INTRODUCTION
Atopic dermatitis (AD) is a dermatological condition, resulting in red and itchy skin. It is common in children but can occur at any age group. It is a chronic dermatological condition which can flare up periodically. Atopic dermatitis is a chronic ,pruritic inflammatory dermatological condition that typically affects face (cheeks), neck, arms and legs but usually spares the groin and axillary region. Atopic dermatitis is commonly associated with elevated levels of immunoglobulin E(IgE).
PREVALENCE
Atopic dermatitis is a common dermatogical condition which results in significant social and financial burden. AD affects adults and children with worldwide prevalence rates of 15-20%. Prevalence of AD varies in different regions of the world. A gradual increase in the prevalence of AD has been observed recently and it can be ascribed to environmental changes consequent to rapid development all over the world.
DEFINITION
According to ICD 10, the terms dermatitis and eczema are used synonymously and interchangeably. It is chronic (childhood) granulomatous disease. Atopic dermatitis is circumscribed neurodermatitis.
A chronic inflammatory genetically determined disease of the skin marked by increased ability to form reagin (IgE) with increased susceptibility to allergic rhinitis and asthma, and hereditary disposition to a lowered threshold for pruritus. It is manifested by lichenification, excoriation and crusting, mainly on flexural surfaces of the elbow and knee. In infants it is known as infantile eczema.
Homoeopathic therapeutics:
Antimonium crudum: Eczema is characterised by thick, cracked skin and dyspepsia. On the cheeks and chin there are yellow crusted breakouts. Cracks in the corners of the mouth. Eczema accompanied by gastrointestinal distress. Pimples, vesicles, and pustules have an eruptive tendency. Thick, hard, honey coloured scabs. Warmth and sun exposure aggravate itching. Sensitive to cold bathing. Children are bashful and irritable, doesn’t like being touched or stared at. Love eating (craves for pickles, vinegar and other sour foods) and may be overweight.
Arsenicum album: Eczema with itching, swelling, oedema, eruptions are popular, dry , rough and scaly, and are worse by cold and scratching. Pustules that are malignant. Sleep disturbed, skin symptoms alternate with asthma and internal disorders. Supressed eruptions leads to intense itching and skin peels off in large scales. Anxiety, exhaustion and restlessness with nightly aggravation are most important symptoms to look for.
Calcarea carbonicum:This medicine is for persons who are chilly and have clammy hands and feet, as well as those who suffer from eczema and cracking skin, which is exacerbated in the winter. They are easily weary by exercise, and if sick or overworked, they feel nervous and overwhelmed. Cravings for sweets and eggs. Sluggish metabolism and predisposition to gain weight are the other indications for calcarea carb. Biting and itching vesicles, on neck and back which extend behind the ear and occiput.
Croton tig: It is an effective remedy in diarrhea, summer complaints and skin disorders and these can be alternating with each other. Itching is intense, yet scratching is painful. Pustular eruption with terrifying itching and excruciating burning, especially on the face and genitals. Person is morose and dissatisfied.
Calc sulph: Children with dry eczema. Skin unhealthy, leaking pus, and does not heal quickly. Crusts or discharge that are yellow and purulent. Exudations in or on the skin that are purulent. Yellowish scabs on the skin. Many little, non- cancerous pimples under the hair that bleed when scratched.
Graphites: Thick, leathery skin with fissures and pain, as well as long history of skin problems( impetigo, herpes, etc). Cracks appear behind the ears, around mouth and on the hands, and a golden oozing discharge hardens in to crusts. Itching is aggravated by being warm in bed, and the individual will constantly scratch the affected areas until they bleed. A person who requires Graphites often faces difficulty in concentrating, notably in the morning.
Hepar sulphuris calcareum: This remedy may be beneficial to person who are highly sensitive to cold and whose eczema is extremely painful and easily infected. Skin appears chapped and deeply cracked, particularly on the hands and feet, and heals slowly. The person is frequently irritable and vulnerable, with a low resistance to infection and disease. Every little injury suppurates.
Petroleum: Remedy indicated for a person whose skin is very dry and which tends to crack, more on the fingertips and palms. Eczema is worse in winter, with deep, sore cracks that which often bleed. The person feels a cold sensation after scratching. Itching is worse at night and from getting worm in bed. The skin is easily infected, and may get tough and leathery from chronic irritation. Crust is thick and green. Extremely sensitive skin, all clothing is painful.
