Psoriasis

Psoriasis initially presents with erythema accompanied by silvery-white scales on the scalp, knees, and elbows, and then the rash spreads to the rest of the body. Factors such as colds and the abrupt discontinuation of steroid creams can trigger the disease. There are types of psoriasis that involve widespread pustules (generalized pustular psoriasis) and psoriatic arthritis, which is associated with joint pain, joint deformities, and other joint symptoms.Psoriasis is considered a difficult-to-treat condition in Western medicine, and managing the symptoms remains challenging. Traditionally, psoriasis has been treated with steroids, topical treatments like Tar Anthralin, ultraviolet B (UVB) therapy, PUVA therapy (oral and topical), oral retinoids, oral methotrexate (MTX), and sometimes gold preparations for psoriatic arthritis. However, these treatments have not been entirely effective. The introduction of the immunosuppressant cyclosporine (CYS), commonly used in organ transplantation, has revolutionized psoriasis treatment. With a dosage of 3-5 mg/kg/day, psoriasis can be controlled relatively easily. However, some cases do not respond. While this drug shows dramatic clinical effects, it is not a fundamental cure, and symptoms often relapse soon after discontinuation. Furthermore, side effects such as kidney dysfunction, liver dysfunction, hypertension, gingival hypertrophy, hirsutism, tremors, sensory hypersensitivity, and diarrhea are concerns.In Traditional Korean Medicine (TKM), the pathology of psoriasis is understood as blood heat, blood stasis with heat, or deficiency of yin leading to blood heat. Blood heat refers to a condition where inflammation in the circulatory system leads to abnormalities, and symptoms such as hematemesis, nosebleeds, hematuria, subcutaneous hemorrhages, and excessive menstruation are included. Psoriasis is similar to this in that the normal flow of blood is obstructed in the dermal and intradermal level. Blood stasis with heat refers to trapped heat within the body, which causes itching and pain. Yin deficiency with blood heat refers to a state where improper treatment of blood stasis with heat leads to pathological changes in the body's lymph, saliva, and other bodily fluids, leading to symptoms like weight loss, mild fever, redness near the cheekbones, dry stools, and others.In TKM, even for patients suffering the same condition which may be called “psoriasis”, different signs and individual characteristics of the patient are considered when understanding the disease and formulating a treatment plan.Treatment Case: 58-year-old womanThis patient presented with the following symptoms. Psoriatic plaques are visible on the scalp, elbows, knees, and lower back.Red, inflamed lesions with silvery-white scales. Occasional itching, particularly at night.Mild burning sensation in the affected areas.Low energy, fatigue.Mild headaches in the evenings, particularly after stressful events.Dry mouth and throat with a slight, persistent low-grade fever.The patient has no significant comorbidities, but she has a history of seasonal allergies and has been experiencing chronic stress over the last few years. She reports a history of mild eczema as a child, with occasional flare-ups of psoriasis in recent years, particularly on her elbows, knees, and scalp.She was previously given UVB therapy and other herbal medicine to clear heat, but it was not effective. Her tongue was reddened and her pulse was weak with no strength. The patient was diagnosed as having blood stasis with heat and Yin deficiency. A special herbal formula was selected with herbs that help in plaque formation, this was in consideration of her long history of psoriasis and the supposition that dryness of the dermal and intradermal region was a great contributor to her subjective discomfort. After two weeks of treatment, the clinical presentation was only somewhat improved but the itching and discomfort was diminished greatly. After another two weeks, the psoriasis appeared to be almost gone. After another two months of treatment, it was resolved and the treatment was discontinued.