Prof G R Mohan
M D (Hom) PG dip (Env Stud)
Principal, Devs Homoeopathic Medical College, RR District, Hyderabad.
Visiting Professor (PG) Vinayaka Homoeopathic Medical College, Salem, TN
Email : firstname.lastname@example.org
Introduction: The Guttate form of psoriasis is the second most common form of psoriasis. About 2% of those with psoriasis have the Guttate type. This type of psoriasis is more common in children and adults younger than 30 years. In US, the Guttate form of psoriasis is relatively uncommon, occurring in less than 2% of the psoriatic population.6
Case presentation: Pt by Name Mr SC, Male Gender with 17years case of Guttate Psoriasis successfully treated with Nat Muraticum.
Conclusion: In conventional system of medicine treatment is very less; In Homoeopathic system psoriatic skin diseases can be treated successfully. A Guttate form of psoriasis treated with Nat Muraticum with evidence based study. Without any recurrence is presented below.1
The cause of psoriasis is not fully understood. There are two main hypotheses about the process that occurs in the development of the disease. The first considers psoriasis as primarily a disorder of excessive growth and reproduction of skin cells. The problem is simply seen as a fault of the epidermis and its keratinocytes. The second hypothesis is believed to result from an immune reaction triggered by a previous streptococcal infection in a genetically susceptible host. An autoimmune phenomenon has also been postulated for Guttate psoriasis because some streptococcal products and components have been found to cross-react with normal human epidermis2,3.6
Perianal streptococcal infections, which often present with chronic pruritus of the anus in children, have also been associated with Guttate psoriasis. The following organisums are associated ,Staphylococcus aureus, Bacteria, Fungi -Malassezia, Candida Fungi and Human papillomavirus , retroviruses, human endogenous retroviruses.6
The onset of the Guttate psoriasis skin lesions often is acute, with multiple papules erupting on the trunk and the proximal extremities, the lesions may sometimes spread to involve the face, the ears, and the scalp. The palms and the soles are rarely affected in Guttate psoriasis .Nail changes in the form of pits, ridges, and the oil-drop sign, which are characteristic of chronic psoriasis, may be absent. The lesions are often accompanied by slight pruritus. In most cases of Guttate psoriasis, a history of an antecedent streptococcal infection, usually of the upper respiratory tract, such as pharyngitis or tonsillitis, 2-3 weeks prior to the eruption can be elicite 2.3.6
The degree of severity is generally based on the following factors: the proportion of body surface area affected; disease activity (degree of plaque redness, thickness and scaling); response to previous therapies; and the impact of the disease on the person. Psoriasis is graded as mild (affecting less than 3% of the body); moderate (affecting 3-10% of the body) or severe several scales exist. The Psoriasis Area Severity Index(PASI) is the most widely used measurement tool for psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease).7
Since in conventional medicine has a very limited role to play in Psoriasis, Homoeopathy comes as a rescue not only as a palliative but also as a curative in a vast majority of cases. In certain obstinate cases it is difficult to achieve the cure.skin diseases can be considered as external manifestations of internal diseases,to treat diseased skin successfully we must treat the patient as a whole as skin eruption is mearly an effect, the outward and visible sign of an internal dynamic derangement. These diseased conditions have developed as an expression of the inward turmoil and distress under which the whole individual suffers. They come under local maladies which are one-sided diseases. Treating with external ointments is not a treatment in long run skin diseases will be suppressed leads to a chronic problems.5
“No greater crime can be committed against the human economy than to aid and abet these suppressions. Suppression is the source of many functional disturbances.”
– Dr. H. A Roberts [The principles and art of cure by Homoeopathy]4
Skin is a superficial subject, and being an ectodermic structure takes time to heal; treatment must be individualized to suit every patient and great care should be exercised in prescribing the right constitutional remedy. The causation is always to be carefully investigated. Along with Re-assurance to the patient, he should be advised to continue the treatment till the last lesion has disappeared. The general health of the patient should be maintained by good natural diet and the exciting causes should be studied and eliminated as far as possible. Undue stress affects either body or mind should be avoided.
Guttate psoriasis is a nonfatal eruption that either can run a limited course over several weeks to a few months or can develop into the chronic plaque-type of psoriasis Scarring is not a problem. Previously affected areas may show post inflammatory hypo pigmentation or post inflammatory hyper pigmentation.
