RARE PRESENTATION OF ERYTHRODERMIC PSORIASIS (DA-US SADAF) – A CASE STUDY

Benish Bashir*, M. A. Quamri, Mohd. Adnan Ansari and Yusra Qureshi

ABSTRACT

Erythrodermic Psoriasis (EP) is an aggressive and inflammatory form, though it is uncommon among patients. The main symptom is a peeling rash on the body’s whole surface. The rash itches and burns and spreads very rapidly. This type of psoriasis affects more than 75% of the surface of the body with inflammation and with/without exfoliation.[1] This paper presents the case of a 47-year-old married male patient, who came to the outpatient department (OPD) of National Institute of Unani Medicine (NIUM) Bengaluru. Clinical presentation: His chief complaints were widespread erythematous plaques with itching & burning sensation all over his lower limbs & upper limbs since two days, which then progressed to all over his body including the scalp & ears as well. On examination, erythematous plaques with desquamation covering >90% of his body surface involving scalp, palmoplantar surfaces & genitals were seen. Moreover, lichenification was seen over both legs with pitting in his right middle finger nail. The lesions started peeling and crusting gradually, and the patient also had a history of on and off fever and body pains for the last month. The patient was febrile on admission with severe distress and had signs of moderate dehydration associated with severe malnutrition. Generalized skin redness and desquamation were seen over his entire body surface except on his face. There was no history of consanguinity but there is positive family history for Psoriasis. The patient was diagnosed with Plaque Psoriasis 26 years ago and had been treated with topical corticosteroids and moisturizing creams including some homeopathic drugs as well. His condition exacerbated after withdrawal from steroids & application of a plant juice viz, Thespesia populnea yellow juice, the lesions worsened during winters. Diagnosis: The patient was diagnosed clinically as Erythrodermic Psoriasis resembled to Da-us-Sadaf in the Unani system of medicine. Interventions: The patient was treated with Joshanda Munzij Sauda (decoction) and Majoon Ushba (compound formulation) orally alongside with Habb e Suranjan (orally) and Marham Asfedaj + Roghan e Hindi for local application all over body except face. Outcome: Assessment of efficacy was done by PASI Score before and after treatment. Conclusion: This Unani formulation effectively improves pruritus, scaling, lichenification and ulceration in Erythrodermic Psoriasis and may be considered for complimentary management of it.

Keywords: Erythrodermic psoriasis, Da-us Sadaf, Joshanda Munjiz Sauda, Lichenification, Unani.