NHR Apr-Sept 2019: Effect of Individualized Homoeopathic medicine in Psoriasis: A Case Report

Effect of Individualized Homoeopathic medicine in Psoriasis: A Case Report


Hanuman Ram *1, Minakshi Kamboj 2

  1. Senior Research Fellow, CCRH Headquarters, New Delhi, Ministry of AYUSH, Govt. of India. Formerly PGT, Department of Materia Medica, Dr. MPK Homoeopathic Medical College, Hospital and Research Centre, A Constituent College of Homoeopathy University, Saipura, Sanganer, Jaipur (Rajasthan).
  2. PGT Department of Homoeopathy Philosophy, Dr. MPK Homoeopathic Medical College, Hospital and Research Centre, A Constituent College of Homoeopathy University, Saipura, Sanganer, Jaipur (Rajasthan).

*Correspondence: drhrchoudhary@gmail.com


ABSTRACT

Psoriasis is a disorder of the immune system. It is an inflammatory skin condition which affects around 3% of the population. It can affect any age-group but mostly between 11 to 60 years. The cause behind psoriasis is not well understood but it has been observed that various emotional factors such as stress, trauma, shock or deprivation are capable of triggering it. Homoeopathic medicines have been found to be useful in treating such cases. One such case, treated using homoeopathic medicines is presented in this paper with photographic evidence.  The patient was treated with constitutional homoeopathic medicine – Natrum muriaticum 30C followed by 200C potency with follow-up of 16 months. This case report suggests that constitutional homoeopathic medicine prescribed on the basis of totality of symptoms can be a promising treatment option for patients suffering from psoriasis.

Keywords: Psoriasis, Homoeopathy, Case report, Repertorization, Individualized Homoeopathic Medicine, Natrum muriaticum.


INTRODUCTION

Psoriasis is a chronic, non-communicable, painful, disfiguring and disabling autoimmune disease.[1] It can occur at any age and usually aggravates in winters.[1, 2]  Normally skin cells are formed at the bottom of the outer layer of our skin. These cells go through a cycle of change, moving upwards through the layers to the surface of the skin where they die and are shed within a period of three to four weeks. In psoriasis this process is sped up and cells go through this cycle within three to four days. Due to immune system overactiveness, the body starts attacking its own cells and tissues.[3] The lesions are pink-red, sharply demarcated papules and rounded plaques covered by silvery scales and it affects mostly elbows, knees, gluteal cleft, scalp and trunk area.[4] Psoriasis can be associated with an inflammatory arthritis known as psoriatic arthritis, which involves the joints of the spine and other areas.[1] About half of patients have finger nail involvement. The characteristic nail changes are punctate pitting (Thimble pitting),[5] onycholysis and subungual hyperkeratosis.[4] On scraping a psoriatic lesion, underneath the silvery scales, pin point bleeding can be observed at the base of the lesion. This sign is known as Auspitz’s sign. About 5-10% patients develop psoriatic arthritis. The different types of psoriasis are as follows – Psoriasis vulgaris, Guttate psoriasis, Flexural psoriasis, Pustular psoriasis and Plaque psoriasis. Here we are discussing a case of Plaque psoriasis – It appears in big patches of thickened skin usually with white/silvery scales on the elbows and knees, but also other parts of the body.[1]

CASE PROFILE

A male patient, aged 55 years, residing Sanganer, Jaipur reported to outpatient department of Homoeopathy University on November 5, 2017 with the complaint of red patches with white silvery scales on left ear, abdomen, back and anterior part of both legs since 4-5 years. Itching and burning which aggravates after exertion.

History of present Complaints: Patient was apparently well 5 years back. Gradually, he started developing red patches on legs followed by silvery scales with itching burning. Later, he observed the eruptions spreading other parts of the body like back, abdomen and left ear with itching, burning and soreness feeling after itching. There is also a history of allopathic treatment without any remarkable improvement.

Past History: Typhoid at the age of 25 years.

Physical generals:

  • Appetite: 3-4 chapatis, twice in a day.
  • Thirst: extreme, drinks more in short interval.
  • Desire: Nothing significant
  • Aversion: Nothing significant
  • Urine: Dribbling of urine after micturition
  • Stool: Regular but unsatisfactory stools
  • Sleep: Sound sleep (7-8 hours sleep), refreshing

Mental generals: Ailment after death of brother, Irritation from contradiction, Desire for company.

Family History: Elder brother died due to unknown cause 5 years back.

Totality of Symptoms:

  • Ailment after death of brother.
  • Irritation from contradiction.
  • Desire of company.
  • Thirst: extreme, drinks more in short interval.
  • Urine: Dribbling of urine after micturition
  • Stool: Regular, but unsatisfactory stools
  • Itching exertion after
  • White scaling on left ear, abdomen, back and b/l anterior part of leg.

Evaluation of symptoms:

  • Mental General: Ailment after death of Brother, Irritation from contradiction
  • Physical General: Thirst extreme, drinks more in short interval, dribbling of urine after micturition, unsatisfactory stool.
  • Characteristics particular: Itching after exertion, Eruption- white scaling

Prescription:

Natrum mur 30/1 dose, Placebo tds (thrice in a day) for 28 days

Repertorial sheet:

Follow-up:

 

        DATE                 SYMPTOMS        PRESCRIPTION
05/12/2017 Itching, burning in skin – better. All other complaints- status quo (S.Q.) Placebo tds for 28 days.
02/01/2017 Itching, burning in skin –better. Satisfactory stool. All other complaints S.Q. Placebo tds for 28 days.
30/01/2017 Itching, burning in skin– better. Satisfactory stool. Patches on back reducing. Patches on on  ear, abdomen and legs S.Q. Placebo tds for 28 days.
28/02/2017 Symptoms relapse. Itching, burning in skin reappear. Unsatisfactory stool. Patches on back, ear, abdomen and legs S.Q. Natrum mur 200/ 1 dose

Placebo tds for 60 days.

