A CASE OF ACUTE EXACERBATION OF CHRONIC PSORIASIS TREATED WITH MILLESIMAL POTENCY
DR. D.BHAVANI (PG SCHOLAR), DR.CH.SRINIVAS REDDY (H.O.D), DR.C.NANDA KISHORI (ASST. PROF.)DEPARTMENT OF PRACTICE OF MEDICINE
JSPS GOVERNMENT HOMOEOPATHIC MEDICAL COLLEGE HYDERABAD.

KEYWORDS: Psoriasis, Homoeopathy, Chronic plaque Psoriasis, Millesimal potency

ABSTRACT:
Psoriasis, a disease affecting the cellular degeneration and regeneration of the skin, is one of the major reasons for psychological disturbances in the majority of the population in today’s world. Homoeopathy has a lot to offer in such cases as it is found on the principles of the Holistic and individualistic approach. A male patient presented with complaints of acute aggravation of chronic psoriasis and fever. Based on acute totality, a drug was prescribed in centesimal potency, taking care of the fever. After detailed case-taking, the same drug was indicated. LM potency was selected to attain swift changes as we can repeat the dosage. There was marked improvement in the lesions thereafter.

INTRODUCTION:
Psoriasis is one of the leading causes of cosmetic distress in today’s world alongside eczema, acne vulgaris, and a few fungal infections. The basic pathology here is that the topmost layer of the skin is not shed off and the new layers keep forming leading to hyperkeratotic changes in the top-most layer of the skin. It presents clinically as erythematous scaly papules usually on the extensor surfaces except for inverse psoriasis which affects the flexor surfaces. It runs a chronic course with acute exacerbations where the lesions become intensely itchy and spread to newer areas agonizing the patient. Prevalence of psoriasis in different parts of the world varies from 0.1% to 3%. Onset of psoriasis is most common in the second to fourth decades of life though it can appear just after birth or in old age. A high familial occurrence of psoriasis (7% to 36%) suggests that genetic factors play a role in its etiology. Psoriasis occurs in equal frequency in males and females.

The most common variety of psoriasis is called plaque type. Plaque psoriasis generally develops slowly and symmetrically and runs an indolent course. Patients have stable, slowly enlarging plaques, which remain unchanged for long periods. The most commonly involved areas are the elbows, knees, gluteal cleft, and scalp. Conventional treatment: Most cases of localized, plaque-type psoriasis can be managed with mid-potency topical glucocorticoids, although their long-term use is often accompanied by loss of effectiveness (tachyphylaxis) and atrophy of the skin.

CASE SUMMARY
In this case of chronic plaque psoriasis, the patient has presented with an acute aggravation of chronic psoriasis with high-grade fever triggered due to cold exposure causing upper respiratory tract infection along with skin complaints. The drug was selected based on acute totality and was administered in 3 fractionated doses. It has brought down the fever and has also produced marked changes in the skin lesions. The major complaints of burning and itching which were presented with skin complaints have come down. On further inquiry, the patient said that the skin complaint had been recurring annually for the past 5  years and was triggered by emotional stress and cold exposure every time. On taking the totality of the case, the same drug was indicated. Since it helped to reduce lesions in centesimal potency, to obtain rapid and gentle results, 50 millesimal potency was chosen. Within a short time, marked improvement was seen.
Patient information:
A male patient of 38 years of age who is a known case of psoriasis has presented with complaints of fever with severe chills since one day. Ailments from cold exposure. Bilateral nasal block

1st attack: In 2019 – 2-3 months after his Mother’s death he was under financial stress and debt. He developed itchy, scaly eruptions on his head in November. He has taken allopathic medicines for 1 month after which the eruptions and itching came down. 

2nd attack: In 2020, the Eruptions again started in November. Constant financial stress and cold weather were the triggering factors Lesions on the head increased and new lesions spread to both elbows, the back of the trunk, and knees with itching and burning. He took allopathic medicine again for 2 months this time The itching came down to some extent and the lesions persisted thereafter, especially on the back.

3rd attack: In 2022, the itching and scaling of the skin started again in November due to cold weather The lesions were in the same location as the second attack. i.e., head, elbows, back of the trunk, and knees. The severity increased. He did not take any medicine this time. In January 2023, he had a clash with his family members regarding his financial state after which the scaling and itching intensified with new lesions appearing on his face and entire body. The itching and scaling of the skin increased. Itching and scaling of the skin on the face, head, elbows, back of the trunk and knees Since 1 month < night (6:30 pm, 12 am, Early morning) >hot water bathing+; scratching until it bleeds; Reduced appetite, Intolerance to cold air, Sleeplessness+ As a state, the patient is easily Angered on contradiction, Wants everything to go in his way Shouts out and sometimes hits others in anger, Drinks alcohol uncontrollably when angry or upset Desire for spicy food, Dreams of watching someone fight.

