An overview on acne vulgaris and homoeopathic treatment

Dr Sangeeta PG scholar

ABSTRACT
Acne is a common multifactorial inflammatory condition affecting most commonly adolescent population and disturbing person’s Quality of life(QOL). Many internal and external factors play a role in development of acne. Homeopathic medicine given on the holistic approach and standard principles will give the absolute relieve leaving no scars.

KEY WORDS: Acne vulgaris, Homoeopathy, Quality of life.

INTRODUCTION
Acne is a common multifactorial chronic inflammation of the pilosebaceous units. The condition is extremely common; it generally starts after puberty and there are reports of it affecting over 90% of adolescents. It is usually most severe in the late teenage years but can persist into the thirties and forties, particularly in females.¹

Acne is estimated to affect 9.4% of the global population, making it the 8^th most prevalent disease worldwide.²

inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes.³

It affects 80% of the population in the age group of 11 to 30 years.⁴

AETIOLOGY¹
The key components are increased sebum production; colonisation of pilosebaceous ducts by Propionibacterium acnes, which in turn causes inflammation; and hypercornification and occlusion of pilosebaceous ducts. Severity of acne is associated with sebum excretion rate, which increases at puberty. Both androgens and progestogens increase sebum excretion. There may be a positive family history; there is high concordance in monozygotic twins.

PATHOGENESIS⁴
Acne results from a complex interplay of increased sebum production, ductal hypercornification, follicular colonisation with Propionibacterium acnes, and inflammation. Acne lesions begin with the microcomedo, a microscopic lesion not visible to the naked eye. With time, the follicle fills with lipids, bacteria and cell fragments. Ultimately, a clinically apparent lesion occurs, either a non-inflammatory lesion (open or closed comedo) or an inflammatory lesion.

Comedogenesis is unique to acne and ductal hypercornification is a key step in it. There is hyper proliferation and abnormal cellular differentiation in the follicular infundibulum, resulting in accumulation of excess and sticky keratinocytes that turn into plugs (comedones). Propionibacterium acnes, a Gram-positive, rod-like bacterium, resides in sebaceous follicles and contributes to comedogenesis and inflammation in acne through production of lipases and proteases, through elaboration of cytokines (TNF-α, IL-1α, IL-8), and through activation of toll-like receptor 2.

 CLINICAL FEATURES

• Acne usually affects the face and often the trunk. Greasiness of the skin may be obvious (seborrhoea).
• The hallmark is the comedone: open comedones (blackheads) are dilated keratin-filled follicles, which appear as black papules due to the keratin debris; closed comedones (whiteheads) usually have no visible follicular opening and are caused by accumulation of sebum and keratin deeper in the pilosebaceous ducts.
• Inflammatory papules, nodules and cysts occur and may arise from comedones.
• Scarring may follow deep-seated or superficial acne and may be keloidal.¹
• Lesions may leave behind post inflammatory hyperpigmentation and scars. Severely inflamed lesions heal with small but deeper scars known as ice-pick scars.⁵
• Acne tends to aggravate in hot and humid weather, under stress, and by injudicious use of oils and oily skin care products.
• Premenstrual flares are common and indicate hormonal imbalance.

GRADING OF ACNE⁴

Grade 1: Mild acne: Comedones < 30, Predominance of comedones Papules < 10, No scarring

Grade 2: Moderate acne: Comedones any number, Predominance of papules Papules > 10, Nodules < 3, Mild scarring ±

Grade 3: Severe acne: Comedones any number, Predominance of nodules/cysts Papules any number, Nodules/cysts > 3, Extensive scarring.

VARIANTS OF ACNE⁵

1. Acne excoriee: It is seen in depressed or obsessional young women who often squeeze the lesion. Picking and scratching the lesions lead to exacerbation of lesions.
2. Infantile acne: It is seen on the face of some infants, mostly males and disappears spontaneously.
3. Drugs like systemic/topical steroids and androgens induce acne.
4. Acne conglobata: It presents as severe acne with abscesses, burrowing sinuses and scarring.
5. Occupational acne: Exposure to cutting oils and lubricating oils cause acne due to occlusion at the site of contact. Oily cosmetics can also cause acne.

DIAGNOSIS⁴
Acne is diagnosed clinically. Laboratory tests are only done to evaluate for hormonal imbalance and to screen and monitor for certain treatments. Differential diagnosis includes acneiform drug eruptions, folliculitis, and rosacea.

MANAGEMENT
Acne treatment plans are based on severity, and presence of associated features such as cutaneous hyperandrogenism.⁴

General measures: Gentle washing of the face with soap and water without vigorous scrubbing is recommended.

Cosmetics should be non-comedogenic. Diet has no effect on acne.

Specific therapy: In the early stages with comedones and papules, a topical retinoid such as tretinoin 0.025% to 0.1%, adapalene 0.1% or tazarotene 2.5% at night and benzoyl peroxide 5% in the morning would suffice.⁵

HOMOEOPATHIC APPROACH

REPERTORY

Kent’s repertory⁶
FACE-eruptions, acne: anti-c, ars, ars-i, aur, bar-c, calc, calc-s, calc–sil, carb-an, carb-v, caust, chel, con, cop, crot-h, eug, hep, iod, Kali-br,  kreos, lach, led, nat-m, nit-ac, Nux-v, ph-ac, psor, puls, sabin, sanic, sel, Sep, Sil, sulph, thuj, tub, uran-n. 

