Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.
Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes and results from the interplay of genetic, environmental, and immunological factors. Four decades of clinical and basic research on psoriasis have elucidated many of the pathogenic mechanisms underlying disease and paved the way to effective targeted therapies. Here, we review this progress and identify future directions of study that are supported by a more integrative research approach and aim at further improving the patients’ life.
As said earlier according to modern medical science the causes of psoriasis are unknown. But the following factors can trigger psoriasis.
- Heredity – If one parent is affected then there is 15% of chances for the child to suffer from psoriasis. If both the parents are affected then the possibility of a child getting the psoriasis is 60%.
- Throat infections trigger psoriasis.
- Trauma or hurt on the skin like cuts, bruises or burns may cause psoriasis.
- Some medicines or skin irritants initiate psoriasis.
- Smoking and alcohol are other two factors which activate psoriasis.
- Mental stress or psychological trauma may also set off psoriasis.
- Due to an abnormality in the mechanism in which the skin grows and replaces itself causes psoriasis.
- Abnormality with the metabolism of amino acids.
- Use of certain medicines.
- Due to infections.
- Heredity factors are also responsible.
- Physical and emotional stress.
- Diet- common in non-vegetarians.
- Weather- exacerbations in winters & remissions in summers.
- Hormonal- worse at or after menopause & remission during pregnancy.
Types of Psoriasis
The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis.
Plaque psoriasis (psoriasis vulgaris)
- Plaque psoriasis is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.
Flexural psoriasis (inverse psoriasis)
- Flexural psoriasis appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the breasts (inframammary fold). It is aggravated by friction and sweat and is vulnerable to fungal infections.
Guttate psoriasis
- Guttate psoriasis is characterized by numerous small round spots (diagnosis: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">differential diagnosis-pityriasis rose-oval shape ulcer. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।" data-rx-term="lesion" data-rx-definition="A lesion is an abnormal area of tissue such as a spot, wound, patch, lump, or ulcer. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।">lesion). These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. Guttate psoriasis is associated with a streptococcal throat infection.
Pustular psoriasis
- Pustular psoriasis appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasis can be localized, commonly to the hands and feet (palmoplantar pustulosis), or generalized with widespread patches occurring randomly on any part of the body.
Psoriasis of a fingernail
- Nail psoriasis produces a variety of changes in the appearance of finger and toenails. These changes include discoloring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail.
- Psoriatic pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">arthritis involves joint and connective tissue infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees, and spine (spondylitis). About 10-15% of people who have psoriasis also have psoriatic arthritis.
Erythrodermic psoriasis
- Erythrodermic psoriasis involves the widespread infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling, and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body’s ability to regulate temperature and for the skin to perform barrier functions.
Clinical classification of Psoriasis
Psoriasis is a chronic relapsing disease of the skin, which may be classified into nonpustular and pustular types as follows-
Nonpustular psoriasis
- Psoriasis Vulgaris (Chronic stationary psoriasis, Plaque-like psoriasis).
- Psoriatic erythroderma (Erythrodermic psoriasis).
Pustular psoriasis
- Generalized pustular psoriasis (Pustular psoriasis of von Zumbusch).
- Pustulosis palmaris et plantaris (Persistent palmoplantar pustulosis, Pustular psoriasis of the Barber type, Pustular psoriasis of the extremities).
- Annular pustular psoriasis.
- Acrodermatitis continua.
- Impetigo herpetiformis.
Additional types of psoriasis include
- Drug-induced psoriasis.
- Inverse psoriasis.
- Napkin psoriasis.
- Seborrheic-like psoriasis.
- Scalp, extensor surfaces of arms, forearms, legs, trunk, joints, nails, palms and soles.
There are several different types of psoriasis. Here are a few examples:
- Plaque psoriasis – which causes patches of skin that are red at the base and covered by silvery scales.
- Guttate psoriasis – which causes small, drop-shaped lesions on your trunk, limbs and scalp. This type of psoriasis is most often triggered by upper respiratory infections, such as strep throat.
- Pustular psoriasis – which causes pus-filled blisters. Flares can be caused by medications, infections, stress, or certain chemicals.
- Inverse psoriasis – which causes smooth, red patches in folds of skin near the genitals, under the breasts or in the armpits. Rubbing and sweating can make this type of psoriasis worse.
