Psoriasis is an endogenous immune mediate condition(believed to be autoimmune) where there is increased epidermal cell proliferation which is result of excessive cell division in basal layers and transit time of keratinocytes through epidermis is reduced and reduced epidermal turnover from 28days to 5-6 days; its clinically characterized by well-defined erythematous plaques with silvery scales and flakes
A strong association has been noticed between certain loci on genome , many genes have been identified but still it remains unclearance how they all might be interelated
Most of the gene identified are related to MHC (Major Histocompatibility Complex) and T cells.
- 9 Loci on different Chromosomes are identified by Genome-wide linkage Analysis which are supposed to be linked with Psoriasis and named Psoriasis Susceptibility 1 to 9 (PSORS1 till PSORS9) within this locus are also found genes contributing in pathways of inflamation and certain mutations in this region have been found in psoriasis. Genome Wide Association Scan identified many other non-specific genes which are responsible in expressing inflamatory protiens which affects the cells of immune system which are also involved in psoriasis.
- PSORS1 is located on chromosome 6 in Major Histocompatibility Complex ; 3 Genes in this Locus are associated with Psoriasis vulgaris viz:- 1)HLA-C variant HLAC-w6 it encodes a MHC Class 1 Protien 2)CCHCR1 variant WWC it encodes coiled protein which if found to be overexpressed in epidermis of Psoriatic patch on skin.
- CDSN Variant allele5 which encodes Corneodesmosin it is expressed in Granular and Cornified layers of Epidermis and upregulated in Psoriasis.
- IL12β gene on chromosome 5q which expresses Interlukin12B(IL12B)
- IL23R gene on Chromosome 1p which expresses interlukin23 receptor and is inlolved in T cell differentiation;psoriasis is belived to be T cell medaited inflamatory condition.
- Both this above mentioned genes are also involved in upregulating Tumour Necrosis Factor α (TNFα) and Nuclear Factor κB.
- Gene encoding CARD14 is found directly linked to Plaque type Psoriasis; any mutation in this gene and environmental trigger causes plaque type psoriasis.
ii)Envirinmental and lifestyle
Harsh environment like excess of heat and cold, extreme dry wether, irregular diet and sleep pattern, excess of mental and physical stress, substance abuse, regular exposure to excess of chemicals and other pollutants etc have been associated with aggravations in those with prexisting psoriasis and precipitates in those genetic predesposition to develop psoriasis.
After infection with certain bacteria and virus its been observed that body develops an autoimmune state resulting into psoriasis.
Certain medicines induce it, like beta blockers calcium channel blockers , antihyperlipidaemic medications , captopril , anti malarials, lithium, NSAIDS, terbinafin, glyburide, interleukins, interferons , TNF inhibitors like infliximab and adalibumab, terbinafin , Granulocyte colony stimulating factor, glyburide, withdrawal of cortocosteroidal topical applications shows severe rebound aggravations.
TYPES OF PSORIASIS
OTHER MAJOR SUBTYPES :-
Generalised pustular psoriasis/pustular psoriasis of Von Zumbusch; during pregnancy its termed as impetigo herpetiformis
Any of above type may present with involvement of nail and joints and it will be termed as nail psoriasis and Psoriatic Arthritis respectively.
SIGNS & SYMPTOMS FOR DIAGNOSIS
Though all signs may not be present or common in every case and also many different type of psoriasis present in different manner but still there are few signs and symptoms ; the presence of which may help us in diagnosis.
Silvery adherent scales and flakes
Well defined margins
Itching irritation and pain restricted only on papuler/pustules /plaque
Red erythematous base with plaque above
Frequently observed cyclic pattern of eruptions
Extensor surface involvement
Auspitz’s sign ; there is pin point bleeding when the scale is removed
Koebner Phenomenon; in this we observe psoriatic lesions are induced at the site of trauma to the skin.
Common Homoeopathic medicines for Psoriasis
A constitutional approach is required in its treatment
Remedies are selected after proper case taking and repertorisation ; Few of the remedies frequently prescribed are
Sulphur is an elementary substance occuring in nature as a brittle crystalline solid. Sulphur was used as a most powerful specific against itch. Sulphur is a very beneficial remedy in Psoriasis and has marked affinity towards skin. Sulphur is the greatest antipsoric remedy for almost every kind of itch. Troubles of very long standing resulting from suppressed erruptions. Skin is usually dry, rough, scaly, with voluptous itching. Itching of whole body aggravated at night from warmth. Unhealthy skin, useful in dirty filthy people who are prone to skin infections. Severe burning after scratching. Painfully sensitive to warmth of bed causes severe itching.
