A Case of Psoriasis

Introduction:

Psoriasis is not a mere skin disease. It is a chronic systemic auto-immune disorder which manifests primarily on the skin, but it can also affect nails or joints and cause debilitating arthritis. Like all other auto-immune diseases, psoriasis is a condition which is very hard to treat. While conventional medicine considers psoriasis incurable and controls the symptoms with side-effects-producing medications like corticosteroids, methotrexate, cyclosporin, hydroxycarbamide or cytokines, homeopathy can offer gentler and many times more effective help. In most cases, it can provide relief from symptoms and prevent further progression of the disease without serious side effects, provided that we select correct remedies. The relief from symptoms after homeopathic treatment is often significant and the quality of life of these patients is limited only very little or not at all. Some cases, though, can be cured completely with homeopathy. The prognosis is usually dependent on several factors, mainly on the patient’s level of health¹, personal and family medical history (especially an occurrence of psoriasis in the family), aetiology, duration of the disease, and finally, on the stage of the progression of the disease.

The case:

Female, 68 years.

Chief complaint: Psoriasis

This lady’s complaints started 3 months ago and she was immediately diagnosed with psoriasis. It started with red patches on her abdomen which later on turned into white plague lesions. She has also developed itching in her eyebrows (2). A dermatologist prescribed topical corticosteroids for her, but in spite of their everyday use, she still develops new lesions. She also has one big spot on her left leg, but according to the dermatologist, this is a fungal infection. She applies antifungal cream on it, without any effect, though. The spots are more apparent after bathing (2).

She has a red swollen lump at one of her nail beds on her hand (2) and the nail is transversely bent in a way that it creates a convex curve. This started 3 weeks ago. She had brittle nails for 15 years but since she developed psoriasis, they have become stronger.

Six months ago, she was vaccinated against encephalitis. Four to five months ago she underwent quite extensive dental treatment with several anesthesia injections. She never had symptoms of psoriasis before and there is no occurrence of the disease in her family. Her mother had tuberculosis and died from pulmonary embolism at the age of 35. The patient’s maternal grandmother had serious liver problems after hepatitis and died from liver cancer. Both the mother and grandmother had varicose veins.

As far as acute diseases are concerned, the patient has mild coryza which tends to go down to the bronchi without fevers about twice a year. She used to have high fevers up to 39°C until 40 years of age. She used to have them about twice a year and besides that, she also had some mild coryzas with cough at that time. In her youth, she used to have tonsillitis once every year or two, but that stopped appearing at the age of 25. As a child, she was not ill very often.

She has had caries of teeth since childhood and in her pregnancy (at the age of 22) she suffered from abscesses of teeth roots.

For the last 3 months, she has also suffered from pains in her lumbar region (3) which she never had before. The pains are only on the left side (3) and they are located at the left sacroiliac junction region. The pains shoot down to her left hip (3). They are worse from sitting (3) and moving her left leg sideways when sitting (3). The longer she sits, the worse it gets (3). The pains get better when she lies down on her back on a hard surface (e.g. a floor) (2) and from motion (2/3) and walking (2/3).

Since she was 30 years old, she has had frequent eructations and distention around the area of the stomach. It produces pressure on her heart and makes breathing more difficult (3). She was diagnosed with hiatal hernia. She has taken an antacid drug and a dopamine D2 receptor antagonist for the last 4 years. The intensity of the complaints remains the same, even for the last 3 months. She has had a tendency to constipation her whole life. She has elevated cholesterol levels and takes medication for it.

At the age of 48, she developed myomas and a hysterectomy was performed. Since the age of 19, she has had varicose veins which are painful during changes of weather (2/3); they are better from cold shower (2). She takes venotonic medication. For the last few years, she has had problems with breaking of capillaries (3).

She is chilly in general (2) and likes warm drinks and hot baths (2).

She has an aversion to cold drinks (2), fish (3) and vegetables (1). She likes sweets (1), meat (3), pork (2) and sour food (2).

Her thirst has always been very low (3).

One week ago, she developed a herpes sore on her lip for the first time in her life.

