A 35 year man CC of itching of whole skin
of about 12 years. The skin appears like
as whitish scaly lesions got aggravated
by sun exposure, night and during sleep.
He also complaints of right knee joint
pain since 3 months got aggravated
from rising from seat, walking and
ameliorated by rubbing and lying on
bed.
On enquiry complaints started as lesions on
knee joint as pustules and scaly lesions
on anterior part of leg, scalp, hands and
face. PMH suggests about allopathic
treatment but only temporary relief.
PH suggests about bronchial asthma from
childhood, before 1 year as
hepatomegaly.
FH suggests about mother died due to D.M
& H.T.
O/E, pulse rate: 78/min.
resp. rate: 18/min.
B.P: 98/68 mm of Hg.
mild pallor.
H.S: S1 long and dull, S2 normal.
Psychic features as indecsessive, use abuse
words, disappointed when others say
wrong about him, desires solitude.
Regional features as scaly eruptions as
whole body, nails in all toes as yellowish
tiny pittings and kollionychia. He also has
palilalia and slurring of speech.
Other investigations report as on colour
doppler study as mitral valve and
tricupsid valve reguritation.
Individualistic features as
1. scrapping with knife.
2. always wants to be neat.
3. worries about little matters.
4. worries about his family.
5. when anger use abuse words.
Medicine prescribed as
Ars. Alb 0/6 / 1D.
the remaining days as SL..


A papulosquamous disorder….

It is a chronic inflammatory skin disorder
clinically characterized by well defined
erythematous, sharply demarcated
papules and rounded plaques, covered
by silvery scale and a chronic fluctuating
course.

The patches are most common on the
knees, elbows, scalp, tailbone, and
back, but they may be anywhere on the
body (including the fingernails, palms,
and soles of the feet).

Psoriasis is not contagious. The exact
cause of psoriasis is not known, but the
body's natural defense system (immune
system) is believed to be involved. The
condition tends to run in families
Doctors believe that the immune system is
a factor in the development of psoriasis.
This is because increased numbers of
white blood cells are present between the
abnormal layers of skin and because
psoriasis responds to drugs that suppress
the immune system.
The patches (called plaques) are made up
of dead skin cells that form thick layers.
The body replaces normal skin cells every
28 days, but in psoriasis, skin cells are
replaced every 3 to 6 days.
 The
histological changes of psoriasis
are two key pathophysiological
features.
› The keratinocytes hyperproliferate with a
grossly increased mitotic index and an
abnormal pattern of differentiation, leading
to the retention of nuclei in the stratum
corneum, not normally present as the
stratum corneum cells are dead.
› There is a large inflammatory cell infiltrate.
The T-cell infiltrates in psoriasis have a nonrandom patterns of migration including
CD8+T cells present in the epidermis, and
CD4+ T cells in the dermis.
Besides T cells, other immu-nocyte subsets
include increased numbers of
neutrophils, dermal dendritic cells,
macro-phages, and mast cells.

Especially in chronic plaque lesions, a
marked epidermal thickening is
observed This thickening is a result of
hyperplasia of basal and suprabasal
keratinocytes. At the same time,
abnormal keratinocyte differentiation
with marked PARAKERATOSIS (nuclei in
the stratum corneum)and an absent
granular layer is demonstrated.
Neutrophilsinvade the epidermis and
accumulate as small spongiform Kogoj
pustules or migrate up to the stratum
corneum forming
Munro’smicroabscesses.
 Munro’s microabscesses are found only
inparakeratotic areas of the epidermis.
 Infiltration of neutrophils is striking in
pustular and in guttate psoriasis.

The number of epidermal lymphocytes of
the psoriatic lesion is significantly increased
and comprises both CD8+ (killer) T
lymphocytes and CD4+ (helper) T
lymphocytes,
 Langerhans cellsand a macrophage
subpopulation called non-Langerhans
dendritic cells represent the epidermal
dendritic cells.
 In psoriasis, fully mature Langerhans cells
are increased in number and have
enhanced antigen-presenting capacity
due to overexpression of HLA class II
molecules

Neoangiogenesis is characteristic of
psoriatic plaque formation, and in
lesional skin increased numbers of
dilated, tortuous vesselsare thus
encountered.
 Indeed, a four-fold increase in
endothelium of the superficial, but not of
the deeper, microvasculature in lesional
skin is reported

Psoriasis vulgaris
Also known as "plaque psoriasis," it is the
type that affects 80% to 90% of people
with the disease. Psoriasis vulgaris can be
recognized by the presence of raised,
red, scaly patches (or "plaques"), usually
on the elbows, knees, scalp, chest, nails,
and lower back and associated with
fever, malaise, diarrhea, and arthralgias.
These may vary in size. The scales may
be thick and silvery.

Guttate psoriasis
This form is less common; only about 10% of
patients have this type. Guttate psoriasis
often appears after someone suffers
from strep throat. It commonly starts in
childhood or adolescence with the
sudden appearance of drop-sized
patches (guttate means drop-like).
 These lesions may spread to cover large
areas of the upper body, legs, arms, and
scalp.