Key words: Psoriasis, Guttate psoriasis, Homoeopathy, Natrum Muraticum
Case presentation :
Pt by Name Mr SC, Male Gender with 17years came to me on 24/9/2010.
Presenting complaints: Eruptions over trunk, limbs, thighs with itching 14 months duration
H/o Presenting complaints: small multiple eruptions over trunk, limbs, thighs with itching, Perspiration < itching, > cold air, < sun > cold bathing, hard stools, bowels constipated, pain after passing stools. Aversion to curd
Past history: Past history of throat infection, suffered with enteric fever used antibiotics.
Past treatment history: Took Allopathic and homoeopathic treatment for same complaints.
Family history: Mother and aunt suffering from dermatitis.
Desires: Nothing Particular
Aversions: – Curd
B/M: constipated, hard stool, pain after passing stools.
Sleep: disturbed due skin problem
Life space investigation: patient one of the two children of upper middle class family. Was good at education, had good childhood and adolescence period with few throat problems for which he took conventional medicine. Presently studying Batch course at Hyderabad.
General physical examination:
Provisional diagnosis: Guttate form of psoriasis (as it was diagnosed by a local Dermatologist.)
Investigations of significance: NP
Clinical diagnosis: Guttate form of psoriasis
Clinical classification: Dynamic chronic fully developed miasmatic disease
Miasmatic diagnosis: Psora, Sycosis, Syphilis
Totality of symptoms: A shown in reportorial chart
Repertorial totality: A shown in Repertorial chart
Repertorial result: Nat Mur 21/9. Sulphur 20/8, Lycopodium 19/8,
Analysis of repertorial result:
Reasons for selecting the remedy: The reasons for selecting Natrum Mur are the irritability was present in sulphur, pulsatilla and Lycopodium; three out of four generals were present in all above remedies. Itching < perspiration not covered by sulphur, pulsatilla and Lycopodium. Hence Natrum Mur selected. Face was Greasy, oily, with dry eruptions.1
Treatment and follow-up:
First prescription: 24/09/06: Nat Mur 0/6 5doses were given on the bases of Repertrisation as show in Repertrisation chart shown below. Rubrum one dose twice a day was given for 10 days.
07/10/06 itching was reduced: rubrum for 15 days was given.
21/10/06: patient returned with slight itching; Nat Mur 0/6 5doses were given, Rubrum one dose twice a day were given for 10 days
03/11/06: bowel movement was normal, hair loss was present, and rubrum for 15 days was given.
18/11/06: skin is better, bowel movement was normal, sleep: refreshing, appetite: good; rubrum for 15 days was given.
02/12/06: skin is better, bowel movement was normal, sleep: refreshing, appetite: good; rubrum for 15 days was given.
16/12/06: skin is better bowel movement was normal, sleep: refreshing, appetite: good; rubrum for 15 days was given.
01/01/07: skin is better; Sulphur 0/1 in water was given. For 11 days and rubrum for one month was given.
15/06/07: patient came with fever, skin was better except pigmentation.
Nat. Mur. Is a deep acting, long acting remedy? It gave good result in the above case. There was gradual improvemt as show in the visual taken from 24/09/06 to 15/06/07. Even recurrent pharyngitis was cured. Except the intensity of irritability all the 8 symptoms were relived. This evidenced based example how homoeopathy can cure a rare varity of Guttate psoriasis. The Psoriasis Area Severity Index also came down.
Authors’ information: www.drgrmohan.com
Acknowledgements : I thank the patient for the cooperation he has extended during the time of treatment.
Marks. R, Roxburgh’s Common Skin Diseases, 16th Edition, Chapman & Hall Medical, London [page no.124-140]
Behl. P.N., Practice of Dermatology, Eighth Edition, CBS Publishers & Distributors, New Delhi, India [page no.253-260]
Parthasarathy, Vishpala et al, Psoriasis. National journal of homoeopathy 1995 Jul/Aug vol iv no:4
Roberts. A Herbert, The Principles and Art of Cure by Homoeopathy
1996 Reprint Edition, B. Jain publishers Pvt. Ltd, New Delhi, India.
Guttate Psoriasis, Cary Chisholm, MD