- Erythrodermic psoriasis – which causes red and scaly skin over much of your body. This can be a reaction to a bad sunburn or taking certain medications, such as corticosteroids. It can also happen if you have a different type of psoriasis that is not well controlled. This type of psoriasis can be very serious, so if you have it, you should see a doctor immediately.
Causes
- Infections.
- Stress.
- Changes in the weather that dry out your skin.
- Certain medicines.
- Trauma to the skin, such as cuts, scratches or sunburns.
Symptoms of Psoriasis
Psoriasis usually causes patches of thick, red skin with silvery scales that itch or feel sore. These patches can show up anywhere on your body, but they usually occur on the elbows, knees, legs, scalp, lower back, face, palms, and soles of feet. They can also show up on your fingernails and toenails, genitals, and inside your mouth.
- Red and irritated skin with bright silvery scales.
- Itching characteristically absent.
SKIN
- Start as dry, well defined erythematous papules.
- Symmetrical distribution.
- Coin-shaped (nummular psoriasis).
- Layers of silvery scales form.
- Papules increase peripherally and coalesce (psoriasis gyrate).
- Become thicker (due to the accumulation of scales) to form plaques.
- Candle-grease signs positive – when the psoriatic ulcer. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।" data-rx-term="lesion" data-rx-definition="A lesion is an abnormal area of tissue such as a spot, wound, patch, lump, or ulcer. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।">lesion is scratched, candle grease like the scale is produced even from non-scaling lesions.
- Scales looser towards the periphery of the patch, firmly adherent at center.
- Auspitz signs positive: – complete removal of scale produces pin-point bleeding.
- Koebner phenomenon positive in acute phase: – psoriatic lesions appear at the site of scratching or trauma.
- When patches reach a diameter of 5 cm: – central clearing occurs producing ringed lesions (annular psoriasis).
- Lesions heal with faint staining which disappears slowly.
NAILS
- Pits of 1 mm diameter.
- Transverse ridging of the nail plate.
- Onycholysis.
- Separation of the distal portion of the nail from nail bed and walls.
- Subungual hyperkeratosis causing thickening of nails.
- Oil drop sign: – brownish-red areas of discoloration adjacent to nail plate. Oil spots are 2-4 mm in diameter.
COMPLICATIONS
- Psoriatic arthropathy.
- Exfoliative dermatitis.
- Hypoproteinaemia.
COURSE
- Chronic, inconstant course.
- Remissions and exacerbations.
- The disease may remain localized to the original site of affection for an indefinite period, or completely disappear, recur or spread to other parts.
- Nail lesions are resistant to treatment.
- Prognosis variable.
Diagnosis of Psoriasis
A diagnosis of psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy, or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed Rete pegs if positive for psoriasis. Another sign of psoriasis is that when the plaques are scraped, one can see pinpoint bleeding from the skin below (Auspitz’s sign).
Treatment
There are several different types of treatment for psoriasis. Your doctor will work with you to decide on the best treatment for you, taking into consideration the type of psoriasis you have, where it is on your body, which treatment helps the most, and the possible side effects of medications.
People respond differently to treatment, so you may have to try a few different types of treatment before finding one that helps you. Your skin can also become resistant to treatment over time, especially if you are using corticosteroids, so you may have to switch treatments after a while.
Your doctor may recommend that you try one of these or a combination of them:
- Topical treatment – using creams or ointments such as corticosteroids, vitamin D3, retinoids, coal tar, or anthralin.
- Light therapy – or phototherapy, which involves having a doctor shine an ultraviolet light on your skin or getting more sunlight. It’s important for a doctor to administer the therapy, since too much ultraviolet light can cause skin damage, increase your risk of skin cancer and make your symptoms worse.
- Systemic treatment – which can include taking prescription medicines or getting injections of medicine. These treatments can have serious side effects, so it’s important to talk with your doctor and keep your appointments to monitor your condition. Here are a few medicines used to treat psoriasis.
- Retinoids – are compounds with properties similar to vitamin A. They may help some people with severe psoriasis who do not respond to other treatments. They can also cause birth defects, however.
- Cyclosporine – which suppresses the immune system to slow down cell turnover. It can also impair kidney function or cause high blood pressure, so patients should be monitored by a doctor.
- Methotrexate – also suppresses the immune system to slow down cell turnover. It can be taken as a pill or by injection. It can also cause liver damage and decrease the production of blood cells and platelets, so patients should be monitored by a doctor.
