HOMOEOPATHY IN A CASE OF PALMO-PLANTAR PSORIASIS: A CASE REPORT

Dr Sapna Gupta, BHMS Reader, Department of Pathology, Nehru Homoeopathic Medical College and Hospital, Dte of AYUSH, Govt of NCT of Delhi. E-mail: [email protected]

Abstract Psoriasis is a chronic skin disease characterized by its strong tendency to recur despite any treatment. A 46 years male patient suffering from palmoplantar psoriasis was treated with a homeopathic medicine, Electricity, on the basis of anamnesis. Few doses of this medicine induced long-term remission, which was confirmed objectively by the PASI score. Keywords Psoriasis, palmoplantar, homoeopathy, electricity Introduction Psoriasis is a chronic non-infectious skin disease [1] characterized by presence of well-defined, erythematous, scaly plaques of varying sizes [2]. There occurs a markedly increased epidermal cell proliferation rate in lesions of psoriasis [2], which have a typically extensor distribution in the body affecting the scalp, elbows, knees, front of legs, back [1,2].The exact etiology of Psoriasis is still not known [1,2]. A combination of genetic, immunological and environmental factors plays a role in its causation[1, 13 ]. Genetically pre-disposed persons develop Psoriasis on exposure to exciting causes like mental trauma, physical trauma, fever, infections, drugs et [1] . Psoriasis has a natural course of remission and relapses. It usually aggravates/relapses in winters[1,2]. The chief characteristic of disease is its very strong tendency to recur[3]. The most common variety of this disease is Psoriasis vulgaris wherein large geographical lesions are present bilaterally on the extensor surface of the body. Itching or burning may be present and may cause extreme discomfort. Guttate psoriasis is usually seen in children following an upper respiratory tract infection or tonsillitis due to streptococci. Multiple, small, rain drop like erythematous scaly papules erupt abruptly and are distributed bilaterally symmetrically all over the body especially on trunk. When sterile pustules form on the erythemo-scaly plaques, it is known as Pustular psoriasis [1,2]. In Inverse psoriasis or Flexural psoriasis, lesions affect the flexors like groins, axillae, infra mammary area, genitalia and gluteal crease. Here, the lesions are moist, fissured, bright, red and itchy[1]. In Exfoliative psoriasis/ erythroderma, the lesions become extensive with very prominent erythema with fever, chills and rigors[2]. It is usually precipitated by sudden withdrawal of systemic corticosteroids, therapy with chloroquine, adrenergic blockers or excessive topical treatment. In Palmoplantar psoriasis, the lesions are confined to palms and soles and present as well defined patches of

hyperkeratosis and fissures on an erythematous base [1,3]. This type of psoriasis accounts for approximately 3 - 4% of all psoriasis cases and is usually painful and distressing, significantly impacting the functional and social ability of an individual[4]. Nail changes (thickening and pitting of nail plate, onycholysis, uplifting of distal portion from nail bed, cracking at free edges, accumulation of heaped up crusts underneath nail plate etc.) [2,3] are seen in 20-50% of the patients of psoriasis. Joints may be involved especially the distal inter-phalangeal joints of fingers, joints of feet and ankles (psoriatic arthropathy) [1,2]. Psoriasis Area and Severity Index (PASI) is used as a measure of overall severity and extent of coverage in a patient. It provides a baseline quantitative assessment of the case and enables monitoring the response to treatment. It takes into consideration the percentage of body surface area involved (on a scale of 0 to 6) and the disease parameters like erythema, scaling and thickness (on a scale from 0 to 4- from none to maximum) [5,6]. The Allopathic mode of treatment consists of topical applications containing various medications like corticosteroids, tars, salicylic acid and retinoic acid. Systemic/Internal treatment is given with pills and injections containing methotrexate, corticosteroids, cyclosporine. In Phototherapy, Ultraviolet (UV) light is used to treat Psoriasis.[3] A long list of homoeopathic medicines are enlisted under the rubric Psoriasis in various repertories e.g. Ars alb, Ars iod, Clematis, Dulcamara, Graphites, Phosphorus, Ran-b, Sepia, Staphysagria, Sulphur, Thyroidinum, Tuberculinum etc.[7-11] However, homoeopathic prescription is never based on the nosological diagnosis. In order to select a suitable remedy, we need to investigate the most significant points in the whole history of chronic cases as per the guidelines of Master Hahnemann in Aphorism 5 of Organon of MedicineUseful to the physician in assisting him to cure are . the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration. [12] I discuss here a case of Palmoplantar Psoriasis treated successfully with the homoeopathic medicine Electricity. Case Report Mr. B, 45years old, dark complexioned, obese with a protruding belly, shiny nails presented with psoriatic lesions on both palms and soles since 1 year and 6 months. The lesions first appeared on right palm and then spread to involve the left palm, right foot and left foot. He complained of much itching and burning in the