She says she has been quite sensitive to stress and negative occurrences for all her life and she has always worried a bit more than other people (2).

Note: numbers behind the symptoms mean their intensity (underlining)

Analysis of the case:

Let me now analyze the sequence of events in the patient’s life with regard to her level of health. Obviously, this woman was born at a high level of health and her inborn vitality must have been quite good because she only had seldom acute diseases in childhood and she had no chronic complaints at that time. Later on, as her level of health dropped down a bit, she started having more frequent acute diseases, but the organism was still able to produce high fever. This ability to produce high fevers sustained until she was 40 years old which is not so common in today’s society and points to good vitality. However, in the past years, she has had only mild acute diseases without fevers, which means that her level of health has dropped down and the defense mechanism became weaker and unable to counteract infections in an intense strong manner (according to the theory of Levels of Health from Prof. George Vithoulkas, her level of health would be classified as C7) [1]. Until the age of 40, she must have been in one of the levels of group B. Her probable level of health in childhood was A1 or A2.¹

As far as the prognosis is concerned, there are several positive factors. The fact that she was born at a high level of health and that her vitality must have been quite good until the age of 40 is favorable. The other positive factor is the absence of psoriasis in her family medical history. What is very favorable for the prognosis is the fact that she has had the complaints only for 3 months and that they were most probably triggered by some external factors. In particular, the vaccination and extensive dental treatment with a lot of local anesthesia are the most probable triggering factors. Of course, the patient must have had some genetic predisposition to psoriasis (but as it did not occur in the family, the predisposition was not very strong), but these factors may have put such a strain on her organism that her vitality has dropped down below an imaginary threshold where her defense mechanism is not able to prevent activation of this predisposition any more. When we treat a case where the complaints developed under an influence of some external stress, the prognosis is always better than in a case in which the complaints develop spontaneously and the organism is unable to prevent their development even without any external stress.

As it is usually not possible to cover all symptoms of a patient’s life with one homeopathic remedy (except some cases of very young children or a very few people who are exceptionally healthy), we use the idea of layers of remedies[2] where we suppose that a person needs several different remedies in a correct sequence in order to achieve the maximum possible degree of health. During our lives, symptoms tend to change, according to our age and factors that influence us. Very often, indicated remedies need to be also changed accordingly. In some very vital people, symptoms can remain the same for many years in spite of different external influences or even if they change, they still point to the same remedy. However, this is rather rare. In most cases, we see symptoms of several different homeopathic remedies and we try to determine the so-called uppermost layer, in other words, the symptomatology that we should focus on and that has to be treated at the moment. Although the uppermost layer is usually (but not always) created by the most recent symptoms, in most cases, we do not use all current symptoms to find the remedy and we have to select only the most characteristic symptoms of the case. It would be great if were always able to find a remedy that covers all current symptoms, or even better, all symptoms of a person’s life and homeopathy would be very easy then, but unfortunately, this is usually not possible.

The most characteristic symptoms of a case (the symptoms which represent the unique way of how the organism is dealing with the imbalance or how he reacts to a negative stimulus) comprise of so-called strange, rare and peculiar symptoms[3] and intense symptoms.

In this case, we have to focus primarily on the most recent symptoms because the patient developed a whole new syndrome 3 months ago. The most recent symptoms are the symptoms of psoriasis, the corrugated nail with the inflamed nail bed, and the back pains. We could also take into consideration the stomach hernia (it is most probably a recent problem when she has taken the medication for it only the last 4 years) and breaking of capillaries as they are also quite recent. However, it is probable that these complaints represent a deeper layer which will need another remedy. We can always take into consideration all symptoms of the case during the differential diagnosis but the most recent and most bothering symptoms should comprise the base of our first prescription.