ON EXAMINATION:
Irregular, large, Scaly macular lesions with an erythematous base on the head, face, extremities, and back of the trunk.
No discharges.
Offensiveness+

DIAGNOSTIC ASSESSMENT:
The case was diagnosed as Chronic plaque psoriasis based on the history and clinical presentation.

TOTALITY OF CASE:
Ailments from losing money and financial debts
Anger on contradiction, wants everything in his way
Strikes when angry
Drinks uncontrollably when angry or disappointed
Dreams of fights
Desire for spicy food
Complaints appearing annually
Itching and burning all over the body scratching until it bleeds; hot water bathing;
Complaints associated with Reduced appetite since 1 month;
Intolerance to cold air for 2 months.

REPERTORIAL RESULT:
Nux vomica – 15/8
Verat. alb – 11/7
Ars. alb – 10/7
Lyco – 14/7
Dulc – 13/7
Staph – 13/7

THERAPEUTIC INTERVENTION:
Arsenicum Album 200 3 doses for fever. (increased thirst, fever spiking at noon - 12 PM, chills all over the body) Though Nux v and Verat. alb scored more than Ars. Alb, the latter was selected to continue the treatment as it helped in reducing the skin lesions to some extent when administered based on acute totality in centesimal potency. Arsenicum album 0/1, daily once, 1 pill in 1/4th cup of water, was administered according to Hahnemannian principles for 1 week. (Ailments from financial crisis, Alcoholism, itching and burning all over the body hot water bathing).

FOLLOW UP AND OUTCOMES:
DATE AND TIME SYMPTOMS TREATMENT
10-02-2023 At 1:15 pm

Chills all over the body wants
to cover always.
Fever < noon (12 PM)
Increased thirst since 1 day -
for small quantities often
Intense weakness
Burning and itching all over the body
TEMP – 101F
Arsenicum album 200 -1 dose
10-02-2023 At 6 PM Chills decreased
Burning all over the body is persistent.
Pt. feels better by 50% overall
TEMP – 100F
Arsenicum album 200 -1 dose
10-02-2023 At 1:30 AM Chills and weakness decreased
Pt feels better overall
TEMP – 99F
Arsenicum album 200 -1 dose
11-02-2023 At 7 AM Chills came down to maximum extent.
Weakness reduced
Burning and itching all over the body were relieved by 20%
TEMP – 98.4F
Sac lac every 2 hours
12-02-2023 At 7 AM No fever spikes again
Weakness improved.
Burning all over the body
reduced by 40%
Itching-30 % reduced and
scales also reduced on the face with no change in the extremities.
TEMP – 98.4F
Sac lac 3 doses
This was after giving Arsenicum album 200 3 doses for 1 day.

DATE SYMPTOM AND IMAGE TREATMENT
21-02-2023

Burning and itching of the upper and lower
limbs
Sac lac daily twice
24-02-2023 –
01-03-2023
Burning and itching of upper and lower limbs
27-02-2023 01-03-2023
Arsenicum album 0/1 daily
once in ¼ cup of water
07-04-2023 Feeling better with previous medication
No new lesions or itching
Ars. Alb 0/3 daily once for 7
days

DISCUSSION:
The case was presented with an acute exacerbation of a chronic complaint in which case, the exciting factor is considered according to aphorism 5 of the 6th edition of Organon of Medicine. Cold weather exposure, fever < 12 PM, burning and itching of lesions, chills, and thirst for small quantities of water at small intervals are considered, and Ars.Alb 200 was given. After the acute attack subsided, the totality of the case was extracted from the patient, and accordingly, Ars. Alb was selected even though it was not in the first place because it helped in reducing the skin lesions during acute attack when given in centesimal potency. The main indications for Ars. Alb were Ailments from the financial crisis, annual recurrence, Alcoholism, itching and burning all over the body hot water bathing. In aphorism 246 of the 6th edition of Organon of Medicine, Master Hahnemann wrote about the importance of repetition of medicine when it is homoeopathically indicated especially in chronic conditions. He also advocated that his new and renewed dynamization can help in achieving the desired result of rapid, gentle, and permanent cure by repeating the dose. This repetition is not possible with centesimal potency which makes LM potency a better choice in such cases. After starting millesimal potency, the lesions on the hands slowly started to disappear and then lesions on the legs started to disappear. The burning and itching of lesions came down slowly along with the lesions.
- Cure is from above downwards direction – head to toe
- Efficacy of millesimal potency and the repetition of the homoeopathic remedy in chronic conditions 15-02-2023 10-03-2023

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