Rhustoxicondendron: A person whose eczema has blister like eruptions that look red and swollen, itch intensely , and are soothed by hot applications may respond to this remedy. The person is restless from discomfort and often is very irritable and anxious. Muscle stiffness, relieved by warmth and motion.
Silicea: Person with unhealthy skin, every injury suppurates. Painful pustular eruption at last, forming a suppurating ulcers over forehead and occiput. Itching over whole body. Eczema, eruption itch only during day time and evening. Rhagades over eyelids and mouth. Itching, burning eruption behind ears. Skin is sensitive to cold, patient wants to wrap up warmly.
Sulphur: Intensely burning, itching, inflamed eruptions that are worse from warmth and worse from bathing suggest a need for this remedy. Affected areas may be red, with scaling or crusted skin. Eruptions can be either dry or moist. This remedy is sometimes helpful to people who have repeatedly used medications and ointments on their eczema without success.
CASE REPORT
A 10 year old boy was brought to the outpatient department of Government Homoeopathic Medical College, Bengaluru on 14/01/2022 with the complaint of eruptions with peeling, on bilateral hands for the past 2 years and increased since 6 months.
History of presenting complaints: Child was apparently healthy till the last 6 months. Gradually started with complaint of papular eruptions with itching on the right hand followed by left hand. There is oozing of thin watery discharge and occasional bleeding with burning sensation on scratching. Skin is dry, with peeling.
- There is no history of pain, blister, ulceration,erythema.
- Past history: Nothing significant.
- Family history: Maternal grandmother- atopic dermatitis since 13 years.
- Maternal grandfather- diabetes mellitus for last 15 years.
- Aunt- atopic dermatitis since 8 years.
- Physical generals:
- Appetite- reduced(since 4 years)
- Thirst- thirstless, drinks only a glass of water per day.
- Bowel habits- once in 5-6 days, hardstools.
- Bladder habits- 3-4 times/ day.
- Sleep- disturbed due to itching.
- Thermals- hot
- Mental generals- irritable, injuring himself.
- Evaluation of symptoms:
- Mental generals- irritable, injuring himself.
- Physical generals: Appetite –diminished, thirst- thirstless
- Bowel habits- hardstools,
- Thermally-hot patient
Totality of symptoms:
- Papular eruptions with itching on hands.
- Skin burning < scratching
- Skin – inflammation
Characteristic particulars
- Mind-injuring himself
- Skin- burning- scratching; after
- Skin-eruptions-papular-itching.
- Skin- inflammation.
Prescription: 14/01/2022 Sulphur 200 1 dose.
DISCUSSION:
Homoeopathy is a system of medicine where we consider the patient as a whole. So here we considered not only the skin complaint but also his mental characters, physical makeup as well as the family history. In this case sulphur was chosen based on individualisation and the recovery was fast in a gentle way. Eruptions and itching reduced within a month and patient continued the follow ups for next 5 months with no recurrence of complaints. No external application was used.
CONCLUSION:
Atopic dermatitis is one of the most common skin disease seen in children. The burden of this disease is not only for the children but also for their families.
Homoeopathic medicines are gentle and acts in most effective way. It does not cause any long term side effects and rapidly reduces the discomfort, and other complaints associated with this condition. This case report is accompanied by photographic evidence along with improvement in patient symptoms.
Declaration of patient consent: parent of the patient was explained about the study and consent was obtained.
ACKNOWLEDGEMENT:
I am thankful to Dr. V. Guruprasad principal & HOD Department of Paediatrics and Dr Muddassir Mulla , Associate Proffessor, Department of Paediatrics, GHMC Bengaluru for their constant support and guidance.
CONFLICT OF INTEREST: Nil.
REFERENCE:
- Gupte The Short Textbook of Paediatrics.12 e/d(2), New Delhi: Jaypee brothers;2016.
- Sathishkumar D, Gupta A, Saini K. Atopic dermatitis in children: an update for paediatricians. Current Medical Issues. 2020Oct1;18(4):317.
- Murphy R. Lotus Materia Medica. Noida; B. Jain Publishers(P). Ltd: 2018; p: 1491, 1489, 1508 ,1589 ,1664 ,1783 ,1833 ,1836 ,1869 ,1951 ,2035 ,
Dr Geethanjali M
PG Scholar
Department Of Paediatrics
Government Homoeopathic Medical College & Hospital, Bengaluru
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