Pustular psoriasis
• This is a rare form of psoriasis. It may be
localized (usually appears on the palms of the
hands and the soles of the feet), or generalized
over the entire body.
Localized pustular psoriasis can be quite painful,
making it difficult to use your hands or walk
normally.
Most commonly, skin becomes red
and swollen, with small, pus-filled pimples that
dry to form brown dots; some people may have
scaly patches
Inverse psoriasis
• This form is also called skin-fold, flexural, or
genital psoriasis, because smooth, red,
dry patches often occur in the folds of
the skin (known as flexures). Inverse
psoriasis may concentrate in the genital
area, as well as under the breasts and in
the armpits, and is more common in
people who are overweight. It is
characterized by increased sensitivity to
friction and sweating. The affected skin
can cause great discomfort, and this can
make sexual relations difficult.
Erythrodermic psoriasis
• Also known as exfoliative psoriasis, this is
a form of psoriasis that covers almost the
entire body. It is characterized by severe
redness and scaling, which is often
accompanied by itching and pain.
Because symptoms are so widespread
over the body, this form can be extremely
serious.
Erythrodermic psoriasis can cause the
body temperature to fluctuate, especially
in extremely hot or cold weather. It can
also complicate heart disease and cause
heart failure, because the heart rate may
accelerate due to increased blood flow to
the inflamed skin
Psoriatic arthritis: a related condition
• Psoriatic arthritis is an arthritic condition—
a condition related to the joints. The most
common symptoms are inflammatory
arthritis, and dry, scaly, thick, and inflamed
skin. However, the skin symptoms and the
arthritis symptoms frequently appear at
different times, often years apart, so their
connection may not be obvious
Psoriatic arthritis usually involves the joints of
the hands and feet, knees, and ankles, which
can become painful, swollen, hot, red, and stiff.
Pain and stiffness can also develop in the lower
back, buttocks, neck, and upper back. Psoriasis
skin symptoms may include pitting and ridges in
the fingernails and toenails. Nearly one quarter
of people with psoriasis have psoriatic arthritis.
NUMMULAR PSORIASIS
PUSTULAR PSORIASIS
Tiny areas of bleeding when skin scales are
picked or scraped off (Auspitz's sign).
• Mild scaling to thick, crusted plaques on the
scalp.
• Itching, especially during sudden flare-ups
or
when the psoriasis patches are in body folds,
such as under the breasts or the buttocks.
• Nail disorders. Nail disorders are common,
especially in severe psoriasis.
Nail symptoms include:
Tiny pits in the nails (not found with
fungal nail infections).
• Yellowish discoloration of the toenails
and possibly the fingernails.
• Separation of the end of the nail from
the nail bed.
• Less often, a buildup of skin debris
under the nails
SECONDARY
SYPHILIS.
• Psoriasis is usually long-lasting, returns
often (chronic), and can be unpredictable.
Symptoms may come on suddenly (flare)
and then improve and go away
(remission). This cycle continues over and
over. In some cases, psoriasis may go away
without treatment. However, in moderate
to severe cases, it is best to treat psoriasis
so that it does not get worse.
Psoriasis can cause significant stress and
lowered self-esteem. In one study, people
with psoriasis reported a reduction in
functioning similar to that of people with
cancer, arthritis, heart disease,
depression, and other serious conditions.
Initial treatment
• Treatment for mild psoriasis,
characterized by a few isolated raised
patches, begins with skin care, which
includes keeping your skin moist and
lubricated.
1. Creams, ointments, and lotions, to
lubricate the skin.
2. Shampoos, oils, and sprays,
to treat psoriasis of the scalp.
3. Some exposure to sunlight.
4. Keep away from all the trigerring factors.
5. Stress, skin injury, infection, and use of
alcohol can all contribute to symptom
flare-ups.
People likely to respond to this remedy
usually are anxious, restless, and
compulsively neat and orderly. They are
often deeply chilly, experience burning
pains with many physical complaints,
and become exhausted easily. The skin
is dry and scaly and may tend to get
infected. Scratching can make the
itching worse, and applying heat brings
relief
Calcarea carbonica:
This remedy is suited to people who are easily
fatigued by exertion, sluggish physically, chilly
with clammy hands and feet, and often
overweight. Skin problems tend to be worse in
winter. Typically solid and responsible, these
people can be overwhelmed by too much
work and stress. Anxiety, claustrophobia, and
fear of heights are common. Cravings for
sweets and eggs are often also seen when
Calcarea is needed.
People needing this remedy often have
a long-term history of skin disorders. The
skin looks tough or leathery skin with
cracks and soreness. Itching is often
worse from getting warm, and the
person may scratch the irritated places
till they bleed. Trouble concentrating,
especially in the morning, is also often
seen when this remedy is needed
People who seem introverted and
formal—but are very intense internally,
with strong emotions and impulses—may
benefit from this remedy. They tend to
have swollen lymph nodes and moist or
greasy-looking skin, and are very
sensitive to changes in temperature. The
areas affected by psoriasis may become
infected easily.
A person who needs this remedy usually is serious,
and often feels strong anxiety in the region of the
stomach. Scaly plaques may itch intensely,
thickening or crusting over if the person scratches
them too much. Cold applications relieve the
itching (although the person feels generally chilly
and improves with warmth). People who need this
remedy often have a craving for fat, and feel best
in open air.
This remedy is often indicated for people whose
physical problems are aggravated by stressful
emotional experiences. It is especially suited to
individuals with extremely dry skin, and problems
that involve the palms and fingertips. The person
may feel a cold sensation after scratching, and the
skin is easily infected and may look tough and
leathery. Itching will be worse at night, and from
getting warm in bed. People who need this
remedy may also have a tendency toward motion
sickness.
When this remedy is indicated for a person with
psoriasis, the skin eruptions are red and swollen,
and often itch intensely. Hot applications or baths
will soothe the itching—and also muscle stiffness,
toward which these people often have a
tendency. The person is restless, and may pace or
constantly move around. A craving for cold milk is
often seen when a person needs this remedy.
This remedy may be helpful to a person who feels
dragged out and irritable, often with little
enthusiasm for work or family life. The person’s skin
may be look dry and stiff. Psoriasis may appear in
many places on the body, including the nails and
genitals. Signs of hormonal imbalance are often
seen (in either sex), and problems with circulation
are common. Exercise often helps this person’s
energy and mood.
This remedy may be helpful to individuals
whose psoriasis has developed after grief
or suppressed emotions. Any part of the
body can be involved but the scalp is
often affected. People who need this
remedy often seem sentimental, meek
and quiet, and easily embarrassed —
but often have a strong internal anger or
deeply-buried hurt.
www.similima.com
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Intensely burning, itching, inflamed
eruptions that are worse from warmth
and bathing suggest a need for this
remedy. Affected areas often look bright
red and irritated, with scaling skin that
gets inflamed from scratching. This
remedy is sometimes helpful to people
who have repeatedly used medications
to suppress psoriasis (without success).
Coral-colored. Red, coppery spots.
 Psoriasis of palms and soles.
 Worse in open air ,changing from a warm
to cold room.


