Psoriasis and Homoeopathy

 

Psoriasis is an immune-mediated, noncontagious, genetic disease manifesting in the skin and/or the joints. Psoriasis is a, lifelong skin disease.

Causes of Psoriasis

These are unknown but it is believed to have a genetic component. Most researchers agree that the
immune system is somehow mistakenly triggered, which speeds up the growth cycle
of skin cells. A normal skin cell matures and falls off the body's surface in
28 to 30 days. But a psoriatic skin cell takes only three to four days to
mature and move to the surface. Instead of falling off, the cells pile up and
form the lesions.

 

Risk factors to trigger Psoriasis

1. Emotional stress
2. Injury to the skin
3. Some types of infection    and reactions to certain drugs
4. Stress can cause    psoriasis to flare for the first time or aggravate existing psoriasis.
5. Injured or traumatized
        areas. This is known as the "Koebner phenomenon." Vaccinations
6. Sunburns Scratches can all  trigger a Koebner response. The Koebner response can be treated if it is   caught early enough.
7. Certain medications,   like antimalarial drugs, lithium and certain beta-blockers, are also known    to cause people's psoriasis to flare.
8. Other triggers may     include weather, diet and allergies.
   Triggers will vary from person to person and what may cause one person's psoriasis to flare may
   produce no reaction in another individual.

Types of psoriasis

 There are five types of psoriasis.

1. Plaque: Most common form      of the disease
2. Guttate: Appears as      small red spots on the skin
3. Inverse: Occurs in     armpits, groin and skin folds
4. Pustular: White blisters      surrounded by red skin
5. Erythrodermic: Intense      redness over large areas

1- Plaque psoriasis

Plaque psoriasis is the most prevalent form of the disease. Its scientific name is psoriasis
vulgaris (vulgaris means common). It is characterized by raised, inflamed, red
lesions covered by a silvery white scale. It is typically found on the elbows,
knees, scalp and lower back, although it can occur on any area of the skin. 

It first appears as small red spots which may enlarge gradually into well-defined patches of
red, raised skin called either "plaques" or "lesions."

They are covered by a flaky, silvery white buildup called "scale," which is composed of
dead skin cells. This scale becomes loose and sheds constantly from the
plaques.

Psoriatic is generally very dry, and other possible symptoms include skin pain, itching and
cracking.

2- Guttate psoriasis

Guttate psoriasis often starts in childhood or young adulthood. The word guttate is derived from
the Latin word meaning "drop." This type of psoriasis resembles
small, red, individual spots on the skin. Guttate lesions usually appear on the
trunk and limbs. These spots are not normally as thick or as crusty as lesions
of plaque psoriasis.

Guttate psoriasis often comes on quite suddenly. It may be due to upper respiratory infections,
streptoccocal infections, tonsillitis, stress, injury to the skin and the
administration of certain drugs (including antimalarials and beta-blockers). A
streptococcal infection of the throat is a common guttate psoriasis trigger.
Strep throat can be present without symptoms and can still cause a flare of guttate
psoriasis. This type of psoriasis may persist despite clearance of the strep
infection.

This form of psoriasis may resolve on its own, occasionally leaving a person free of further
outbreaks, or it may clear for a time only to reappear later as patches of
plaque psoriasis.

3- Inverse psoriasis

Inverse psoriasis is found in the armpits, groin, under the breasts, and in other skin folds around the genitals and the
buttocks. This type of psoriasis starts as very red lesions and usually lack
the scale associated with plaque psoriasis. It may appear smooth and shiny.
Inverse psoriasis is particularly subject to irritation from rubbing and
sweating because of its location in skin folds and tender areas. It is more
common and troublesome in overweight people and people with deep skin folds.

4- Erythrodermic psoriasis

Erythrodermic psoriasis is a particularly inflammatory form of psoriasis that often affects
most of the body surface. It may occur in association with von Zumbusch
pustular psoriasis. It generally appears on people who have unstable plaque
psoriasis, where lesions are not clearly defined. It is characterized by
periodic, widespread, fiery redness of the skin. The erythema and exfoliation
of the skin are often accompanied by severe itching and pain.

Erythrodermic psoriasis can occur abruptly as the initial sign of psoriasis, or come on more
gradually in people with plaque psoriasis. Its causes are still unknown. But it
may be triggered by abrupt withdrawal of systemic treatment; the use of systemic
steroids (cortisone); an allergic, drug-induced rash that brings on the Koebner
response (a tendency for psoriasis to appear on the site of skin injuries); and
severe sunburns.

