Auspitz Sign Research Articles

Management of Plaque Psoriasis with Multimodal Treatment of Ayurveda - A Case Report

Psoriasis is the immune system problem that causes skin to revitalize at faster rate. It’s the chronic disease that has psychological and social impact on patient’s life. This condition had been narrated many decennium ago but proper aetiology and its cure remain under researched. In Ayurveda this multifaceted etiology disease needs multimodal treatment. The modern treatment provides only temporary relief with too many serious side effects. The treatment embraced here was in accordance with ayurvedic Samprapti. This case report details the successful management of plaque psoriasis in a 32-year-old female patient using a multimodal treatment approach, which incorporated Panchakarma, a traditional Ayurvedic detoxification therapy. The patient presented with erythematous plaques on forehead, neck region, lateral surface of legs and at arms along with itchy and burning skin. Auspitz sign and Koebner phenomenon was positive. Diagnosis made on the basis of Sign and Symptoms. After a thorough evaluation of the patient's constitution and the nature of the disease, a customized Panchakarma protocol was devised involving Virechana (Purgation) followed by Basti (medicated enema) along with Shamana Chikitsa (Internal Medication). The results revealed a remarkable improvement in the patient's psoriasis lesions, with a significant reduction in PASI scores, reduction in scaling, erythema, and in duration. The patient reported a substantial reduction in itching and discomfort. This case report emphasizes the potential of Panchakarma as an adjunctive therapy for plaque psoriasis, highlighting the holistic and personalized approach of Ayurveda in managing chronic skin conditions. Further research and larger-scale studies are warranted to confirm the effectiveness of Panchakarma in the treatment of psoriasis and to observe its long-term benefits and safety profile.

A comparative study to evaluate the efficacy of Kushthagna Mahakashaya and Aaraghwadadi Gana along with local application of Karanjadi Taila in the management of Eka-Kushta w.s.r. to Psoriasis

Introduction: Eka-Kushta is one among 11 varieties of Kushdra Kushta which resembles psoriasis clinically. It is one of the most common dermatological diseases, affecting up to 1-3% of the world’s and 0.44-2.8% of Indian population. Currently the treatment available for the management of psoriasis include topical therapy, photo therapy, corticosteroids, etc having their own limitations. Thus, there is a need for safe, effective, and sustainable medicine for the management. Methodology: The clinical study was done on 45 subjects of both genders, between the age group of 18-58 years who were randomly assigned into 3 groups (15 patients in each group) namely - Group A (Kushthaghna Mahakashyay and Karanjadi Taila), Group B (Aaraghwadadi Gana and Karanjadi Taila), and Group C (Placebo). Result: Outcome of the treatment after 45 days was statistically extremely significant in the remission of the symptoms of Eka-Kushta in most of the subjective and objective parameters. Discussion: Group A, treatment was found to be effective in Matsyashalopam, Kandu, Auspitz Sign, Candle grease sign, Koebner’s phenomenon, and PASI Score and the result was very significant in Aswedanama and Vruttam. Group B, treatment regimen was found to be effective in Matsyashalopam, Kandu, and Auspitz Sign, Candle grease sign, Koebner’s phenomenon, and PASI Score and the result was very significant in Aswedanama, Vruttam. Group C, treatment regimen was found to be effective in Matsyashalopam and the result was insignificant in Kandu, Aswedanama, Vruttam, Krishna Varna, Auspitz Sign, Candle grease sign, Koebner’s phenomenon, and PASI Score.