From all the available symptoms of the case I chose these to be the most characteristic:

Peculiar symptoms:

• back pain in the lumbar region on the left side (3) better from motion and walking (2/3) and lying on a hard surface (2), worse from rest and sitting (3) and from moving the leg sideways when sitting (3)
• itching of eyebrows (2)

Intense symptoms:

• psoriasis (3)
• white spot on her left leg (2)
• general left-sidedness (2)
• convex bending of the nail (2)
• lump on her nail bed (2)

We cannot take the information about fungus on her leg into consideration because we are not sure if it is really fungus. It does not react to treatment with antifungal ointment so it may be something else. For example, it may belong to the psoriasis. I do not include generals or food preferences because I am not sure how long she has had them. It is best to make a repertorization with fewer but reliable symptoms. We can always use the other symptoms in the differential diagnosis.

Relevant rubrics: (using The Essential Synthesis repertory)[4]

BACK – PAIN – Lumbar region

BACK – PAIN – lying – hard; on something – amel. (a)

BACK – PAIN – Lumbar region – lying – hard; on something – amel. (a)

BACK – PAIN – pressure – amel. (b)

BACK – PAIN – Lumbar region – pressure – amel. (b)

BACK – PAIN – motion – amel. (c)

BACK – PAIN – Lumbar region – motion – amel. (c)

BACK – PAIN – sitting – agg. (d)

BACK – PAIN – Lumbar region – sitting – agg. (d)

FACE – ITCHING – Eyebrows

SKIN – ERUPTIONS – psoriasis

SKIN – DISCOLORATION – white – spots

GENERALS – SIDE – left

EXTREMITIES – NAILS; complaints of – distorted nails

Note: rubrics with the letters a, b, c, d are combined together

As we do not have rubrics for all existing symptoms mankind can have in the repertory, some rubrics are missing in the list. For the lumps in the nail bed, the rubric “EXTREMITIES – FELON” may be used because it describes a very close problem, but as the problem of our patient is most probably caused by psoriasis and it is not an actual simple inflammation of the nail bed, I rather omit this rubric.

Differential diagnosis of the most probable remedies:

Sepia officinalis: This remedy justifiably comes up first in the repertorization. It is one of the most important remedies for hard dry scaly eruptions like psoriasis. Moreover, Sepia is probably the most often prescribed remedy for vitiligo, which is a skin pigment problem manifesting as white spots on the skin. Sepia also covers ringworm and other fungal infections of the skin. General left-sidedness, chilliness, back pains better from hard pressure (lying on a hard surface) and motion, herpes sores on lips, and a desire for sour food are keynotes of Sepia. It can also be found in the second degree in the rubric for distorted nails and in the third degree in the rubric for back pain worse from sitting. Sepia tends to be very emotionally sensitive in the first stage of its pathology.

Rhus toxicodendron: Pains of any origin (especially in musculoskeletal system) ameliorated from motion and aggravated from rest are very characteristic for this remedy and it is its keynote. In fact, it is the main remedy to think of when we see this symptom. It covers back pains with this modality very well. It also covers back pain better from hard pressure but it is not its keynote. It is an important remedy for skin eruptions of different types including psoriasis, however, mainly for vesicular eruptions and herpes. It is one of the main remedies to think of when we see a combination of complaints of the musculoskeletal system and skin. Herpetic sores on lips and chilliness are its keynotes. Patients who need Rhus toxicodendron like hot bathing and amelioration from a hot bath is a keynote of this remedy. This remedy usually prefers cold drinks, though. It is a left-sided remedy and it is listed in the rubric for itching of eyebrows.

Agaricus muscarius: This remedy represents a very interesting option in this case because it belongs among the main remedies for back pains (especially low back pains) which are worse from sitting and better from lying down. Backache worse from sitting is a keynote of this remedy. It also has back pains worse from raising a leg during sitting, which is not exactly the same as in our patient but it is quite close to what the patient says (moving the leg sideways when sitting). However, back pains of Agaricus are worse from motion. This remedy is aggravated by cold and it can be found in the rubric for itching of eyebrows.

Graphites: It is the first remedy to think of when we see psoriasis with affections of nails. Deformed nails, general left-sidedness and aversion to fish are keynotes of this remedy. The desire for sweets in our patient could be a contraindication for this remedy, but as this symptom may not belong to the uppermost layer (as well as the aversion to fish) and is not very strong, it might not pose a big problem. Graphites can be emotionally sensitive, but especially to music.

