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Impact of individualised homoeopathy in plaque psoriasis – A case report
*Corresponding author: Dr. Sanjib Sahoo, Department of Homoeopathic Materia Medica, National Institute of Homoeopathy, Kolkata, West Bengal, India. pmsanjibsahoo970@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Sahoo S, Mukherjee S, Bhattacharya S, Mondal M, Nayak C. Impact of individualised homoeopathy in plaque psoriasis – A case report. J Intgr Stand Homoeopathy 2023;6:67-72.
Abstract
Psoriasis, a papulosquamous skin lesion, is one of the most common autoimmune multisystemic disorders. Beyond the physical dimension of the disorder, it has a profound effect on the emotional and psychological faculty of the patient which can result in poor self-esteem, stigmatisation, and a stressful mental state affecting social-functioning and interpersonal relationships. Homoeopathy being a holistic science having a bio-psychosocial approach can manage cases of psoriasis effectively. A 43-year-old female attended the National Institute of Homoeopathy Outpatient Department with complaints of multiple circumscribed skin lesions over the scalp, back and extremities for 25 years. After a thorough evaluation of the case, the Arsenicum album was prescribed in 50 millesimal potency. There was a steady clinical improvement in the case and a reduction in the psoriasis area and severity index score. After 6 months of observation following the disappearance of symptoms, there was absolutely no recurrence of psoriatic skin lesions. This case report shows favourable outcomes with individualised homoeopathic treatment. However, a conclusive judgement regarding the efficacy of homoeopathic medications in treating plaque psoriasis cannot be made based on a single case. To evaluate the efficacy of individualised homoeopathic medicine, a large-scale randomised study is suggested.
Keywords
Plaque psoriasis
Individualised homoeopathy
Arsenicum album
INTRODUCTION
Psoriasis, a papulosquamous skin lesion, is a common multisystemic autoimmune disorder associated with various comorbidities.[1] Beyond the physical symptoms, psoriasis has a profound effect on the patient’s emotional and psychological faculties, resulting in poor self-esteem, stigmatisation and a stressed mental state that affects social functioning and interpersonal relationships. The age of onset of the disease reflects a bimodal distribution, with peaks at 30–39 years and 60–69 years in men and 10 years earlier in women.[2] The aetiopathogenesis of psoriasis is multifactorial; genetic factors are a significant contributor, especially in those with early onset (<40 years). Many causal factors are involved in the immunological pathogenesis of psoriasis, including antigen presentation, nuclear factor-Kappa B signalling, Type-1 interferon pathway, interleukin-23/T-helper-17 axis and skin barrier function. This suggests a network of complex interactions among T-cells, keratinocytes and dendritic cells, which results in immune activation, chronic inflammation and keratinocyte proliferation.[3]
Clinically, psoriasis is classified into pustular and nonpustular lesions. Non-pustular psoriasis is classified into plaque psoriasis, guttate psoriasis, erythrodermic psoriasis, palmoplantar psoriasis, inverse psoriasis and psoriatic arthritis.[4] The most common clinical pattern, plaque psoriasis (seen in 90% of cases) is characterised by symmetrically distributed erythematous plaques with sharp boundaries and pearlescent squamae. Lesions commonly occur on the knee, elbow, and extensor surfaces of extremities, scalp, back and sacral region and may show the Koebner phenomenon (Psoriatic skin lesion over the traumatised area). Another diagnostic sign is the Auspitz sign, wherein after scraping the surface of the psoriatic plaque, the scales fall off, leaving a raw, pointed bleeding surface underneath.[5,6]
Conventional treatment of plaque psoriasis includes topical therapy, ultraviolet B phototherapy, non-biogenic first-line therapy, biogenic and second-line therapy.[7] Long-term use of topical steroids is complicated by possible side effects of tachyphylaxis, local skin changes and suppression of the hypothalamic-pituitary-adrenal axis.[8] The tendency for lesions to return at previously affected sites after treatment discontinuation is a major challenge in the management of psoriasis; this is consistent with the concept of localised immunological ‘memory’ following the disappearance of the lesion.[9]
Homoeopathy, an individualised and holistic concept of medicine aims to harmonise the disordered economy. It deals with the person who is sick and not the nosological disease term. It is based on the principle that the remedy, which produces similar symptoms in a healthy individual, is the necessary antidote to overcome the sickness, restore the will and understanding into order and cure the patient. The treatment approach considers the patient in their psychophysical-social axis that includes individual physical make-up, moral and intellectual character, occupation, mode of living and habits, past and family history and social and domestic relations.[10] Due to the minute dose and high potentisation, homoeopathic medicines are thought to be safe and do not provoke any serious adverse reaction.
CASE REPORT
Patient information
A 43-year-old woman presented to the National Institute of Homoeopathy outpatient Department with complaints of multiple circumscribed skin lesions over the scalp, back and extremities for 25 years. The lesions were itchy and exfoliating; following the itching, there was severe burning worsened after the application of water (+). Exfoliation from the patches occurred in large silvery scales. The complaints were aggravated at night (+), after scratching, after the application of water and during mental stress (++). Initially, the lesions were non-itchy and involved the back and upper extremities.
