The Integrative Management of Psoriasis

A Case Study in Homeopathy, Nutrition, and Lifestyle Medicine

A comprehensive, patient-centered approach to managing psoriasis by addressing root causes through homeopathy, gut health, and metabolic balance.

By Marisa Kassimir, ND

Introduction and Case Presentation

Psoriasis is more than just a skin condition—it is a visible sign of deep-seated systemic imbalances. For many, it is a lifelong struggle, with flares triggered by stress, diet, and immune dysfunction. Conventional treatments often provide temporary relief but fail to address the root causes. This case study highlights an integrative approach to managing severe psoriasis, incorporating homeopathy, nutrition, supplementation, and lifestyle interventions.

DL, a 38-year-old female, presented in August 2024 with a history of psoriasis since the age of 20. Her condition had significantly worsened in the 18 months before seeing me, following childbirth and the loss of her mother. The severity of her lesions and associated emotional distress had profoundly impacted her quality of life and activities of daily living.

Medical History

• BRCA2 positive
• Double mastectomy and reconstructive surgery (2015)
• G1P1A0, history of postpartum depression
• Previous use of oral contraceptives

Current Medications & Supplements

• No prescription medications
• Medical cannabis for anxiety and insomnia
• Melatonin 10 mg QHS for insomnia

Symptoms & Systemic Review

• Chronic diarrhea when consuming restaurant-prepared food
• Dysmenorrhea and menorrhagia with a regular cycle
• Difficulty losing weight
• Insomnia with racing thoughts (5–7 hours of sleep per night)
• Seasonal allergies, vertigo, photophobia
• Dry skin, nail changes

Social History & Lifestyle

• Owner of a fitness studio; exercised regularly
• Reported energy level: 7/10
• Hydration: 32 oz of water per day

Psoriasis Presentation

DL exhibited widespread psoriatic plaques, with the most severe involvement on her anterior lower legs and scalp (notably the occiput). Additional lesions were present on her knees, thighs, arms, glutes, and vulva. The scalp lesions were thick and covered with silver scales, causing noticeable hair thinning. The lower leg lesions were erythematous with scales and scabbing, continuously spreading. All plaques were severely pruritic, and excessive scratching led to bleeding.

Psychosocially, DL experienced significant emotional distress. She avoided mirrors, wept multiple times per day, and expressed despair over finding relief. She feared medical treatments, supplements, and food, stating, “I can’t trust anything anymore.” She was anxious about her daughter developing psoriasis, particularly given her husband’s history of the condition. Although resistant to medical intervention, she was desperate for a solution.

Previous treatments tried: 

• Topical steroids (provided temporary relief)
• Acupuncture and Chinese herbal formulas (caused diarrhea) 
• Tanning beds (discontinued during and after pregnancy) 
• Self-guided food elimination challenge (provided temporary relief) 

Laboratory Findings

Comprehensive laboratory analysis revealed multiple systemic imbalances:

• Iron metabolism: Low iron saturation (13%) with low-normal serum iron and adequate ferritin
• Hormonal findings: Suboptimal day 21 progesterone (5.3 ng/mL), LH:FSH ratio of 3:1
• Nutrient status: Suboptimal vitamin D (35 ng/mL)
• Adrenal function: Elevated AM cortisol (20.8 µg/dL)
• Glucose metabolism: Elevated fasting glucose (106 mg/dL), HOMA-IR of 3.0 (indicative of insulin resistance)
• Thyroid function: TSH 3.310 µIU/mL, Free T4 0.99 ng/dL, Free T3 3.2 pg/mL (suggestive of suboptimal thyroid function)

These findings pointed to dysregulation of the hypothalamic-pituitary-adrenal (HPA), hypothalamic-pituitary-ovarian (HPO), and hypothalamic-pituitary-thyroid (HPT) axes, alongside insulin resistance and probable gut hyperpermeability.

Therapeutic Strategy and Rationale

Psoriasis is now understood as a condition that affects several different systems in the body, which is why a whole-body approach is key. Therefore, the treatment approach centered on reducing systemic inflammation, improving gut health and optimizing nutrient status, restoring hormonal balance, optimizing metabolic function, supporting detoxification pathways, and managing stress. 

For example, problems with the gut barrier can contribute to inflammation and worsen psoriasis, making gut-healing strategies an important area to focus on.⁵ Additionally, metabolic health was a priority due to the link between insulin resistance and psoriasis.³ A systematic review from 2022 even found that mindfulness and meditation can help improve both the severity of the skin and the quality of life for people with psoriasis.⁴ There’s no strong evidence that vitamin D supplementation alone is a cure for psoriasis, but deficiency has been linked to autoimmunity. It plays an important role in immune function, making it a valuable addition to treatment.¹

Given the complex, multi-system nature of psoriasis, it was clear that an integrative approach was necessary. Along with addressing factors above, I felt confident from the outset that homeopathy would complement these strategies effectively for this patient. In fact, research backs the use of homeopathy in treating psoriasis. A 2023 double-blind, randomized, placebo-controlled trial demonstrated that individualized homeopathic remedies significantly alleviated symptoms of psoriasis vulgaris, reinforcing homeopathy as a promising treatment for chronic skin conditions. In this study, the most commonly prescribed remedies included Calcarea carbonica, Mercurius solubilis, Arsenicum album, and Petroleum.²

Initial Recommendations (first visit)

• Increased water intake for hydration
• Completion of a 7-day food, bowel movement, and symptom diary for a more complete look at nutrition and any correlation with symptoms
• Castor oil packs to support liver health and its association with metabolic disease, hormone metabolism, and detoxification
• Initiation of homeopathic treatment 

Homeopathic Evaluation & Prescription

The lesions were pathognomonic for psoriasis and not unique from a homeopathic perspective. However, the accompanying profound emotional distress, self-reproach, and overwhelming fear of medical interventions and food were highly distinctive. 