Management of Plaque Psoriasis through Agadatantra Principles – A Case Report

Psoriasis is a chronic, relapsing dermatological disorder characterized by the presence of pink to erythematous plaques with overlying silver hyperkeratotic plaques, distributed on the scalp, postauricular skin, elbows, gluteal cleft etc. Plaque psoriasis is one among the common variety of psoriasis. Though it is manageable with difficulty, its relapsing nature remains a threat to the present management strategies. On the contrary in Ayurveda, a thorough analysis of condition, purification, rasayana and samana medicines proves to be effective in such conditions. A single case report of 42 year old male consulted in the Vaidyaratnam Ayurveda College OPD with presenting complaints as dry itchy and scaly silvery white lesions on chest, lower back, scalp and beard upon reddish patches with duration of two years. He was allergic to dantappala (Wrightia tinctoria) also. On examination the case was having positive candle grease and Auspitz sign with PASI score as 20.8 and DLQI as 21. The case was doignosed as ekakushta associated with severe pitta dushti and poor satva bala. The Doosheevisha chikitsa along with snehapana, svedana, vamana, virechana, takradhara, Shashtika annalepa and rasayana was done with proper medicines. The condition of the patient improved considerably by reducing the symptoms like erythema, dryness, itching, scaling and pain. The PASI score reduced to 2.3 and DLQI reduced to almost zero at the time of discharge. The further follow up has not reported any recurrence of the disease since two years.The proper understanding of the pathology through dasa vidha pareeksha and tracing out the vishaja nidanas can lead to a proper treatment plan. This will give successful management of similar conditions along with the enhancement of immunity to prevent or reduce the recurrence of the disease through principles of Agadatantra.

A CLINICAL STUDY TO EVALUATE THE EFFECT OF VIRECHANA WITH TRIPHALADI CHOORNA IN THE MANAGEMENT OF PSORIASIS

Virechana is among the Pancha Shodhana and Panchakarma, as explained by Acharyas in the classics. Virechana is the procedure in which the orally administered Dravyas act on internally vitiated Doshas, specifically Pitta, and expels them through Gudamarga. Psoriasis is a chronic, recurrent, inflammatory disease of the skin of unknown origin, characterised by well-circumscribed erythematous, dry plaques of various sizes covered with scales. The Prevalence of Psoriasis varies across countries, ranging from 0.09-11.43%. Globally, it is estimated that at least 100 million individuals are affected by Psoriasis. In India, the reported incidence varies from 0.44- 2.8% among skin disorders, with an overall incidence of 1.02%. In Ayurveda, various skin diseases are classified under the broad category of Kushta. Features of Psoriasis resemble multiple types of Kushta. Hence, this clinical study of Virechana with Triphaladi Choorna was taken to assess its efficacy in this disease. The assessment used parameters like PASI Score, Auspitz sign, and Candle grease sign. Objectives: To evaluate the effect of Virechana with Triphaladi Choorna in the management of Psoriasis. Methods: This is an open-label clinical study with pre-test and post-test design wherein 20 patients diagnosed with Psoriasis and fulfilling the selection criteria in the age group of 18 – 70 years of either gender were selected from the OPD/IPD. Results: The study showed a statistically significant result in decrement in PASI Score with a change from before treatment to after follow-up. Interpretation and Conclusion: Hence, Virechana Karma with Triphaladi Choorna was found to be effective in reducing signs and symptoms of Psoriasis

Idiopathic Hypoparathyroidism Presenting with Erythrodermic Psoriasis and Fahr’s Syndrome: A Case Report

Idiopathic hypoparathyroidism may remain asymptomatic or present with hypocalcaemic neuromuscular manifestations. Dermatological manifestations like exfoliative dermatitis, pustular psoriasis and symmetrical brain calcification known as Fahr’s syndrome are uncommon in clinical practice. Even in absence of neuromuscular symptoms, hypocalcaemia associated with exfoliative skin lesions and symmetrical brain calcification should prompt investigation for hypoparathyroidism. A 40-year-old male presented with diffuse erythematous pruritic plaques and fever of 10 days duration. Auspitz sign was positive on examination. Investigations showed leucocytosis with neutrophilic predominance. He was admitted with a diagnosis of erythrodermic psoriasis with secondary infection. On the second day of admission he developed an episode of generalised tonic clonic seizure for the first time. Investigations into the cause of seizure revealed low serum calcium while computerised tomography of head revealed symmetrical calcification of bilateral basal ganglia. Further, he was found to have a low level of intact Parathyroid Hormone (PTH) level and hyperphosphataemia. Based on clinical, biochemical and radiological findings, a diagnosis of idiopathic hypoparathyroidism, psoriasis and Fahr’s syndrome was made. Serum calcium was corrected with infusions of calcium gluconate followed by oral calcium carbonate. The patient was kept under observation for seizure recurrence. Calcium and vitamin D supplements and hydrochlorothiazide were started and psoriasis treatment was continued. His skin lesions resolved over the next two weeks, serum calcium levels returned to normal level and no seizure episodes were reported over three months of follow-up.