30/04/2018 Itching, burning in skin better. Satisfactory stool.  Improvement in patches on back but persisting same in ear, abdomen and legs. Placebo tds for 45 days.
15/06/2018

 

Patient had an episode of diarrhoea with cramps 10 days back. He had taken home remedies Itching, burning and in skin better. Dribbling of urine- better. Patches on back, ear, abdomen and legs –better. Placebo tds for 45days.
11/09/2018 All complaints are better. Placebo tds for 45 days.
30/10/2018 Symptoms relapsed. Dribbling of urine and  satisfactory stool S.Q. Itching, burning in skin  – S.Q. Patches on back, ear, abdomen and legs S.Q. Natrum mur200/ 1 dose

Placebo tds for 60 days.

1/1/2019 Dribbling of urine –better. Satisfactory stool. Itching, burning in skin – better. Patches on abdomen and back much better. Patches on ear and legs reducing in size with scaling. Placebo tds for 45days.
15/02/2018 Dribbling of urine –better. Satisfactory stool. Itching, burning and dry cracked skin – better. Patches on abdomen and back almost clear. Patches on ear and legs reducing in size with scaling. Placebo tds for 30days.
15/03/2019 Dribbling of urine –better. Satisfactory stool. Itching, burning and dry cracked skin – better. Patches and scaling on abdomen and back almost clear. Patches on left leg have marked improvement. Placebo tds for 30 days.

In this case report, Individualized homoeopathic medicine was prescribed after repertorization with the help of Synthesis repertory through RADAR Software.[6] The totality of symptoms comprising mental generals, physical generals and characteristic particular symptoms of the patient were taken into account and Natrum muriaticum 30C potency was prescribed followed by 200C potency. Regular follow-ups were done from Nov 5, 2017 to March 15, 2019, potency was increased when patient reached a stand-still condition after improvement in symptoms.

Assessment by Modified Naranjo score

S. No. Items Yes No Not sure /NA
1. Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed? +2
2. Did the clinical improvement occur within a plausible time frame relative to the drug intake? +1
3. Was there an initial aggravation of symptom? 0
4. Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed? +1
5. Did overall wellbeing improve? +1
6. Did the course of improvement follow Hering’s Rule? +1
7. Did old symptoms (non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement? 0
8. Are there alternate causes (other than the medicine) that-with a high probability could have caused the improvement? (e.g. known course of disease, other forms of treatment and other clinically relevant intervention) +1
9. Was the effect confirmed by objective evidence as measured by external observation(s)? +1
10. Did repeat dosing, if conducted, create similar clinical improvement? 0

The final score in this case was obtained using the Naranjo Criteria, as proposed by the HPUS Clinical data Working Group, March 15 2018. [7] The total score was 8 and this score suggesting a probable association between the medicine and outcome [definite: ≥ 9; probable 5-8; possible 1-4; and doubtful ≤ 0]. Reporting of this case according to Hom-CASE-CARE guideline. [8]

CONCLUSION

Homoeopathy is a system of medicine which treats the patient as a whole not a disease. In homoeopathy, the constitutional medicine is considered the best approach to treat a person. This case report is accompanied by photographic. The patient was treated with constitutional homoeopathic medicine – Natrum muriaticum 30C followed by 200C potency. Follow-ups through 16 months showed marked improvement in overall symptoms. This result corroborates the usefulness of individualized homoeopathic medicines as well as importance of repertory and repertorization in case of Psoriasis.

REFERENCES

  1. World Health Organization. Global Report on Psoriasis. 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/204417/9789241565189_eng.pdf?sequence=1&isAllowed=y [Accessed 29th Sep 2019].
  2. Khanna N. Illustrated Synopsis of Dermatology & Sexually Transmitted Diseases. 5th ed. New Delhi: Elsevier India Pvt Ltd; 2016.
  3. Wiessner A. Psoriasis. British Homeopathic Association. Available from: https://www.britishhomeopathic.org/charity/how-we-canhelp/articles/conditions/p/ psoriasis/ [Accessed 29th Sep 2019].
  4. Mathew K, Aggarwal P. Medicine Prep Manual for Undergraduates. 3rd ed. New Delhi: Elsevier India Pvt Ltd; 2008.
  5. Swash M. Hutchison’s Clinical Methods. 21st ed. Saunders Ltd; 2002.
  6. RADAR 10. Archibel Homoeopathic Software. Belgium; 2009.
  7. The Homœopathic Pharmacopœia of the United States. Draft HPCUS Clinical Data Guidelines. Available from: http://www.hpus.com/HPCUS-Clinical-Data-Guidelines-Draft-08-2018.pdf [Accessed 29th Sep 2019].
  8. Van Haselen RA. Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med. 2016; 25:78-85.
Cite this article as: Ram H, Kamboj M.  Effect of Individualized Homoeopathic medicine in Psoriasis: A Case Report. National Homoeo Recorder 2019; 15(2,3):

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