5- Pustular psoriasis

Primarily seen in adults, pustular psoriasis is characterized by white pustules (blisters of
noninfectious pus) surrounded by red skin. The pus consists of white blood
cells which is not an infection, nor contagious. It may be localized to certain
areas of the body–for example, the hands and feet. Pustular psoriasis also can
be generalized, covering most of the body. It tends to go in a cycle–reddening
of the skin followed by formation of pustules and scaling. It can appear
suddenly as the first sign of psoriasis, or plaque psoriasis can turn into
pustular psoriasis. 

Causes of Pustular Psoriasis

Pustular psoriasis has been triggered by internal medications, irritating topical agents,
overexposure to UV light, pregnancy, systemic steroids, infections, emotional
stress and sudden withdrawal of systemic medications or potent topical
steroids.

Several different types of pustular psoriasis exist. 

Types of pustular psoriasis

a- Von Zumbusch

The onset of von Zumbusch pustular psoriasis can be abrupt. Widespread areas of reddened skin
develop, and the skin becomes acutely painful and tender. Within as little as a
few hours, the pustules appear. The pustules then dry and peel over the next 24
to 48 hours, leaving the skin with a glazed, smooth appearance. A fresh crop of
pustules may then appear. Eruptions often come in repeated waves that last days
or weeks.

It can be triggered by an infection; sudden withdrawal of topical or systemic steroids;
pregnancy; and drugs such as lithium, propranolol (Inderal) and other high
blood pressure drugs, iodides and indomethacin.

It may appear in a person with history of plaque psoriasis. It is associated with fever, chills,
severe itching, dehydration, a rapid pulse rate, exhaustion, anemia, weight
loss and muscle weakness.

 

b- Palmo-plantar pustulosis

Palmo-plantar pustulosis (PPP) is a type of pustular psoriasis that generally affects people
between the ages of 20 and 60 and causes pustules on the palms of the hands and
soles of the feet. This type of psoriasis affects females more than males.

PPP is characterized by multiple pencil eraser-sized pustules in fleshy areas of the
hands and feet, such as the base of the thumb and the sides of the heels. The
pustules appear in a studded pattern throughout reddened plaques of skin, then
turn brown, peel and become crusted. The course of PPP is usually cyclical,
with new crops of pustules followed by periods of low activity.

 

c- Acropustulosis (acrodermatitis continua of Hallopeau)

This rare type of  psoriasis is characterized by skin lesions on the ends of the fingers and
sometimes on the toes. The eruption occasionally starts after an injury to the
skin or infection. Often the lesions are painful and disabling, producing
deformity of the nails. Occasionally bone changes occur in severe cases. This
form has traditionally been hard to treat. 

Psoriasis on specific skin sites

Psoriasis can occur on any part of the body. Psoriasis sometimes appears on the eyelids,
ears, mouth and lips, as well as on skin folds, the hands and feet, and nails.
The type of skin at each of these sites is different and requires different
treatments. The skin on the face is very different from the thicker, rougher
skin of the elbow.

a- Pustular psoriasis of the palms and soles

This form of psoriasis is characterized by white pustules surrounded by red skin. The pus is
not contagious. The lesions are most prominent on the palm toward the base of
the thumb, the fleshy part of the palm toward the ring and little finger, and
on the soles and sides of the heels. Often, the lesions are painful and
disabling. Plaque psoriasis can appear elsewhere on the body at the same time.

 

b- Psoriasis around the eyes

When psoriasis  affects the eyelids, lashes may become covered with scales, and the edges of
the eyelids may be red and crusty. If inflamed for long periods, the rims of
the lids may turn up or down. If the rim turns down, lashes can rub against the
eyeball and cause irritation.

Psoriasis of the eye is extremely rare. When it does occur, however, it can cause inflammation,
dryness and discomfort, and may impair vision. 

c- Psoriasis in the ears

Psoriasis in the ears can cause scale build-up that blocks the ear canal. This build-up may lead
to temporary hearing loss. Psoriasis generally occurs in the external ear
canal, not inside the ear or behind the eardrum.

d- Psoriasis in and around the mouth and nose

Rarely psoriasis lesions appear on the gums, the tongue, inside the cheek, inside the nose or on
the lips. The lesions are usually white or gray. Psoriasis in these areas can
be relatively uncomfortable, and can cause difficulty in chewing and swallowing
food.

e- Psoriasis in skin folds

Inverse psoriasis can occur in the armpits, groin, under the breasts and in other skin folds
around the genitals and buttocks. This type of psoriasis first shows up as
smooth, dry lesions that are very red. Inverse psoriasis is frequently
irritated by rubbing and sweating due to its location in skin folds and tender
areas.

f- Genital psoriasis

Psoriasis can occur in the genital area at the same time it occurs elsewhere on the body, or
it can appear in the genital area only. People with genital psoriasis may have
affected areas that range from small, red spots to large patches.