Trichoscopic pearl: dynamic trichoscopy sequence of scalp psoriasis before and after the development of Auspitz's sign.

Trichoscopic pearl: dynamic trichoscopy sequence of scalp psoriasis before and after the development of Auspitz's sign.

Paradoxical Pustular Psoriasis Following Treatment of Chronic Plaque Psoriasis with Ustekinumab

A 51-year-old female with red plaques and scales for 20 years, aggravated with pustules for more than 10 days.Physical examination: scattered red patches, silver-white scales, thin film, Auspitz sign (+) can be seen on the head and face.The trunk and limbs were scattered in large erythema and erythema, on which were dense pustules of the size of chestnut. The central color of local pustules was brown, presenting target-shaped lesions, and some pustules fused into pus lake.Vulvar mucosa scattered in pustules, erosion surface.Nail clipping thimble changes, deck thickening changes.Histopathology: Hyperkeratosis, fusion keratosis, thinning or disappearance of granular layer, epidermal psoriatic hyperplasia, munro and Kogoj microabscess, dermal papilloma, vascular dilatation, perivascular lymphocyte infiltration.Diagnosis: pustular psoriasis.

Prurigo Nodularis onset during secukinumab treatment of psoriasis: a case report

BackgroundSecukinumab has been approved by the U.S. FDA and the European Medicines Agency for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis with the documented adverse effects. Here we reported in one case that a new symptom, Prurigo Nodularis (PN), developed during the programmed dosing of secukinumab.Case introductionA 22-years-old male with a 6-month history of severe plaque psoriasis vulgaris was presented to the dermatology clinic two weeks after the fifth serial weekly doses of secukinumab, for the reason of the outbreaks of multiple erythematous papules and pruritus nodules on the trunk and extremities. Physical examination showed that psoriatic rash were under effective control with the previous targeted therapy of secukinumab for plaque psoriasis vulgaris, but new dermatologic condition was spotted with multiple edematous red firm papules on the trunk and extremities, in the form of soy or hemispherical nodules, red in color, firm to touch, with some ulcerated crusts visible at tops, but negative Auspitz sign. Pathological examination confirmed these papules as PN.ConclusionThis case report is shared to inform clinicians about an unannounced adverse effect of the secukinumab in the treatment of psoriasis, and it is recommended that patients be carefully informed of the possible risk of PN before starting treatment.

Management of plaque psoriasis (~Ekakushta) through Ayurvedic approach: An experience

Abstract Psoriasis is one of a variety of illnesses brought on by the autoimmune response and is characterized by the rapid inflammatory proliferation of sick skin cells. Even though the illness was first identified several decades ago, the etiology and therapy appear to remain understudied. In Ayurveda, many herbs have proved efficacy in the treatment of psoriasis, but the disease’s complex etiology requires a multimodal therapeutic strategy. A 22-year-old male patient with persistent plaque psoriasis in the last three years presented with erythematous plaques over the back, chest, neck, legs, abdomen, scalp, and forehands. The Auspitz sign, Candle grease sign, and Koebner phenomenon were positive. The treatment plan was based on the Ayurvedic Samprapti (~pathophysiology) of Ekakushta (~plaque psoriasis). Virechana (~therapeutic purgation) along with Ayurvedic oral medicines and a wholesome dietary regimen were given. Within eight months of the treatment, the psoriatic lesions and associated signs and symptoms were healed effectively. No adverse events were reported during the course of therapy and no recurrence was noticed as of reporting the present case report. Altogether, multimodal Ayurveda treatment can be an effective and safe solution for plaque psoriasis.