After considering polycrest remedies for dermatologic conditions (Sulphur, Phosphorus, Arsenicum album, and Calcarea carbonica), Arsenicum album emerged as the most appropriate choice. Key confirmatory symptoms included: health-related anxiety, racing thoughts at night, emotional despair over healing.

Key Rubrics Used (Schroyens F. Synthesis Treasure Edition 2009V)

• Skin – Eruptions – psoriasis 
• Skin – Eruptions – painful
• Head – Eruptions – Occiput 
• Head – Eruptions – scalp
• Mind – Despair – recovery, of
• Mind – Anxiety – Health; about – about one’s own health
• Mind – Anxiety – children – about his 

Prescription: Arsenicum album 30C, 2 pellets per day 

Clinical Course & Progression

At the first follow-up two months later, DL reported she had started the homeopathic remedy. She reported an initial two-week aggravation of symptoms, after which her itching and pain markedly improved. Although the plaques persisted, the emotional burden had lightened, and daily weeping had ceased.

At this visit, additional interventions were introduced:

• Dietary modifications:
  • Increased protein intake (20-30g per meal) for hormone and immune optimization
  • Adjusted macronutrient timing for adrenal support
  • Emphasis on low-sugar fruits (e.g., berries over tropical fruits) for metabolic health
• Botanicals: Nettle and/or dandelion leaf long-infusion once daily for their alterative and nutritive properties
• Supplementation:
  • Multivitamin with iron to replenish nutrients and antioxidants
  • Vitamin D for suboptimal levels
  • Gut support powder (L-glutamine, mucilaginous and anti-inflammatory herbs) to improve the intestinal barrier

At subsequent visits, further refinements included:

• Omega-3 supplementation (fish oil) for its anti-inflammatory properties
• Electrolytes for improved hydration
• Inositol for insulin resistance, sleep support, and hormone balance
• Mind-body interventions, including vagus nerve exercises, grounding techniques, and guided meditation (which she later incorporated daily)

Outcome & Discussion

Over the next several months, DL’s psoriasis improved gradually, as shown in Table 1 and Figures 1 and 2. Her primary relief came from reduced pain and itching, greatly enhancing her quality of life. She reported progressive lesion regression, with patches becoming smaller, less hyperkeratotic, and less erythematous. A downward spread of lower leg lesions, commonly seen in healing processes, was noted.

At the five-month mark, her scalp lesions had fully resolved, with noticeable hair regrowth, confirmed by both her hairdresser and physical examination. Her mental health showed profound improvement—in office, she was notably less anxious and more optimistic. Her outlook on food shifted from avoidance to empowerment, focusing on resilience rather than restriction. This case is ongoing and we are carefully monitoring for any plateau or regression in symptoms that would indicate the need for an increase in homeopathic potency. 

Conclusion

This case underscores the importance of a multi-factorial, individualized approach to psoriasis. While homeopathy appeared to be the catalyst for healing, addressing gut health, metabolic health, systemic inflammation, and stress management played equally critical roles. The resolution of DL’s most distressing symptoms illustrates the potential for integrative therapies in complex chronic conditions.

Her case signifies the importance of further research on the interplay between stress, metabolic health, and gut integrity on skin disorders, as well as the role of homeopathy as a modulator of systemic inflammation and immune balance. 

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References

1. Aranow C. Vitamin D and the Immune System. J Investig Med. 2011;59(6):881-886. doi:10.231/JIM.0b013e31821b8755
2. Balamurugan D, Nayak C, Chattopadhyay A, et al. Individualized homeopathic medicines in the treatment of psoriasis vulgaris: double-blind, randomized, placebo-controlled trial. Complement Med Res. 2023;30(4):317-331. doi:10.1159/000530180.
3. Chan AA, Li H, Li W, et al. Association between baseline insulin resistance and psoriasis incidence: the Women’s Health Initiative. Arch Dermatol Res. 2022;314(9):869-880. doi:10.1007/s00403-021-02298-9
4. Javadian Y, Sadeghi N, Sadeghi M, et al. The effect of mindfulness and meditation on psoriasis: a systematic review. J Dermatol Treat. 2022;33(1):1-7. doi:10.1080/09546634.2021.1909072
5. Sikora M, Stec A, Chrabaszcz M, et al. Clinical Implications of Intestinal Barrier Damage in Psoriasis. J Inflamm Res. 2021;14:237-243. Published 2021 Jan 27. doi:10.2147/JIR.S292544