Dr Anuradha
ABSTRACT
Urticaria is type of skin complaint with red raised itchy bumps called wheals. It occurs with a prevalence of around 20 %. Which is usually a response to allergens, insect bites or food. In some cases, this itchy rash is triggered by physical stimulus such as pressure, friction, sweating, cold, heat, sunlight, water. Such urticaria is known as physical urticaria. This is a case report of patient suffering from chronic urticaria having intense itching, redness, erythematous lesion and treated with Sulphur as a constitutional medicine after a detailed case taking. Changes in urticaria severity scare at baseline and at end of the treatment showed reasonable improvement in disease as well as in quality of life.
INTRODUCTION
Urticaria is a heterogenous group of diseases characterized by the appearance of transient erythematous oedematous papules or plaque known as wheals. It may be associated with swelling of the deeper dermis and subcutaneous tissue known as angio-oedema (1) common clinical presentation of urticaria are wheals associated with an itching or burning. Cells in the skin, on triggering releases chemicals such as histamine, Which causes fluid to leak from tiny blood vessels under the skin surface. Commonest triggering factors are: 1. A physical stimulus (for example by heat, cold or pressure). 2. Allergies (for example food allergies, allergies to insect bites and stings. Allergies to medicines such as penicillin, aspirin etc.). 3. Viral infections such as cold or flu. 4. Skin contacts with chemicals, latex, cosmetics, plants, ointments, nettle stings etc.(2) Urticaria occurs with a lifetime prevalence of around 20%. (3)
Acute urticaria can develop suddenly and will last for <6 weeks, must cases last for 24-48 hours in some cases rashes lasts for few hours. Chronic if it lasts for >6weeks. (2)Chronic urticaria now understood to have autoimmune link presence of auto antibodies against immunoglobulin E (Ig E), CD28 which release histamine, hence leading to chronic urticaria.
Most of the patients suffer from symptoms of depression or anxiety and major impact on their QoL due to the chronicity of condition. Chronic Urticaria can interfere with subjective well-being and daily life. Studies over last decades evidenced that the impact of Chronic Urticaria on QoL is comparable to those suffering from Ischaemic heart disease (4)
Urticaria severity score (USS) is sensitive score, reliable, valid, instrument for monitoring the disease severity quality of life, and treatment efficacy in patients with chronic urticaria. Its application helps in terms of evaluation of efficacy of treatment provided (5)
URTICARIA AND HOMOEOPATHY
Urticaria is a very common and upsetting disease because of recurrence. Homoeopathy is very effective in treating all type of urticaria. Normally body is gifted with natural healing mechanism called as immune power. In urticaria immune power gets disturbed and can show exaggerated reaction to allergen, it activates the antibodies Homoeopathic constitutional dose prescribed after an in-depth study of individual case, strengthens the immunity so that body gains capacity to overthrow the disease on its own.
Homoeopathic literature, Kent repertory contains 101 remedies under rubric SKIN, ERUPTIONS, Urticaria among which is mark remedies are Apis Mellifica, Arsenicum Album, astacus fluviatilis, Calcarea- Carbonicum, Calcarea -sulphusicum, Carboneum Sulphuratum, Causticum, Chloralum, Copaiva officinalis,Dulcamara. Hepar Sulphuris calcareum, Ledum palustre,Natrum Muriaticum, Sulphur, Urticaria urens.(6)
CASE REPORT
A 23 year old male presented with complaints of itchy wheals of different sizes all over the body and is worst on extremities and abdomen. For past one and half years.
- He reported of gradual onset of erythematous lesion of various sizes, burning. Which usually lasts for about 9 to 10 hrs. His complaints are aggravated at night & with warmth, better on cold application. He was on anti-allergic medicines regularly with mild relief. But it recurred repeatedly.
- His father had Diabetes mellitus
- Thermal reaction of patient was hot.
- He has craving for sweets and milk, increased preparation generally sleep was disturbed with itching.
- Patient is irritable person, gets angry easily shouts back and then forgets about it. He prefers to be alone when he is sad. He sticks on to his decisions will not change for others. He does not like to sit in one place, like to hang out with friends and wants to enjoy his life. On observation patient is talkative, prideful and obstinate.
PHYSICAL EXAMINATION
- Appearance stocky, his vital signs were normal.
- CLINICAL FINDING included red wheals with mild swellings. Over arms, legs, & abdomen size varied from 5 to 20mm in length with defined margins.
- Urticaria severity score at base line was 50.
BASES OF PRESCRIPTION
Sulphur 200 was been prescribed on the bases of reportorial totality. As it was must similar to the case and scored highest that is 28/12, also He was irritable, loquacious, prideful. Desired sweets, milk desired, sleep disturbed with itching. Itching egg on warmth and better by cold application led to prescription of Sulphur.
FIRST PRESCRIPTION
1} Sulphur 200/ 1 dose, with EMES
2} PL pills
FOLLOW UP OF CASE
|
8/2/17 |
Sleep No change, itching & redness decreased.
|
SL |
|
13/3/17 |
Sleep improved; size of the wheal’s appearance decreased. Itching and redness decreased. |
SL |
|
27/3/17 |
Complaints increased since 1week evening redness following itching sleep disturbed, irritability. |
Sulphur 200 |
|
7/4/17 |
Generals’ better redness decreased duration less than 5mints. USS-12 He can do his work with minimal disturbance. |
SL |
CONCLUSION
Urticaria is a condition related to immunity. Which is manifested as itching wheals, pathology usually related to allergies of food, insect bite, medication or sometimes related to stress cold, change of weather. Large number of populations worldwide experienced urticaria with recurrence in some subjects. Urticaria in Homoeopathy is considered as internal malady and is being treated effectively with individualized homoeopathic medicine. It helps to treat disease permanently with little side effects and improves quality of life.
REFERENCE
-
- API, Textbook of medicine 10th edition. New Delhi. Jaypee Brothers medical publisher’s (P) Ltd: 2015; p (676-677)
- Harding M. Hives (Urticaria). Patient. Available from: https://patient.info/skin-conditions/hives-inducible-urticaria. [Last accessed on 2019 Apr 20].
- Rath P, Paul. Homoeopathic treatment of chronic urticaria -A case series. Indian J Res Homoeopathy [serial online] 2020[cited 2021 Jun 4]; 14:267-78. Available from: https://www.ijrh.org/text.asp?2020/14/4/267/305258
- Sharma R, Kumar S, Vimal V K, Manchanda RK. Assessment of the effectiveness of homoeopathic remedies in improving quality of life of chronic urticaria patients in a typical clinical setting. Indian J Res Homoeopathy [serial online] 2018 [cited 2021 Jun 4]; 12:139-48. Available from: https://www.ijrh.org/text.asp?2018/12/3/139/242276
- Sunit p Jariwala al; The Urticaria Severity Score: a sensitive questionnaire/index for monitoring response to therapy in patients with chronic urticaria: ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY: June 2009 ;102:475-482
- Kent JT. Repertory of Homeopathic Materia Medica. Reprint Edition. New Delhi: B. Jain Publishers (P) Ltd.; 2007.
Dr Anuradha
PG Scholar,Part-1
Department of Paediatrics
Government of Homoeopathic Medical college and Hospital, Bengaluru’79
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