EXPLORING AYURVEDIC POTENTIAL IN THE MANAGEMENT OF PSORIASIS: A SINGLE CASE STUDY

Eka-Kushtha is one of the most common disorders of Vata and kapha imbalance, which closely resembles Plaque Psoriasis. The Prevalence of Psoriasis in India is 0.44-2.8%.1Phototherapy with narrow-band UVB or PUVA and various corticosteroids have been used for decades in contemporary medicine with good results.2 But their longterm use increases the risk of developing skin cancers, also when the treatment stops the symptoms reoccrus. Aims and objectives: -This study aimed to study the efficacy of Ayurvedic management including Shaman, Shodhan, and lifestyle modification in the treatment of Psoriasis. Materials and Methods: It is a single case study. A 48 - year-old man who was already diagnosed with plaque Psoriasis in the last 2 years correlated with Eka-kushtha symptomatically, approached to Ayurvedic hospital and was treated with Panchakarma treatment like Rakta Mokshan, along with Shamana Chikitsa and lifestyle management. The treatment was continued for three months. Results: Symptomatic assessment of the patient was carried out after three months with Auspitz sign resolved to negative and overall quality of life of the patient was significantly improved. Conclusion: The aforementioned therapy gives symptomatic relief in the management of Eka-kushtha

Generalized pustular psoriasis with nail psoriasis in children: a case report

Background: Pustular psoriasis in children is one of the clinical variants of psoriasis. It is classified into generalized pustular psoriasis (GPP) and localized pustular psoriasis. The aetiology of psoriasis in children has not been known but is believed to be multifactorial. Nail psoriasis rarely occurs in children who suffer from skin psoriasis, with an incidence lower than that reported in adults. The diagnosis is generally made from the clinical and histological examination. The choice of therapy depends on the severity of the disease. Until now, there have been no specific guidelines for the management of psoriasis in children.
 Case report: A-15-years-old Balinese girl presenting with erythema, confluent scaly plaques over the trunk and extremities with pustules localized on the lower extremity. She had a history of fever before the lesions appear. Right third digital nails examination showed subungual hyperkeratosis and onycholysis. Positive auspitz sign and karsvlek phenomena were found. Biopsy result suitable for psoriasis. The patient got improvement after treated with methotrexate tablet orally and desoximetasone cream topically within four weeks without any side effect.
 Conclusion: Combination therapy with methotrexate tablet and desoximetasone cream give an effective result. However, the safety and side effects of methotrexate in children still need further monitoring.

Exacerbation of Psoriasis Vulgaris Induced by Vaccine COVID-19 in HIV Patient: A Case Report

Background: Psoriasis is a chronic and inflammatory skin disease. Many triggering factors can cause exacerbation of psoriasis, such as infection, trauma, and drugs. Several vaccines are known to cause new lesions or exacerbation of psoriasis, including Bacillus Calmette-Guerin (BCG), influenza, tetanus-diphtheria, and pneumococcal polysaccharide. In the COVID-19 pandemic, the COVID-19 vaccine is known to cause the appearance of new lesions or exacerbation of psoriasis.
 Case presentation: A woman, 31 years old, came to the clinic with itchy reddish patches with white scales on her face, chest, stomach, back, arms, and both legs, and increased since 2 weeks ago. Previously, the patient got the first COVID-19 vaccine (Sinovac), and three days later, red patches appeared with white scales on the chest, stomach, and back. The patient had been diagnosed with psoriasis 3 years ago. Dermatology examination showed reddish patches with white scales on the face, chest, stomach, back, arms, and both legs. Auspitz sign and Kaarvetsvlek phenomen were positive. PASI score was 9,2. Dermoscopy examination showed red dot distribution on light pink background and white scales. She was treated with desoximetasone cream 0,05% twice a day and cetirizine tablet 10 mg once a day. After 2 months of therapy, reddish patches were decreased, and the PASI score was 6,9.
 Conclusion: COVID-19 vaccine can cause exacerbations in psoriasis patients, but this vaccine can still be given to psoriasis patients. It is based on the documented efficacy of the COVID-19 vaccine in the prevention of severe COVID-19 infection and fatality. Psoriasis patients should be consulted before getting vaccinated for COVID-19, and prompt clinical visits should be available if exacerbation develops.