Sulphur: This remedy is the most famous remedy for eruptions of any kind including psoriasis. Aggravation of skin complaints from bathing (mainly itching, though) and left-sidedness are keynotes of Sulphur. It also covers distorted nails, aversion to fish and stomach hernia. Sulphur is the only remedy in the third degree in the rubric for itching of eyebrows. However, there are several contraindications for this remedy, namely, the patient’s desire for sour food, general sensitivity to cold (although Sulphur can be chilly in rare cases) and desire for warm drinks. The other contraindication could be thirstlessness of the patient, but as this symptom has been present since the patient’s childhood, it most probably does not belong to the uppermost layer and, therefore, it may not be a strong contraindication for Sulphur at this moment.

Natrum muriaticum: Covers a combination of psoriasis and low back pains which get better from hard pressure or lying on a hard surface and it has herpes sores as a keynote. It is listed in the rubric for itching of eyebrows. Natrum muriaticum patients can have aversion to fish, although more often, we see the opposite. However, patients who need Natrum muriaticum are usually worse from heat, they prefer cold drinks and they are very thirsty (but thirstlessness may not belong to the uppermost layer of this case). On the other hand, they tend to be emotionally very sensitive.

Carbo vegetabilis is a remedy to consider especially for her older problems with distention of the stomach and eructations with impeded breathing (in Carbo vegetabilis, the dyspnea is strongly ameliorated by eructations). It covers hiatal hernia, and it is an important remedy for hemorrhages, which would correspond with the weakness of capillaries in our patient. However, this remedy might rather be needed later on, after we remove the uppermost layer.

Choice of the remedy

From all the discussed remedies, Rhus toxicodendron and Sepia are the most similar to the case. They both score high on the totality and have no strong contraindications (no keynote or essence is contraindicated) so we have to decide which of them is indicated better.

They both cover the low back pains which are better from motion and hard pressure. They both have pains better from motion as a keynote, but the back pain better from hard pressure is a keynote only for Sepia. Both these remedies have aggravation from cold and herpes sores on lips as keynotes. White spots on the skin are not typical for Rhus toxicodendron, but they are very typical for Sepia. They are both left-sided remedies, but for Sepia, it is a keynote. Although both remedies are listed in the third degree in the rubric for back pains worse from sitting, this symptom is more typical for Rhus toxicodendron, but the idea there is that sitting provides rest, which aggravates this remedy in general. However, we do not know if the pain gets worse because of the rest or because of the sitting position itself in our case.

In Rhus toxicodendron, the back pains are usually accompanied by strong stiffness and restlessness, which is not present in our case. This is not a contraindication, though.

Sepia cannot be found in the rubric for itching of eyebrows, but as this is a minor local symptom, it is not necessary for the remedy to cover it. Moreover, Sepia covers eruptions with itching in general and we can find a reference for eruptions at eyebrows in Clarke’s Dictionary of Practical Materia Medica[5].

The distortion of the fingernail can be much better confirmed in Sepia than in Rhus toxicodendron. Rhus toxicodendron is only listed in the first degree in the rubric for affections of nails in general in the repertory, but Sepia can be found in the third degree in the same rubric and in the second degree in the most accurate rubric for the symptom of our case – EXTREMITIES – NAILS; complaints of – distorted nails. Confirmations for distortion of nails in Sepia can be found in different materia medicas, for example, again in H.C. Clarke’s Dictionary.⁵

If we look at food preferences, Sepia can be supported by desire for sour food which is its keynote, whereas Rhus toxicodendron has a desire for cold drinks (although not as a keynote) which is opposite from what our patient has. Emotional vulnerability is also typical for Sepia.

As Sepia covers more keynotes and it can be supported by some older symptoms like food preferences or emotional vulnerability and considering that it is one of the most important remedies for psoriasis, I consider it the best choice in this case at the moment.

With regard to the lady’s level of health and age, the initial potency should not be very high. As the patient is taking several allopathic remedies that could interfere with the action of the homeopathic remedy, I opted for repeated dosing where lower potencies are also more appropriate. I recommended Sepia 30C once a day and advised the patient to let me know when she experiences any reaction (aggravation or amelioration). Once the reaction starts, the dosing should be stopped.