Arsenic album is a very deep acting remedy affecting every organ and tissue. Arsenic is useful in case of psoriasis. Acting on skin Arsenic causes intense itching, burning of skin, with dry rough scaly erruptions worse from cold and scratching. Anxiety, restlessness, prostration, burning with cadaveric odour of body are prominent characteristics of Arsenic. The surface of the body is pale, cold, clammy. Erruptions cause intense burning is the marked general of Arsenicum album.
Phosphorous is suited to young people who grow rapidly and are inclined to stoop. Phosphorous causes degeneratiion and inflammation of mucus membrane. In case of psoriasis the erruptions are dry scaly with severe itching and bhrning of skin. Numbness and formication of skin. Most of the symptoms are aggravated by midnight. Phoshorous is usually suited to tall slender persons, with thin transparent skin weakened by loss of animal fluids with great nervous debility.
Silicea is one of the frequently indicated remedy in case of Psoriasis. The action of silicea is slow. Suited to complaints that develop slowly. Silicea is useful in psoriasis where the erruptions are dry, scaly, with coppery or silverish spots. Erruptions itch only in daytime and evening. Silicea mainly acts on constitution that are sluggish. Slow nutrition if the individual receives a slight injury it suppurates. Silicea hastens formation of abscess and boils. Sometimes Presents with moist scaly erruptions with severe itching.
Natrum muriaticum is another deep acting remedy which is very valuable in Psoriasis. The skin is greasy, oily especially on hairy parts. Dry erruptions especially on margins of hairy scalp and bends of joints. Crusty erruptions in bends of limbs, margins of skin folds, behind the ears. Presents with severe itching. Erruptions become raw red and inflammed by scratching.
Thuja has marked sphere of action on the skin. Thuja cheifly acts on the mucus membrane of skin, glands, gentitourinary tract. Remedy for soft tissue growths like warts. Thuja patient has characteristic picture in case of psoriasis. Presents with waxy shiny face often looks sick. The skin looks unhealthy everywhere about the body. Painful sensitivness of skin. Dry skin with brownish spots. Very sensitive to touch. Erruptions only on covered parts of the body which burn after scratching. Aggravation at night from warmth of bed.
Calcarea carbonicum is one of the polcrest remedies and usually ranks with sulphur and lycopodium at the head of antipsorics. Calcarea is a chief representative of calcium compounds. Calcarea carb is one of the efficient remedies in psoriasis. Muscles and skin of calcarea carb become lax and flabby. With tendency of patient to grow fat. There is flaccidity of skin from head to foot. Scaly or scaby erruptions. Skin is rough dry with burning pains. Very unhealthy skin, every little injury tends to ulcerate. Excoriation of skin in several areas with severe itching. Complaints worse from exertion and cold in every form.
Graphitis is a mineral carbon. The chief action of Graphitis is on skin, especially at the flexures, folds of skin, behind the ears. Graphitis produces thickening and induration of skin. Very efficient remedy in case of psoriasis. Thick crusts are formed on the skin and has tendency to produce excoriations, cracks or fissures at muco cutaneous junctions of eyes, nostrils, folds of skin etc. Erruptions are cracked, moist which bleed easily. Skin is dry rough, irritable that breaks open easily and exude a gluey moisture like discharge. Aggravation in folds and slow to heal. Moist crusty erruptions which are aggravated by heat. As per my clinical experience Very well indicated in women of climacteric age having palmoplantar psoriasis
Petroleum is one of the indicated remedies in psoriasis. Very marked skin symptoms. Skin is usually dry constricted, very sensitive, rough, cracked and leathery at times. Erruptions usually have thick, hard, yellowish green crusts. All erruptions itch violently and one must scratch until it bleeds. Parts turn cold from scratching. Great sensitiveness of skin Complaints worse during winter and relieved by warmth. Petroleum just like graphites has frequently given me very good results in palmo-plantar psoriasis.
Few solved Psoriasis cases at Dr. SHAH’s Homoeopathy with before and after pics in links below