The patient also reported cough with dyspnoea and whitish and thick expectoration for 2 months. Dyspnoea and cough aggravated in the morning and at night before midnight (++). Modern medicine treatment had provided no significant relief.
Medical history
The patient had measles at the age of 12 years and typhoid at the age of 25 years.
Family history
Mother had Type II diabetes mellitus and died of a stroke. Father had arthritic complaints.
Physical generals
Her appetite was low, with easy satiety. She had a thirst for small quantities of water frequently as large quantities caused nausea (++). Her bowels were regular. She had a burning sensation during urination, but the frequency of urination was normal. She had a strong desire for cold food (+), cold drinks (+) and sweets and an aversion to meat as the smell of cooked meat caused nausea. Her sleep was disturbed because of nocturnal itching and subsequent burning sensation in skin lesions. She had dreams of violence, dead and mutilated bodies (++), which would wake her up. Her tongue was dry, coated white, with black streaks at the margin. Thermally, she was chilly (+++) and could not tolerate a cold environment.
Mental generals
The patient was in utter despair regarding her recovery (+++). She was very anxious about her daughter’s future, as her husband left her because of her skin complaints. She was introverted and has reserved discontent regarding her family. Her anxiety and apprehension were higher at night, which caused restlessness. She prefers company and cannot bear solitude as it makes her mental status worse. She had sound memory and could recall remote events perfectly.
Clinical examination
Blood pressure – 130/80 mmHg. Pulse rate – 80/min. Mild anaemia was detected by examining her lower palpebral conjunctiva and tongue. Other general examinations reveal no significant abnormality.
Diagnosis
Scaly circumscribed plaques, reddish, sharply defined and present over the elbows, hands, lumbosacral region and scalp; mainly over the extensor surfaces. The lesions were covered with varying amount of loosely adherent silvery scales [Figure 1a]. The nails showed pitting and deformities, especially the toenails. Punctate bleeding spots were observed on scraping the scales. All these signs were suggestive of plaque psoriasis.[11] The Psoriasis Area and Severity Index (PASI) was used to assess the patient; the score was 26.4 at baseline.
- (a) At baseline, (b) First Follow-up, (c) Final follow-up.
The case was diagnosed as plaque psoriasis (L 40.0 is the International Classification of Diseases, Tenth Revision, Clinical Modification code for plaque psoriasis).
Totality of symptoms
Despair of recovery (+++)
Constant anxiety about future (++)
Restlessness, attacks of anxiety especially at night (+++)
Dream of violence, dead bodies (++)
Chilly patient (+++)
Craves cold food and drinks (+)
Thirst for small quantity of water frequently (+++)
Scaly lesions (+++) with Itching and burning – worse at night and after application of water (+).
Repertorial analysis
Repertorisation chart from synthesis repertory using RADAR software [Figure 2].
- Repertorial analysis chart.
Therapeutic intervention
First prescription (November 12, 2021)
Arsenicum album 0/1; 1 globule of no. 10 to be dissolved in 100 mL of aqua dist. Put 16 marks on the 100 mL bottle. Each part is to be taken early in the morning on empty stomach consecutively for 16 days.
Basis of prescription
Thin and scaly eruptions with burning worse at night, extreme anxiety, apprehension and restlessness, despair of recovery, chilly patient, thirst for small quantities of water frequently, strong desire for cold food. On repertorial analysis, A. album stood at second position.
The case was under observation for another 6 months without any medications. No clinical signs and symptom of psoriasis returned in this period of observation.
RESULTS
Gradually, the patient improved after the administration of homoeopathic medicine A. album 0/1. The medicine was continued up to A. album 0/5 with marked amelioration in the symptomatology [Table 1]. The total duration of treatment with homoeopathic medicine was 5 months [From November 12, 2021 to April 05, 2022] [Figure 1]. The patient was under observation for another 6 months and there was no sign of recurrence of symptoms during that period.