CHEST-eruptions, pimples: Am-m, anti-c, arg-n, ars, berb, bor, bov, calc, canth, chin, cist, con, dulc, fl-ac, graph, hep, hyper, iod, kali-ar, kali-c, lach, led, mez, nat-a, nat-c, nat-p, puls, rhus-t, staph, tab, valer, verat, zinc.

BACK-eruption, pimples: Agar, alum, arg-n, arn, bell, berb, calc, carb-v, cham, chel, cocc, con, crot-h, dig, fl-ac, hyper, iod, kali-bi, kali-c, lach, led, lyc, mag-m, nat-m, psor, puls, sars, sel, sil, squil, staph, zinc.

Homoeopathic medical repertory by Dr Robin Murphy⁷

ACNE, vulgaris: ant-c, ars, ars-i, ARU, bar-c, bell, calc, CALC- SIL, calc-s, CARB-AN, CARB-V, CARBM-S, CAUST, con, cop, crot-h, eug, HEP, KALI-BR, kreos, lach, led, med, nat-m, nit-ac, NUX-V, ph-ac, psor, puls, SEP, SIL, sulph, thuj, tub.

HOMOEOPATHIC THERAPEUTICS ^{8, 9}

BERBERIS AQUAFOLIUM
There is acne, blotches, pimples in girls and boys. Mother tincture can apply externally to clear the scar mark of acne.

CALCAREA CARBONICUM
People of psoric constitution who are pale, feeble, timid, shy, easily weary from physical exertion. Though patient feels weak but their body composition is fatty and obese. Indicated in person with recurrent pimples and skin eruptions in chilly with clammy hands and feet. Sweats profusely with least physical exercise. Forehead filled with little eruptions look like blackhead.

CALCAREA PHOSPHORICUM
Acne more in younger age groups of boys and girls who are physically slender and skinny.

Acne appears in adolescent girls who are anaemic and frequently complaints of headache.

CALCARIA SULPHURICUM
This is a remedy for those who has predisposition to develop pus on their pimples. Individuals have low tolerance of heat. Acne can be big, inflammatory, red and painful.

DULCAMARA
This is plant-based treatment treating acne and blemishes that leaves scar. Acnes more frequently appear when weather changes from dry to humid.

KALI BROM
Acne is pustular and indurated in character. Scar remain after the acne heals up. Suitable to obese and younger person. Person is depressed, uneasy, has anxious despair, restlessness and lack of sleep due to grief caused by loss of job, property, reputation. Melancholic personality.

NATRUM MURIATICUM
Acne result of hormonal disturbances like in menstrual irregularity or PCOD. Face is oily, hairy, hypertrophic acne, ugly scars in young adults. Person is self centered, reserved, brooding over past events, less expressive of emotions.

 PULSATILLA
Acnes exacerbated on eating rich or fatty food and more in warmth or heat. Pulsatilla is a remedy for adolescents or acne appear near menstrual periods. Individual usually fair complexion and prone for emotions and moodiness.

SULPHUR
People who are unclean, prone to skin complaints and dislike being cleaned. Pustular eruptions, dry, scaly, unhealthy skin with itching and burning. Worse on scratching and washing. Indicated skin eruptions after local applications.

DISCUSSION
Homeopathic medicines selected on the basis of principles of homeopathy proving to be very effective in the treatment of acne vulgaris and improving QOL of the patients. Homeopathy effectively reduces usage of antibiotics and topical products.

REFERENCE

1. Penman, I. D., Ralston, S. H., Strachan, M. W. J., & Hobson, R. (Eds.). (2022). Davidson’s principles and practice of medicine(24th ed.). Elsevier Health Sciences.
2. Rai, S., Gupta, G. N., Singh, S., Michael, J., Misra, P., Gupta, B., Singh, S., Prakash, A., Tomar, M., Sadhukhan, S., Koley, M., & Saha, S. (2022). Efficacy of individualized homeopathic medicines in treatment of acne vulgaris: A double-blind, randomized, placebo-controlled trial. Homeopathy: The Journal of the Faculty of Homeopathy, 111(4), 240–251. https://doi.org/10.1055/s-0041-1739397
3. Williams, H. C., Dellavalle, R. P., & Garner, S. (2012). Acne vulgaris. Lancet, 379(9813), 361–372. https://doi.org/10.1016/s0140-6736(11)60321-8
4. Munjal, Y. P., & Sharm, S. K. (2012). API textbook of medicine, ninth edition, two volume set. Jaypee Brothers Medical.
5. Krishna Das, K. V. (2008). Textbook of Medicine(5th ed.). Jaypee Brothers Medical.
6. Kent, J. T. (2023). Repertory of the homeopathic materia medica. B Jain. Pg no- 366, 830, 888
7. Murphy, R. R. (1993). Homeopathic medical repertory: A modern alphabetical repertory. Hahnemann Academy of North America. Pg no- 370
8. Boericke, W. (2023). Pocket manual of homeopathic materia medica & repertory. B Jain.
9. Clarke, J. H. (2023). Dictionary of practical materia medica: 3-Volume set. B Jain.

Dr. Sangeeta
MD part II
Department of Practice of medicine
Government Homoeopathy medical College and hospital Bangalore
Under the guidance of Dr. Veerbhadrappa. C
Professor and PG Guide