Abstract: Psoriasis is an autoimmune disease, thought to have a genetic predilection and triggered by environmental factors. There is no cure for psoriasis in conventional medicine, and those affected by it can have poor self image along with fear of public rejection. Coping with psoriasis can create stress and this can make the disease worse. The following case demonstrates the vicious cycle of psychological stress of disease
Key words: Psoriasis, psychological stress, Xanthoxyllum, Mezereum.
Psoriasis is a common, chronic, recurrent, inflammatory disease of skin characterised by rounded, circumscribed, erythematous, dry, scaling patches of various sizes covered with greyish white or silvery white, imbricated scales. The eruptions have predilection for scalp, nails, extensor surfaces, palms and soles. The lesions usually develop slowly with subjective symptoms such as itching or burning which may be very distressing and peeling can lead to significant pain and self-esteem issues. By far, the patient’s quality of life is affected most with plaque psoriasis. Self-consciousness and embarrassment about appearance, inconvenience, and high costs of treatment options all affect one’s outlook when living with psoriasis.
Complications of the disease are relatively uncommon. Many of the complications of plaque psoriasis are related to the treatments used for the disease. Systemic steroids (steroid pills or steroid injections) are not recommended in the routine management of psoriasis. They may appear to work very well, but once the medication is discontinued the patient may develop a much more severe form of the disease. These include pustular psoriasis or erythrodermic psoriasis (“red skin,” in which the entire skin becomes red, swollen, and painful). Oversensitivity to the sun is possible with many of the treatment options (especially phototherapy). The treatment is equally distressing and time consuming.
The lesions may disappear spontaneously or as a result of therapy, but recurrence is almost certain and there is a tendency for each medicine to lose its effectiveness gradually. Psoriasis is a stressful thing to deal with, and that can make managing it more difficult. For example, people with psoriasis may be uncomfortable exposing areas of their skin that show signs of the condition. It is a stigmatizing disease for many people because the lesions are sometimes quite ugly and visible to all. Someone with psoriasis might avoid wearing warm-weather clothing, instead choosing to sweat in long sleeves and pants because they want to hide their skin. People around you may not understand your condition and may be frightened by it. Their ignorance is hard to overcome. Psoriasis can make you feel deeply isolated and excluded, and that can have serious psychological costs. Coping with psoriasis can create stress and this can make the disease worse. Studies have shown that psoriasis detracts more from quality of life than any other condition except depression. The following case demonstrates the vicious cycle of psychological stress of disease
A 23 years old post graduate female student of commerce, of dark complexion and medium frame, came for consultation for her skin lesions. Her lesions started 3 years ago with small papules which progressed to hyper pigmented spots after topical application. There was itching in these spots and scratching led to bleeding. There were multiple coin shaped spots on the trunk, and bigger irregular pustular lesions below the umbilicus making her movements painful and restricted. She mentioned that the lesions seem to get worse before her menses and also on eating chicken, eggs and spicy food. She had been to many physicians for her ailment and tried many medicines without relief. Some of her lesions had healed with scaring and disfigurement. Besides the lesions she also complained of itching on scalp and dandruff.
With regards to her personal history she has marked craving for spicy food and is averse to sweet. Her perspiration is moderate of insignificant odour and stain. Her menstrual cycles are affected by her current allopathic medications. The flow has reduced from 9 days to 3 days. Dysmenorrhoea is severe, more so, on anticipating the flow. She was born and brought up in Mumbai and is good in her studies and currently doing her M Com. She wants to get an MBA degree in the future. Coming from vernacular school, she is trying hard to overcome the language barrier. She’s close to her mother and wants to support her family financially.
She mentioned very spontaneously that she has immense fear of water. She has been to beach only once, but looking at the waves and water she got scared and never went close to it. She is scared that she may drown in the water. She lives in Aarey milk colony where there are plenty of snakes, and she fears them a lot. She prefers staying indoors, spending time with her family especially her sisters. She has a peculiar quality that she can sit for hours alone staring blankly out of the window; this behaviour has become a habit since her lesions have worsened. She is quite particular about her belongings and keeps them neat and tidy. Her introvert nature is responsible for her not having many friends. She doesn’t talk much even with her sisters.
She is not finicky about her looks or appearance, but doesn’t like looking at the lesions. The lesions have made her more introverted, as she fears people may react adversely on seeing her skin. She prefers changing her clothes in darkness, even closes her eyes, so that she doesn’t have to look at her skin. She is quite depressed due to her ailment and not sure whether she will ever get better.
She had an episode of Chickengunia 5 years back and another attack of gall stone colic a year back. Thermal modality: Chilly.