The most common type of psoriasis in the genital region is inverse psoriasis.

Affected areas

The six regions of the genital area that may be affected by psoriasis include:

1. pubis
       
2. upper
        thighs next to the groin - Psoriasis of the upper thighs often
        consists of many small, round patches that are red and scaly. Psoriasis in
        between the thighs may be more easily irritated if the thighs rub together
        when moving, walking or running
3. creases
        between the thigh and the groin
4. genitals
        themselves (the vulva, for women; the penis and scrotum, for men) -  In women, psoriasis of
        the vulva often appears as a smooth, nonscaly redness. If this sensitive
        area is irritated by scratching, it may become infected. Scratching also
        can produce dryness, thickening and further itching of the skin. Genital
        psoriasis usually affects the outer skin of the genitals. Mucous membranes,
        such as the vagina, are not normally affected by psoriasis–however, they
        can be. In general, genital psoriasis does not affect the urethra, the
        canal through which urine is expelled from the body.

In men, psoriasis of the penis may appear as many small, red patches on
the glans or shaft. The skin may be red and scaly, or it may be smooth and
shiny. Genital psoriasis affects both circumcised and uncircumcised males.

5. skin
        between the anus and vulva or anus and scrotum, and the skin around the
        anus –Psoriasis on or near the anus is red, no scaly and prone to
        itchiness. Psoriasis in this area may be confused with yeast, fungal
        infections, hemorrhoidal itching, strep infections and even pinworm
        infestations. The presence of these conditions can complicate the treatment
        of psoriasis, and make the psoriasis worse.
6. crease
        between the buttocks - Psoriasis in the buttocks crease may be red
        and nonscaly, or red with very heavy scales. The skin in this area is not
        as fragile as that of the groin.
   Genital psoriasis in children

Children my also have genital psoriasis. Itching can cause irritation, which may become infected.
Scratching also can produce dryness, thickening and further itching of the
skin.

g- Scalp psoriasis

Scalp psoriasis is very common. Like psoriasis elsewhere on the body, skin cells grow too quickly
on the scalp and cause red lesions covered with scale to appear. 

Scalp psoriasis can be very mild, with slight, fine scaling. It can also be very severe with
thick, crusted plaques covering the entire scalp, which commonly can cause hair
loss. Psoriasis can extend beyond the hairline onto the forehead, the back of
the neck and around the ears. Most of the time, people with scalp psoriasis
have psoriasis on other parts of their body as well. But for some, the scalp is
the only affected area.

 

Differential diagnosis of scalp psoriasis

 

Other skin disorders, such as seborrheic dermatitis, may look similar to psoriasis, but
there are differences. Scalp psoriasis scales appear powdery with a silvery
sheen, while seborrheic dermatitis scales often appear yellowish and greasy.
Despite these differences, the two conditions can be easily confused. 

h- Psoriasis of the nails

The nail problems most commonly experienced by psoriasis patients are: 

• Pitting—shallow or deep  holes in the nail
• Deformation—alterations  in the normal shape of the nail
• Thickening of the nail
• Onycholysis—separation of the nail from the nail bed
• Discoloration—unusual  nail coloration, such as yellow-brown

Special Conditions of Psoriasis

Conception, pregnancy and psoriasis

Psoriasis, in and of itself, does not affect the reproductive system of a woman or a man. Some
women report their psoriasis improves or worsens during pregnancy.

Psoriasis often changes because of pregnancy.

In the postpartum phase, psoriasis usually gets worse, most often within four months of delivery.

Psoriatic arthritis

Psoriatic arthritis is a chronic inflammatory disease of the joints and connective
tissue, was first described in 1818 by a French physician, Baron Jean Louis
Alibert.

About 10 percent to 30 percent of people with psoriasis also develop psoriatic arthritis, which
causes pain, stiffness and swelling in and around the joints. Both genetic and
environmental factors seem to be associated with the development of arthritis.
The immune system plays an important role.

Signs and symptoms

Psoriatic arthritis causes stiffness, pain, swelling and tenderness of the joints and the
tissue around them. Movement of the joint(s) may be difficult.

Some cases of psoriatic arthritis cause deterioration of the spine and deformity of the
joints, leading to disability.