- PDE4 Inhibitors – Taken orally, phosphodiesterase 4 (PDE4) inhibitors target molecules inside immune cells to suppress the rapid turnover of skin cells and inflammation.
- Biologic -response modifiers are injections made from proteins produced by living cells. They suppress the immune system processes that cause the overproduction of skin cells and inflammation. Because they suppress the immune system, they increase the risk of infection and may interfere with patients taking vaccines. They have also been associated with some other diseases, so it’s important for a doctor to monitor patients taking biologics.
There are various treatment options for psoriasis
- Basic therapy (skin care): Care of the affected areas of skin using lipid-replenishing ointments, creams or lotions. This is done to keep the skin supple, protect it from injury and relieve itching. Some products also contain medications that are supposed to reduce sheddings, such as urea or salicylic acid.
- Topical treatment: Products containing corticosteroids or vitamin D analogs are typically used in topical treatment (treatment applied to the skin from the outside). These are available in the form of creams, ointments lotions or foams.
- Light therapy: Light therapy, also known as phototherapy, involves exposing the plaques to ultraviolet light (UV light). The UV light reduces inflammation in the skin, and also slows the production of cells. Sometimes medications called psoralens are used in combination with light therapy. Psoralens make the skin more sensitive to light. Light therapy is best suited for people who have moderate or severe psoriasis and in whom topical treatment alone wasn’t effective enough.
- Medications that are taken orally or injected: These medicines are a treatment option for moderate or severe psoriasis. They inhibit the body’s immune response. Methotrexate (MTX), fumaric acid esters, apremilast and biological drugs (biologics) are commonly used for this purpose.
Topical therapy
- Corticosteroids – Considered the cornerstone of topical treatment, corticosteroids are often well tolerated and effective for patients with mild psoriasis.[rx] Despite widespread use for more than half a century, large RCTs and head-to-head comparisons are rather limited. A Cochrane review of 177 RCTs, however, showed that corticosteroids performed at least as well as vitamin D3 analogs, with standardized mean differences ranging from −0.89 (95% CI −1.06 to −0.72) to −1.56 (95% CI −1.87 to −1.26) for potent and very potent corticosteroids, respectively.[rx] Overall, topical steroids in various formulations, strengths, and combinations are efficacious initial therapy for rapid control of symptoms. For instance, salicylic acid, a keratolytic agent, can be combined with steroid therapy to help treat plaques with thicker scales, for better penetration of medication. Although uncommon, long-term use is complicated by possible side effects of local skin changes, tachyphylaxis, and hypothalamic-pituitary-adrenal axis suppression.[rx]
- Vitamin D3 analogs – Calcipotriol, a vitamin D3 analog, is a first-line topical agent for treatment of plaque psoriasis and moderately severe scalp psoriasis.[rx] It reduces symptoms by modulating keratinocyte proliferation and differentiation, and by inhibiting T lymphocyte activity. Multiple randomized trials have shown calcipotriol to be safe and efficacious for patients with mild plaque psoriasis and not inferior to most corticosteroids with respect to efficacy.[rx],[rx] Further, a Cochrane meta-analysis of 177 RCTs showed that vitamin D3 analogs are more effective than all other topical medications, except the most potent of corticosteroids; standardized mean difference ranged from −0.7 (95% CI −1.04 to −0.30) to −1.66 (95% CI −2.66 to −0.67) for twice-daily becocalcidiol and once-daily paricalcitol, respectively.[rx] Given their efficacy and safety profile, vitamin D3 analogs are commonly used as monotherapy or, more often, as combination therapy. Side effects include mild irritant dermatitis and rarely hypercalcemia with excessive use. These agents should not be used in combination with salicylic acid or before phototherapy.
- Combination products – Combination of calcipotriol and betamethasone dipropionate was shown to be more effective for psoriasis than either monotherapy alone in a Cochrane review of 177 RCTs.[rx] Clinical trials have also demonstrated a reduced incidence of adverse events with concomitant or sequential use of vitamin D3 analogs and topical corticosteroids.[rx] Based on a systematic review of 6 RCTs with 6050 patients, the mean reduction in Psoriasis Area and Severity Index score at 4 weeks was 74% with combination therapy, compared with 59% and 63% with calcipotriol and betamethasone dipropionate, respectively.[rx] The combination gel is well tolerated and can be applied once daily, avoiding the facial, genital, and flexural areas.
