Psoriasis in a Man of 40

CASE REPORT

PRELIMINARY DATA

Name: Mr. Y

Age: 40 years

Sex: Male

Marital Status: Married

PRESENTING COMPLAINT:

September 2019: A 40 year old male patient reported with erythmatous, scaly, papular lesions with itching on lower area of face at madibular region on both sides of his face.

HISTORY OF PRESENTING ILLNESS:

A dry lesion started slowly on his face during change of weather, i.e from cold to warm in March 2019. It appeared on the right side and gradually increased in size. The lesion developed fine scales and gradually another lesion also appeared on the left side. Other scaly lesions also appeared on his face gradually during the course of time and he presented in OPD in September 2019.

TREATMENT HISTORY:

Applied skin ointments but of not much use.

PAST HISTORY: No history of any significant illness.

FAMILY HISTORY: No significant family history present.

PERSONAL HISTORY: No addition of any kind. Vegetarian.

PHYSICAL GENERALS:

Thermal reaction: Hot patient

Appetite: Adequate

Thirst: Adequate

Desire: Sweets

Aversion: Nothing significant

Stool: Constipated, feels as if there is narrowing of anal opening and so he has to strain to expel stool.

Urine: Regular, no associated complaint. D4-5N0

Perspiration: Normal

Sleep: Sound sleep

Intolerance to coverings, unable to cover face while sleeping, feels as if suffocated.

MENTAL GENERALS:

In the OPD he was constantly talking and was describing his complaints too much. For answering a simple question, he was telling long stories.

GENERAL PHYSICAL EXAMNATION:

Build: Mesomorphic

Pulse: 80 beats/minute

B.P. 130/80 mm Hg

Temperature: Afebrile

Nails: No clubbing noticed

SYSTEMIC EXAMINATION:

G.I.T/C.V.S/C.N.S/Musculoskeletal system: No abnormality detected.

DIAGNOSIS: Psoriasis (on basis of clinical presentation of lesions – erythmatous papular lesion with characteristic scales)

Medicine selected: Lachesis 200

BASIS OF PRESCRIPTION:

In this case the prescription was done on basis of “Keynote symptoms” of the case. In this case the following keynotes of the case were taken into consideration:

Loquacity, theorizing (as stated in mental generals, constantly talking, telling long stories for to answer a question)
Discomfort on covering his face
Complaint started at change of weather from cold to warm

These selected keynotes were matched with the symptomatology in Allen’s keynotes. In Lachesis the following symptoms are found:

Great loquacity; wants to talk all the time, one world often leads into another story.
The least thing coming near mouth or nose interferes with breathing.
Spring aggravation

These three symptoms and considering the thermal reaction as a hot patient, the most appropriate remedy came out to be LACHESIS.

TREATMENT:

Follow up	Medicine prescribed	Remarks
1^st prescription (12/09/2019)	Lachesis 200/3doses Sac lac 30/tds/15 days
2^nd prescription (27/09/19)	Sac lac 30/tds/15 days	No specific change
3^rd prescription (13/10/19)	Lachesis 1M/1dose Sac Lac 30/tds/15 days	No specific change
4^th prescription (30/10/19)	Sac lac 30/tds/15 days	Scaling and itching slight reduced
5^th Prescription ( 16/11/19)	Sac Lac 30/tds/15 days	No new lesions appeared. Existing lesions slightly reduced in size.
6^th Prescription (4/12/20)	Lachesis 1M/1dose Sac Lac 30/tds/15 days	No further improvement, so same medicine in same potency repeated.
7^th Prescription (21/12/20)	Sac Lac 30/tds/15 days	Much improvement. Scaling and itching less, lesions size decreased.
8^th prescription (13/01/2020)	Sac Lac 30/tds/15 days	Lesion size further decreasing, scaling improved and smaller lesions disappearing.
9^th Prescription (29/01/20)	Sac Lac 30/tds/15 days	Patient much improved
10^th Prescription (10/02/20)	Lachesis 10M/1 dose Sac lac 30/tds/15 days	No further improvement
11^th Prescription (26/02/20)	Sac lac 30/tds/15 days	Much improvement
12^th Prescription (12/03/20)	Sac lac 30/tds/15 days	Lesions almost disappeared
14^th Prescription (20/03/20)	Sac lac 30/tds/15 days	Lesions completely better

Patient followed for a further 3 months and no new lesions appeared.

Conclusion: In this case the correct medicine was selected based upon the keynotes. The concept followed was “Three legged stool” as stated by Dr. Hering. The higher potency (200C) was selected in this case. As stated by Dr. Stuart Close in The Genius of Homoeopathy, Chapter XIII, Homoeopathic Posology “The more similar the remedy, the more clearly and positively the symptoms of the patient take on the peculiar and characteristic form of the remedy, the greater the susceptibility to that remedy, and the higher the-potency required.”

REFERENCES:

Khanna Neena, Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases. 4^th New Delhi. Elsevier, a division of Reed Elsevier India Pvt Lts, 2011
Mayo Clinic. Psoriasis. Updated on 2020 May 02 [Cited on 2020 October 16]. Available from: https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845
Allen H.C. Keynotes and Characteristics with comparison of some of leading remedies of the Material Medica with Bowel Nosodes. 8^th edition (15^th impression). New Delhi. B Jain Publishers (P) Ltd. 2016
Close Stuart. The Genius Of Homoeopathy- Lectures and Essays on Homoeopathic Philosophy. New Delhi. Pratap Medical publishers Pvt Ltd

Before Treatment

1. 2.