Nail Changes as the Initial Sign of Psoriasis: A Case Report

Abstract Introduction: Nail psoriasis has a profound negative influence on quality of life and has a more closely relationship with psoriatic arthritis. However, patients with nail changes only were often overlooked with the diagnosis of psoriasis. It is necessary to pay more attention to nail psoriatic changes. Herein, we report a 24-year-old male patient with nail changes as the initial sign of psoriasis who was finally diagnosed with nail psoriasis. Case presentation: The nails presented with white streaks, deformations, and had been missed for 8 months. Physical examination further revealed one erythematous scaly plaque on the buttock, anusand scalp respectively with positive Auspitz sign. Combined with the negative fungal microscopic, dermoscopic results and pathological results, the diagnosis of nail psoriasis was made. Oralacitretin (30 mg/day) and topical calcipotriene liniment was prescribed for 3 months followed with etanercept (50 mg once per week), and the nail symptoms were well controlled. Discussion: Nail psoriasis is usually noticed after the occurrence of skin lesions, but may occur simultaneously with or before skin psoriasis. Occasionally, nail involvement is the only manifestation of psoriasis. Nail lesions maybe one of the strongest clinical predictors of psoriatic and it has a profound negative influence on quality of life, so that timely recognition and proper treatment are improtant. Conclusion: Nail psoriasis can cause substantial physical and psychological impairment. However, nail involvement is an often overlooked feature of psoriasis. More attention should be paid to nail psoriatic changes and the administration of appropriate treatment.

Effects of individualized homoeopathic medicaments in Psoriasis: A single blind, simple randomized, placebo controlled study

Psoriasis is a non-contagious, chronic skin condition that produces plaques of thickened, scaling skin. It is considered as an incurable, long-term (chronic) inflammatory skin condition. Psoriasis is estimated to affect 2–4% of the population of the western world. Commonly appears for the first time between the ages of 15 and 25 years. In India the prevalence varies from 0.44 to 2.8%.Specific medical signs used for diagnosis are Auspitz's sign, Koebner phenomenon, Candle grease sign with itching, pain localized to papules and plaques. As it was understood to be a chronic, intractable & incurable disease, hence it was felt imperative to carry out a systematic constitutional treatment to validate the observations of earlier Homoeopaths and the subtle homoeopathic philosophy.Research Objectives: Primary objectives were to observe the change in disease severity and change in quality of life of the people. Secondary objective was to ascertain the effect on frequency of relapse and recurrence interval.Methodology: The study was simple randomized and single blind method. The sample size was fixed at 90.Test group 60 i.e. Group – I(Centesimal -30), Group – II(50 Millesimal -30) & Group – III( Control) 30. Duration of study was for two years. It was carried out at International Study & Research Centre on Homoeopathy, Bhubaneswar. There were inclusion & exclusion criteria, treatment plan, follow up with Psoriasis Area Severity Index (PASI), Psoriasis Disability Index (PDI), Relapse and Recurrence Interval (RRI).Results: Were documented on following points. Psoriasis Area Severity Index (PASI)/Psoriasis Disability Index (PDI)/ Relapse & Recurrence Interval (RRI). Statistical Analysis: By Kruskul Wallis Test, H0 was rejected. In paired ‘t’ test for PASI, Group – I and II results (P

Scalp psoriasis: a rare clinical image.

Psoriasis is a skin condition that affects about 2-3 percent of people worldwide, according to the National Psoriasis Foundation. But scalp psoriasis occurs in rare conditions. Scalp psoriasis is a long-lasting autoimmune disease having thick scales on clearly-defined, erythematous skin. Frequently, the scales are silvery white. The hairline may be partially covered by psoriasis. Even though the hair frequently serves as an effective covering for scalp psoriasis, the flaking of the scales and excessive ´dandruff´ make it a common cause of social disgrace. Scalp psoriasis might be asymptomatic or can cause severe itching. Even though its severity frequently changes over the course of several years, it typically persists. The line of treatment for scalp soriasis includes topical therapy, intralesional therapy, systemic therapy, and photochemotherapy. According to ayurved, all skin disorders are included under kustha disease. Scalp psoriasis can be considered Ekkustha which is one of the types of kustha disease. A 26-year-old male student came with complaints of a red, scaly patch with itching on the lower occipital and neck region for 4-5 months. On clinical examination, candle, grease sign, and auspitz sign were positive with normal blood count and blood glucose level. From this, it was diagnosed as scalp psoriasis, as shown in the image. Therapeutic purification therapy and the palliative treatment mentioned in Ayurveda were given for 2 months. After 2 months of follow-up, complete remission was observed. This image is useful for differential diagnosis between seborrheic dermatitis, lichen planopilaris, and scalp psoriasis.