Systemic therapy
- Phototherapy –Phototherapy is a mainstay treatment of moderate to severe psoriasis, especially in psoriasis that is unresponsive to topical agents.1 It is available as psoralen plus UVA, broadband UVB, and narrowband UVB (NB-UVB). Owing to its efficacy and safety advantages, as shown in multiple RCTs,[rx]NB-UVB therapy is often used as first-line treatment. In fact, NB-UVB therapy can be given to almost any patient, including children and pregnant women. There is no evidence that NB-UVB increases the risk of skin malignancy.[rx] Despite its safety, limited availability of phototherapy centers (fewer than 50 centers across Canada) and the need for frequent visits (3 times a week for 3 months initially) renders this option extremely inconvenient for patients.
- Acitretin – Acitretin is a synthetic retinoid indicated for the treatment of moderate to severe psoriasis. Its role as adjunctive therapy to other systemic agents has been well documented to enhance efficacy, lower doses, and reduce the occurrence of side effects.[rx]–[rx] However, large robust trials studying its efficacy and safety as monotherapy are lacking. Common side effects include mucocutaneous dryness, arthralgia, gastrointestinal upset, and photosensitivity. This medication can sometimes cause transaminitis and elevated triglyceride levels. Acitretin is a potent teratogen that is best avoided in women of childbearing age and potential; it is recommended that women not get pregnant for 3 years after discontinuing the medication.[rx]
- Methotrexate – Methotrexate is an inhibitor of folate biosynthesis, used for its cytostatic and anti-inflammatory properties in the treatment of moderately severe to severe psoriasis, as well as psoriatic arthritis.[rx] Despite substantial clinical experience with this drug, large robust studies of its efficacy and safety are extremely limited. One randomized, double-blind, placebo-controlled study showed 75% improvement in Psoriasis Area and Severity Index score in almost 40% of patients with methotrexate, compared with 18.9% of patients with placebo at 16 weeks.[rx] A well-known side effect is hepatotoxicity.[rx]Other more common side effects include nausea, vomiting, diarrhea, and fatigue.
- Cyclosporine – Cyclosporine is a calcineurin inhibitor indicated for the treatment of moderate to severe psoriasis.1 There is also some evidence for its efficacy in psoriatic arthritis.[rx] It has been shown to cause significant improvement or complete remission in 80% to 90% of patients within 12 to 16 weeks in a 1-year open, multicentre, randomized study with 400 patients.[rx] Advantages over other systemic agents include rapid onset of action and less concern about myelosuppression or hepatotoxicity. Adverse effects include nephrotoxicity, hypertension, elevated triglyceride levels, gingival hyperplasia, tremors, hypomagnesemia, hyperkalemia, numerous drug interactions, and malignancies such as skin cancers and lymphoma.[rx]
- Biologic therapy –Biologics have emerged as highly potent treatment options in patients for whom traditional systemic therapies fail to achieve an adequate response, are not tolerated owing to adverse effects, or are unsuitable owing to comorbidities.[rx] There is no single sequence in which biologics should be initiated or switched[rx]; however, a meta-analysis of pivotal phase III studies has shown that infliximab might be the most efficacious, followed by ustekinumab, adalimumab, and etanercept.[rx] Choice of therapy depends on clinical needs, benefits and risks, patient preferences, and cost-effectiveness (around $20 000 to $25 000 a year on average). Previous randomized trials and retrospective studies have shown that biologic therapy was not associated with an increased risk of malignancy or serious infection.[rx]
Prevention of Psoriasis
- Education.
- Reassurance.
- Avoid exposure to cold.
- The moderate, warm climate is beneficial.
- Adequate exposure to sunlight.
- Avoid undue stress.
- Diet – Avoid fats, highly seasoned and salty dishes.
- High protein diet (cut down animal protein).
- Avoid tea, coffee, alcohol.
- Maintain good hygiene.
- A hot bath in winter, drying, and oiling.
- Avoid all factors which trigger psoriasis.
- Reduce stress levels through meditation and Yoga.
- Do not prick, peel or scratch the skin. This may trigger psoriasis.
- After bath or wash, pat dries the skin. Do not rub the towel vigorously on the skin.
- Avoid soap. Instead, use gram flour (besan flour) as soap dries the skin.