lesions. Itching aggravated in the evening. He had applied several topical allopathic ointments, which provided temporary relief. The patient was working in electrical department of the telecom industry and had suffered repeated minor electric shocks. He correlated the appearance of first lesion on right palm after suffering with a severe electric shock injury in his right palm about two years back. The past history revealed an episode of jaundice followed by diarrhea during early years and dog bite 20 years back. His father has passed away after suffering with carcinoma of liver. Patient occasionally chewed tobacco and preferred salty food items (1+), fish (1+) and meat with a rich gravy (+2). He also suffered with constipation and occasionally burning during micturition. The patient perspired profusely on on scalp and preferred sleeping on left side. His tongue was clean and moist with central furrow. Mentally, the patient had empathetic and helping attitude. Analysis: The anamnesis brought several remedies to mind viz. Lyssin, Natrum mur, Causticum, Bacillinum etc., but, there was a scarcity of concomitant symptoms for selecting the remedy. Since the patient correlated the onset of disease to an exposure to severe electric shock and his usual occupation also exposed him to repeated minor electric shocks, it was decided to prescribe Electricity. Prescription and Follow ups: 29 Aug 2006 - Electricity 200/one dose. Over next four months, old lesions regressed and itching improved. No new lesions developed. His bowels also improved and he was kept on Placebo. In the month of December, some new lesions appeared on right foot hence another dose of Electricity 200 was prescribed. Since he developed cracks in palms and soles and another dose of the remedy was prescribed in January 2007. The lesions regressed thereafter and itching markedly diminished. Skin thickening also reduced. The lesions cleared completely by July 2007. On 2 Sep 2008, he reported with some recurrence of Psoriatiform lesions on palms and soles and a dose of Electricity 200 was repeated. Since he is a part of the ongoing project he reports annually and has not reported any recurrence of disease over last 5 years. The comparative PASI score of the case is as follows: DATE TOTAL PASI SCORE 29 Aug 2006 2.4

13 Mar 2007 18Dec 2007 3 Feb 2009

1.2 0 0

Discussion: Dr. Heinrich Koebner first described that traumatic events in remote parts of the body evoked outbreaks of psoriasis in the patient at exactly the same site, in the shape of the injured skin. This phenomenon is known as the isomorphic or Koebner response to injury. Psoriatic lesions have appeared following trauma due to gunshot wounds, lacerations, operative incisions, tattooing, burns, ultraviolet light, primary irritation from chrysarobin, iodine application, or in association with infections and furunculosis, pressure from wrist watch and even grasping of a pencil. There is usually a 10 to 14 day latent period between injury and development of lesions, but onset may be delayed as long as 2 years.[14] Hence it was decided to consider Electricity as the homoeopathic remedy in this case due to the absence of clear-cut indications of any other polychrest remedy. As regards homoeopathic literature on Electricity, Caspari and Jahr wrote about the Homoeopathic use of Electricity. The medicine is mentioned in Materia Medica of the Nosodes by H C Allen[15,16]. The Clarkes Dictionary of Practical Materia Medica mentions the following symptoms under the remedy[15].Skin Eruption of small nodosities on the spot touched by the sparks. Scurf on the scalp. Red,smooth spot on the hand, Whitish, itching place in the palm of right hand, Lower limbs- red spot on the skin. Itching of foot , or else red and itching vesicles on the foot. Itching or else tingling over the whole body.

Bowels Fruitless inclination for stools. South Downs School of Homoeopathy, UK, has recently conducted a proving of Electricity[17]. Some of the relevant symptoms from their proving records are Skin Dry. Desires meat. Constipated. Fingernails flaky. Conclusion A diagnosed case of palmoplantar psoriasis responded to the indicated homoeopathic remedy, Electricity, which was prescribed in 200th potency. A few doses of the remedy have maintained disease remission over last five years as

verified objectively with PASI score. Further documented case studies may establish that homoeopathy offers a safe and effective treatment in such clinical conditions. References 1. Behl, P N. Practice of Dermatology, CBS Publishers, India. 5th edition, pp 265-271 2. Gupta R, Manchanda RK, Textbook of Dermatology for Homoeopaths, New Delhi, B.Jain Publishers (P) Ltd, India. 3rd edition 2009 pp. 186-190 3. Arnold, Odom, James. Andrews DISEASES OF THE SKIN Clinical Dermatology, W.B Saunders, USA. 8th edition 1990, pp 198-213 4. Khandpur S, Singhal V, Sharma VK. Palmoplantar involvement in psoriasis: A clinical study. Indian J DermatolVenereolLeprol 2011;77:625 5. http://www.dermnetnz.org/scaly/pasi.html as accessed on 1/02/14 6. http://en.wikipedia.org/wiki/Psoriasis_Area_and_Severity_Index as accessed on 1/02/14 7. Kent ,J T. Repertory of the Homoeopathic Materia Medica, B.Jain Publishers (P) Ltd, India. Enriched Indian Edition 11th impression 2013. pp 1316 8. Boger, CM. Boenninghausens Characteristics MateriaMedica and Repertory with word index , B.Jain Publishers (P) Ltd, India. Reprint edition 2003. pp 952 9. Phatak ,S R. A concise repertory of homoeopathic medicines, B.Jain Publishers (P) Ltd, India. Reprint edition 1992 pp 108 10.Murphy R, Chapter Skin, Homoeopathic Medical Repertory, B.Jain Publishers (P) Ltd, India. 2nd revised edition. pp 1663 11.Knerr, C.B. Chapter Skin, Repertory of Hering Guiding Symptoms of Our MateriaMedica, B.Jain Publishers (P) Ltd, India. Reprint 1990. pp 1161 12.Hahnemann,S. Organon of Medicine, 5th edition, B.Jain Publishers (P) Ltd, India,Low price edition 2002 fifth impression 13.http://emedicine.medscape.com/article/1943419-overview as accessed on 15/12/2013 14.Krishna K. Koebner response in psoriasis. Indian J Dermatol Venereol Leprol [serial online] 1998 [cited 2014 Feb 9]; 64:42-3. Available from: http://www.ijdvl.com/text.asp?1998/64/1/42/4642 as accessed on 12-14 15.Allen, HC. Keynotes and Characteristics with comparisons of some of the leading remedies of our Materia Medica. Economic Homoeo Pharmacy, Calcutta, India. Fifth Indian edition (enlarged) pp 340-346. 16.http://www.provings.info/pruefungen/electricity%20en.pdf as accessed on 15/12/2013 17.Clarke ,J H. A Dictionary of Practical Materia Medica, B.Jain Publishers (P) Ltd, India. Reprint edition 2003. Volume 1 pp 700-804