Transcript Slide 1

Evidence based cure of
Psoriasis cases
Prof G R Mohan
MD(Hom),PG Dip(Env Stud)
Principal, Devs Homoeopathic Medical College,
[email protected]
www.drgrmohan.c
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Prof G R Mohan
Skin disease infrequently kills,
But Often produces
unhappiness,
Usually loss of work and social
Deprivation as well as
considerable
Physical discomfort.
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Physician should know
what not to do in treating
skin diseases
is an important thing to
know.
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Concentration comes
out of a combination
of confidence and hunger
-- Arnold palmer
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Hahnemann's rule to treat
the totality of symptoms
complained of by the patient,
the only method by which
we may cure our patients.
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How patients come to us
1. Skin eruption that has been
for years with Cortisone used
suppressed eruptions.
2. Eruptions cured earlier and
suffering from various other
problems.
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If Skin eruption that has been for
years and suppressed with
Cortisones
Prescribe best indicated remedy
based on the generals, mental
emotional and on skin problems.
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If Eruptions cured earlier and
suffering from various other
problems
If eruptions are treated, there
will be problems
• The organism should be
stimulated by right remedy to
evoke a skin eruptions
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Body must be left to fight the eruptions it self.
How long to leave the eruption ?
It depends up on the severity.
If treated earlier for cosmetic reasons or itching
The case will be spoiled . Case will be partially
suppressed with half the eruption being driven
inside and other half reaming on the skin
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Psoriasis
Psoriasis is a common , genetically
determined,
inflammatory
skin
disorder of unknown cause which in its
most usual from is characterized by
well-demarcated raised red scaling
patches that preferentially localize to
the extensor surface.
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Pathophysiology
• The keratinocytes hyper proliferation
due to excessive division of cells in the
basal layers.
• Epidermis and dermis are involved
Hyperkinetic with increased cell
production of new cells 20-30 times,
Increased epidermal volume, Rate of
nail growth increased, Formation of
abnormal
nucleated
,loose
scaly
stratum cornea.
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PSORIASIS
Occurs in 1% to 2% population.
Affects males( more)
Age on set: early : 16-22y
late
: 55-60y
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Aetiology
• The cause is unclear but involves immune
stimulation of epidermal keratinocytes; T
cells seem to play a central role. Family
history is common, and certain genes and
HLA antigens (Cw6, B13, B17) are
associated
with
psoriasis.
An
environmental trigger is thought to evoke
an inflammatory response and subsequent
hyperproliferation of keratinocytes.
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Basic defects
• Genetic
• Bio chemical
• Immunological
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Precipitating factors
• Trauma
• Infection
• Sun light
• Emotion
• season
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Clinical patterns
Discoid
Rupioid
Guttate
Pustule
Napkin
Nail
Flexural
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PSORIASIS
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Psoriasissites
Extensor aspects of trunk& limbs
Knees, elbows & scalp
Mucosa seem spared
Nails
Flexural areas (genital, axillae,
Inframamary folds, abdominal folds,
umbilicus.
• Face
• Site of minor injury.
•
•
•
•
•
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Clinical features
• common, chronic, and recurrent
• Very demarcated margin
(plaque)
• Papulo -squamus disorder.
• dry ,well circumscribed, silvery,
scaly papules &plaques of
various sizes
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SYMPTOMS & SIGNS
Gradual onset,
Remitting &relapsing.
Usually non itchy
Horny layers
Increased epidermis thickening.
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These cycles of flare-ups and
remissions often lead to feelings
of sadness, despair, guilt and
anger as well as low self-esteem.
Depression is higher in people
who have psoriasis than in the
general population. Feelings of
embarrassment
also
are
common.
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Severity of psoriasis
• Psoriasis is graded as mild (affecting less
than 3% of the body);
• moderate (affecting 3-10% of the body) or
severe several scales exist.
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Psoriasis Area Severity Index
(PASI)
• The Psoriasis Area Severity Index (PASI)
is the most widely used measurement tool
for psoriasis. PASI combines the
assessment of the severity of lesions and
the area affected into a single score in the
range 0 (no disease) to 72 (maximal
disease).3
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Diagnosis
• Clinical evaluation
• Rarely, biopsy
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Patient Ms T, aged 33y,house wife,
came (03/01/2009)with eruptions
over ears, scalp, hands ,Weight 47
Kgs, hand s, scalp, neck ,hairline
margin with itching, thirst less,
Case was Diagnosed as Psoriasis by
local dermatologist.