Dermoscopy as a diagnostic tool to differentiate between tinea pedis and plantar psoriasis

<p><strong>Background</strong>: Clinical differentiation between tinea pedis and plantar psoriasis may sometimes be challenging, with consequent diagnostic delays and unnecessary therapies; in such cases histopathological analysis helps to differentiate the 2 conditions. In this study we used a dermoscope as a non-invasive tool to investigate the significance of specific dermoscopic features and to improve their non-invasive differentiation.</p><p><strong>Methods:</strong> A clinical diagnosis of plantar psoriasis/tinea pedis was made on basis of accepted literature and proved by histopathology. Image capturing was performed using a dermoscope. Based on combination of history, clinical, and dermoscopic examination conclusive diagnosis with specific dermoscopic features for each disease was achieved.</p><p><strong>Results:</strong> The 15 patients of biopsy proven tinea pedis and 17 patients of biopsy proven plantar psoriasis were selected. We found that the presence of whitish powdery scales located in the furrows with apparently uninvolved skin in between was significant in tinea pedis whereas the presence of silvery white scales on a pinkish red erythematous background with regularly distributed red dots was significant in plantar psoriasis.</p><p><strong>Conclusions:</strong> Dermoscopy showed significant patterns in tinea pedis and plantar psoriasis due to their well-known different histological and physio pathological background, with white diffuse scales reflecting the dry and hyperkeratotic nature of plantar psoriasis and the red dots signifying the pin point blood vessels seen clinically as Auspitz sign. The peculiar scaling in tinea pedis might result from the predilection of dermatophytes to proliferate in moist environment, such as the furrows.</p>

Precipitating Factors of Psoriasis in North Indian Population

Aim: This study aims to study precipitating factors of psoriasis in the north Indian population.Material & Method:Two hundred twenty-eight psoriasis patients regardless of age, sex, religion,occupation, attending the skin, and V.D. outpatients Department, B.R.D. Medical College, Gorakhpurfor were taken because of the subject of this study. The bulk of patients belonged to the Eastern U.P.and adjoining areas of Bihar and Nepal. The clinical criteria for diagnosis of psoriasis were thepresence of Erythematous and papulosquamous lesions with loosely adherent silvery-white scales.The auspitz's sign was demonstrated all told the cases. The detailed clinical history and examinationwere recorded. Each patient was categorized into mild to severe psoriasis. Result: The maximumpercentage of cases was aggravated by weather (winter), 55.26%, next to that was trauma 27.19%, and least after infections 4.35%. The summer and spring seasons showed an improved effecton the condition of psoriasis. Alcohol, smoking, and mental stress found no relation with psoriasis.In most cases, where the infection was associated with the disease, it had been aggravated only inchildren, and young adults and lesions were of guttate type. Pregnancy had no effect in 25.43% ofcases, while the disease was improved in 3.50% of patients and worsen in 4.35% of cases.Conclusion: Psoriasis is positively correlated with the winter season and negatively associated withSummer and Spring.

