Keywords: psoriasis, homeopathy, case report, precision medicine
Psoriasis is a chronic inflammatory and hyper-proliferative skin condition, affecting over 2 percent of the global population.1 The etiology is multifactorial. Drugs, lifestyle, trauma (Koebner phenomenon), stress, and infections all have a role in the pathogenesis.2
There is evidence that psoriasis has strong genetic and epigenetic components to it. According to recent research, the HLA-Cw6 and LCE3 genes play an important role in the development of psoriasis.3,4 Clinical research has shown that stress has an important role in the onset and exacerbation of psoriasis, emphasizing the link between major stressful life events and disease onset. 5,6
When triggered, T-cells secrete cytokines, which mediate an immune response. Disturbances in the innate and adaptive immunity due to gene mutations are responsible for sustained psoriatic inflammation.7 Besides this, psoriasis shows a clear autoimmune mechanism in which auto antigen LL37 has been attributed.8
The hallmark of psoriasis is chronic inflammation which overlaps with autoimmune response that leads to uncontrolled keratinocyte proliferation and retention in the stratum corneum causing hyperplasia.2
Classic psoriatic lesion presents as red, scaly, well demarcated plaques particularly over extensor surfaces of the body. Diagnosis of psoriasis is clinical. It is clinically classified as pustular and non-pustular type of psoriasis.2 The variants under each type are listed in table 1.
The immune response varies in each clinical variant and displays discrete treatment outcomes Psoriasis Area Severity Index (PASI) is used to measure severity and percentage of areas affected. The disease is extremely variable in the periodicity of its flares, extent, and clearance.
Recent advances in the treatment with use of biologics have short term response and cause massive immune suppression.2 Hence, more research is required to understand the role and relevance of complementary therapies.9 Many studies exist which provide favorable outcomes for use of homeopathy in psoriasis.5,10 This case report suggests an alternative for treatment of psoriasis with classical homeopathy.
A 15-year-old girl developed psoriasis vulgaris since 2015. The eruptions appeared after she was isolated from her parents and sent to live with her grandparents. She used to weep by herself in bed when no one else was around. First consultation took place on 14/03/2019.The symptoms available for prescription were:
- Ailments from grief (+++)
- Weeping when alone (++)
- Tearful mood at night (++)
- Vertigo <rising on (++)
- Desire- salt (+++)
- Desire sour (+)
- Psoriasis of palms (+)
- Psoriasis of legs (++)
Past history: The girl had history of febrile convulsions during high fever in childhood. Further, she reported 2 incidents of super infection in eruptions and intervention with antibiotics when she was under the previous pluralist homoeopath.
Family history: Father – Hemorrhoids and Paternal grandmother osteoarthritis. Otherwise, the health of family was good
Diagnosis: psoriasis (ICD-10:L40)11
Case analysis and prescription:
At the time of consultation, her baseline PASI score was 5.2 (Fig. 1). After a thorough investigation, it was obvious that psoriasis started after grief of separation from parents, and it gave rise to a specific totality of symptoms (Fig. 2). Natrum muraticum 10M one dose was prescribed on 14/03/2019. The follow up of the case is listed in Table 2.
Psoriasis is an autoimmune disease, and it necessitates a multifaceted strategy that goes beyond just skin clearance to enhance overall quality of life. While conventional medicine concentrates on reducing the inflammation and skin clearance, classical homeopathy explores the reaction of an individual’s immune system to the genetic and epigenetic trigger.4,12
The result of this struggle manifests as physical, emotional and mental symptoms depending on the overall health at the moment of stress, which guides the homoeopath to choose a remedy.12,13
The theory of levels of health propounded by Prof. George Vithoulkas provides a wealth of information regarding the disease, its treatment and prognosis for a case. There are twelve levels, which are further classified into four groups (A-D).14 Besides that, it also gives guidelines for evaluation of acute diseases during the chronic homeopathic treatment.
The above presented case belongs to group C with no significant fevers in the recent past, except during superinfection. Patient developed an acute within 10 days after homeopathic intervention. According to the theory, appearance of fever within the first few days of treatment for a chronic inflammatory disease indicates a healthy immune system and is an encouraging sign that the remedy was correct and the case is curable.14
The acute diseases must be carefully handled especially given the danger of sepsis in these cases.5 The general guideline here is to interfere with a remedy only when the acute is due to a complication or severe infection, in which case either a clear new remedy picture will be available or in the absence of such a picture, the chronic remedy may be repeated. Otherwise, a hands-off approach yields the desirable results.
Her baseline PASI score was 5.2 and she achieved a complete skin clearance (PASI 0) within 3 months of classical homeopathic treatment and a shift in her health level was appreciable. The Modified Naranjo Criteria for Homeopathy (MONARCH) causality assessment provided a score of 10, suggesting a significant causal relationship to the treatment (Table 3).15
This case demonstrates that classical homeopathy may have a solution to psoriasis which not only helps in skin clearance but also to improve general health. Hence, homeopathy must be scientifically investigated further in light of such evidence.
This case displays a complete skin clearance with overall improvement of general health and PASI score. While this case shows a positive result for treatment of psoriasis caused by psychological stress through individualized classical homeopathy, extensive research is necessary to establish the therapeutic advantage observed here.
