Dr Sushmita Mudenur
Psoriasis is a non-infectious chronic skin condition, occurs due to interaction of both genetic and environmental factors. The prevalence of psoriasis has been increasing in recent years. Palmoplantar psoriasis is a variant of psoriasis which affects skin of palms and soles and this type of psoriasis is very common among Indian children which can be explained by the practices of walking barefoot and increased incidence of injuries. A male child, aged 6 years presented with the complaint of Peeling of skin of hands and feet, since 9 months increased since 4-5 months. Homoeopathic medicine Staphysagria was selected and administered on the basis of individualised case analysis. It shows the positive effect in the treatment of Palmoplantar psoriasis.
KEYWORDS – Homoeopathy, Palmoplantar psoriasis, Staphysagria
Palmoplantar psoriasis can occur as a part of more general plaque psoriasis. The symptoms include- well-defined areas of raised, thickened skin, redness and scaling, an itchy and burning sensation, pain, cracking and bleeding, small pustules, pitting, ridging, and thickening of the nails, the patterns may be symmetrical, for example similar on both hands.3
The important diagnostic points for psoriasis includes- Auspitz sign pinpoint bleeding spots following removal of yellowish white scale, pitting of the nailplate, Koebner or isomorphic response, i.e., appearance of fresh lesions at the site of trauma.4
Homoeopathic treatment focuses on the patient as a person as well his pathological conditions. Homoeopathic medicines target the immune system and works at the nanomolecular level and help the immune system to set right the misplaced defense attacks and slowly stimulates the immune system to function physiologically. Following case represents the importance of homoeopathic treatment in palmoplantar psoriasis.
A male child, aged 6 years , brought to the outpatient department of government homoeopathic medical hospital , Bengaluru ,by mother on 29/9/2019 , with the complaint of Peeling of skin of hands and feet , since 9 months, increased since 4-5 months.
HISTORY OF PRESENTING COMPLAINTS
Informant – Mother
Gradually patient developed peeling of skin since 9 months. Probable exciting cause was not known. First it started on ,,,,Course – Right hand » Lt hand » Lt foot » Rt foot. Itching +++ and slight burning sensation , wants to scratch all the time , after scratching there are cracks with bleeding spots on palms and soles , after some days healing of red bleeding spots with mild thickening of skin.
Peeling of skin – in white scales < after scratching >Cold application
Negative history – No particular triggering factors, no history of contact with irritants, No history of – allergic complaints , urticaria , asthma ., no history of dehydration , no other repeated respiratory complaints , no fever , no climate variations , no joint pains
|Location (with duration, extension, radiation etc)||Sensation (with pathology)||Aliments from / Modality||Concomitants|
|Palms and surrounding finger nails, and on soles and on the toes of the feet (since 9 months ).
Course- Right hand » Lt hand » Lt foot » Rt foot
Cracks and bleeding spots
Mild thickening of skin
|< after Scratching
> cold application
TREATMENT HISTORY- Previously on allopathic treatment for presenting complaints (for 3 months ), at present since 1 month not taking any medications.
PAST HISTORY– No other major illnesses in the past
FAMILY HISTORY– Father- HTN, Mother- Hypothyroidism, MGM-Psoriasis, MGF-HTN, PGF- DM and HTN, PGM- OA and DM.
PHYSICAL GENERALS-Appetite was adequate, child was extremely thirstless, had desire for chocolates, thermally he was chilly, bowel movements were regular. micturition was 6-7 / 0-1 D/N, sleeps on abdomen, generalized perspiration.
LIFE SPACE INVESTIGATION- The boy is from a middle class family. Born and brought up in Bengaluru. He stays with mother and with younger sister. He was more attached to father but since 2 years he is staying away from his father because of some familial issues. Two years back some fight happened between mother and father so that they got separated, this incident affected him a lot. He remembers his father often but does not share this to anyone. He is more matured than his age, consoles mother about life and about his complaints. He is very much sensitive to sayings of others. In school he is active having good memory.
LOCAL EXAMINATION OF THE LESIONS-
Hands – Pitting nails , Scaling around finger nails
Palms – Silvery white scaling of skin, red spots and cracks in the fingers, Skin is slightly thick and rough
Feet –Scaling on toes of both the feet
Soles- Silvery scales , cracks
RESULT AND DISCUSSION
After the first prescription, there was improvement in the first month of treatment itself. As shown in Figure-3 (Pictures taken on 14/10/19) burning and itching sensation reduced, there was slight increase in the lesion of the feet. In the beginning of 2nd month patient was 50% better scaling, itching, burning was reduced with reduction in the size of the lesions as shown in the figure- 4 (Pictures taken on 1/11/19). In the 3th month further improvement in lesions was noticed as shown in the figure-5 (Pictures taken on 2/12/19). In the 4th month visit psoriatic eruptions over the palms and soles were completely healed with normal skin layer as shown in figure- 6 (Pictures taken on 3/1/20). The patient was followed up after one year there was no history of any recurrence of the complaints after the treatment.
Palmoplantar psoriasis can be successfully treated with Homoeopathic medicines based on detailed individual case analysis. Homoeopathic treatment has shown the ability to treat psoriasis internally and removes predisposition state to the psoriasis.
DECLARATION OF PARENTS CONSENT – Parents consent was taken for images and clinical information to be reported for this article.
- Gupta Piyush, Menon PSN, Ramji Siddarth, Lodha Rakesh. PG Textbook of Pediatrics, 2nd/e.Jaypee Brothers Medical Publishers (P) Ltd. New Delhi; 2018; Vol(3)p3109-3110.
- Venkatesan A, Aravamudhan R, Perumal SK, et al. Palmoplantar Psoriasis-Ahead in the Race-A Prospective Study from a Tertiary Health Care Centre in South India. J Clin Diagn Res. 2015;9:WC01-WC03. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413136/
- Gupte Suraj.The short textbook of Pediatrics ,12/e.Jaypee Brothers Medical publishers (p) Ltd.New Delhi 110 002 India. 2016; p721
Dr. Sushmita Mudenur
MD Part II -PG Department of Paediatrics,
Government Homoeopathic Medical College & Hospital, Bengaluru