Psoriasis

chronic recurrent skin disease characterized by well circumscribed silvery scaling papules and plaques

Etiology
1. unknown 2. onset between ages of 10-40 3. common to have + family history 4. trauma, sunburn, irritation, drugs may bring on an attack

Signs & Symptoms
1. gradual onset 2. usually on scalp, extensor surfaces of extremities esp elbows and knees, back, buttocks 3. sharply demarcated lesions 4. nonpruritic erythematous papules or plaques 5. covered with silvery or opalescent shiny scales 6. chronic remissions and recurrences

Diagnosis
1. clinical

Treatment
1. very few effective tx ---lubricants, steroids, methotrexate 2. food sensitivities 3. avoid animal fats, simple CHO 4. antioxidants 5. EPO 4 caps tid 6. flaxseed oil 1 tbsp/d 7. zinc 30 mg/d 8. bioflavonoids, garlic 9. avoid NSAID’s, biotin, ginseng, vit. C, burdock, echinacea 10. kukui nut oil 11. Earthing

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============================================================== //TCM Pathology// Psoriasis: Song Bi Xuan, Yin Xie Bai

Clinical Characteristics
-Usually scalp, nape, upper back, buttocks, lateral side of the extremities -Skin lesion: flat & smooth papulae -> erythema in different shapes, w/ clear demarcation & covered with many layers of silvery or slightly opalescent scale -Film phenomenon ( a layer of fat-like lustrous film on removing scales -Cribriform bleeding phenomenon - pin-point bleeding (Auspitz's sign) -Skin lesions heal without scarring -Hair growth is not altered -Nail involvement may resemble fungal infection (nail plate is like thimble surface) -Psoriatic arthritis is a rheumatoid-like arthritis associated with psoriatic lesions -Chronic, recurrence, mild in summer, severe in winter, accompanied with arthritis, impetigo

3 Stages
1. Active stage: expanding & coalescing skin lesion, severe itching, new papules, very red, tends to have more scaly layers 2. Regressive stage: reducing or no scales on erythema, dark red or purple 3. Resting/Remission stage: No extending skin lesions, fairly stable condition, mild or no itching, yellow/orange in color

Wind-Heat Invasion (with Blood Heat)
Red papule, scaly erythematous lesion with red halo around them, severe itching, isomorphic reaction - can cause new eruptions in new areas if scratched or needled. If nails involved, pitting at nails (thimble surface), joints may be involved Tongue: Red in Lung area with thin white/yellow coat Pulse: floating, large

Wind-Cold Invasion
Usually seen inchildren, early cases, or psoriatic artthritis, pale red lesions with thickj white scales that are easily shed when scratched, mild-itching, joint soreness or pain, aversion to cold, the condition recurs or is exacerbated in winter, & improves or disappears all together in summer. Tongue: normal, slightly pale, or slightly purple with thin white coat Pulse: tight, wiry or soft

Blood Stagnation
Scales on erythema or the erythema with silvery scales on the skin may subside. Mild itching

Blood Deficiency
Light Yellow, orange or pink patches, or light brown pigmentation, with little fine white dry scales, mild itching, dry skin Tongue: slightly purple with less coat or thin white coat Pulse: Thready

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Kampo Herbal Treatment
Blood stasis: Rhubarb and Motan Combination [Da Huang (3g.), Mu Dan Pi (4g.), Tao Ren (4g.), Mang Xiao (4g.), Dong Gua (6g.)] OR Gui Zhi and Hoelen Combination [Gui Zhi (4g.), Fu Ling (4g.), Mu Dan Pi (4g.), Tao Ren (4g.), Shao Yao (4g.)]

No Oketsu: Dang Gui and Gardenia Combination [Dang Gui (4g.), Sheng Di (4), Shao Yao (3g.), Chuan Xiong (3g.), Huang Qin (3g.), Zhi Zi (2g.), Huang Lian (1.5g.), Huang Bai (1.5g.)

Orthomolecular Treatment
-Alkyl Glycerol (AKG)

Recommended Minerals
-Sulfur

Homeopathic Remedies
**Arsenicum album:** 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. **Graphites:** 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. **Mercurius solubilis:** 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. **Mezereum:** 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. **Petroleum:** 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. **Rhus toxicodendron:** 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. **Sepia:** 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. **Staphysagria:** 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. **Sulphur:** 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).

Prescription
Morning: Ribes D1, 50 drops Noon: Cedrus D1, 50 drops Evening: Rye D1, 50 drops