disfiguring condition involving the skin and nails. It consists of localised or widespread skin lesions that are in the form of red papules and plaques; the lesions are usually symmetrical, sharply delineated, and covered with scales that are white or silver. Lesions can be painful, itchy, or stinging.[3]
The pathology of Psoriasis is not clear; one of the theories behind the pathology is that imperfect regulation of T helper lymphocytes is the major mediator in this disease. Development of Psoriasis is quite complex; the person with a genetic predisposition is more susceptible to the development of Psoriasis and is more susceptible to a variety of risk factors.[3]
Although there is proof of a hereditary tendency, the exact cause of Psoriasis is still unknown. There are many comorbidities that are linked to Psoriasis. Both internal and environmental factors, including minor trauma, sunburn, infections, systemic medicines, and stress, can cause Psoriasis.[4,5]
CASE REPORT
Patient information
A 37-year-old male reported on 25 September 2021 with complaints of psoriatic patches on almost the entire body for 18 years.
History of presenting complaint
The patient’s complaints began 18 years prior; the psoriatic patches started from the head and extended downward until the lower limbs. All patches showed marked redness and burning [Figure 1]. Scaling was present only in the scalp lesions. The burning is aggravated in summer, and from heat, undressing ameliorates the complaints. From 4–5 months, psoriatic changes were seen in the right-hand thumb, left-hand thumb, index finger, and great toe of the right foot. The patient had undergone Allopathic, Ayurvedic, and Homoeopathic treatments, including local applications, without any results.
- (a-d) Before treatment.
Medical history
An episode of COVID-19 in May 2021; otherwise no major illness in the past.
Family history
His father had tuberculosis.
Mental generals
Not significant.
Physical generals
The patient was thermally hot and desired spicy food, especially mutton. Stool was hard and unsatisfactory. Ineffectual urging for urine, but cannot hold urine for a long time. Burning sensation during urination. Profuse and offensive perspiration stains linen yellow. Sleep was refreshing, and lying on back. General modalities aggravated in summer.
Examination
On observation, the patient was fair and endomorphic in appearance.
His tongue was dry and slightly white coated, blood pressure was 120/90, pulse was 74/min, and he was afebrile.
Skin: psoriatic eruptions on head, extremities, and chest. Lesions are reddish in appearance, scaling in scalp lesions.
Miasmatic analysis
Miasmatic analysis of all the presenting symptoms, including particulars and physical generals, was done by referring to different classical books on miasm (chronic diseases and organon of medicines) [Table 1].[6,7] This case was judged to have a predominance of ‘Psora’ as per the Hahnemannian approach.
| S. No. | Symptoms | Characteristics symptoms | Common symptoms | Intensity |
|---|---|---|---|---|
| 1. | Wants to be alone | ✓ | + | |
| 2. | Avoid arguments | ✓ | + | |
| 4. | Desire spicy food, mutton | ✓ | ✓ | ++ |
| 5. | Stool hard and unsatisfactory | ✓ | ++ | |
| 6. | Ineffectual urging for urine. Cannot hold the urine | ✓ | ✓ | ++ |
| 7. | Burning sensation during urination | ✓ | ✓ | ++ |
| 8. | Perspiration profuse, offensive, staining yellow on the whole body | ✓ | ✓ | ++ |
| 9. | Aggravation in summer | ✓ | ✓ | + |
| 10. | Psoriatic patch on scalp, chest, extremities with burning and Redness < in summer and from heat. > From undressing | ✓ | ++ | |
| 11. | Psoriatic changes present in nails | ✓ | + |
Totality of symptoms
Ineffectual urging for urine. Cannot hold the urine
Burning sensation during urination
Psoriatic patch on scalp, chest, extremities with burning and redness < in summer and from heat > by undressing
General aggravation during summer
Stool hard and unsatisfactory
Desire spicy food, mutton.
Remedy selection
Apis mellifica was determined as the remedy on the basis of symptom totality and keynotes, including redness burning ameliorated by undressing and sensitivity to heat. Materia Medica differentiation was done in the different books of material medica like Lectures on Homoeopathic Materia Medica. A Dictionary of Practical Materia Medica. Vol. 1. Boericke W. New manual of Homoeopathic Materia Medica and repertory. Allen H.C. Allen’s keynotes and Characteristics with a comparison with bowel nosodes.[8-11]
Intervention
Apis mellifica 30C single dose.[12] was prescribed on 25 September 2021, along with a placebo twice a day for 14 days on the basis of keynote symptoms. Follow up was taken every 2 weeks [Table 2].
| Date | Symptoms | Medicine | Justification |
|---|---|---|---|
| 9.10.2021 | Lesions slightly better, relief in a burning sensation. Burning in urination is slightly better | Placebo/BD/14 days | Relief in all complaints; no new complaints present. As per Kent's observation, not to disturb the action of medicine[13] |
| 25.10.2021 | Redness decreased, and relief in the burning sensation. Burning in urination better than before | Placebo/BD × 14 days | Amelioration in complaints. As per Kent's observation, not to disturb the action of medicine[13] |
| 9.11.2021 | Redness markedly decreased, and lesions were better than before. Burning in urination much better than before | Placebo/BD × 14 days | Complaints better than before. As per Kent's observation, not to disturb the action of medicine[13] |
| 23.11.2021 | Improvement in symptoms; redness not present. Burning sensation better. Burning in urination is not present | Placebo/BD × 14 days | Complaints better. No other complaints were present. As per Kent's observation, not to disturb the action of medicine[13] |
| 11.12.2021 | Surface had cleared, Redness was not present. Relief in burning sensation. Burning urination not present | Placebo/BD × 14 days | Markedly improvement. As per Kent's observation, not to disturb the action of medicine |
| 30.12.2021 | Patient better, and Redness not present. Relief in burning sensation. Burning urination was not present. | Placebo/BD × 14 days | Amelioration of all complaints. As per Kent's observation, not to disturb the action of medicine[13] |
| 26.2.2022 | Itching reappear with slight scaling on the scalp | Apismel 30/1 dose stat Placebo/BD × 14 days | Some symptoms reappear again. As per Kent's observations, the same medicine was prescribed.[13] |
| 16.4.2022 | Itching better than before. Eruption improved | Placebo/BD × 14 days | Complaints better than before[13] |
DISCUSSION
Apis mellifica, remedy has numerous skin-related symptoms. These include inflammatory conditions, patches on the skin, distress by heat, burning and stinging sensation, skin extremely sensitive to touch.[8] After analysis of case Apis mellifica was prescribed and symptoms of patient was gradually improved [Figures 1-3].[8-11] It was found that other than skin symptoms the physical symptoms of Patient also match with the keynotes like urinary symptoms. So the prescription was based on the same.
- (a-d) During treatment.
- (a-d) After treatment.
CONCLUSION
In any particular case, even if a few symptoms of the patient match with the keynotes of the medicine, treatment is effective.
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship
Nil.
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