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Cracked skin over her palms and soles. The cracks which were not apparent currently as they were masked with the recent use of local steroids.

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A 60 year old lady, Mrs. R.S (Patient identification number: L-7591) reported to the clinic with her daughter with cracked skin over her palms and soles. The cracks which were not apparent currently as they were masked with the recent use of local steroids. She had stopped using steroids though for the past 10 days and was only applying a moisturizing cream.

With these complaints she also had a massive hair fall where in she reported to loose more than 500 strands in a day. She had hair loss for the past 23 years now. She also had dandruff on her scalp. On examination of her scalp, she was found to have sebborrhoic dermatitis.

She also had gall stones for the pat 8 years but was asymptomatic currently. Previously also she did not have any complaints because of these stones, but it was detected in a routine examination.

She had severe pain in her knees for the past couple of months. She had constipation for years together and she had to take some form of laxative daily for a satisfactory bowel movement.

Her constitution: She was an obese female with a fair complexion and dark colored hair.

Her Personal details: She craved for sweets, fruits and particularly food items which were hard and crispy. She was thermally a hot patient. She used to have profuse perspiration all over her body.

She was an introvert female. She did not speak out anything and always kept things within herself. She is oversensitive and very family oriented. Her daughter reported that she was over concerned about her family.

Her family history: Her paternal uncle and aunt both were diabetic.

Her mental make-up: She was always much stressed since her related with her husband were very strained. She did not even talk to her husband for the past so many years. She said that her husband was a overly possessive man. He used to always interfere in the trivialest of her matters. Because of these circumstances she feels that she is never appreciated. Moreover, the husband always used abusive language, which upseted her the most.

Her sleep remained disturbed for years together for which she was taking sleeping pills on and off for the past many years.

Family set up: She lived with her husband (who was a retired mechanical engineer). Her son and her daughter-in-law lived separately in a different city. She had two daughters and both were married.

Follow up details: Initially after starting the medicine there was infection on both her soles, because of which the cracks had aggravated and there was pus formation. She was given Hepar Sulp in the 200 th potency for the same. Gradually the cracks have healed up and the suppuration ceased.

After a period of 3 months there is over 50% improvement in her palmoplantar psoriasis. The knee joint pan is much better. This pain is alleviated further when she exercises. However her hair fall remained the same.

There were necessary changes made in her line of treatment. She continued the medicines regularly and when her case was reviewed after a period of over 6 months the thickened psoriatic eruptions on her soles as well as the palms have healed over 90%. The other associated complaints of hair fall and constipation had also started responding. She is advised to continue treatment for further improvement.

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