Acknowledgements: The author thanks Dr Aaditi Lakshman for help in preparing the manuscript
- Griffiths CEM, van der Walt JM, Ashcroft DM, et al. The global state of psoriasis disease epidemiology: a workshop report. In: British Journal of Dermatology. Vol 177. Blackwell Publishing Ltd; 2017:e4-e7. doi:10.1111/bjd.15610
- Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20(6). doi:10.3390/ijms20061475
- Chandra A, Lahiri A, Senapati S, et al. Increased Risk of Psoriasis due to combined effect of HLA-Cw6 and LCE3 risk alleles in Indian population. Sci Rep. 2016;6. doi:10.1038/srep24059
- Woo YR, Cho DH, Park HJ. Molecular mechanisms and management of a cutaneous inflammatory disorder: Psoriasis. Int J Mol Sci. 2017;18(12). doi:10.3390/ijms18122684
- Mahesh S, Shah V, Mallappa M, Vithoulkas G. Psoriasis cases of same diagnosis but different phenotypes—Management through individualized homeopathic therapy. Clin Case Reports. 2019;7(8):1499-1507. doi:10.1002/ccr3.2197
- Martins AM, Ascenso A, Ribeiro HM, Marto J. The Brain-Skin Connection and the Pathogenesis of Psoriasis: A Review with a Focus on the Serotonergic System. Cells. 2020;9(4). doi:10.3390/cells9040796
- Shao S, Gudjonsson JE. Epigenetics of Psoriasis. In: Advances in Experimental Medicine and Biology. Vol 1253. Springer; 2020:209-221. doi:10.1007/978-981-15-3449-2_8
- Herster F, Bittner Z, Archer NK, et al. Neutrophil extracellular trap-associated RNA and LL37 enable self-amplifying inflammation in psoriasis. Nat Commun. 2020;11(1). doi:10.1038/s41467-019-13756-4
- Timis TL, Florian IA, Mitrea DR, Orasan R. Mind‐body interventions as alternative and complementary therapies for psoriasis: A systematic review of the English literature. Med. 2021;57(5). doi:10.3390/medicina57050410
- Witt CM, Lüdtke R, Willich SN. Homeopathic treatment of patients with psoriasis – A prospective observational study with 2 years follow-up. J Eur Acad Dermatology Venereol. 2009;23(5):538-543. doi:10.1111/j.1468-3083.2009.03116.x
- 2021 ICD-10-CM Codes L40*: Psoriasis. Accessed June 20, 2021. https://www.icd10data.com/ICD10CM/Codes/L00-L99/L40-L45/L40-
- Vithoulkas G and Tiller.w. The Science of Homeopathy. 7th Edition.; 2014.
- Vithoulkas G, Carlino S. The “continuum” of a unified theory of diseases. Med Sci Monit. 2010;16(2).
- Vithoulkas G. Levels of Health.; 2017.
- Lamba CD, Gupta VK, Van Haselen R, et al. Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports. Homeopathy. 2020;109(4):191-197. doi:10.1055/s-0040-1701251
Table 1 – classification of psoriasis
|Classification of psoriasis (ICD-10 Code):|
|Non-pustular psoriasis:||Pustular psoriasis:|
|1. Psoriasis vulgaris (L40.0)||1.Generalised pustular psoriasis (L40.1)|
|2. Guttate psoriasis (L40.4)||2.Localized pustular psoriasis (L40.2)|
|3. Erythrodermic psoriasis (L40.8)|
|4. Palmoplantar psoriasis (L40.3)|
|5. Psoriatic arthritis (L40.5)|
|6. Inverse psoriasis (L40.8)|
Table 2 – Follow up of the case.
|19/04/2019||· Patient developed fever on 25/03/2019 with no clear remedy picture, they did not record the temperature
· Skin eruptions are better (Fig. 3)
· LMP- 10/04/2019; Dysmenorrhoea is better
· Vertigo increased <rising on
· Shortness of breath <ascending stairs, exertion.
· Appetite is better
|30/05/2019||· Skin eruptions cured (Fig. 4)
· No vertigo and shortness of breath.
· LMP- 15/05/2019; No dysmenorrhoea.
· Desire salt- reduced
· Desire sour- reduced.
· Generally better.
|04.01.20201||· Her skin is still better with no lesion of psoriasis
· Menses regular, no dysmenorrhoea.
· She now visits with acutes such as otitis
Table 3: Modified Naranjo Criteria for Homeopathy (MONARCH) – for causality assessment
|Criteria||Y||N||Not sure/NA||Score in case|
|1. Was there an improvement in the main symptom or condition for which the homeopathic medicine was prescribed?||2||-1||0||2|
|2. Did the clinical improvement occur within a plausible time frame relative to the drug intake?||1||-2||0||1|
|3. Was there an initial aggravation of symptoms?||1||0||0||1|
|4. Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed?||1||0||0||1|
|5. Did overall well-being improve?||1||0||0||1|
|6 (A) Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease?||1||0||0||0|
|6 (B) Direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms:- from organs of more importance to those of less importance, from deeper to more superficial aspects of the individual, from the top downwards||1||0||0||1|
|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?||1||0||0||0|
|8. Are there alternate causes (other than the medicine) that with a high probability could have caused the improvement? (consider known course of disease, other forms of treatment, and other clinically relevant interventions)||-3||1||0||1|
|9. Was the health improvement confirmed by any objective evidence? (photos before and after treatment)||2||0||0||2|
|10. Did repeat dosing, if conducted, create similar clinical improvement?||1||0||0||0|
Figure 1: psoriasis before treatment (14/03/2019)
Figure 2: Reportorial result on 14/03/2019 (Vithoulkas compass)
Figure 3: psoriasis during treatment (19/04/2019)
Figure 4: psoriasis after treatment (30/05/2019)