- After washing, pat the skin dry, don’t irritate it by rubbing vigorously.
- Apply moisturizing creams liberally on affected areas after.
- Opt for cotton clothes over synthetic ones.
- Take a well-balanced diet including fruits, vegetables, nuts, seeds, and grains.
- Apply a moisturizer to lubricate and soften scaly patches of skin.
- Take a daily bath in warm water to soak off the scales.
- Try deep breathing and relaxation exercise to reduce stress.
- Do not take tea, coffee, all animal fats, and processed foods.
- Don’t scratch or rub patches of thickened skin.
- Avoid harsh skin products and lotions that contain alcohol. They may dry the skin and make psoriasis worse.
- Keep your towel, clothes separate and clean.
Homeopathy Treatment for Psoriasis
- Arsenic.
- Ars.iod.
- Borex.
- Calc.sulph.
- Chrysarobinum.
- Graph.
- Kali.ars.
- Kali.brom.
- Lyco.
- Merc.sol.
- Nit.acid.
- Petro.
- Psorinum.
- Sulph.
ARS-ALB.
- The appearance of the skin is dry, rough, scaly, dirty and shriveled. The eruptions are frequently acuminate with excessive scaling. There is a severe burning sensation in the eruption which is worse in the evening, at night and by cold application, it is better by warm application. Psoriasis has a tendency to alternate with internal affections.
Great Prostration, with rapid sinking of the vital forces; fainting. The disposition is
- Depression, melancholy, despairing, indifferent.
- Anxious, fearful, restless, full of anguish.
- Irritable, sensitive, peevish, easily vexed.
The greater the suffering the greater the anguish, restlessness, and fear of death. Mentally restless, but physically too weak to move. Indicated by its periodicity and time aggravation: after midnight, and from 1-2 a.m. And by its intense restlessness, mental and physical: its anxiety and prostration.
ARS-IOD
- The psoriasis is characterized by marked exfoliation of skin in large scales leaving an exudating surface beneath it. There is intense burning with itching. The patient scratches violently till it bleeds. The psoriasis is worse in dry cold weather, even though ars-iod is a hot patient, skin symptoms are better by local application of heat.
BORAX
- The skin of hands and face is covered with multiple psoriatic eruptions. There is furfuraceous peeling off of epidermis. The psoriatic lesions ulcerate easily, especially from slightest injury.
- Here the psoriasis is worse in warm weather and better in cold weather. There is a sensation of cobweb on the skin. It typically affects individuals who are excessively nervous, frightened easily and sensitive to sudden noise.
CALC-SULPH
- The psoriasis eruptions are chiefly located on the scalp, extremities, back. The appearance is scarlet red with lichenification of the surrounding skin. There are severe itching and burning which is worse in a warm room, from warm bath and better by cold application and cold bath.
- Due to the presence of secondary infection, the psoriatic eruptions suppurate, which heal with the formation of thick yellow scabs. There may be a greenish-yellow, acrid and offensive discharge.
CHRYSAROBINUM
- Psoriatic eruption especially around eyes and ears. There is the presence of violent itching with a tendency to formation of a thick crust. The lesions may get infected and can form an eczematous patch which is associated with acrid, foul smelling, pustular discharge.
GRAPHITES
- Folds of the skin. e.g., ears, buttocks, groins, bends of joints are the important site for an eruption. The eruptions are absolutely dry with little desquamation and more cracking. The cracks bleed very easily and exude gluey moisture. The eruptions are typically agg. With the local application of heat. The presence of psoriasis in persons who are obese, chilly and constipated. Psoriatic eruption alternating with digestive complaints.
- Suited to – Excessive cautiousness; timid, hesitates; unable to decide about anything. Fidgety while sitting at work. Sad, despondent; music makes her weep; thinks of nothing but death.
KALI-ARS
- It is one of the most chilly patients to develop psoriasis. The patient is extremely chilly that he wants to warm himself enough even in summer. There is the severe sensation of burning in lesion accompanied by intolerable itching which is worse undressing, night, walking, warmth.
- The eruption tends to be better during monsoon season. It typically affects individuals who are restless, nervous, anemic and they may have a family or past history of malignant disease.