| Date of visit |
Symptoms | Medicine with doses and repetition |
Justification of medicine and potency |
PASI score |
|---|---|---|---|---|
| December 2, 2021 | Itching, induration and desquamation in arms as before Desquamation of scalp-slightly better Lesions of legs – much better (more than 50% better) [Figure 1b ] Nocturnal cough -relieved completely Anxiety and restlessness-better than before Sleep is better. Mild anaemia -persisting |
A. album 0/2 16 doses Once daily for 16 days Followed by A. album 0/3 16 doses, once daily for 16 days |
Intensity of symptoms slightly better than before. As a whole, patient is better than before, which suggests the next 50 millesimal potency | 17.3 |
| January 04, 2022 | Itching, desquamation and induration of skin, lesions over the arm, head, legs and trunk were reduced around 90% Anxiety and restlessness -much better than before Patient had sound sleep and was free from terrifying dreams. On examination – the mild anaemia which was present at baseline was corrected |
A. album 0/4 16 doses Once daily for 16 days Followed by A. album 0/5 16 doses Once daily for next 16 days |
There was marked improvement in the symptoms. Few non itchy lesions remained in the lower extremities. To complete the curative process, the next potency of A. album was administered |
1.6 |
| February 05, 2022 | Psoriatic plaques completely disappeared. There was no existing skin lesion Physical generals and mental generals were much better than before |
Placebo for next 1 month | As there was complete disappearance of all perceptible signs and symptoms, placebo was prescribed | 0 |
| March 08, 2022 |
No psoriatic skin lesions. Patient developed few eczematous eruptions over dorsum of feet with itching and burning for 5 days. Patient narrated that she had similar type of eruptions in childhood which was treated with some unknown ointment | Placebo for 1 month | Reappearance of old symptoms indicates a favourable prognosis of the disease and in this context no medicine should be administered as previous medicine was still acting | 0 |
| April 11, 2022 |
Skin eruptions disappeared after 1 week of taking placebo There were no residual complaints [Figure 1c] |
Placebo for 1 month | The patient was better in all the physical and mental aspects. Therefore, placebo was prescribed | 0 |
PASI: Psoriasis area and severity index, A. album: Arsenicum album
DISCUSSION
An alternative strategy is necessary as the standard treatment for autoimmune disease like psoriasis has significant therapeutic limitations and deleterious effects like tachyphylaxis, local skin changes and recurrence.
Here, we present a case of plaque psoriasis in a 43-year-old woman. The approach – ‘The real sick man is before the sick body’[13] was undertaken in this case as we have considered striking mental generals, physical generals and particulars for the final selection of the remedy. On repertorisation, Calcarea carb scored the highest. The patient was not unwieldy or corpulent, did not have profuse perspiration of the head, craving for egg and aversion to milk and meat, and constipation of pronounced form, all of which are the characteristic features of C. carb. The case was treated with A. album 0/1–0/5 as it matched with the physical constitution, prominent anxiety, restlessness and characteristic physical generals.[14] There was a steady clinical improvement and the skin lesions disappeared gradually with treatment together with amelioration of other associated symptoms. The treatment outcome was also assessed using the PASI score that showed a marked reduction (from 26.4 at baseline to 0 after third follow-up). The patient was treated with placebo for next 6 months with no recurrence of presenting and associated complaints. This case shows a favourable clinical prognosis of an autoimmune disease like plaque psoriasis with homoeopathic treatment. The case was evaluated through modified Naranjo criteria which showed positive association between Homoeopathic treatment and the outcome [Table 2]. Previous studies of plaque psoriasis have reported promising results with individualised homoeopathic treatment.[15,16] However, a conclusive judgement regarding the effectiveness of homoeopathic medications in treating plaque psoriasis cannot be drawn from a single case. To evaluate the treatment efficacy of homoeopathic medicines, large-scale studies with larger sample sizes and sound methodology are suggested.
| Domains | Yes | No | Not sure or N/A |
|---|---|---|---|
| 1. Was there an improvement in the main symptom or condition for which the homeopathic medicine was prescribed? |
+2 | 0 | 0 |
| 2. Did the clinical improvement occur within a plausible timeframe relative to the drug intake? | +1 | 0 | 0 |
| 3. Was there an initial aggravation of symptoms? | +1 | 0 | 0 |
| 4. Did the effect encompass more than the main symptom or condition (i.e., were other symptoms ultimately improved or changed)? |
+1 | 0 | 0 |
| 5. Did overall well-being improve? | +1 | 0 | 0 |
| 6. Did the course of improvement follow Hering’s Rule? | 0 | 0 | 0 |
| 7. Did ‘old symptoms’ (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement? |
0 | 0 | 0 |
| 8. Are there alternate causes (other than the medicine) that—with a high probability— could have caused the improvement? (known course of disease, other forms of treatment and other clinically relevant interventions) | 0 | +1 | 0 |
| 9. Was the health improvement confirmed by clinical observation? | +2 | 0 | 0 |
| 10. Did repeat dosing, if conducted, create similar clinical improvement? | 0 | 0 | 0 |
| Total score | 9 |
CONCLUSION
Autoimmune diseases are difficult to treat because of therapeutic complications and recurrences. In this case study we have treated a severe form of Plaque Psoriasis with minute doses of individualized homoeopathic remedy A. album in 50-millesimal potencies. The case showed an excellent clinical outcome and there was no sign of recurrence after significant time of observation. Homoeopathy can successfully treat severe forms of Plaque Psoriasis if the totality of symptoms corresponds with the genius of the remedy, potency chosen strictly corroborates with the susceptibility of the patient and with judicial repetition of the similimum.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest
There are no conflicts of interest.
Financial support and sponsorship
Nil.
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