Clinical Cases

Management of Psoriasis with a Constitutional Approach

Management of Psoriasis with a Constitutional Approach 1

Dr. Tom Alexander shares a case of psoriasis in a man of 28. The patient’s mild personality, his grief from disappointed love, and desiring of company and consolation led to the simillimum.

PRELIMINARY DATA:

Name:   Mr A A

Age:  28 Years                                                                                                  Date of Case taking: 22/10/2018

Sex: Male                                                 Religion: Islam

Address: Ullal                                          Occupation: Businessman.

CHIEF COMPLAINTS:

Location Sensation Modalities Concomitants
Skin

Head, genitals, scrotum

Since 2 years

Gradual onset and progression.

Allopathic medication

Dryness

Itching++

Eruptions+, reddish

Dandruff

Scaling++

 

 

< touch+

< non veg items+

<cold weather+

Skin

Right side

Palm , medial side

Since 1 year

Wart

Bleeding occasionally

 

 

<pressure

HISTORY OF CHIEF COMPLAINTS:

Patient was apparently well 2 years back, then he started with complaints of itching and dryness of the scalp and scrotum. The complaints were gradual in onset and progression. Itching is aggravated by touch.

Along with the itching he also had eruptions which were reddish in colour, also dandruff from the head and there is also scaling of the skin from the affected part.

The scaling is aggravated by taking non-veg items. Also, the complaints are aggravated in the cold weather. He had taken allopathic medicines for the complaints but was better only for a temporary period.

Patient also complains of a wart in the right palm over the medial side since one year, which is irregular and bleeds; bleeding is more with pressure.

PAST HISTORY: Iron deficiency anaemia

SURGICAL HISTORY: Nothing significant

FAMILY HISTORY:

Mother- HTN

Uncle-DM

PATIENT AS A PERSON:

Appearance: Stocky, moderately build and

nourished.

Appetite: Moderate.

Thirst: 1-2 litters / day, warm water.

Craving- Sweets++

Aversion- Nil

Bowel habits- Normal stool, passes once in a day, no difficulty.

Bladder habits- 3-4 times in day, 1 time at night, no difficulty.

Dreams- Unremembered

Perspiration: Increased, generalised, sticky.

Thermals-towards hot

LIFE SPACE EXAMINATION

Patient hails from a good socio-economic status; his father was a vender in the fish market and was financially sound, and mother is a house wife. He has four siblings, three brothers and one sister.

The patient studied up to Degree BCA, and presently working in a supermarket as manager; also he is a partner. He has a good business and is happy with it.

Patient had one love affair with a girl for many years, then 3 years ago he had to break up the relationship as she was forced to marry someone else by her parents and she agreed to that. Because of this incident he was depressed.

Almost the same time one of his uncles expired with whom he was very close. The uncle used to take care of the patient, who also helped him in the business. The patient was very sad and very depressed about the incident.

As a person – He doesn’t get angry easily. He likes company but prefers to rest when he is tired. He is attached to his family. At work he wants things to be done perfectly.

General physical examination

No signs of pallor, cyanosis, clubbing, icterus, oedema, lymphadenopathy,

Weight- 70 kg

Vital signs-

Pulse-68 beats per min., regular rhythm, moderate volume, vessel wall not palpable.

Blood pressure- 110/80 mm of Hg, left arm supine position.

Temperature- patient was afebrile at the time of examination

Respiratory rate-16 breaths per minute

Systemic examination

CNS – higher mental functions intact, cranial nerves intact, no abnormality detected

CVS- S1S2 heard, no added sounds.

RS – normal vesicular breath sounds heard. No added sounds

Local examination

Scaling and dryness of the skin all over the scalp, redness++, thickness.

Wart on medial side of palm, one in number, irregular.

Provisional diagnosis: psoriasis with verruca vulgaris.

Fundamental Miasm: Sycotic

Dominant Miasm: Sycotic

CHRONIC TOTALITY:

Mental Generals

Mild++

Grief++ from disappointed love.

Likes company+

Likes consolation.

Perfectionist+

Physical Generals

Craving- sweets++

Perspiration: generally increased, sticky.

Thermally- Hot patient

Characteristic Particular

Scaling and dryness of scalp

< Non veg

Itching ++<touch

Wart on palm bleeding+

Provisional Remedy:

Pulsatilla

Differential Remedy:

Causticum

First prescription

DATE: 22/10/2018.

Rx

  1. Pulsatilla 200 1P HS
  2. No ii pills 4-4-4 for 15 days

Follow up criteria

  1. Appetite
  2. Perspiration
  3. Itching
  4. Scaling
  5. Eruption
  6. Wart

Management of Psoriasis with a Constitutional Approach 2

PHOTOGRAPH OF THE FIRST VISIT- 22/10/2018.

PASI SORING ON FIRST VISIT- 3.5

FOLLOW UPS

DATE SYMPTOM CHANGES PRESCRIPTION
 FOLLOWUP CRITERIA
 

5/11/18

1234561.     PULS 200 2P

1P H.S. Weekly

2.No ii pills(4-4-4) x2 weeks

G 

S

>SS>
 

 

19/11/18

1234561.SL 2P

1 P  HS weekly

2.No ii pills(4-4-4) x 2 weeks

GGA    >>S
 

10/12/18

1234561.     PULS 200 2P

1 P  HS weekly

2.     No ii pills (4-4-4) x 1 month

GGAS<S
 

31/12/18

1234561.      PULS 0 2P

1P HS weekly

2.     No ii pills (4-4-4) x 2 weeks

GG   A>+>++S
 

14/1/18

1   234561.     SL 2P

1P  HS weekly

2.     No ii pills (4-4-4)x 2 WKS

GGA>++>++ S
28/1/191234561.     SL 2P

1P  HS weekly

2. No ii pills (4-4-4) x 2 wks

GGA 

>++

 

>++S
 

11/2/19

 

 

 

G

 

G

 

A

 

>++

 

>++

 

S

1.     SL 2P

1P  HS weekly

No ii pills (4-4-4) x 2 wks

25/2/19GGA>++>++S1.     SL 2P

1P  HS weekly

2. No ii pills (4-4-4) x 2 wks

18/3/19GGA>++A>+1.     SL 2P

1P  HS weakly

2.  No ii pills (4-4-4) x 1 month

Management of Psoriasis with a Constitutional Approach 3

PHOTOGRAPH ON VISIT ON 18/3/19.

PASI SCORING ON 18/3/19 – 0.6.

SUMMMARY

This is a case of scalp psoriasis treated with the constitutional method considering the patients mentals, physical generals and characteristic particular symptoms.

The remedy Pulsatilla was indicated and given in 200th potency, repeated as the case demanded. PASI (psoriasis area and severity index) was checked before and after the treatment and showed significant reduction from 3.5 to 0.6.  This shows homoeopathy can be very efficacious in the treatment of psoriasis.

About the author

Tom Alexander

Tom Alexander

Dr. Tom Alexander holds a BHMS and MD HOM). He did his undergraduate and post graduate schooling at Father Muller Homoeopathic Medical College, Deralakkatte, Mangalore, Karnataka, India. He is currently Assistant professor, Yenapoya Homoepathic Medical College, Mangalore, His approach is classical homeopathy and his hobbies include badminton.

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