Note: In cases with very serious physical pathology, we can continue with dosing even when the reaction is established, but in these cases, very low potencies are usually used. This patient does not belong to this group.

Prescription: Sepia 30C once a day until there is a reaction

Outcome of the treatment:

After 6 days of taking the remedy, the patient called me and said that the pains in the sacroiliac junction had disappeared, but she started feeling a tremendous pain in her sacral area of the spine. The pain was worse from sitting and lying. I asked if she had ever had such pains before. She confirmed having exactly the same pains 10 years ago.

At that point, I advised her to stop taking the remedy and wait.

Then she called a month and a half later and said that the psoriasis had become much better. Most of the plague lesions had healed and although new lesions still tended to develop, their number had been gradually decreasing and they had been smaller and smaller. At the time when she called, she only had 3 small “pimples” in the lower part of her abdomen. Her nail remained the same. She was having no pains in her back and she only had some pain in her hip joint, which she had already had for several years.

I advised her to wait further.

After another month, she developed an acute cough with coryza, which was stronger and longer than usual. She did not take any medicine for it except a remedy for better expectoration. We did not treat this episode as it did not seem serious, even when it was intense (intense does not always mean serious). It lasted for 10 days and finally went away on its own.

Note: It is worth noticing that acute diseases of this patient are becoming more intense which is very common in patients in group C after a correct remedy and it is a good sign. It means that the immune system is recuperating and the organism is heading closer towards group B where we can see frequent acute diseases with high fevers.¹ In this case with such chronic pathology and in a patient of this age, it may take more time get from group C to group B and in some cases, it may take months or years or it may not be possible at al.

All skin symptoms of the patient completely disappeared 3 months after the beginning of the treatment. She also started feeling better in general and energy wise. The lump in her nail bed disappeared and the nail started slowly getting a normal shape. The only problem that remained were minor joint pains which fluctuated, but were never unbearable and did not limit her in her daily routine. These joint pains are signs of beginning osteoarthritis (which she was diagnosed with) common in people of her age and she had already had them before she developed psoriasis.

Follow-up of the case now is 14 months. So far, there has been no need to repeat the same remedy or to give any other remedy. She is free of psoriasis, feels much more vital in general and the joint pains do not limit her much. So far, there has not been a clear picture of another remedy which might help her with her osteoarthritis. If there is no clear picture and the problems are not much bother, the next remedy should not be prescribed.

Discussion:

Cases like this prove that psoriasis can be totally cured with homeopathy. Of course, there may be a relapse if the organism gets under an influence of some stress (physical or psychological), but the results from a few doses of the remedy in a relatively low potency are remarkable. As the effect of the remedy has lasted for more than one year now and there was an aggravation followed by a general improvement, the remedy can be pronounced correct and it was a simillimum. The patient may need some other remedy in the future, most probably covering the joint problems, but as her complaints are not very limiting and she feels well in general, there is no need to rush with the next remedy at the moment.

[1] VITHOULKAS, G., WOENSEL, E. The Levels of Health: The Second Volume of The Science of Homeopathy. Athens, Greece: International Academy of Classical Homeopathy, Center of Homeopathic Medicine, S.A., 2010. ISBN: 978-9-6087-4294-9

[2] VITHOULKAS, G. The Science of Homeopathy. Athens, Greece: International Academy of Classical Homeopathy, Center of Homeopathic Medicine, S.A., 2009. ISBN: 978-960-87429-3-2

[3] HAHNEMANN, S. Organon of Medicine, Sixth edition. New Delhi: B. Jain Publishers, 2008. ISBN 978-81-319-0223-3, §153, page 158

[4] SCHROYENS, F. The Essential Synthesis 9.2E. London: Homeopathic Book Publishers, 2007. ISBN: 978-0-9557151-0-5

[5] CLARKE, J.H., Dictionary of Practical Materia Medica. Apis [online]. https://homeopathybooks.in/dictionary-of-practical-materia-medica-by-j-h-clarke/sepia-3/