Precipitating Factors of Psoriasis in North Indian Population

Aim: This study aims to study precipitating factors of psoriasis in the north Indian population.Material & Method:Two hundred twenty-eight psoriasis patients regardless of age, sex, religion,occupation, attending the skin, and V.D. outpatients Department, B.R.D. Medical College, Gorakhpurfor were taken because of the subject of this study. The bulk of patients belonged to the Eastern U.P.and adjoining areas of Bihar and Nepal. The clinical criteria for diagnosis of psoriasis were thepresence of Erythematous and papulosquamous lesions with loosely adherent silvery-white scales.The auspitz's sign was demonstrated all told the cases. The detailed clinical history and examinationwere recorded. Each patient was categorized into mild to severe psoriasis. Result: The maximumpercentage of cases was aggravated by weather (winter), 55.26%, next to that was trauma 27.19%, and least after infections 4.35%. The summer and spring seasons showed an improved effecton the condition of psoriasis. Alcohol, smoking, and mental stress found no relation with psoriasis.In most cases, where the infection was associated with the disease, it had been aggravated only inchildren, and young adults and lesions were of guttate type. Pregnancy had no effect in 25.43% ofcases, while the disease was improved in 3.50% of patients and worsen in 4.35% of cases.Conclusion: Psoriasis is positively correlated with the winter season and negatively associated withSummer and Spring.

A case study on psoriasis

Psoriasis is a non-contagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. Psoriasis is generally thought to be a genetic disease which is triggered by environmental factors. Psoriasis is estimated to affect 2-4% of the population of the western world. The rate of psoriasis varies according to age, region and ethnicity; a combination of environmental and genetic factors is thought to be responsible for these differences. Psoriasis affects both sexes equally. It can occur at any age, although it most commonly appears for the first time between the ages of 15 and 25 years. Approximately one third of people with psoriasis reports being diagnosed before age 20. In India the prevalence of psoriasis varies from 0.44 to 2.8%, it is twice more common in males compared to females, and most of the patients are in their third or fourth decade at the time of presentation. In addition to the appearance and distribution of the rash, specific medical signs may be used by medical practitioners to assist with diagnosis. These may include Auspitz's sign (pinpoint bleeding when scale is removed), Koebner phenomenon (psoriatic skin lesions induced by trauma to the skin), Candle grease sign and itching and pain localized to papules and plaques. A patient of sixty five years old was suffering from Psoriasis for last 12 years resorted to all systems of treatment but failed, was finally treated by constitutional treatment and was cured for last 5 years. The case taking was done in a standardized format and all symptoms were passed through standard procedures to arrive at totality of symptoms such as analysis of symptoms, conceptual image, analysis of the case/ synthesis, reportorial totality/ evolutional totality, miasmatic diagnosis, repertorisation. The medicine was prescribed in 50 millesimal scale in infrequent repetition scheduled. Change of potency and medicine were done as per the guidelines of tenets of Homoeopathy and cure was achieved to an intractable chronic disease like Psoriasis.

Cutaneous candidiasis mimicking inverse psoriasis lesion in a type 2 diabetes mellitus patient

Background:  Type 2 diabetes mellitus (T2DM) condition could affect the skin. The disease is among the greatest risk factors of skin infection such as cutaneous candidiasis and is also associated with autoimmune skin diseases such as psoriasis, which lesion morphologies and predilection areas are quite similar. These similarities are a source of confusion to clinicians. Case illustration:  We present a 60-year-old female patient with uncontrolled T2DM and multiple erythematous plaques in the form of shiny lesions at the intertriginous area that developed 1 week prior to her hyperglycemic state. The lesions had recurred at the same site for approximately 10 years and were initially diagnosed as  intertriginous candidiasis. Bedside testing revealed a positive Auspitz sign, while the patient’s fungal culture  was unremarkable. She was diagnosed with inverse psoriasis (IP) and treated with 0.1% mometasone furoate cream twice a day. The lesions improved but were not completely resolved. Discussion:  Inverse psoriasis is a subgroup of psoriasis characterized with thin, non-layered scales, and various predilection areas. The features of the primary l esion may be altered by a patient’s activities, such as  use of cleansing soap, which may cause lesions to dry out and ooze, similar to cutaneous candidiasis. Additional examination, such as bedside testing and laboratory work, could help obtain a proper diagnosis.  Conclusion:  The similar morphologies and predilection areas of IP and cutaneous candidiasis lesions may confuse clinicians. In some limited cases, the correct diagnosis may be obtained by complete history taking, physical examination, and other simple tests. Keywords : inverse psoriasis, intertriginous cutaneous candidiasis, type 2 diabetes mellitus Normal 0 false false false EN-US X-NONE X-NONE