Diagnosis: Psoriasis – A few lesions on trunk are gutate and the remaining lesions all over the body except on face are bigger and irregular with thick crust and scarring. Duration of illness is more than 3 years, during which she has undergone mainly allopathic treatment without any relief. Scarring seen over the larger patches is most likely due to topical applications. The lesions on her abdomen and hypogastrium are painful and limit her movements.
The first prescription was made keeping in mind the extreme fear of water and drowning, great depression of spirits and weakness, especially before menses and indifference and apathy about everything. She gets frightened easily, has many fears (phobias), in general. She was prescribed Xanthoxyllum 30 TDS. On the third visit, when the case failed to progress in a positive direction, (she also got new lesions) the case was reviewed.
The following rubrics were selected:
- [Complete ] [Mind] Dullness, looking out of window lasting for hours.
- [Complete ] [Mind] Indifference, dead everything seems, window looked hours at.
- [Complete ] [Mind]Fear: Water, of:
- [Complete ] [Mind]Fear: Drowned, of being:
- [Complete ] [Mind]Company: Aversion to, agg.: Alone: Amel. when:
- [Complete ] [Mind]Anxiety: Salvation, about:
- [Complete ] [Mind]Fear: Animals, of: Snakes, of:
- [Complete ] [Generalities]Darkness: Amel.:
- [Complete ] [Mind]Conscientious about trifles:
- [Complete ] [Mind] SADNESS, despondency, dejection, mental depression, gloom, melancholy.
- [Complete ] [Mind] TALK, indisposed to, desire to silent, taciturn.
- [Phatak ] [Phatak A-Z]Cravings: Condiments, spices, pickles:
- [Complete ] [Generalities]Food and drinks: Sweets: Aversion:
- [Complete ] [Female Genitalia]Menses: Scanty:
- [Complete ] [Generalities]Food and drinks: Chicken: Agg:
- [Complete ] [Generalities]Food and drinks: Eggs: Agg:
- [Complete ] [Generalities]Menses: Agg.: Before:
- [Complete ] [Skin]Eruptions: Psoriasis:
- [Phatak ] [Phatak A-Z]Skin: Shiny:
Sulph, Lyco, Nat Mur, Puls, Ignatia, Phos, Sep, Ars Alb, Lach, among other remedies that emerged after repetorisation did not seem to fit the case.
No rest when alone; wants to be in company; looks through window for hours without being conscious of objects around. Aversion to talk, it seems to be hard to utter a word. Indifference to everything and everybody; “Scars and birthmarks that dominate the way a person is perceived by his surroundings are a strong theme in Mezereum. The theme of feeling oneself wronged because of judgement only on appearances.” “Issues on the basis of which people are superficially judged or valued in society, like clothing and the house you live in, can be very important to Mezereum.” Vermulen F.
One important characteristic of the patient is her habit of looking out of the window without seemingly noticing anything. This perhaps implies the need for society without being looked on/ judged? Another characteristic is no courage to look at her lesion… she changes her clothes in total darkness so that even she cannot see her lesions, which speaks of deep seated mental trauma because of her skin condition. Mezerium 30 tds was prescribed on 27/8/2016.
Follow up summary:
|10/8/16||First prescription||Fear of water, of being drowned..||Xanthoxyllum 200 tds for 7 days.|
|19/8/16||Eruptions – agg|
New eruptions on face and forearm.
|Itching – initial amelioration and then agg.|
Sleep – disturbed due to itching.
|Xanthoxyllum 200 tds for 7 days.|
|27/8/16||New lesions on legs, painful. Stiffness all over the body – SQ.||Itching – SQ|
Sleep – disturbed due to complaints.
|Mezerium 30 tds for 7 days.|
|3/9/16||Eruptions – reduced in thickness, dryness – same.|
Not able to sit because of eruptions.
|Itching – 20% less. Stiffness – SQ.|
Constipation – needs to strain, hard stools.
|Mezerium 30 tds for 7 days.|
|22/9/16||Thickness of lesion – reduced, no discharge Sleep disturbed, wakes up several times at night, worried about exams.||Itching – SQ. Dandruff and hair fall +.|
Stools – no constipation.
|Mezerium 30 tds for 14 days.|
|13/10/16||Lesions seem to be same||Dandruff +||Mezerium 30 tds for 14 days.|
|2/11/16||Lesions dried up completely. Itching > 60%|
Burning – reduced
|Dandruff +, no hair fall|
All general – better
|Mezerium 30 tds for 14 days.|
|8/12/16||No itching, burning.||Dandruff – >>, hair fall +||Mezerium 30 tds for 14 days.|
|7/1/17||All lesions healed completely. Hair fall >90%||General – fine.|
Mentally – more confident.
|Rubrum 30 tds.|
Patient asked to report SOS as patient has no complaints
Patient has not reported any relapse to this day.