KALI-BRO
- The eruptions are present on chest and back. The causative factor in the above case is ill-effects of worry, loss of business, loss of reputation and embarrassment, or illness of near or dear ones. As kali brom also has an affinity for the sexual sphere, ill effects of lascivious fancies, satyriasis or nymphomania, could produce a psoriatic eruption. The skin of the patient is cold and numb to feel. The patient, in general, feels well when he is busy mentally as well as physically.
- Adapted to large persons inclined to obesity; acts better in children than in adults. Loss of sensibility, fauces, larynx, urethra, entire body; staggering, uncertain gait; feels as if legs were all over the sidewalk. Nervous, restless; cannot sit still, must move about or keep occupied; hands and fingers in constant motion; fidgety hands; twitching of fingers. Fits of uncontrollable weeping and profound melancholic delusions. Loss of memory; forgets how to talk; absent-minded; had to be told the word before he could speak it. Depressed, low-spirited, anxious person.
LYCOPODIUM
- The appearance of the skin is dry, thick and indurated. The psoriatic eruptions are full of fissures with little itching and desquamation. The eruption tries to ulcerate early during the course of sickness. It typically affects individuals who grow old prematurely, who are intellectually keen, and who have ill-effects of fear, fright, anxieties, loss of vital fluids. The patient gets a good sense of relief whenever cold applications are applied to the lesion. However one should remember that burning sensation of lycopodium is always better by local application of heat. The psoriasis is associated with urinary, gastric and hepatic disorders.
MERC-SOL
- The skin has a general tendency to free perspiration, but the patient is not relieved thereby, the skin is always moist. The skin around psoriatic eruptions is excoriated like raw meat. The eruption are prone to early suppuration and ulcerations. There is a sense of itching which is worse at night in bed. Presence of psoriasis in individuals who have a history of suppressed gonorrhea.
NIT. ACID
- The skin is dry, eroded and cracked in every angle. Multiple psoriatic eruptions are present with zig-zag and irregular margin. The appearance of the lesion is like raw flesh. The cracks within the lesions ulcerate easily and are extremely sensitive to pain and touch.
- There may be the presence of burrowing pus within the lesion. The skin is extremely unhealthy and may have large jagged warts at various places. There may be itching in the lesions which are worse on undressing. It is suitable for individuals who have yellow discoloration, who are of spare habits and who have a tendency to catch a cold or diarrhea. Bad effects of, maltreated syphilis and gonorrhea.
PETROLEUM
- One of the chilly remedies with the tendency to develop deep cracks, in angles, nipples, fingertips. Psoriatic eruptions develop in the winter season and get aggravated periodically. Early formation of the thick, hard, yellowish green crust is the most characteristic symptom. The eruption itches violently and one must scratch until they bleed. The parts become cold after scratching. Psoriatic eruptions typically affect the occiput and the groins. The psoriasis is associated with long lasting and lingering gastric complaints. Psoriasis usually follows after unusual mental strains, fright, and grief. Also, psoriasis develops after skin diseases are suppressed by local applications.
PSORINUM
- The psoriatic eruptions disappear in summer only to occur in winter. The skin is dirty, rough, scabby and greasy. Nape of the neck, scalp, folds of the skin and groins are typically affected. Eruptions itch intolerably which are worse by the heat of bed. The patient scratch until it becomes raw and bleeds.
- It is usually indicated when well-related remedies fail to relieve or permanently cure or when sulfur seems indicated but fails to relieve. Psoriatic eruptions developing after maltreated infectious diseases or long lasting grief reactions. The patient is extremely chilly and hungry with foul carrion-like odor.
- Specially adapted to the psoric constitution. In chronic cases when well-selected remedies fail to relieve or permanently improve; when Sulphur seems indicated but fails to act. Lack of reaction after severe acute diseases. Appetite will not return.
SULPHUR
- The skin is dry, rough, wrinkled and scaly. The eruptions break out on almost any part of the body having the following characteristics. There is voluptuous violent itching which is aggravated at night, in bed, < scratching and washing. The skin burns whenever the patient scratches.
- The skin surrounding eruption is excoriated. Psoriasis usually gets worse during springtime and in damp weather. Psoriasis develops after any other skin disease is suppressed by local measures. Psoriasis alternates with various other internal ailments e.g. asthma. It typically affects individuals who are stoop-shouldered, unwashed, tall and lean, untidy with offensive body odor. It is to be thought of in chronic and obstinate cases of psoriasis or it should be given after an acute exacerbation of a psoriatic attack to prevent relapse.
References
