A LONGITUDINAL CASE REPORT OF CHRONIC SCALP PSORIASIS AT DR BATRA’S

Abstract

Background: Scalp psoriasis is a chronic inflammatory dermatosis characterized by erythematous, scaly lesions and a relapsing-remitting course. Persistent scalp scaling and itching may significantly affect quality of life. This case describes the longitudinal management of chronic scalp psoriasis in a middle-aged male with childhood onset, recurrent episodes despite previous dermatological treatment, and significant emotional stress following legal separation.

Case Presentation: A 53-year-old male presented with thick, scaly lesions over the scalp that had been present since childhood. He had previously been diagnosed with scalp psoriasis by a dermatologist and had consulted multiple skin specialists because of recurrent disease. Examination showed annular reddish discoloration of the scalp without active scales at presentation, as the patient had a habit of repeatedly removing the scales. Itching was associated with the lesions and was aggravated particularly during winter. There was a family history of similar skin disease in his father. No nail pitting was noted. Wood's lamp examination showed no fluorescence. The patient was also a known case of type 2 diabetes mellitus for 4–5 years and was taking sitagliptin 50 mg and metformin 500 mg. His psychosocial history was notable for legal separation approximately 1.5 years earlier, associated emotional stress, health anxiety, fear of having no one to support him in case of illness, sensitivity, mistrust and a tendency to suppress emotions. Repertorial assessment documented features including grief, emotional sensitivity, suspiciousness, fear of loss of position and health-related anxiety. The documented prescription included Lycopodium 200, Kali arsenicosum 6C and Sulphur as an intercurrent/antimiasmatic prescription. During follow-up, itching reduced by approximately 50%, scaling progressively reduced, and subsequent examination documented absence of scaling and healing of old lesions without new lesions.

Conclusion: This case demonstrates improvement in documented scalp symptoms during longitudinal follow-up. However, because multiple factors and treatments may influence psoriasis and objective disease-severity scores were not recorded, the observations should be considered hypothesis-generating rather than evidence of treatment efficacy.