Eruptions red and moist with increasing
moon, dry and pale with decreasing
moon.
burning, stinging, itching,
 agg. heat of bed, washing, esp. cold.
 Great sleepiness during daytime, sleepless
at night

Dry, scaly eruption, especially around
eyes and ears, scabs with pus underneath.
Violent itching
Erythemato-squamous eruptions in round
plaques on elbows, knees, integument, sacral
region even on nails and heels.
 Aggravation: In company, after meals, before
menses, by the heat of bed, at night.
 Amelioration: By movement, by passing
flatus, by eructation.

Psoriasis associated with adiposity
 worse night.
 Cold hands and feet.
 Itching without eruption, worse night.


Pustular psoriasis.


Dry, itching eczema. Erythema around
roots of nails. Skin dry, wrinkled. Painful
cracks. Nails thicken.
Modalities.-Worse, in bed, afternoon,
evening and night; open air.
Burning eruptions. Eczema.
 Itching agg. Cold, undressing.

Scaly eruptions. Desquamating.
 Agg: HEAT. Overheated. Warm room.
 Amel: COLD, OPEN AIR.
 Agg: Evening.

Nails exfoliate, falling out.
 Eruptions, coppery spots.

Itching.
 amel. rubbing, with burning pain
afterwards.

Agg: COLD, WET WEATHER.
 Agg: Night, motion.
 amel. Warm and dry, rest.
 Eruptions begin on scalp and spreds all
over body.

Chronic eczema, with amenorrhoea,
 agg. menses or menopause.


Itching all over body, burning of skin, as if
a fire.
Heat and irritation; itching.
 Scaly and itching eczema.
 Crops of boils.
 Purities of pregnancy.



Intense itching of skin, especially of lower
extremities; worse, exposure to cold air
when undressing.
Worse, in evening, from inhaling cold air;
left chest; uncovering.
Worse on chest shoulders and face.
 Anesthesia of skin.
 Modalities :better when occupied
,mentally or physically.

Pustular eruptions.
 Agg :night.

Psoriasis = “marriage of all the miasms”
predominantly Psoric and sycotic
more of Psora
a pinch of sycosis
a lot of syphilis
dryness predominates
 fine, thin scales
 Tendency for recurrence
 Skin cannot endure water

Fish scale eruptions
 Pruritus with thickening of the skin
 pigmentation
 < change of weather(damp) < meat

nails - paper like, spoon shaped,
bending tearing easily
 mentally - dull, heavy, stupid, stubborn,
sullen, morose

• nails - irregular , brittle, breaks, split
easily
 • with many hang nails
 • also spotted with white specks

Psoric and syphilitic..
 From the state of lesions and mental
behaviors.