It can develop slowly with mild symptoms, or it can develop quickly and be severe. Major
symptoms include-

 

1. Generalized fatigue
2. Tenderness, pain and
        swelling over tendons
3. Swollen fingers and toes
4. Stiffness, pain,
        throbbing, swelling and tenderness in one or more joints
5. A reduced range of
        motion
6. Morning stiffness and
        tiredness
7. Nail changes; for
        example, the nail separates from the nail bed and/or becomes pitted and
        mimics fungus infections
8. Redness and pain of the
        eye, such as conjunctivitis
9. The disease can develop
        in a joint after an injury and may mimic a cartilage tear.
10. Muscle or joint pain can
         occur without joint inflammation.
11. Tendonitis and bursitis
         may be prominent features.
12. Swelling of the fingers
         and toes can suggest a "sausage-like" appearance.
13. Psoriatic arthritis
         affects the distal joints in fingers or toes. The lower back, wrists,
         knees or ankles also may be affected.

 

Types of Psoriatic Arthritis

There are five
types of psoriatic arthritis:

1. Symmetric
2. Asymmetric
3. Distal interphalangeal   predominant (DIP)
4. Spondylitis
5. Arthritis mutilans.

1- Symmetric arthritis

This form of  psoriatic arthritis is much like rheumatoid arthritis but generally milder with
less deformity. It usually affects multiple symmetric pairs of joints (occurs
in the same joints on both sides of the body) and can be disabling. The
associated psoriasis is often severe.

2- Asymmetric arthritis

Asymmetric (not occurring in the same joints on both sides of the body) arthritis can involve a
few or many joints. It can affect any joint, such as the knee, hip, ankle or
wrist. It could involve just one finger or a number of them. The hands and feet
may have enlarged "sausage" digits. The joints may also be warm,
tender and red. Patient may experience periodic joint pain.  

3- Distal interphalangeal predominant (DIP)

This form of arthritis, although the "classic" type, occurs in only about 5
percent of people with psoriatic arthritis. Primarily, it involves the distal
joints of the fingers and toes (the joint closest to the nail).

4- Spondylitis

In about 5 percent of individuals with psoriatic arthritis, inflammation of the spinal column is
the predominant symptom. Inflammation with stiffness of the neck, lower back,
sacroiliac or spinal vertebrae are common symptoms in a larger number of
patients, making motion painful and difficult. Peripheral disease can be
present in the hands, arms, hips, legs and feet. Spondylitis, when severe, may
be associated with generalized symptoms.

 

5- Arthritis mutilans

This is a severe, deforming and destructive arthritis that affects fewer than 5 percent of people
with psoriatic arthritis. It principally affects the small joints of the hands
and feet, though there is frequently associated neck or lower back pain.
Arthritic attacks and remissions tend to coincide with skin flares and
remissions. 

Differential Diagnosis of Psoriatic Arthritis

1. Bursitis: Inflammation
        of a bursa, a small sac of fluid that cushions and lubricates an area
        between tendon and bone or around a joint
2. Tendonitis: Inflammation
        of a tendon, a ropelike fiber that connects muscle to bone
3. Gout: Disease
        caused by deposits of uric acid crystals in the joints; characterized by
        pain, swelling, redness, heat and stiffness in a joint or joints
4. Reactive
        arthritis: Form of arthritis that, in addition to joints, can affect the
        eyes; typically is triggered by an infection
5. Rheumatoid
        arthritis: Inflammation of membranes or tissues lining the joints; over time,
        the inflammation may destroy the joints
   
   

Psoriatic arthritis can develop without the skin lesions characteristic of psoriasis or
the nail changes. Generally, psoriasis appears before the arthritis.

 

Therapeutics

Synthesis Repertory- SKIN - ERUPTIONS – psoriasis with remedy
grades-

alum.-1       am-c.-1       ambr.-1       ant-t.-2       ars.-2       ars-i.-3       ars-s-f.-1       ars-s-r.-1       aur.-1       aur-ar.-1       bell-p.-1       berb-a.-1       borx.-1       bry.-1      bufo-1       calc.-2       calc-s.-2       canth.-2       carb-ac.-1       carb-v.-1       chin.-2       chrys-ac.-2       chrys-ac.-2       cic.-1       clem.-2       cor-r.-1       cupr.-1       dulc.-1       gali.-1       graph.-2       hydrc.-1       iod.-1     

iris-2       kali-ar.-2       kali-br.-1       kali-c.-2       kali-p.-1       kali-s.-2       led.-1       lob.-2       lyc.-3       mag-c.-1       mang.-2       merc.-2       merc-c.-1       merc-i-r.-1       merc-k-i.-1       mez.-2       naphtin.-1       nat-m.-1       nit-ac.-2       nuph.-1       petr.-2      ph-ac.-1       phos.-2       phyt.-3       pix-1       psor.-2       puls.-2       rad-br.-1       ran-b.-1       rhus-t.-2       sars.-2       sep.-3       sil.-2       staph.-1       stel.-1       still.-1       sul-i.-1-       sulph.-2       tell.-1-       teucr.-1-       thuj.-1       thyr.-1       tub.-1       x-ray-1