F/H : DM & HTN
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The case was repertorised by Phataks method
Reportorial analysis is : Graphites 20/2,
Pulsatilla 20/2, sepia 21/2,
3/01/09 : eruption over ears, scalp, hands with
itching ,sadness, Pulsatilla was selected giving
importance to Thirst less ,aversion to water
Pulsatilla 30,3 doses were given placebo for 30
days, advice about diet was given.
06/02/09 – eruption increased with itching,
oozing was present, Graphites 30,3 doses,
Placebo for 15 days, advice about diet and
personal cleanliness was given.
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21/05/09
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21/05/09 Due domestic problems she came
late for one month and half she was better and
again itching, oozing started in the same
places, Graphites 30,3 doses, Placebo for 15
days,
30/07/09
oozing is lees ,itching is less
,sadness still persisting Graphites 200,3
doses, Placebo for 30days were given.
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03/08/09 no oozing ,itching is
less ,sadness is less ,scalp still
scales are seen, hair fall still
persisting,
Graphites
200,3
doses, Placebo for 30days were
given.
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03/8/2009
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03/08/09
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30/10/09
30/10/09 no oozing
, occasional itching
,sadness is less ,scalp
scales are few seen,
hair fall better ,
Placebo for 30days
were given.
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30/10/09
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24/11/09 : itching increased,
Graphites IM,1doses,Placebo for 30days
were given
25/12/09
skin totally cleared from
eruptions, Placebo for 30days was given
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29/6/10
29/06/2010 she
came after 6
months after
stopping
medication (as
shown in visual )
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Patient Mr. A, aged 30y,Software
eng, came (21/01/09)with fissures
over
tongue
since
3years
diagnosed as Psoriasis of tongue
by Dermatologist. , sleeplessness,
Weight 53 Kgs, thirst less
,
Case no 2
Patient Mr. A, aged 30y,Software
eng, came (21/01/09)with fissures
over tongue since 3years diagnosed
as
Psoriasis
of
tongue
by
Dermatologist,
sleeplessness,
Weight 53 Kgs, thirst less
,
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21/01/09 itching increased, Acid Nitricum 30c ,5 doses,
Placebo for 30days were given
5/03/09 no change no difference in taste , sleeplessness .
Acid Nitricum 30c , Placebo for 30days were given
16/08/09 patient is feeling fissures are reducing , no
difference in taste , sleeplessness is better, Acid Nitricum
200c, 3 doses, Placebo for 30days were given.
19/09/09 fissures are reducing , no difference in taste ,
sleeplessness is better, Acid Nitricum 200c, 3 doses,
Placebo for 30days were given.
23/10/09 : had fever a month back was admitted in hospital
took allopathic medicines, fissures are reducing, Ars Alb
200c,( because he was still felling after affects of fever)
3doses, Placebo for 30days were given.
29/12/09 no change , Thuja 1m I dose was given, Placebo
for 30days were given
21/02/10 anterior part
of tongue improved a
lot as shown in visual,
thickness of tongue
reduced a lot , Acid
Nitricum IM, 1doses,
Placebo for 30days
were given.
Views of authors about psoriasis of
tongue
They report that fissured tongue (FT) and benign migratory glossitis (BMG;
geographic tongue) were the two most frequent findings. FT affected 33% of
psoriasis patients and 9.5% of controls, while BMG affected 14% of patients
and only 6% of controls.
Notably, the frequency of BMG increased with the severity of psoriasis in a
sub-group of patients with plaque-type disease, as assessed by Psoriasis
Area and Severity Index, Daneshpazhooh et al report in the journal BMC
Dermatology.
They conclude: "Overall, although oral lesions might not be considered
authentic oral psoriasis unless proven histologically and with a parallel clinical
course, nonspecific tongue lesions are significantly more frequent in psoriatic
cases."
The team recommends further studies to "evaluate the clinical significance of
these seemingly nonspecific lesions in a suspected psoriatic case".
Tongue lesions common in psoriasis patients
12 November 2004
BMC Dermatol 2004; 4: 16. http://www.medwirenews.md/60/30030/Psoriasis/Tongue_lesions_common_in_psoriasis_patients.html
Conclusion
Skin disease infrequently kills, But Often
produces unhappiness, Usually loss of work and
social Deprivation as well as considerable Physical
discomfort. has proved to be correct in both
cases.
Concentration to treat comes out of a
combination of confidence in system and
hunger to learn is a fact.
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References
1)Marks. R, Roxburgh’s Common Skin
Diseases, 16th Edition, Chapman & Hall
Medical, London [page no.124-140]
2)Behl. P.N., Practice of Dermatology,
Eighth Edition, CBS
Publishers &
Distributors, New Delhi, India [page
no.253-260
]
3)http://psoriasis,about.com/od/psoria
sisfags/f/pasi.htm
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